[Guest]

A very good friend is trying to make a decision regarding further treatment for his colon cancer. It is difficult to make a decision secondary to conflicting advice from several oncologists. He is a 44 year old man who has undergone resection of a proximal transverse colon cancer which was adherent to the duodenal sweep and the pancreatic bed. Pus was noted in this area secondary to perforation. Path demonstrated infiltrating, poorly differentiated, focally mucin producing adenoca with transmural invasion. Mets were noted in 1/5 lymph nodes. Biopsies of the duodenal sweep and pancreatic bed were negative.

The confusion: Path indicates that he had a T3N1 lesion but op note indicates a strong suspicion that he should be considered a T4N1 lesion. No distant mets were noted on CT or at the time of surgery. His choices are as follows:

1. 5-FU with leucovorin. His oncologist indicated that if he chose this route he would receive "mega" doses of 5-FU secondary to studies done in Germany and France.
2. The above with CPT-11.
3. A different oncologist brought up the consideration of 5-FU with leucovorin and radiation, citing a 1993 study at Mass General. This same oncologist suggested against the 3 drug combination.

My friend is not interested in radiation. I can find studies that support the 3 drug combination in Stage 4 cancers, but it is not clear if he is Stage 3, Stage 4, or a Stage "3 1/2". We are trying to determine if he should do the 5-FU/leucovorin combo, leaving the CPT-11 in reserve vs. all 3 at once. He is afraid that if he does the 3 drug combo, than he will have nothing to fall back on. I am aware of other agents being used in Europe that may obtain FDA approval within the next year. I am also aware of the TS, TP, and DD markers and relation of response to 5-FU but I do not know how sensitive and specific these are, nor do I know if they are commonly used markers.

He is asking my advice because I have a medical background and can sort through the research. He is supposed to start chemo this week. I know that I wrote a lot, but he does not fall in to a "clear cut" category and I wanted you to know all of the facts. Thanks for your help.