Search Results for '5fu'

Hi,
Thanks Gavin for the info.
Rebecca ,if your father in law has liver metastasizes, I will get a 2nd opinion from the liver surgeon and also from an interventional radiologist to see whether the tumors can be removed first ,then will talk with the medical oncologist for adjuvant chemotherapy or targeted therapy. MASS GENERAL,JOHN HOPKINS SLOAN-Kettering are great hospitals just to name a few near you.

First line chemo therapy include. GEM/CIS, GEMOX, 5FU/CIS,FOLFOX among others, second line including GTX,TARCEVA+Avastin, Sorafinib ,Rituximab etc.

Below is a link about systemic chemotherapy and targeted therapy in general, so you can have some ideas.

http://www.cholangiocarcinoma.org/punbb/viewtopic.php?id=7843

Clinical trials are worth it depends on each individual case and the availablity and suitability to the patient, it is best to ask referral from your current oncologist if he/she opens to the idea.
Please check out the clinical trials on our web site under the cholangiocarcinoma on the top , open and click clinical trials and you will have some idea whether your father can go .

God bless.

Hi,
I also had chills and a fever after Gem/Ox. It only went up to 101.5 most of the time, tho. And my blood counts were always low. And I visited the hospital a few times with blood infections. It’s a hard life, being a chemo patient. We have to balance cancer vs. poison.
Unfortunately, it sounds as if gem/ox is just too toxic for your father. The good news? The doses he DID get will continue to work in his system.
I would ask the doc about other treatment options, like 5fu, or the pill form, Xeloda. Maybe a clinical trial?

Hi,
Replacing “Plastic” stents every 2 months is not uncommon here in the States .
Metal stents may last between 6-18 months in general.

In your mom’s case,systemic chemotherapy like Gemzar+cisplatium or 5FU+ cisplatium will be a start because the tumor involves both the right and left hepatic artery and the main portal vein. In addition, there are nodal spread to the celiac axis and the aortocaval nodes. ; GEMOX or FOLFOX may be a better choice if the kidney function is of concern. it will be all up to the oncologist to decide after the lab work are done prior to chemotherapy each time.
Sometimes the chemotherapy will shrink the tumors enough to allow more choices of treatment down the road.
59 years old is young and should be treated aggressively if no other health problems involved. But it is all up to your mom to decide since this disease is difficult to treat and the ups and downs like a roller-coaster is not for everyone easy to accept both emotionally and physically.
There is currently no effective treatment for this cancer except may be surgery,but as you can see, it is a relatively comparison only. i had recurrence and have surgery twice ;but it still come back for the third time.
Keep up your knowledge on this cancer is a good idea to allow you to know what other options you can have.
God bless.

How old is your dad?

Do you know the status of the surgical margins? (negative / microscopically positive / macroscopically positive)

My wife had Whipple two years ago at the age of 44. Extrahepatic CC, Stage 2B. 2/15 positive nodes. Microscopically positive margins where they reconnected the common bile duct.

She had radiation for 28 days combined with 5FU chemo around the clock.

Followed by: 6 cycles of Gemcitabine/Cisplatin chemo. 2 weeks on, 1 week off. 12 trips to the chemo chair in total.

To answer your question, your dad’s treatments sound appropriate, but that depends a lot on his age and general state of his health. Positive node is a big risk factor. Note that I’m not a doctor.

Take a look at NCCN Treatment Guidelines for Hepatobiliary Cancers. You will need to register for a free account to see the PDF.

http://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf

The document describes the current standard of care for CC. Slide #30 (labelled EXTRA-2) is the one you should be looking at. It shows the treatment protocols post Whipple.

Given that your dad is very discouraged, it’s a good idea to go for a second opinion at a major cancer center that sees many CC patients.

Hi,
Dr. Fong is a good surgeon specialized in larproscopy( robotic liver surgery)) , according to the fellow I talked to who is working with him.
He also one of the most experienced doctor to prescribe the FUDR pump to deliver the 5FU analog drug directly to the cancer site. The only problem is at times, it may leak at the site of incision. So check and clean the site daily.

One question, is it the primary tumor in the lung is different than cholangiocarcinoma , if not why they don’t want just use RFA or microwave to burn it off.? Get a 2nd opinion of interventional radiologist and talk about.

So far, what is your husband age. 61 just like me I am 63? And when is the date you discover you husband have CC. WHen did .Dr Fong start the 5fu pump and for how long now ( June 24till when,till now? But do have any chemotherapy before that?If they change would they aim at the lung CA or still focus on CCA as the primary cancer for treatment. If they use GEM/CIS orGEMOX OR FOLINOX then mostly is still treating the CCA as the primary.
Get your husband to drink more protein shake, soy milk to increase to protein and therefore the albumin ,so less chance for ascites.
Keep a positive attitude, always seek 2nd or third opinion on surgery after chemotherapy for a there month periodic to see the resection will be ther, also on interventional radiologist( this is the fastest moving field to help us at this point) and chemotherapy, don’ t just say yes, ask why. GEM/CIS have kidney side effects ;GEMOXhas neuropathy,other targeted therapy, TARCEVA, Sorafenib have their problem too. As and compare. It is your husband’s life , hie is not a guinapig.
My fiend, what I say may not be of any value since I am ,like your husband, is a patient for thesis disease for 52months, and I am no doctor.

God bless.

Hi,,
If I may, as far as I am concern, chemotherapy agents are toxic in general. For example, 5FU or Gemzar kills cancer by interrupting their cell reproduction cycle, as well as to the healthy cells inside a human.
I am not a doctor, but I can say the above assumption without a doubt with my professional career experience.
I agree sometimes” not to be treated” is as good as or better than “to be treated” especial in some cancer patients at the late stage of the game.
I agree with Eli, chemotherapy is not only tough,but in my point of view, sometimes it is more inhuman than you think both physically and mentally speaking. I can say that because I am also a patient too of this cancer.
I think the oncologist did your mom a favor by suggesting no to chemotherapy.
I am not surprised if some doctor will provide your mom treatment knowing that it may actually decrease the quality of life of your mom.
Therefore your mom’ s oncologist do have a heart for his/her patients.
God bless.

Hi,
Normally Chemotherapy will be started 6-8weeks after surgery.

Adjuvant chemotherapy after surgery is relatively ineffective but most of the oncologist will get you father a 6 month treatment if he can tolerate it.
It seems FOLOX(5FU+oxaliplatin) is a reasonable choice the same apply to CAPOX (capecitabine+Oxaliplatin); By some unknown reason 5FU or capecitabine works better for extrahepatic CCA than intrahepatic CCA.
If your father’s kidney function is normal.( serum creatinine 1-1.4) or CRCL>50,then the standard GEM/CIS regimen will be ok too.
But at this time, I believe either FOLOX or GEMOX(gencitabine+oxaliplatin)will be fine since most of us at old age will have some kind of kidney problems.
Remember please, I am only a patient like your father and not a doctor.
Listening to your choices offered by the oncologist,asking questions about the above regimens and make a choice( after a day or two thinking about it).
Attach below is the link about most of the chemotherapy used for CCA,their side effects etc.

http://www.cholangiocarcinoma.org/punbb/viewtopic.php?pid=57198#p57198

God bless.

Hi Hugh,

You wrote:

You can lower your out-of-pocket cost by doing IMRT with 5FU, followed by Gemcitabine and Cisplatin. This adjuvant treatment plan is common in North America. My wife had this treatment after her surgery.

I’m not aware of any data to say that IMRT+Xeloda is more effective than IMRT+5FU, or that Xeloda/Oxaliplatin is more effective than Gemcitabine/Cisplatin.

Note that 5FU and Xeloda are similar drugs. Xeloda is a pro-drug of 5FU. It converts to 5FU in the liver. 5FU is older than Xeloda, so it costs less. Xeloda is more convenient for the patient because it’s a pill that you can take at home. 5FU is done through IV.

You further wrote:

I agree with your assessment. I think she pulled those numbers out of thin air to sell you on her treatment plan. I doubt she can produce any solid evidence to validate her claim. By solid evidence I mean published, peer-reviewed medical studies.

That said, I think she is right to recommend a more aggressive treatment that combines radiation and chemo. 5 positive nodes put your wife at a high risk of recurrence.

Hi,
If the diagnosis for your wife is ICCA, and if I were her, I will start the 1st- line chemotherapy such as GEM/CIS first. and if it is not working later, then I will start the 2nd-line chemotherapy such as Folflorinox. You can get some ideas about the toxicity of each regimen like GEM/CIS and Folflorinox by combining
each individual drugs(GEM/CIS=gemcitabine+cisplatin) and (Folflorinox=5FU+oxaliplatin+irinotecan,the folinic acid is not a chemotherapy agent).

http://www.cholangiocarcinoma.org/punbb/viewtopic.php?pid=57198#p57198

I think your doctor’s original suggestion of GEM/CIS and radioembolization is a logical and good combination choice for non-resectable ICCA.

But I think you have had made up your mind already. So good luck and
God bless.

Hi,
There is no consensus regarding the optimal management after resection and the true benefit of adjuvant chemotherapy remains uncertain for Ampulary.
In the States, however most of the patients with resected ampullary cancer stage IB or higher will offer adjuvant chemotherapy.
Depending on the true origin of the periampullary tumors which are of intestin al,biliary or pancreatic origin is very important in pts with metastatsis as the approach differs since the optimal regimen for ampullary is not established.GEM/CIS or GEMOX have been used as well as GEMZAR mono therapy; Infusional 5fu is preferred concurrently with chemoradiation,followed by gemcetabine alone for the chemotherapy portion.uptodate.com(oct.2012).
clinical trial is another option.
Ampullary Cancer is among biliary cancers that has the highest 5 yr survival rate than any of other form of CCA.

For overall 2nd opinion, MASS Gemeral or John Hopkins is the place to go;
For surgical consult, Dr.KATO is the guy because he is very experienced and willing to be on the cutting edge of liver surgery.Talk to him first is not a bad ideas but should be as soon as possible due to the multiple lymph nodes involvement in your case. If you have peritoneal carcinomatosis(abdominal lymph nodes did mention in your message), then it may be too late for this consult.Mare sure it is not the case.
For oncology consult, MD Anderson in Texas is the place to go.but I will wait for the assessment of DR. KATO first.

I took vitamin D1000 units twice daily for about 2 months, it lower the ALP to about 10-12 points withtin one month in my case.But I ask my oncologist what is that mean. he said ,I only monitor and check why the ALP goes up with regard to the CCA; but not about the lower value and what it means.We just don’t do that. and he may be right,he is my friend and I think he spoke the truth. therefore I stop doing vitamin D,( it goes below 32)

I took Celebrex too,but the recommended high dose for cancer is too high and can cause stroke and cardiac problem.it does require a bit of medical and pharmacology knowledge to titrate the dose for the maximum benefit and watch for the side effects as it comes with.I am not a doctor but a patient only, and as I said before,” I am a one man clinical trial specimen” and for that ,please ask your doctor to see Celebrex is right for you.
God bless.

Hi,
Nausea and vomiting ( N/V)always come together as side effect for chemotherapy and radiation treatment.
There are 3 types of N/V. they are Acute,Delayed and Anticipatory.
Chemotherapy Folfirinox regimen recently followed by chemo-sensitized radiation( xeloda and radiation) may compound the risk for the outcome of N/V.
Irinotecan (30-90% chances), 5FU (10-30%)are emtogentic chemotherapy agents that N/V are the side effects of each drugs. the risk of radiation induced nausea and vomiting (RINV)for Upper abdominal irradiation is between 60-90%.
therefore when you combined all the risk factor. Delated nausea and/or vomiting is not uncommon .—uptodate.com literature review RINV & CINV.

Ativan, Compazine are more useful in the Anticipatory type; Zofran is widely use for the Acute type but the updated ASCO guideline suggests to use the newer type of the 5-HT3 agent palosertron(Aloxi) just before chemotherapy treatment. However, for RINV there are no available data on the appropriate dosing frequency with Aloxi. The updated version of ASCO guideline suggests given every other day or every third day may be appropriate for Aloxi.
That means you have to consult with the radiologist or oncologist to see whether Aloxi is good for your mom. To increase the effectiveness , dexamethasone can be used alone or in combination with Zofran and Aloxi.

As you know I am not a doctor, I am just a patient like your mom for almost 4 years. So consult your doctor first is a must in changing medication.

God bless.