I saw the oncologist this morning. The good news first: The pulmonary embolus has full resolved on the CT scan. I had noticed that I was no longer breathless on climbing stairs. I guess this means that when my current supply of full dose Clexane runs out I can switch to a prophylactic dose.
There has also been a marginal fall in my CEA from 24 to 22.
However, there has been an increase in my ascites and in the omental disease. In addition the lesion that was suspicious in my liver is a little bit more suspicious.
This means that the chemotherapy has not been successful. Unfortunately (or perhaps fortunately) the clinical trial that I was being booked into has closed, so I move on to monoclonal antibody therapy.
This means either Cetuximab or Panitumumab. Cetuximab is indicated for the treatment of patients with epidermal growth factor receptor (EGFR)-expressing, KRAS wild-type metastatic colorectal cancer (mCRC), in combination with chemotherapy, and as a single agent in patients who have failed oxaliplatin- and irinotecan-based therapy and who are intolerant to irinotecan. The positive opinion from the Committee for Medicinal Products for Human Use (CHMP) was received for mCRC 1st line use in May 2008.
Many clinical trials have been conducted to investigate the efficacy of cetuximab (Erbitux) in metastatic colorectal cancer (mCRC) and there is increasing evidence to support the use of biomarkers, such as KRAS, to predict tumor response to anti-EGFR therapies. Two large clinical trials of cetuximab, OPUS and CRYSTAL, have recently been published, and have provided further evidence that cetuximab significantly improves response rates and disease free survival rates in mCRC patients with KRAS wild-type tumors.
Panitumumab was approved by the U.S. Food and Drug Administration (FDA) for the first time in September 2006, for "the treatment of EGFR-expressing metastatic colorectal cancer with disease progression" despite prior treatment. Panitumumab was approved by the European Medicines Agency (EMEA) in 2007, and by Health Canada in 2008 for "the treatment of refractory EGFR-expressing metastatic colorectal cancer in patients with non-mutated (wild-type) KRAS".
I have wild type KRAS.
This is the way it works. My oncologist will apply to the Primary Care Trust for one or other of the drugs, but because they are not NICE approved they will be refused. There will be an automatic referral to the Cancer Drugs Fund, which is a special fund of £200 million set aside by the government for situations like this. It is currently underspent, so the belief is that it will be approved withing 3 weeks. My oncologists tells me that all the requests he has made have been approved so far.
What it means is that I have at least a 3-week holiday from chemotherapy in which I hope to be able to improve.