4 versus 8 cycles of CAPOX

Hi ellen93. There has been a recent trial (the Scot trial) that found that 3 months chemo was as beneficial as 6 but with less side effects however I think you will need to discuss the reason for the 8 cycles with your oncologist. It’s also worth discussing reducing the dosage? The chemo is usually started on the maximum dosage for a persons weight and height and a reduction of say 20% can make a big difference to the side effects.

Hope the meeting goes well

Take care

Karen x

https://www.thelancet.com/journals/lancet/article/PIIS1470-2045(18)30093-7/fulltext

Hi ellen93

I have linked in the research Karen mentioned for you to have a wee look at .

My mum had six cycles each time in preparation for surgery so a different aim , but her oncologist made a small dosage adjustment and it made the world of difference to her ability to tolerate it and quality of life .

Not ease on them at all !

Take care ,

Court 

Thank you Kareno62 yes I think 8 cycles was suggested due to number of lymph nodes and EMVI/PNI but he did say this depended on how Tony was coping etc..

Thank you court it's not easy at all and it's hard seeing him struggling with side effects...we are thinking of asking about a reduced dosage to get through the next 4...

Hi ellen93

I hope you don't mind me asking - did you ever get much information about the EMVI and PNI aspects of your husband's case.

Last year my histology confirmed I had EMVI, EMPNI and EMPVI but I've not been able to learn much about what can be done about the invasions or even how (and who?) should check status.

 CrumpetsOrToast Hello there..well you've asked a very good question as when my hubby was diagnosed two years ago I couldn't really find out much about PNI as it's only something they have started to add to histology results fairly recently..from my understanding on speaking to the nurses and oncologists it's really not significant as it's just part of building the picture of what the cancer is doing and whether chemo should be offered..if you have EMVI or PNI present then chemo is a given even without lymph node involvement as those pesky cells need wiping out so it just helps the oncologists to make these decisions and tailor your treatment more effectively.....I think as time goes on histology reports will include all sorts of information which helps the medical team but because they send the patients a copy we get to see it too but with a layman's eyes and it can be pretty overwhelming especially once you start googling which I did and ended up with alot of info I didn't understand and made things alot worse..I hope this helps and you continue to do well...xx

Hi ellen93.

Thank you for replying. I realised I had a bad typo there EMVI, EMPNI and EMPVI should of course been 

EMVI, EMPNI and EMLI

Your explanation may be why my colorectal nurses look very blank whenever I ask about invasions and related surveillance.

I was at start told of the loss of disease free forecast due to my cancer being in all transport routes.

As you say however, maybe those pesky cells have been wiped out with the agressive 6 months of chemo, at least for now. Was that true for your hubby?

I hope you and hubby are navigating this bumpy journey well together. 

Maybe others in the forum with invasions will help us gain a better picture too. court have you spotted any discussions on this or aware of any trusted info?

 CrumpetsOrToast  Thank you..it's a bumpy road and not always easy but what can you do other than keep going...sending you lots of love..

Hi. The histology from my surgery showed 22 out of 31 lymph nodes, along with some associated blood vessels, had been invaded. I had a pretty rough time with the chemotherapy too. I was scheduled for up to eight cycles and managed six, although my oncologist said the benefit beyond four cycles was small - around an additional 2.5% with regard to survivability. At that time I was happy to take the extra 2.5% but a year on and I am now incurable. In hindsight, with that level of invasion and a rare form of bowel cancer I’m pretty sure those pesky cancer cells had already moved on! 

 CrumpetsOrToast  Very similar with my husband..within a year he had a recurrence in his liver which was successfully removed but then in March we were it had spread further and he was incurable...since May he has battled a bowel obstruction and sepsis and to be honest he hasn't really recovered..he remains frail and we are just waiting to hear if further treatment can be offered but I know in my heart he wouldn't be able to tolerate it...but we are trying to make the most of each day..