Doctor Q&A

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My wife is 54 years old and in good spirits. In June 2019, she underwent surgery to remove a stage II rectal tumor, which did not require follow-up treatment. Her CEA level was 3.2 after the surgery. In June 2020, her CEA level rose to 10, indicating that the colorectal cancer had metastasized to her liver. She started her first treatment course on June 26 (injection of Oxaliplatin plus two weeks of oral Xeloda). After that, she was transferred to a public hospital to receive targeted therapy and chemotherapy. She just completed her first targeted therapy with Cetuximab and her second chemotherapy with Oxaliplatin (Eloxatin), Fluorouracil (5FU), and Folinic Acid on July 15. She was supposed to be hospitalized again in two weeks for continued treatment. Blood tests on July 27th showed low platelet count and high liver enzymes, requiring another blood test on August 3rd to determine if chemotherapy could continue. Unfortunately, the doctor on August 4th said the platelet count was 0.8 and liver enzymes were three times the normal level, so the second targeted therapy and third chemotherapy session could not begin. The next treatment cycle would depend on the blood test results on August 10th, meaning the third chemotherapy session was delayed by three weeks. My question is, my wife's current CEA level of 3.3 is lower than before chemotherapy, but if the blood test results remain unsatisfactory and treatment is delayed, will this affect her condition and drug resistance? Also, how can we increase platelet count and decrease liver enzyme levels during this period? Thank you!

Oxaliplatin, a chemotherapy drug, often causes low platelet counts. To maintain the dosage without affecting its efficacy, a regimen of chemotherapy every three weeks can be considered, switching to once-every-two weeks (retaining Oxaliplatin and replacing Xeloda with 5-FU). If combined with an artificial blood vessel, even a three-day, two-night hospital stay can be avoided, allowing chemotherapy to be administered on an outpatient basis. Another drug, eltrombopag, has been found in studies to accelerate platelet recovery; consult your doctor for more information.

More importantly, I recommend that your wife undergo extensive genetic testing of her previous tumor tissue. Since her tumor does not have the K/N ras gene mutation, making her a suitable candidate for cetuximab, there is a significant chance of finding other drug-compatible gene mutations (called "feasible gene mutations"). The testing should also include a potentially very specific gene mutation: microsatellite instability. If the tumor carries this mutation, immunotherapy may be suitable, and a considerable percentage of patients may eventually be able to undergo radical treatment for metastatic colorectal cancer!

We also need to determine whether her liver tumor has spread to a single location and whether it can be completely removed. If it is marginal and resectable, we should reassess it using computer-generated imagery as soon as possible, which may allow us to schedule surgical removal earlier.

  • EGFR gene, KRAS gene, PD-L1 gene, Chemotherapy, Laboratory examination, Gene classification articles, colorectal cancer, Information for newly diagnosed patients, Targeted therapy, Male/Female physical examination plan, Pathological diagnosis, Cancer treatment, Types of cancer, Cancer diagnosis, liver cancer, Bowel cancer