Does Missed Doses Of Xeloda After Colon Cancer Surgery Affect Its Efficiency?

Posted on Sat, 3 Jan 2015

Question: If a person who had colon cancer surgery took xeloda but late after surgery ( 11 weeks after) and missed few doses only , can this
Effect
The efficiency ? As he still develpoed a liver met and 1 node met whilst on it ?

Answered by Dr. Shafi Ullah Khan (4 hours later)

Brief Answer:
Recurrence is possible.

Detailed Answer:
Thank you for asking

I understand your concern. Xeloda is a capecitabine , an antineoplastic and antimetabolite. It is used as adjuvant chemotherapy after surgery. Like others as oxaliplatin . 5FU , Folfox or Xelox.

Xeloda is taken for average of 8 cycles for cancers of stage C and above. Each cycle is of 21 days comprising of 14 days of 12 hourly 1250 mg / meter square of xeloda followed by one week of rest and then the next cycle begins.

Now starting after 11 weeks is 2 and a half month which is later.. I believe that much time is taken any how after recovering from a surgery. However it should have been started earlier abit but your doctors knows best so he might have seen it for the best.

Skipping a dose or two might not affect the schedule. But keeping it compliant is needed for the optimal results. Dont skip any further and you wont have a problem.

As far as recurrence is concerned. Xeloda reduces it, does not finish it completely. SO there still might be recurrence is some unlucky cases. COntinue the chemo therapy and we will hope for the shrinkage of this newly metastasized node. Correlating with a few doses in compliance might be the factor but hard to say a reason as ca colon itself is quite aggressive and even taking doses compliantly would have caused it.

I hope it helps. Take good care of your father and dont forget to close the discussion please.

May the odds be ever in your favour.

Regards
Khan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shafi Ullah Khan (1 hour later)

Thanks . What is outlook like then for a liver met of 16 mm and 1 node( aortocaval)? Node is 10 mm. They have started him on irinotecan

Answered by Dr. Shafi Ullah Khan (3 hours later)

Brief Answer:
Significant and hopefully managed with chemo.

Detailed Answer:
Thank you for getting back

It takes minimum of 5mm of the size to be noticed by a radiograph or CT, so 16 mm is significant and a concomitant nodal involvement makes it a significantrecurrence. Irinotecan is also an adjuvant chemo. It would have been better to be put on combination chemo.

But i am afraid this is all they can do now. As surgery is already done. If the mets are still appearing and showing up, its only these adjuvant therapies which have to be decide. Lets hope your father is lucky enough.

I wish i had a daughter like you who would take care of me like you are taking care of your dad.

Allah Bless you miss XXXXXXX My prayers are with you.

Regards
Khan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shafi Ullah Khan (11 minutes later)

Thanks . Yea im too worried about him . Day in and day out. The surgery removed the colom tumor and there was no spread. Also all prevous scans were clear. But suddenly the sept scan shows this . Can they remove surgically? Thry said liver met easy but they are more concerned re the node.

Can this chemo kill them n prevent further ones?

Also for prognosis we not looking at less right?

Answered by Dr. Shafi Ullah Khan (10 hours later)

Brief Answer:
Lets hope for the best

Detailed Answer:
Thank you for getting back!

Please know that your father is a stage 4 colorectal cancer and prognosis is not good for that already. As well as no more intervention is wise. A single lymph node and a small liver metastases should not be a problem for adjuvant chemotherapy. But the wisest maneuver is to get prepared for the worst. Not regarding lymph nodes recurrence but the morbidity associated with ca colon and associated troubles.

And even if chemo is not enough, you have no other option than to go for another cycles. As i said there are 8 cycles of it. So they should suffice.

Lets hope for the best.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shafi Ullah Khan (17 minutes later)

Even ppl
With 4,6 liver mets have them
Removed, so can they not remove the liver met,

Answered by Dr. Shafi Ullah Khan (9 minutes later)

Brief Answer:
Let's stick to adjuvant therapy now.

Detailed Answer:
They can and they will. See the morbidity factor and see the already done procedure. As I said metastasis is conserved by adjuvant therapy. But any metastasis to liver is stage 4 and is not favourable as far as prognosis is concerned.

But a complete clinical correlation will d e code what is the outcome. Let's commit to the 8 cycles of this adjuvant therapy and stick to the compliance plan.

We can't afford another surgery now. It will bring more harm than good. Let the adjuvant therapy work and keep the follow up in timely manner to have a look and assessment of the size of mets. If it increase any further the get the surgery after consulting with his oncologist.

I hope it helps.

Take care
Khan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shafi Ullah Khan (10 minutes later)

But what if the ironotecan dont work ? As his cea is 9 still . It was 8 in sept, 9.8 in august.

Answered by Dr. Shafi Ullah Khan (2 minutes later)

Brief Answer:
Let's wait.

Detailed Answer:
Let the cycles complete. He showed improvement woth just one cycle. There are 8 minimum.whats the hurry. and if it still does not respond the surgical removal of metastasis should be Considered. But there is no hard and fast rule. Some oncologist still prefer early removal of mets even in recurrence.

Discuss it with his oncologist and let them be the judge of that.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shafi Ullah Khan (5 minutes later)

I mean cea was creeping up. In august was 9.8 while on xeloda . But when xeloda stopped it dropped to 8 in sept and dec 9
Again . Irinoten started october . So dec cea gone up by 1 point

Answered by Dr. Shafi Ullah Khan (34 minutes later)

Brief Answer:
:)

Detailed Answer:
As I said cea is slightly raised considering the age and stage and recent surgical intervention. You have the options of adjuvant therapies which is favourable. Recurrenct Intervention will put an extra stress over already compromised immune system.

So would stick to adjuvant chemotherapy if I were you at least till completion of therapy.

Please calm down. I have Been noticing this question for a few months. You took it way over in the head and have put you to psychological stress you need to get rid of it or you will end up OCD.

Discuss the management options with your dad's oncologist. See what they have to say. Stick to their advice. Ours is just shooting blanks.

Take care.
Khan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shafi Ullah Khan (5 minutes later)

Ur right im extremley worried. I need to calm down . U think im worrying too much?

Answered by Dr. Shafi Ullah Khan (10 hours later)

Brief Answer:
Yes XXXXXXX :)

Detailed Answer:
Yes XXXXXXX I do that's why I mentioned it in first place. You need to take care of yourself too.

There is notice else you can do here. Your father is getting the best treatment available in the health care and he should be proud he has caring offspring's.

Let's hope for the best. All his illness needs are met very keenly and there is not much else any one else can do any more.

I hope it soothes your nerves.

Take care.
Assalam o Alaekum
Khan

Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar