Treatment options

Allan Crimm, MD, in his Philadelphia office, May 2006

There is not instruction booklet on how to proceed in times like these. Having faith and asking questions are requisite. Here is a letter I received from my good friend, Dr. Allan Crimm. We are so grateful for this bit of encouragement. Martijn and I will follow up.

Susie,
I have talked with 2 cancer specialists and have a call in to a 3rd person who I hope will call me back early this week.
Since Martijn has had spread of the cancer despite his initial treatment, it may be appropriate to have him take further treatment once he is stronger and recovered from the surgery. The idea is that it may very well prevent the cancer from coming back or slow it’s progression. The treatment would be a type of chemotherapy for which there is some evidence of efficacy in squamous cell cancer of the anus. There are not large trials in people who have not responded to the type of initial combination of chemotherapy with 5-FU and radiation like Martijn had. However, most oncologists who specialize in GI cancers have seen other people like Martijn and have found that selecting medications that have efficacy in fighting squamous cell cancer originating in other parts of the body (e.g head and neck cancer) may help with this type of squamous cell cancer originating in the anus. The drugs that have been mentioned are Erbetux (which is a monoclonal antibody that affects a cancer stimulating growth factor) and Irinotecan (which is a chemotherapy medication).

Remember that the advice you received about no further treatment was from the cancer surgeon, not from a medical oncologist. Someone with the latter background would most likely discuss options similar to the ones I have outlined above. I recommend that you ask that the medical oncologist who has seen him before be consulted now AND ALSO make an appt to see someone in Amsterdam or Rotterdam – wherever the person is with the biggest experience with GI cancers of various types – including anal cancer.

I hope this is useful to you.
Sara and I send you our love,
Allan