<s>[INST] My brother has stage 4 esophageal cancer . He started chemo in Nov. 2011 and when he was scanned in Jan. it showed the tumors in the esophagas had shrunk, but the tumors in the liver had multiplied and were still growing. They added herceptin to his treatment, and after another scan, the liver tumors are still growing. What are his chances now of remission? [/INST] Saying 4th stage(liver spread from esophagus primary) is very dismal disease per se. After chemotherapy, primary disease response well but progression at liver site is a not good finding. If patient is not affording for Herceptin then patient can be shifted to cheaper chemotherapy like MELODY(CAPACITATIVE) as single agent chemotherapy as it is in oral form and side effect profile is also not bad.  Finally it's a matter of the best supportive case only as patient will die because of ALTER LIVER PROFILE with raised jaundice, .hope for the best as chemotherapy only extent life with some extent only. </s>