Adjuvant chemo- or radiotherapy?

Hi,Kate,

“I wonder if it makes a difference that with Richard’s wife we are talking about adjuvant therapy with negative margins. “

Yes, according to ESMO(European society of Medical Oncology) guidelines. they suggested either supportive care or palliative chemotherapy and/or radiotherapy after a noncurative resection of CCA (intra and extra)and consideration of postoperatvie chemoradioptherapy as an option after complete surgical resection. But the NCCN guidelines(National Comprehensive Cancer Network) in the States indicated for extraCCA patients with resected,margin-negative ,observation or fluoropyrimidine-based chemoradiotherapy are acceptable options. for intraCCA patients,have no residual local disease,no adjuvant therapy recommendation are made.

“Is there some evidence you have seen that Gem also works better in adjuvant therapy? The reasons for the Bilcap trial using Xeloda seem to be based on it’s positive results with colon/pancreatic cancers.
I’m wondering what a study of Cap v Gem would yield. ” please go to http://www.mdpi.com/journal/cancers and put in title as Targeted therapy for biliary tract cancer.author=junji Furuse and review the article. It will provide you,on table 1 phase II studies of the most used chemo agents up to date for CCA;except 2 studies, most are very current(after 2004 to 2010) especially table 2.(all are in 2010).

“Also interested in why you think Gem and Cap together might be more effective? “
It is because gemzar and 5FU(or capecitabline) are the 1st-line treatment chemo agents,by EACH itself ,proven to be effective in treating CCA. for Gemzar itself alone is arounf 7-27% and 5FU by itself is around 0-34%.And there were studies indicated when they combined together the objective response rate is 31% with an additional 42% had STABLE disease.(you can read more into it from the above studies from table1 and 2 in that article.)

“Did you find something which shows radiation successful after a resection with good margins? I seem to find studies which say radiation is usually used with positive margins?”
Please see the above NCNN and ESMO recommendations that I have just included in this message. And no.I did not find anything showing radiation is necessary after resection with good margin.But as I talked to Dr, Levy from Mayo during the ASCO 2011 where he presented”Soup and Nuts about CCA” he said one thing about EUS for extrahepatic CCA was that ,”there are always residual CCA cells may involve in recurrence.” in short ,it is difficult even with great care when taking biopsy from tumors .By the same token, it is very difficult,even with good surgeon,to resect with clean margin and expected the CCA will never return for the same reason. I had >1cm in clean margin the 1st resection and still recur after 18 months. (that might mean microscopically the residual CCA cells (not the tumor) may be too small to be pick up by intraoperative ultrasound,but macroscopically ,thru the surgeons naked eyes it is clean even is 1 cm away from the tumor site.)

What I am trying to say is that ,be vigilant,be watchful for your dad’s CCA, even the doctor said is all clean;monitor his CCA every 3-6 months;and deal with the outcome as soon as possible with the best treatment options at that time frame.

Kate, not that many people like to know the details about cancer,but knowledge helps in understanding the tumor biology and hopefully one day the CURE can be find earlier enough for all of the CCA patients and give the caregivers like you the ultimate joyful reward of knowing that your participation is meaningful and rewarding not only to your love ones but as well as to the society- discover the cure or pathways for better and more effective treatment plans with minimun or no toxicity.
God bless.

Hi,Gavin and Marion,
you are always welcome.

Gavin, with last nite’s win ,the Bear may actually have a chance for playoff.
If they will beat the Lions this Sunday ,then I may ask your mum to borrow 20 pounds from her and bet on the Bears to win the NFC at least;.Again the 49ers looks so good this year under Jim Habrough -a former Bear QB from the Golden era. Make sure you say hi to your mum for me.

And to Marion, sometimes I feel bad that I cannot comfort those patients and caregivers like you and Lainy or Gavin did. I know as patients,some of them just don’t want to know.
and therefore sometimes I choose not to answer ALL the messages I saw on the board but selectively in fear of upsetting them more.It is a difficult choice;plus I am not good at that anyway emotionally.
God bless.

Here’s a link to the Journal that you mention Percy –

http://www.nature.com/nrgastro/journal/v8/n4/full/nrgastro.2011.20.html

Thank you Percy for everything.

Gavin

Percy……did you see some studies on the extrahepatic vs. intrahepatic and response to above mentioned?

Hi,Richard,
If your wife’s histology reported indicated positive margin;do what the 2nd opinion recommended;that is Gem/cis and radiation. If your wife’s CCA is extrahepatic CCA,Gem/Cap , radiation with or without FUDR or Capecitabine may be a better choice since 5FU or capecitabine for some unknown reason works better for extrahepatic CCA than intrahepatic CCA unless your wife have done some chemo sensitivity test for choosing the proper agents.and it is much easier to take the Capecitabine than the cisplatin.(less toxic to the kidney and hair loss.)
I love to see a copy of the BILCAP procotol if you can e mail me one.
God bless.

Thanks Richard, it’s been nearly two years since I did my research but I think I had read most of those-I can still see why our oncologist said’what would we radiate?’. Margin status seems to play a more significant role in RT .

I had not found a Bilcap protocol of 75 pages though-would be very interestedto read that.
What chemo/radiation has your wife been offered?
Kate