Search Results for 'gemcitabine cisplatin'

Hi Michelelynn0305,

Welcome to our community.  I am sorry to hear about your mother’s diagnosis and that she is feeling poorly.

We are patients and caregivers here, so we are not in a position to offer medical advice.  Here is some general information, and there are additional patient and caregiver resources on the Cholangiocarcinoma Foundation website you may find helpful.

Gemcitabine (Gemzar) alone is a chemotherapy sometimes offered to patients who are very elderly or in poor health, as it has fewer side effects and is easier to tolerate than other chemo options.  Gemcitabine alone has effectiveness in treating cholangiocarcinoma, but it is somewhat less effective than the more common chemo regimen that adds cisplatin to the gemcitabine.

It can be difficult sometimes to know if adverse symptoms are side effects of treatment or due to the cancer itself.  These are questions best handled by doctors.  Cancer treatments usually include medications that address side effects and cancer symptoms, such as anti-nausea drugs or pain medications.  Sometimes the initial drug the doctor prescribes does not work very well, in which case patients should ask for a different option.  No patient should attempt to soldier through pain or nausea when there are many medication options that can help – it is just a matter of working with doctors in finding the best ones for each patient.  If the medical facility where your mother is being treated offers palliative care resources (which address discomforts and side effects of illness and medical treatment), they might be able to help her feel more comfortable.

Concerns with diminishing appetite are often reported by caregivers.  The initial guidance for patients not feeling hungry includes steps such as trying frequent small meals, avoiding hard-to-digest foods, choosing nutritious foods that are high protein/high calorie, offering foods the patient enjoys (rather than going overboard on unfamiliar or unappetizing foods believed to be more healthy) and using liquid nutrition products like protein shakes.  If these types of remedies are not working, this should be reported to your mother’s medical providers as there may be a medication solution such as a better anti-nausea drug, or it may be important information relative to the progression of your mother’s cancer that might inspire a change in treatment.  There are medications available that can stimulate appetite.  We have not seem them much used with our cancer patients, but certainly this is something you can ask about.

The question of how to know if a patient is reaching end-of-life is a highly sensitive topic.  Some of the major cancer organizations have posted good information on this question.  If you internet-search “end of life signs” and “liver cancer” (or something similar) you will find information in reputable sites such as the American Cancer Society and the National Cancer Institute, that may help you assess how your mother is faring.  If there are changes to your mother’s health that are concerning to you, the oncology staff where she is being treated should be able to offer advice on what to do.

Please stay connected to our community as you navigate your mother’s care.  We are here for you, and there is a great deal of experience documented on the boards.  I hope your mother feels better and that her doctors are responsive to your concerns.

Regards, Mary

Hi Jj950,

The gemcitabine with cisplatin chemotherapy combination is considered standard of care as a first line treatment for cholangiocarcinoma when surgery is not possible (“nonresectable”).   First line means it will be the first chemo tried.  The results of a past clinical trial (“ABC-01”) undertaken in the U.K.  showed that the two chemos taken together are more effective than gemcitabine alone, and the results of this trial contributed to establishing this chemo regimen as a go-to approach for nonresectable cholangiocarcinoma.

Standard of care does not mean that everyone gets the same cookie-cutter treatment.  Oncologists look at the specifics of each patient and determine an appropriate treatment regimen, which may or may not be gem-cis.  Factors that may be considered include the patient’s health status, the location and aggressiveness of the cancer, and the oncologist’s own clinical judgment of what treatment is most appropriate and likely to be effective.

Chemos tend to lose effectiveness over time–sometimes because the cancer mutates and becomes resistant.  When this happens, a second-line chemo treatment may be selected.  Folfirinox, which I will describe further below, is an example of a chemo regimen that may be used as a second-line treatment for cholangiocarcinoma.   There is not yet a second-line chemo considered standard of care for cholangiocarcinoma, to my knowledge, so there are several different ones reported by patients and caregivers on this board.  Some have similar names – folfirinox is different from folfox which is different from folfiri.  The selection criteria for a second-line treatment would be the same as mentioned in the paragraph above.

Folfirinox is a combo of four drugs: folinic acid, fluorouracil (or 5FU), irinotecan and oxaliplatin.  The first drug is a vitamin which protects against some possible adverse side effects of the chemo, and the last three are the chemos.  Because this regimen involves three chemo drugs, it is described by some (not all) patients as a tougher one to tolerate; however, it has shown effectiveness in slowing down the cancer.  If you search folfirinox using the discussion board search engine, you will find stories on patients who had this treatment.

Patients tend to hone in on their CA 19-9 results as strong signals of how they are doing.  My CA 19-9 gets measured every two months and waiting for the results always causes anxiety and worry.  That said – interpreting CA 19-9 movements during treatment is best left to doctors.  CA 19-9 does not always track disease progression and the treatments themselves for some patients will induce temporary increases in this tumor marker.  This number is just one bit of information that is factored into the overall picture, which also includes imaging, patient symptoms, and other blood tests such as liver enzymes.  I am repeating what my doctors have said about not paying so much attention to CA 19-9, and it is a reminder to me to try and listen to that good advice myself.

I hope the folfirinox is effective in bringing your family member’s cancer under control without too many side effects.

Regards, Mary

Hi Jules,

There are lots of discussions on this board about gem-cis and its side effects. Worth running some searches to see what experiences other have had.

My mom is about to start her 10th (and hopefully final!) gem-cis cycle, 6 pre-operatively and 4 post-operatively. What we’ve learned along this long road is that each week things are different, but that there are some general trends. By and large, the day of the infusion goes pretty well, as does the day that follows. They pump her up with anti-nausea medications and with dexamethasone. We were told that day 3 was the really hard one, but for her, days 1-4 have typically gone pretty well (if kinda ‘zippy’ from all the dex), whereas days 4-6 were some shade of crappy, and then just as she started feeling good again it was time to head back in for another infusion. This pattern has been changing of late though as the side effects accumulate.

Because the gem-cis tends to sneak up on you mid-week, it’s really important to keep up with the supportive meds for when he reaches the low point in his weekly cycle. If your husband is having a lot of trouble with particular side effects, make sure that his doctors know about them. They have every kind of medicine in their arsenal (and can also mess with dosing, etc) to help mitigate. My mom has now had this chemo administered by two different hospitals, and we’ve discovered that there is a lot of variation in terms of what kinds of supportive anti-nausea meds/etc. are offered, how they dose the dex, etc. From experience: don’t skimp on the anti-nausea meds. Better to take them as a prophylactic than to struggle to get the nausea under control once it’s pounced. We’ve found that a lot of my mom’s other side effects (trouble sleeping, acid reflux, etc) are related the dex that she needs to take, and have experimented (never entirely successfully) with different strategies for tapering her dosage down through the week.

It’s worth noting that your husband will be simultaneously experiencing several different overlapping cycles in terms of how the drugs affect him, and that each week will look different. In addition to the usual weekly up and down (as well as a longer up-down of each 3-week cycle)  both drugs also impact blood cell production according to a different schedule. Cisplatin has a long cycle with a neutrophil nadir at 18-23 days, and recovery by day 40. Gemcitabine has a shorter cycle, with nadir at 10-14 days and recovery by day 21. In practice, this means that the gem’s low point will usually be during the off week, when your husband will likely be feeling better, while the cisplatin’s low point will kinda slough over into the start of the next infusion cycle, and will sometimes overlap. These may feel invisible but they are cumulative in terms of their impact on his blood counts. Whether he feels them or not, these are the times when he will be most vulnerable to picking up an opportunistic infection. He should always be extra careful about being in public, handwashing, etc., even when he’s feeling pretty good, because even a common cold can be dangerous when your neutrophils are low. My mom took to wearing a hospital mask when in crowds, which was very effective in warding away unwanted contact.  In my mom’s first 6 cycles, she really struggled with low neutrophil counts, and several times had to have her infusions delayed as a result. These delays were really distressing in the moment, and I remember her expressing her anxiety that the delays meant that she wasn’t responding well to the chemo (which turned out not to be true at all!). At this second hospital where my mom is now getting her infusions, they’ve taken an aggressive approach to this by giving her regular doses of neupogen, which helps boost her blood cell production. It has its own range of side effects, though. Sigh.

I hope some of this is useful, and I really hope that your husband’s cancer will have a strong response to the gem-cis!

Hannah

• This reply was modified 5 years, 5 months ago by Hannaha.

Thanks to Gavin for posting the recent spate of articles related to cholangiocarcinoma.

If you are like me, and find some of the medical-speak tough reading, I would still suggest taking a glance at this material.  Some of the drugs are in testing through clinical trials, which may be something patients are thinking about or will think about in the future.

This report out on adding abraxane to the standard-of-care chemo (gemcitabine and cisplatin) is worth highlighting.  While the number of cholangiocarcinoma patients involved in the study is not large, the results are sufficiently promising to take note.  I showed these results to my oncologist because they had just come out at the time of my last appointment.  One comment he made was this chemo combination involves medications that are available now for cancer patients, as compared to other reports in the medical literature that discuss treatment options only accessible by enrolling in a trial.

Regards, Mary