CLINICIAN BRIEF — RUSS READ-BARROW
Version 2026-09-30 · current as of 30 September 2026 · next review 14 October 2026
Not medical advice. Patient-maintained, checked against source documents.

DIAGNOSIS
  Moderately differentiated adenocarcinoma, rectosigmoid colon. ypT4a ypN1b (3/24 nodes) M1a V+.
  Treatment began Dec 2021; primary resected Mar 2022.
  Sites of disease: Lungs · mediastinal lymph nodes · liver segment VII (new, Jul 2026).
  Also: Smouldering myeloma (diagnosed end of 2021, under haematology surveillance); Gilbert's syndrome (can raise bilirubin).
  [Original pathology; clinician letters]

MOLECULAR
  KRAS/NRAS wild-type · BRAF wild-type · pMMR / MSS · HER2 IHC 0 · TMB-low · 3 Mut/Mb · PD-L1 <1% (22C3, 28-8)
  Key detected tumour alterations: APC p.S1415Rfs*4; TP53 p.R342*; PTEN reported, not specified
  Platform: Oncomine Comprehensive Plus, 517-gene targeted panel, hg19.
  Not whole genome or whole exome. Reported tumour-only.
  [Commercial sequencing]

TREATMENT LINES
  Dec 21–Feb 22  Neoadjuvant XELOX ×4 · good partial response
  Mar–Oct 22     Primary resected · liver met resected (R0) · adjuvant CAPOX
  Oct 22–Apr 23  Lung mets appear, progress · SABR 55 Gy/5
  Jun & Aug 24   Lung ablations (1 left, then 1 left + 4 right)
  Feb 25         EBUS confirms mediastinal nodal disease
  Apr–Jul 25     FOLFIRI + cetuximab ×6 · good partial response
  Feb–May 26     Rechallenge ×6 · excellent partial response
  Jul–Aug 26     Progression during the break · FOLFIRI + cetuximab restarted 19 Aug
  [Clinician letters]

CURRENT REGIMEN
  FOLFIRI + cetuximab (rechallenge, 3rd block), 14 days cycles.
  Plan: 8–12 weeks, then consider maintenance 5-FU + cetuximab if response is good. CT after Cycle 5.
  Chemo day    Standard pre-meds (Akynzeo, dexamethasone, chlorphenamine, atropine) · pegfilgrastim 24h after
  Supportive   Dexamethasone ×3 days · domperidone · loperamide · doxycycline + Plazon (skin) · Laxido · antihistamine · zopiclone PRN
  Other        Citalopram 30 mg (breakfast) · melatonin 60 mg (evening) · loratadine 10 mg
  NOT currently taking: Mistletoe and most supplements / off-label drugs, during chemo on my oncologist's advice
  [Patient-reported]

PLANNED CHANGES (2 October 2026)
  - Metformin — introducing this week
  - Mebendazole — following, over the next few weeks
  - Atorvastatin — following, over the next few weeks
  Proposed by my integrative oncologist (private). Not yet discussed with my primary oncologist or the NHS team.
  Each step is subject to tolerance. Nothing here is agreed with my treating oncologist yet.
  [Patient-reported]

LATEST IMAGING
  23 Jul 2026 · CT chest, abdomen & pelvis:
  Progression above and below the diaphragm, and a new liver metastasis. [Imaging report]

CEA (ug/L, ref 0-5.2)
  12 May 26 15.8 · 23 Jul 26 49.4 · 07 Aug 26 87.6 · 01 Sep 26 146 · 14 Sep 26 50.9 · 29 Sep 26 44.6
  [Laboratory bloods]

BLOODS OUT OF RANGE (29 September 2026)
  Haemoglobin         126 g/L          low, ref 130–170
  Red cells          4.09 ×10¹²/L      low, ref 4.40–5.80
  ALP                 169 U/L          high, ref 30–130
  Bilirubin            21 µmol/L       high, ref 0–20
  [Laboratory bloods]

OPEN QUESTIONS
  - Which alteration is the driving event? The panel reports APC p.S1415Rfs*4 and TP53 p.R342* as detected, but it does not designate a driver and no clinician has characterised one on my file. If a driver were formally called, would it change anything actionable?
  - NHS whole genome sequencing referral — the testing to date is a 517-gene panel, not WGS or WES.
  - Matched tumour/normal sequencing — the tumour panel is reported tumour-only.
  - Platelet count from 29 Sep 2026 — unreadable on my copy of the report, not yet confirmed.

TREATING TEAM
  Primary oncologist - Consultant clinical oncologist, Bath Clinic; Haematologist - Consultant haematologist, Bath Clinic (smouldering myeloma); Integrative - Integrative oncologist (private), separate from my NHS/Bath Clinic team
  Named identifiers are not published here. A version carrying them is sent to
  clinicians directly on request.

SEQUENCING
  Tumour DNA and RNA, liquid biopsy, germline and exosomal transcriptome.
  Astron / EXACTA (Astron Health), August 2025. 517 genes. Not the whole genome, not the whole exome.
  Set out in full, with the raw variant files, at the link below.
  Germline data is not published openly.

Full record:      https://fcancerwith.ai/full-record
Structured data:  https://fcancerwith.ai/data/profile.json
Corrections:      https://fcancerwith.ai/corrections