Dear all, I am new to this forum.
My father-in-law has just been diagnosed with Stage 4 metastatic colorectal cancer. He is Latin American living in a Latin American country. We live in London.
A couple of background notes:
The head oncologist back home informed us his body is likely to respond well to Cetuximab (Erbitux). However, the social security system back home takes long in approving this drug, mainly because it is so expensive. Hence, we have been informed his chemo (Folfox) and Erbitux will not start simultaneously. While chemo is likely to start this week, social security could take as long as 3 months to start the use of Erbitux on him. The head oncologist told us all current medical studies have studied a simultaneous administration of both chemo and Erbitux, so he strongly recommends that if we have the money we should try to start funding Erbitux’s treatment until social security takes over.My father-in-law’s cancer has metastized to his liver and lungs. The metastases are small. In the case of the liver, there are two small balls (around 15 mm) on opposite sides of the liver. In the case of the lungs, the doctor said they are localized and the “balls” are small enough (around 5mm) so that the CT is unable to identify whether these balls are a metastasis or calcifications from his smoking history. In one of the meetings, he mentioned that “doctors in this (Latin American) country may be reluctant to perform surgery, but you will probably find doctors in London that will be willing to do it”.
I have several questions, and we are basically looking for all the possible help in finding the best course of action. Any input will be greatly appreciated:
Regarding Erbitux:Is there any medical study showing the effect of starting Erbitux 3 months after the start of chemo (FOLFOX)?What is the additional survival gain using Erbitux? Back home, our head doctor informed us we could expect about 20 additional months of life by using the drug compared to just chemo. However, most medical studies I have come across only point to a few months gain (around 2 to 4 months). Privately funding the treatment back home is expensive, probably more so than funding it here in the UK. The monthly cost of Erbitux hovers the £15,000. Funding the treatment privately for three months before social security takes over will hover £40,000. We are not rich, this is going to empty our accounts. Therefore, and even though it sounds terrible and sad, our decision will be partly based on cost-effectiveness. For us it is very important to know whether Erbitux can improve his outcome in terms of months or years.Regarding surgery:My reading of medical studies suggest that being able to perform surgery can have a crucial impact on overall survival. When our head oncologist said that there could be oncologists in London willing to perform surgery on him, it made us consider this option. But again, we are not sure whether we can afford it. We have no idea of what is the cost of performing such surgeries. Any indication on what the cost could be would be welcome.I know many of these questions will probably be best addressed by a doctor or a hospital and more research, but we need to move as fast as possible and we are trying to gather information from all possible sources. So any help will be greatly appreciated.
