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  • #99511
    gavin
    Moderator

    Hi there,

    I did a search on the boards for you using the search forum function and it threw up these discussions here –

    https://cholangiocarcinoma.org/db/search/5Fu+monotherapy/

    Not a lot to go on there I know. So I did another one for you on just 5FU and it came up with this, much more here.

    https://cholangiocarcinoma.org/db/search/5fu/

    I hope that some of that will be of use and interest to you. And I will be keeping my fingers crossed for you as well with regards to the treatment and hope that it works very well indeed.

    My best wishes to you,

    Gavin

    Shshaw
    Participant

    Had 6 cycles of Gem/Cis for intrahepatic non-resectable ICC. A Scan shows main tumor has shrunk, however several small tumors (mets) have grown. Anyone else had results like this? Oncologists now has me on 5Fu monotherapy using pump. Has anyone had this treatment before and what were results?

    #60490
    pcl1029
    Member

    Hi,
    The key to Chinese Herbal medicine is to find an experienced practitioner(very important);please read about this under our experience forum title under “Complimentary and alternative treatment”

    HCC is relatively chemotherapy-refractory tumor .Systemic chemotherapy is usually not well tolerated by ptients with significant underlying hepatic dysfunction(ie: liver cirrhosis,hepatic B or c involvement).
    In general, monotherapy like 5FU,gemcitabine,irinotecan and thalidomide have been used;combination therapies of cisplatin with other agents like 5FU,,Xeloda,gemcitabine,doxorubicin have been done also. GEMOX and FOLFOX and XELOX are regimens that can be of use.
    Summary: The efficacy of cytotoxic chemotherapy is modest in patients with HCC.— “Systemic treatment for advanced HCC”– from uptodate.com literature review version19.3 sept.2011.
    Targeted agent like Nexavar( ie:400mg twice a day) provide some benefit to patients and the treatment is well tolerated(side effecgts included diarrhea,hand-foot skin reaction) the treatment outcome depended on the health status of the patient(ie:degree of liver cirrhosis) at the time of diagnosis.
    Other targeted agent like Avastin,sunitinib(Sutent),erlotinib,cetuximab have been used for HCC as clinical trials when used in combinations.
    Hormone therapy like tamoxifen,megestrol and octreotide have been studied in advnced HCC but cannot be recommended outside the context of a clinical trial.
    If there are no spread or mets outside the liver, 2nd opinion or consult by interventional radiologist is recommended to consider other radiation treatments like RFA or radioembolization is of value to the patient.
    I hope the info helps.
    God bless.

    #59653

    In reply to: xeloda-oxiliplatin

    pcl1029
    Member

    Hi,
    there are no standard protocol .normally is 6 cycles and scan for progress of the treatment and determine the next step to go forward or change to another treatment for the cycles that is recommended for that new chemotherapy, Kris is right on her assessment about the treatment plans for CCA. In short, they are trying what they think is good for the patient at that point of time (the time of appointment). I still don’t think chemotherapy is the way for finding the cure fast enough for most of us who suffer for CCA.
    Most of the chemo regimens is for 6-8cycles and scan for results ;as you can see on this web site there is not uncommon to be on Gem/CIS more than 6 cycles.;not to mention Gemox ; Gemzar or 5FU monotherapy which the manufacturers indicated ” till disease progress or side effects intolerable.” as the criteria to stop the use of the drugs. that means if the drug works , the therapy can be used for life.(what kind of quality of life is that?).

    My suggestion is that you are always prepare psychologically the CCA will be back,(>65%);do not expect otherwise. so if this is what you believe and agree; then “to stop the treatment and wait “may not be the best option; but I also know patient are tired of chemotherapy(I know, I am on Gemzar,the easy one for 14 month and I hated it.)
    So the logical choice here will be just have the Xeloda 2 or 3 tablets twice a day,but make sure you talk to the oncologists first and he agree,he is the doctor and i am only a patient .I think in that way ,the patient still have chemotherapy to control the CCA but can avoid the harsh side effects of oxaliplatin or cisplatin . The patient will have both sides of world -less and tolerable side effecte and stil have chemotherapy to keep the CCA under control.
    Yes, there are side effects on Xeloda,but I think if your want both the worlds(good and bad); Taking Xeloda by mouth is my choice under you circumstances.
    God bless.

    pcl1029
    Member

    Hi,there are 3 reprinted messages here about Capecitabline (Xeloda)side effects.

    As always,consult your oncologist BEFORE any change of your treatment plan.
    Thanks to the CC foundation ,according to the package insert I picked up at the Genentech booth for Xeloda(dated 4/2011).

    #1 Reprinted message about Xeloda side effects.— about nails problem.

    If you are on montherapy only with xeloda; the adverse effect of nail DISORDER is about 7% in a phase II trail involved 162 patients of stage IV breast cancer.
    If you are on a combination therapy with Xeloda,the chance is about 14%,and 2% of them is in the Grade 3 category.(the scale is from Grade1-Grade 4 ,a scale developed to measure the adverse drug reaction of medication;Grade 4 is being the most serious.):the chance for nail DISCOLORATION is 6% .
    Generally,dose reduction of Xeloda may be needed base on the condition of the nails and other related issues until problem resolved ; this is why you should call your oncologist and make an appointment to let him/her to determine what is the best way to due with the problem.You should not change any current treatment plans until you talk to the oncologist.
    There is also a phone # (1-877-987-2487) you can call for support and a oncology nurse who trained about Xeloda will answer your questions about Xeloda 24/7 in 150 languages;it is provided by Genentech,the company that makes Xeloda.and you may need your oncologist to refer you to such a service.

    #2 Another reprinted message as below:—How to take Xeloda correctly.
    Hi,
    Xeloda(Capecitabline) is related to 5FU,a first-line chemo agent to fight CC and colon cancer.It is taken by mouth twice daily (12hr apart)within 30 min. of a meal and with about 200ml or water to flush it down.
    Side effects are diarrhea/constipation ,hand and foot syndrome ,mouth sores and fatigue. For most patients the side effects are manageable using medications.(lomotil,imodium/colace and miralax; creams and moisturizers,nystatin and baking soda mouthwash to relieve the corresponding symptoms.)
    Xeloda most of the time are used with Gemzar ,but it can be used “off protocol” by itself too.
    Under the chemo forum on this web site there is a study call BILCAP done by UK researcher and you can have a glimpse of the side effects percentage of Xeloda.
    the study is on going and up-to date.
    Have a second opinion if you don’t feel you are satisfied with your current oncologist’s treatment plans for your mother.

    #3 another reposted message about Capecitabine (Xeloda)—about diarrhea

    According uptodate.com. and clinicalpharmacology-ip.com

    Capecitabine(Xeloda):
    Diarrhea is a dose-limiting toxicity of Xeloda,and occur in 50-57% of patient.
    11-12% patients taking Xeloda will have Grade 3 diarrhea .
    2-3% of pt. taking Xeloda will have Grade 4 diarrhea
    The recommended dose modifications are as following:(*any change in dosing must talk to your doctors first.*)
    Grade 4 diarrhea:(>10 stools/day or grossly bloody)=discontinue Xedola permanently or physician judgement decrease dose by 50% after diarrhea resolved to Grade 0-1.

    Loperamide and lomotil are the common oral meds to treat diarrhea.
    Octreotide(Sandostatin) is in injectable form used to treat severe waterly diarrhea.
    PS: Grade2=increase of 4-6stools/day or nocturnal stools.
    Grade 3=increase of 7-9stools/day or incontinence and malabsorption.
    if you have any of the above while you are on Xeloda as monotherapy,
    talk to your doctor(oncologist) for dose adjustment.

    #4 a reposted message about Xeloda side effects–The hand and foot syndrome”
    Hi,
    This is for information purposes only,seek doctor advice BEFORE any changes of your current treatment plan.

    The “hand and foot syndrome” you mentioned has been reported in roughly 45-57% of patients who is on Xeloda.(package insert of Xeloda)

    If I may suggested ,make an appointment to see your oncologist to determine the severity of the problem(there are four grades of severity of this side effect;and the treatment will be different depend on the grade of severity.)
    This side effect of the Xeloda is very common ;it may occur as early as 2 weeks after treatment begins. sometimes it may require dose reduction if the problem is severe enough and that is why you need to talk to the oncologist about it.

    Modification of normal activities of daily living to reduce friction and heat exposure ;keep palms and hands and sole of feet using emollients such as Aveeno or Lubriderm; OTC medications to relieve pain,rash and other symptoms(ask the pharmacists for their recommentions ).
    God bless.

    #4b reprinted message about neuropathy of Xeloda from the”Marion collection”
    — a detail oriented message to understand “hand & foot syndrome”.and good tips for helping how to cope with the side effects.

    marions wrote:
    Tom: there are two different kind of problems with sensitivity to hand and feet.

    Nervous System Changes (Neuropathy)

    Sometimes cancer treatment can cause damage to your nervous system. This is called neuropathy (new-RAH-path-ee), or problems with nerve function. Sometimes these symptoms can be made worse by other conditions, such as diabetes, kidney failure, alcoholism, and malnutrition. Most people first notice symptoms in their hands or feet, usually starting with their fingertips and toes. Sometimes, the tingling and pain move up the fingers to the hands or from the toes to the feet.

    Common symptoms include tingling, burning, weakness, or numbness in your hands or feet; sudden, sharp, stabbing, or electric shock pain sensations; loss of sensation of touch; loss of balance or difficulty walking; clumsiness; trouble picking up objects or buttoning clothes; hearing loss; jaw pain; constipation; and being more – or less – sensitive to heat and cold.

    Symptoms can start when you begin chemotherapy or after treatment. If they do, tell your health care team right away. Symptoms can improve over time, but it may take up to a year or more.

    Treatments include medications, topical creams, and pain patches.
    Other approaches include acupuncture, physical therapy, and exercise.
    Managing Nervous System Changes

    Be careful when handling knives, scissors, and other sharp objects.
    Avoid falling. Walk slowly, hold onto handrails, and put no-slip bath mats in your tub or shower. Remove area rugs or cords you could trip over. Steady yourself when you walk by using a cane or other device.
    Wear tennis shoes or other footwear with rubber soles.
    Use a thermometer and gloves instead of your bare hand. These can help you avoid being burned when checking water temperature. If possible, lower the temperature setting on your hot water heater.
    Allow yourself time to rest.
    Copied from NCI website.

    The other is:
    Hand-Foot Syndrome (Palmar-Plantar Erythrodysesthesia; PPE)
    which can occur with several types of chemotherapy or biologic therapy drugs used to treat cancer. (Capecitabine (Xeloda

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