ascites
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Fatima….cetuximab is not used frequently and certainly has not been used much for our members within the last few years. I would also question KRAS and the available chemotherapies for Cholangiocarcinoma.
If I were you I would try my best to reach a specialist in the field of Cholangiocarcinoma for direction in the treatment for your Mom.
All my best wishes,
MarionHi,Fatema,
I found the the article link,here it is.http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=102&abstractID=82334
This is the link,I hope it works.
I think as you said,just wait til the next SCAN to see what the next course of action will be.
BTW, please give your opinion on the article after you read it. I think on the earlier study he mentioned only about 10-15% of the patients are KRAS mutated and it is a surprise to him and that is why this current study he tried to separate the marker driven treatment into two groups.
also did you consider radioembo or chemoembo (even your mom has metastasis ,in the States if pt. has metastasis,they may not qualify for the treatment)for the next step if your mom qualify ? i had chemoembo and I did not have any side effects and went home the next day. It may take a few sessions but it will give your mom a better quality of life. I personally donot like chemotherapy.
God bless.
God bless.Hi Percy,
Thanks for your information, unfortunately i couldn’t find the article by dr.Jensen so if you please could you give me the link not the title.In the trial by Dr.Gruenberger they concluded that “Neither PFS nor OS were affected by K-ras status” and when i asked my doctor he answered that gene mutation doesn’t show significance in CC (not as in cancer colon or lung cancer) so he told me that we will gain nothing if we tested gene mutation.
Regarding Panitumumab i think i’ll postpone inquiring about it till my mother’s follow up CT (i mean if i found that cetuximab is not working) but i think its complications are major (as edmund said severe infected rash) which as i understand wasn’t easy.
When i told you about radiaion therapy and cetuximab i asked her doctor and he answered me that cardiopulmonary complications occured in patients with head & neck SCC and the cause is that they received radiation nearby the heart so complications occured but my mother received radiation over her lower back due to bone met. as i said before.
My mother’s cetuximab dose isn’t reduced some clinical trials gave 400mg/m2 (loading dose) followed by 250mg/m2 weekly (which is the same but weekly)
Hi, Fatema,
I got the permission from Edmund and below is what his thought about the GEMOX+panitumumab he is currently on.
“Hi,Edmund,
I was requested by Dr.Fatema from Egypt from the web site for your thought on the GEMOX+panitumumab.
the following is the part I will disclose on the web if you permit me to do so.As I said before I am still on the trial, which began on July 13, 2011.
Prior to the trial there were blood tests to measure liver function and baseline other standard markers. I also had an eKg to test for heart conditionThe treatment has not been easy, mainly due to the panitumimab. But also because the three drug combo seems to spread the side effects over a longer period.
Side effects
1) the normal fatigue , constipation for the first 4 days (managed pretty well with drugs). Appetite is a little lower than norma for the first week…and then I need to eat like a crazy person in the second week to maintain weight.2) skin rash from panitumimab …was most intense side effect more so for first 8-9 treatments
After first treatment intense facial rash, felt like a sunburn from the inside
After second treatment face still hurt plus scalp broke out with open pustules
Lots of pain and blood trying to sleep at night lasted about 3-4 days
After treatment four same scalp issue with in infection
After treatment eight Intense breakout on legs and arms…it hurt to move
Since the eighth treatment rash has decreased in intensity but still have facial rash, scabing, misc rash arms legs and scalp
There is a lot of maintenance for the skin. Showers hurts a bit, need to stay out of the sun, lots of moisturizing and ointment.3) Typical oxaliplatin side effect cold sensitivity and after 13 treatments starting to get first signs of neuropathy
So a decent amount of side effects but the reason we kept going was we were responding
I have had an original scan and 3 subsequent post treatment scans. The original showed a large tumor in the left lobe (8.4cm by 7.9 cm) one measureable tumor on the right lobe (1.8 cm) and 20-30 Small hypo densities z in the right lobe. Will type in the impressions from the three scans but the summary is that we saw a 30%, 35 % and 10% reduction on the large tumor (61% total) and the 1.8 cm tumor can longer be seen.”Also,I have just found this from my notes at ASCO2011 convention.
this is the e mail address for Dr.Jensen.you can talk to him directly for additional insight. He may not remember me since there were so many people there at the convention.“BTW,You may have read this too. it is by L.H.Jensen” Marker driven systemic tx of inoperable CCA: Panitumumab and combination chemotherapy in KRAS wild type tumors.”it is on the ASCO web site under ACSO 2011 poster abstract No. 4010. “
who did the study about Panitumumab.Lars.Henrik.Jensen@ slb.regionsyddanmark.dk
God bless.Hi,Fatema,
If I remembered correctly,you mentioned reduced dose of cetuximab may be used for your mom by her oncology because your mom also has radiation treatment. If so, then the acneiforn rash may not be as severely as it should be.(the dose in the Gruenberger trial is 500mg/m2 for cetuximab on day 1 and repeated every 2 weeks for 12 cycles.) 13% of the patient (pt.pop=30 pt) had Grade 3 skin rash and overall,in clinical studies of cetuximab, acneiform rash was reported in 76-88% of 1373 patients. Therefore you may be correct in the assumption of the “mild” rash may not produce the desire response it should be for your mom.
“There is a trend toward improved survival with increasing grade of rash,with grade 3 rash appearing to have a longer survival as compared to patients with less severe skin rash”–direct quote from clinical pharmacology on drug info. for cetuximab.
From the same resource,,when discuss about colonCA patient on cetuximab in combination with other chemotherapy,”No benefit was observed over chemotherapy alone in patients whose tumor expressed mutant K-RAS.— In contrast to K-Ras wide type patients showed significant improvement in efficacy endpoints over chemotherapy alone.”
You may have to look into whether your mom is KRAS mutant or not.
As you know GEMOX+C or P are clinical trials use for other tumors.
The one study below is for Squamous cell carcinoma and is not using GEMox;they use cis/5FU+cetuximab ,but the strength of recommendation is strong and level of evidence rating are high and date of review is very recent 11/09/2011 take a look ;1.Vermorken J,Mesia R etal. Platium-based chemothrapy plus cetuximab in head and neck cancer. N Engl J Med 2008;359:1116-27.
I had studied the article”Targeted Therapy for Biliary tract Cancer” by Junji Furse and Takauji Okusaka,that you have mentioned about 3 months ago;. I did not looked at the Franch study but I did looked at the Austria trial done by Gruenberger because it was cited most often in the States.In my opinion, except the Gem/Cap+ Avastin that personally I have observed from my sister -in -law. with amazing results except the perfolation of the colon( I think patients who has diverticulitis are prone to this side effect if they take Avastin or other similiar targeted agents.);
Targeted therapy is still a long way to go . A well-known GI specialist who have done a lot of work on CCA at one of the most famous clinic specialized in CCA told me about Sorafenib may be of value to CCA patients;but I take a look at the old studies; sorafenib is not that special,but indeed as he said to me about 3 weeks ago, it is a targeted agent that target a lot of different signaling pathways in cancer cells. May be something is new on the horizon for that drug .
BTW,You may have read this too. it is by L.H.Jensen” Marker driven systemic tx of inoperable CCA: Panitumumab and combination chemotherapy in KRAS wild type tumors.”it is on the ASCO web site under ACSO 2011 poster abstract No. 4010.
I talk to the author Jensen during the 2011 ASCO convention, he said hopefully the results will be updated this year.
I still haven’t heard from the member’s response for the permission.I will keep you informed as soon as possible. But the side effects of his/her tx of the GEMOX+cetuximab is in line with the Austria trial .
The Austria trial did not tell us the “endpoint” (PFS or overall survival); however,he Poster #4020 will provide some insight on this front even it is not cetuximab.)
God bless.Hi Percy,
My mother’s acne is not that bad it causes her only on & off itching which is not severe so until now we are not going to use antibiotics but i’m inquiring if “mild” rash is a bad sign ???
i’m sure that you read that article about targeted therapy in cholangiocarcinoma but i’ll send the link to you in case you didn’t read it
Cancers 2011, 3, 2243-2254; doi:10.3390/cancers3022243
i wish to know your comment on it from the table showing ongoing trials and results of previous two trials (in austria & france) i think cetuximab may be of help, i don’t know if the results of the two ongoing trials will be published soon but i hope, something more i preferred cetuximab as it showed the least side effects, as you said pneumonitis and lung fibrosis are not easy also avastin may cause GIT perforation so when i consulted her physician he said that erbitux has few side effects (mainly acne).Hi, Fatema,
Thanks for your compliment, below are part of the info. about pantiumumab,avastin and cetuximab.that i discuss with him;
however,I will need his permision to copy his response and show it to you due to privacy issues.Did they give you antibiotics like minocycline or doxycline for your acneiform rash which occur in upto 90% of the patients who took panitumumab as compare to 76-88% of the patient who took cetuximab and 84% of Avastin users developed exfoliative dermatitis..
And how bad is your dermatitis problems NOW?
the other side effects of panitumumab being mentioned quite often is pneumonitis ,pulmonary fibrosis and cough.
so if you develop any respiratory related symptoms; call MD or go to ER rightaway to check it out.
for GEMOX+ Avastin —the median progression free survival (PFS) is about 7.6 month;and overall survival is 14.2months. So I expect more or less the same observation results for GEMOX+panitumumab and GEMOX+cetuximab..BTW,Fatema,If you like, you can email me like others at anytime so I can learn from you too.
God bless.Hi Percy,
thanks for your nice words i wish to help anybody when it is possible, i know how everybody could feel when somebody he cares for is affected by that disease, although i’m a doctor but really i have panic attacks since my mother was diagnosed and really i feel that i need any support frequently, i believe that not only patients are suffering but also their caregivers specially when seeing them in pain
As regard my mom thanks GOD she is mildly better but she is still suffering from the back pain ( as her doctor said ther is partial response to radiotherapy), she started her third cycle today (GEMOX) cycle was supposed to be given last monday but unfortunately her neutrophil count continued dropping down and she received (Neupogen) after the injection she got viral infection and was feverish for 8 days.
She is also in Erbitux (cetuximab) for the forth week but rash is not as that much so i’m inquiring if that means no response ???
She is supposed to have CT scan next week after day 8 for evaluation.
I read a post where you were asking about Panitumuamb so if you please could you tell me if it showed a better effect than cetuximab??? i know that all these drugs are still under trials but we are searching for any hope in treatment.
Thank you so much for your concern and advices for everybody here.
(You can call me using “she”)Hi,mcf,
Ascites and swelling of the legs are common problem happen more in ECCA then ICCA patients.In addition, liver decompansation do occur in in chronic cirrhosis patients who have the disease for a long time and ascites is a problem as well as portal hypertension due to the back up of fluids in the lymphatic system.
It may be of value to ask to see a nephrologist for consult and manage the situation. As Dr. Fatema Alzalraa indicated above; I did see nephrologist use ablumin and add Bumex(a more potent diuretic) together to manage the fluid problems . So, the more you come here,the more you may know .Thanks to other people like Fatemn Alzalaa not only come here often for info. to help her mother but also contribute to this forum what she knows to help our patients as well ;for that ;thank you doc. and if I mix up about whether you are a she or he,i am sorry.
BTW,how’s your mother? can you share what treatment your mom has now and is the results are what you expected ?
God blessI remember reading an article about Ascites and it stated that it is caused by an inbalance of protein in the body. Not enough protein, so the body startes causing fluid buildup in an effort to regain that balance! When my husband Tom had it, they put him on a strong water pill, and encouraged him to eat as much protein as he could. Power Bars are great for that! He had the fluid drained 2 times.
The draining is a pretty quick procedure, ultrasound to find a large enough pocket, little puncture wound in the lower tummy, hook up to a vacumn bottle and it sucks the flud out.Each time we noticed his stomach was starting to bloat, he’s start on the water pills and much as he could he’d eat protein. Power Bars were the best as he was diabetic and the power bars we choose satisfied his never-ending craving for sweets. He would also drinkt Boost Plus, as it has a lot of protein! Good Luck!
Margaret
mcf….please keep us informed. Know that we are thinking of you and Sheila.
All my best wishes,
MarionThanks to everyone for the responses to my post. I cannot even begin to say how much help this website has been over the last few years. Our oncologist actually talks to Mayo every once in a while for direction treating CC. But perhaps it is time for a return trip. I am certainly open to anything that will help Sheila in this fight. Today she had an ammonia blood test to see if that was the cause for the mental confusion she has been having the last two weeks. Really slow and very confused, really scares me when she has to drive Hopefully, we can get a few answers about that. Again, thanks for all the help. Bob
Hi Bob,
Sorry to hear what Sheila is going through here with her ascites. My dad had ascites also with swelling in his legs and abdomen as a result of that. Here is a link on ascites and I hope that it will be of some use to you.
As Lainy says, maybe you could get Sheila seen by another onc or doctor if you feel that this one has run out of ideas. I hope that you can get some help with this.
Best wishes to you and Sheila,
Gavin
Bob….Sheila had her resection at the Mayo Clinica (according to your previous postings) and you might want to reach out to their physician. If her treating doctor is stumped by Sheila’s current condition then I wonder as to how much experience he has with this cancer. Either way I strongly believe that an expert needs to be consulted.
Please, keep us posted.
All my best wishes,
MarionDear Bob,
I’m a physician (cardiologist), according to my information ascites occurs when liver function is disturbed, liver function tests are serum albumin and prothrombin time from which INR is calculated, neither liver enzymes nor bilirubin reflect liver function so i think you should consult your treating physician about that and if she should receive human albumin or plasma transfusion?? Something more unfortunately in cases of malignancy ascites (actually any fluid collection in serous cavities of body) usually are rapidly accumulating but still it could be managed. wish her speed recovery.
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