Hi @micki8899, I’m really sorry you and the patient are facing this. Seeing progression after two treatment lines must feel frightening and exhausting, especially with spread to the liver and lungs and the added concern of past heart problems. At this stage, it may help to ask the oncology team very directly what the goal of irinotecan would be: slowing the cancer, easing symptoms, or giving more time with acceptable quality of life. Because of the cardiac history, tolerance matters just as much as response. You could also ask about support for swallowing, nutrition, pain, breathing trouble, fatigue, and emotional comfort alongside treatment. I hope you get clearer answers soon and that the next step brings some relief. ... View more