Search Results for 'gemcitabine cisplatin'
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Search Results
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Topic: Where do we go from here?
My husband, Tim, is a 50 yr old non-smoker, non-drinker, former DIV 1 college athlete who still ran 15 miles/week and had no major health issues. The past Christmas eve, I rushed him to the ER because he was vomiting blood. They said he had a bleeding ulcer, acute pancreatitis, and gall stones. After CAT scan and MRI they found the mass, diagnosed cholangiocarcinoma and transferred him from our local community hospital to Thomas Jefferson University Hospital in Philadelphia. After placing a plastic stent and doing a biopsy on a nearby lymph node, they told us the liver was non-resectable and oh, by the way, he also has cirrhosis of the liver. It turns out he has a genetic condition causing Alpha one antitrypsin deficiency which caused the cirrhosis. Knowing surgery was our only hope for a cure we got a second and third opinion from Univ of Penn and Johns Hopkins. They both concurred with original opinion. After extreme emotional turmoil, we prayed that Tim would get selected for the experimental arm of a photodynamic therapy clinical trial in the hopes it would buy us some time so that he could see our youngest graduate from high school and maybe go on a few trips we had planned to do after retirement. Tim did get into the trial. In late January, during an ERCP they performed the PDT and placed two plastic stents in the biliary ducts. The next week he began chemo with Gemcitabine and Cisplatin. He tolerated the first 2 treatments well. By the 3rd treatment he began to retain fluid in his legs and abdomen. After the 4th treatment they had to stop chemo and perform a paracentesis removing 6.5 liters of fluid. In late March he suffered deep vein thrombosis and multiple pulmonary embolisms. He was hospitalized for two weeks in an attempt to get the acute ascites under control. He no longer could tolerate the chemo and in June they performed an ERCP to place a permanent metal stent. He has now lost 40 pounds, is on a low salt diet, taking diuretics, and receiving a paracentesis about every 11 days. The liver failure has taken precedence over the cancer and the oncologist agrees that further chemo would probably only exacerbate the liver problems. He sleeps about 14-16 hours/day, has balance issues, periods of pain and nausea, can’t get up without help, and only leaves the house for doctor visits. We initially had a Plan B of proton beam radiation and were pursuing an appeal to the insurance company, but honestly now don’t want to introduce further toxicity into his system. In reading other people’s posts on this site, I wonder about Keytruda. Our only thought at this point is the possibility of immunotherapy. Our concern is that could it make things even worse for him, now. His quality of life is already poor and I don’t want to make it worse. While his slow deterioration has been extremely difficult for me to watch, it has been devastating for him to live through. Only our faith in God and the love and support of our incredible family and friends has sustained us thus far. Is he even eligible for the treatment? Who would you recommend we contact for information about an evaluation?
Hi All,
I know some of you are seeking out patterns in people’s medical histories. In case it’s helpful, here is a fuller version of Peter’s medical history, as written up by the Mayo Clinic during his last hospital visit there before returning to Alaska (interventions once we returned to Alaska were minimal).
[From 14-Jul-2015]
Age: 29
Sex: M
Patient is a 29 year old male who was admitted post ERCP (Endoscopic retrograde cholangiopancreatography) and PTC (percutaneous transhepatic cholangiography) for observation.He has the following oncologic history
1. ~2007: Diagnosed with ulcerative colitis, previously treated with Imuran, Asacol, and a single course of prednisone. Not currently on medication. Controlled with diet.
2. ~2008: Diagnosed with primary sclerosing cholangitis, not currently on immunosuppressant therapy. Controlled with diet.
3. October, 2014: New jaundice, pruritus, and fevers. Received antibiotic therapy.
4. March 4, 2015: Local Gastroenterologist recommended abdominal ultrasound due to rising CA 19-9 levels. This showed central intrahepatic bile duct dilation.
5. March 20, 2015: ERCP showed left main hepatic and right main hepatic duct with multiple diffuse stenosis. Stents placed. Biopsies with brushing performed which showed abnormal glandular proliferation. Development of post-ERCP pancreatitis resulting in hospitalization for one week.
6. March 31, 2015: Presented to Mayo Clinic, Department of Gastroenterology, Dr. LaRusso; recommended further work up.
7. April 1, Ultrasound of the abdomen showed subtle isoechoic central hepatic tumor, likely cholangiocarcinoma, results in intrahepatic bile duct dilatation involving both the right and left lobes. Stents are noted in the extrahepatic bile duct. Hyropic gallbladder.
8. April 3, 2015: MR Elastogram performed which showed an approximate 5 cm hilar mass obstructing both right and left lobe bile ducts (both massively dilated), highly suspicious for cholangiocarcinoma. The biliary stent seen on outside CT is below the level of the mass and isn’t decompressing the biliary tree. There appears to be direct invasion of the mass into the left portal vein near the bifurcation, and at least 6 distinct lesions in both hepatic lobes suspicious for metastases The hilar lesion has increased from about 4 cm on 3/21/2015 to 5cm on today’s study.
9. April 6, 2015: Transplantation consultation with Dr. Poterucha; deemed ineligible for liver transplant.
10. April 7, 2015: ERCP performed which removed one stent from the biliary tree. A biliary tract obstruction was noted, secondary to what appears to be a mass, in the bifurcation of the right and left hepatic ducts; bilateral biliary systems were trained with stents (2). Dilation and brush cytology performed which was negative for malignancy. FISH for biliary tract malignancy was abnormal indication a high suspicion for malignancy or high-grade dysplasia of the pancreaticobiliary tract. Biopsies taken at the hilar stricture which showed minute detached cluster of atypical epithelial cells in a background of ulceration and squamous metaplasia with acute inflammation.
11. April 8, 2015: Medical Oncology consultation with Dr. Grothey; recommended systemic chemotherapy, gemcitabine and cisplatin, once bilirubin levels decreased.
12. April 29, 2015: In Alaska, ERCP showed the hepatic duct bifurcation contained multiple stenosis. Dilation with a 6-mm balloon dilator was successful, and two additional 7-Fr by 12 cm plastic biliary stents were placed.
13. ~May 2015: He started to present with fever and chills, and he underwent placement of an external drainage catheter. He seemed to have been started on meropenem for possible recurrent cholangitis (though this is unclear) with no planned stop date.
Subsequently post PTC insertion his bilirubin does not appear to be improving following placement of the percutaneous biliary drain. Therefore plan was to have the stents removed with an EGD and place a percutaneous biliary drain in the right duct. He therefore was planned to undergo a right side PTC and a left cholangiogram to make sure the left percutaneous biliary drain is in position.
Today he underwent an ERCP in which:
-Four stents were removed from the biliary tree.
-A localized biliary stricture was found. The stricture was secondary to primary sclerosing cholangitis.
-One plastic stent was replaced into the left hepatic duct.There was a plan to perform RFA, however given the bleeding from the duct post stent removal and necrotic looking mass at the hilum it was deferred. He then subsequently underwent PTC.
Under interventional radiology he underwent
1. Cholangiography
2. Placement of a 10-French Cope biliary drainage catheter in the posterior right biliary tree
3. Injection of the 10 French Mac-Loc drainage catheter in the left biliary tree. The left side looked to be draining appropriately.On arrival to the floor, he was well. Had no acute complaints. His vitals were stable.
[Written 15-Jul-2015]He then had a repeat procedure on 7/15 where there was:
1. Conversion of the right hepatic lobe biliary drain to a 10F BCL with locking loop in the duodenum across the ampulla. Additional sideholes fashioned to extend across the obstructing tumor.
2. Conversion of the left hepatic lobe biliary drain to a 10F BCL with locking loop in the duodenum across the ampulla. Additional sideholes fashioned to extend across the obstructing tumor.These 10F tubes were found to not drain appropriately and his percutaneous biliary drain was noted to drain a milky white purulent fluid. He was taken back to IR and both the right and left transhepatic biliary drains were then externalized and exchanged for 8 Fr. Locking BCL catheters with pigtails repositioned in into the peripheral dilated ducts.
He felt well after the externalization procedure, and remained afebrile. His leukocyte count was noted to be 23, increased from 15 the day before. During the admission we also consulted ID given the fact that he was on meropenem. They recommended:
1. Please continue Meropenem 500mg IV every 8 hours to complete 14 day course ending 7/28.
2. If he is still in town after finishing IV therapy, please call Infectious Disease and set up a follow-up appointment.
3. If he returns home before his IV antibiotic course is complete, please arrange followup with Infectious Disease with his home doctor.
4. At this point we would recommend eventual transition to oral suppression with alternating weekly courses of Moxifloxacin and Augmentin. This may be adjusted through his outpatient ID followup.
[Note from Elizabeth: Peter remained on Meropenem – fevers returned whenever he was taken off of it]Past Medical/Surgical History:
1. Metastic hilar cholangiocarcinoma
2. Primary sclerosing cholangitis
3. Ulcerative colitis, not currently on treatment
4. Recurrent cholangitis 2/2 #1Family History:
Unremarkable for any GI malignanciesFollowing his discharge from the hospital, Peter twice had outpatient paracentesis to drain excess fluid from his abdominal cavity. He passed away on August 11th, 2015 under at home hospice care.
If you would like information on the medicines Peter received while at Mayo, a more extensive writeup of an ERCP, Stent Extraction, and Single stent placement procedure he had while there, or the records from an ultrasound of his abdomen he had prior to his diagnosis, please feel free to message me. Excluding what is below, this is the totality of the records of his that I have.
Below, I’ve included pictures of Peter’s bloodwork from when he was at the Mayo Clinic in July as well as some bloodwork from that March, before he was diagnosed. (keywords I’m including so that people can find this post if they’re searching for these words: Hemoglobin, Hematocrit, Erythrocytes, MCV, RBC Distrib Width, Leukocytes, Platelet Count, Hematology AG CBC Aggregate, Hematology AG Auto Diff, Neutrophils, Lymphocytes, Monoctyes, Eosinophils, Basophils, Coagulation AG, Hematology AG Auto Diff, Coagulation AG Coagulation Tests, Prothombin Time, INR, APTT, Chemistry AG, Blood Chemistry 1 AG, Sodium, Potassium, Glucose, Random, Alk Phosphatase, AST (GOT), ALT (GPT), Bilirubin, Total, S, Bilirubin, Direct, Blood Chemistry 2 AG, Creatinine (w/eGFR), eGRF-Non African American, eGFR-African American, Albumin, BUN (Bld Urea Nitrogen), Chloride, Bicarbonate, P/S, Anion Gap, Enzymes, Amylase (S) )
In reply to: My mom’s case
Julie…..I have learned that Gemcitabine and Cisplatin is the first line of treatment. Once failed or patient reached optimum benefit the choices become less clear. You are mentioning a targeted agent, has your Mom’s tumor tissue been tested for molecular alterations? The data derived from such testing will set the path to available targeted agents.
Our Melinda had Immune cell therapy (Adoptive T cell therapy) with spectacular results and if offered, is worth checking into. However up to date (as far as I know) only 3 cholangiocarcinoma patients experienced tumor regression to various degrees. But this is an ongoing study and many more may have had the opportunity to enter a clinical trial of this kind.
Dendritic cell therapy has not been discussed on this discussion board, hence I have no knowledge of efficacy with this treatment.
Drugs that work with your immune system to interfere with the growth and spread of cancer cells in the body include: Opdivo (nivolumab) and KEYTRUDA (pembrolizumab) and often are combined with targeted agents.You may also want to get in touch with two physicians very familiar with this cancer.
Dr. Suebpong Tanasanvimon: https://www.bumrungrad.com/doctors/Suebpong-Tanasanvimon
and Dr. Virote Sriuranpong: https://www.bumrungrad.com/doctors/Virote-Sriuranpong
Hugs,
MarionTopic: My mom’s case
My mom was diagnosed as cholangiocarcinoma on month ago, with presentation of skin itch, jaundice, body weight loss. I am desperate. I’m a medical student and I know that cholangiocarcinoma has a very poor prognosis. And I couldn’t detect my mom’s situation earlier!!The doctor told us the remnant lifetime was approximately 6 months. A big shock!!
I don’t know who to ask or where to seek for the most professional medical opinion.
While waiting for the declining of bilirubin level, I found a doctor who has managed many kind of these cases. And he gave us hope that the tumor is at least resectable.
Now, my mom had just done her operation(central hepatectomy+bile duct resection) for 1 week. However, another desperate news strikes. The staging is T2a and 1/5 node positive. Lymph node metastases is a significant prognostic factor. Now, we are searching for the adjuvant therapy. If anyone could give us some advice, we would be very greatful!!
Now, gemcitabine plus cisplatin is the most common regimen. We’ve seen a clinical trial with cisplatin + target therapy with ADI PEG 20, I’m wondering if anyone have done this? We also seek for another chance with immunocell therapy(still confused whether dendritic cell series or T cell specific series would be more suitable for cholangio).
I saw a lot of brave friends fighting for their lives here. Very thankful to have this communication board, and know there’s many people working for this cancer. We’re not alone. We gave each other courage to fight and hope to live.
By the way, we are from Taiwan.In reply to: new member
Lorraine….welcome to our site. Congratulations on the successful surgery. How are you feeling? How is your recovery coming along?
Yours is the first posting referring to focal signet cells. I hope and wish someone will be able to share his/her experience on this subject.
Adjuvant therapy is a much discussed subject on this site, we are awaiting data release of a clinical research study comparing surgery and capecitabine with surgery alone for cancer of the bile duct or gallbladder; however the majority of physicians recommend adjuvant chemotherapy. It may consist of gemcitabine/ cisplatin or gemcitabine/oxaliplatin, but other agents are used as well.I am glad you found us, dear Lorraine, I look forward to others chiming in as well.
Please stay in touch, we care and we are in this together.Hugs,
MarionIn reply to: Husband’s Case
googily……At last you have conclusive answers from which a clinical treatment plan has emerged and the molecular test will provide additional information. From what I have learned the IDH-1 mutation appear in 40% of all intrahepatic patients and we have seen some excellent responses to immunotherapy targeted drugs.
Regarding gemcitabine and cisplatin (first line of treatment) has a port been discussed?Hugs,
MarionIn reply to: New Clinical Trial in Switzerland?
Dear Marion.
You are so nice, thank you. I have posted it in the link.
I have been told about three other trials, guess you know about them.
– MC1345: Pilot Study of Ponatinib in Biliary Cancer Patients with FGFR2 Fusions
– S4-13-001 A Phase I/II Study of CX-4945 in Combination with Gemcitabine plus Cisplatin in the Frontline Treatment of Patients with Cholangiocarcinoma
– MC1542 – A Phase Ib, Open-Label, Dose-Escalation trial of ACY-1215 in combination with Gemcitabine and Cisplatin in patients with Unresectable or Metastatic Cholangiocarcinoma
(This trial is not open yet, but will be opening soon)Mayo Clinic Phone: 507-284-3279 | Fax: 507-538-1070
http://www.mayoclinic.orgTake care,
hug,
AnneBeatriz…..sorry for the late reply.
1. advantages of getting into a clinical trial…..first line of treatment consists of Gemcitabine and a Platin drug, most likely Cisplatin. Some patients respond favorably, some do not. Those that benefit will stay on the drug combo until tumor progression. The question then becomes: what is the next systemic line of treatment? We don’t have a second line of treatment proven successful in large controlled studies and for a cancer such as this, a clinical trial may very well be beneficial.
There are risk and benefits to consider:Possible Benefits
You will have access to a new treatment that is not available to people outside the trial.
The research team will watch you closely.
If the treatment being studied is more effective than the standard treatment, you may be among the first to benefit.
The trial may help scientists learn more about cancer and help people in the future.Possible Risk
The new treatment may not be better than, or even as good as, the standard treatment.
New treatments may have side effects that doctors do not expect or that are worse than those of the standard treatment.
You may be required to make more visits to the doctor than if you were receiving standard treatment. You may have extra expenses related to these extra visits, such as travel and childcare costs.
You may need extra tests. Some of the tests could be uncomfortable or time consuming.
Even if a new treatment has benefits in some patients, it may not work for you.
Health insurance may not cover all patient care costs in a trial.2. is molecular testing required for treatment with chemo/radiation. The answer is “no, it is not required.” Once diagnosed, physicians can administer chemo (cytotoxic treatments) or radiation based on what he/she believes is most beneficial to patient. Traditional cytotoxic chemotherapies usually kill rapidly dividing cells in the body by interfering with cell division.
However; this is different for targeted agents (drugs) which identify faults in the DNA that drive cancer growth. Targeted cancer therapies are drugs designed to interfere with specific molecules necessary for tumor growth and progression, they don’t kill dividing cancer cells. This requires molecular testing results.
Larger cancer institutes automatically conduct molecular testing however; they do not conduct testing for the entire genome as provided by larger labs such as Foundation One, Caris, Perthera, etc.
DNA testing can be requested by the treating physician. Depending on the lab, patients may have to cover additional cost not covered by insurance.
Hugs,
MarionPhase I study of DKN-01, an anti-DKK1 antibody, in combination with gemcitabine (G) and cisplatin (C) in patients (pts) with advanced biliary cancer.
Topic: Elevated ca 19.9
Hello everybody..I am a new member here. ..my mother was diagnosed with distal common bile duct cholangiocarcinoma in December last year…she underwent Whipple’s procedure for the same …the post surgical biopsy report showed that her malignancy was T4 N1…5 nodes were positive..so she was kept on 6 cycles of gemcitabine and cisplatin..which she finished last month…
She underwent pet scan and blood investigations after her chemotherapy got over…her PET scan came out to be normal but ca 19.9 was very high…it was 300…post operatively it was 75…and it was 283 at the time of diagnosis…I am extremely worried at this rise of the marker…can anybody please tell me if it has happened with them? What does it suggest…In reply to: Hi From Australia
Hi Everyone,
Well after just replying to 2 posts I thought it time to inform you of Greg’s progress (or lack there of)
In my original post I said that Greg had started chemo. Because he has his kidney problem, his Oncologist only put him on the drug Gemcitabine. It is usually used in combination with Cisplatin but Greg’s kidneys could not handle the 2nd drug. He has had 1 cycle of Gemcitabine, ending in 2 infections in the blood and hospitalisation. He recovered from that and started Day 1 Round 2 of chemo last Tues (5 days ago). Again he had to be hospitalised with a fever last night.
His Oncologist told us before Tue if this drug was too hard in him, he may try a new one called Taxol. I googled it and its other names are Paclitaxel or Onxal. Does anyone know much about this drug? The Doc told us it is not quite as effective as Gemcitabine and will cause hair loss (Not that that is a major concern).
So once again that brick wall has stuck itself right in front of us with his 1st chemo experience.
I am wondering if we are doing the right thing. I never thought I would say that.You want to prolong Greg’s life but at what cost? Being constantly sick and tired and having no desire to do anything much at all. He is not the boy I know! From what I have read chemo can prolong life but only by a few months. Once again I suppose it depends on the individual and the type of drug. Does anyone have any insights into how much time chemo can prolong your life?
Anyway, we will soldier on yet again and see what the Doc has to say. Maybe this new drug may help. Will visit Greg in hospital this morn.
Thanks for being there everyone
LynnIn reply to: Newly diagnosed
Jill…..the physicians’s at King’s Hospitals very familiar with this cancer and follow the recommendations for first line of treatment, which consists of Gemcitabine/Cisplatin. It is likely for your husband to respond very well while experiencing few side effects. Following this treatment, other options may become available as well. I believe we feel best with concrete numbers such as the ones given to you however; patient health status and biological response are individual in nature and what works well for one may be much better or worse for someone else. Ultimately though, patients must make decisions none of us well are prepared to make. You too will find your way through this.
Hugs,
MarionMy name is Annie, and I am a cholangiocarcinoma patient (inoperable, multi-focal, intrahepatic). I am American, although I have been living in Dublin Ireland for 9 years. We will be moving back to the US in July. I am currently a candidate for an NCI immunotherapy trial in Wash DC starting in June, pending its approval.
I am 51, married, and have a 7 year old son. I was diagnosed (first as hepatocellular carcinoma) in November of 2013. It was later diagnosed as cholangiocarcinoma, but likely is mixed. I have undergone surgery (to find it was inoperable), TACE, Sorafenib, Gemcitabine/Cisplatin (partial response), Gemcitabine alone (9 months maintenance), and most recently Folfox (no response, 10% growth in 2 tumours). I have been off chemo since February to give my body a break and my scan this week showed continued growth of my tumors, but thankfully still confined to the liver.
The plan is to have a few doses of chemo prior to the immunotherapy trial to hopefully manage the cancer until the trial. I will start back on chemo next week (gem/cis).
Despite my advanced disease, I am virtually asymptomatic, only fatigue and mild discomfort. I am otherwise fit and healthy.
I wish I had made it to the conference!! Maybe next year!! This site has been an amazing source of information and support for me. Thank you so much!!
In reply to: Occipital headaches
azmkwells……Hello from me as well. I assume that you are receiving gemcitabine and cisplatin, first line treatment for this cancer. Obtaining a second opinion has become standard of care, something already your are contemplating. I also wanted to mention that USC, Los Angeles, has a robust biiary department and treats a high volume of Cholangiocarcinoma patients.
On another note: nearly 30% of intrahepatic cholangiocarcinoma patients harbor the ID-L1 tumor gene, which may respond to immunotherapy treatments. You would want to investigate this further.
http://www.cancer.gov/research/areas/treatment/immunotherapy-using-immune-systemHugs,
Marion
