chemo question
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Hey all so I decided message my DR. in regards to the 8 cycles bc I didn’t want to wait another 3 weeks to ask her in person.
Her response (which I am happy with, please let me know your thoughts) is that “a lot” of patients have maximum response with 6 months of chemo, though she said this is not a hard and fast rule. She said if we do see shrinkage with the next scan on Dec 9th, we can still def. consider chemo but she is thinking if we were going to try some localization therapy and she specifically mentioned Y90 that, that might be a good time to try that. And she also informed me that as long as cancer is not growing on any chemo cocktail we can go back to chemo. I feel better that I got these questions out of the way. Blessings to all..
PorterThanks Carl for your input. These are all great as they are all questions/suggestions I can go back and bring up with my doc. Makes sense about the cisplantin too. In fact i think my CRE was within normal high yesterday and I know that is a kidney function test and usually that number is much lower. I am trying to remind myself to feel fortunate that I am well and still not sick and have options to even treatment at this point. Though I still ask myself “why me” and get frustrated that having this cancer is part of me and my life. Thanks again all for the input.
PorterYa know, Sam, sometimes one just needs to let it out and it does of world of good. Other times a change of pace, something different helps. While my problem is not Cancer I had that 4 years ago, I am NOT going to have an Illiostomy at 73 1/2, and while I have 15 side effects on a daily basis as the Remicade is nasty stuff I do have my moments, lots of them. I have come now to let myself feel bad for me now and then and it’s OK. Is there nothing the ONC can do to help the neuropathy? Have you ever had a 2nd opinion? You know we are big believers in that. I just pray that everyone hangs in and hangs on until that next new treatment comes around the corner.
My wife has been on the two weeks on, one week off regiment since February 20th, 2013. The side effects are what makes her want to stop. Neuropathy is so painful/”buggy.” The doctor states that she is not so bad yet as she can still button up her buttons. The tumor is still shrinking but she is not a resection candidate because of the location by the portal vein. She is a tough bird, but at some point, you just want to stop. As long as it is shrinking, and you can handle the Gem/cisplatin, why not keep going? Hopefully you can get to resection to extend time. Keep on keepin’ on!
Sam
Carl, thank you for more clarification. I am so happy that using just the Gem is working so well for your wife. Especially for comfort. Have a delicious Thanksgiving.
We went through 8 rounds of gem/Cis. We saw good results. Even with the good outcome, our oncologist suggested taking a break from the combination and move to just gemcitabine as a maintenance plan. Her primary reasons, which were confirmed by our second opinion doctors both at Sloan and fox chase, were 1) the long term effects that cisplatin can have on the body, especially the kidneys. And 2) to give the body some time to recover from the effects of the combined drugs. We just finished the first round (3 infusions) of gem only. So far it is much easier on the body.
Carl
pfox….multidisciplinary approaches to this disease have come to the forefront for our patients. We know that chemotherapy will not cure this disease but, it can lead other interventions hence, I like to compare Cholangiocarcinoma to that of a chronic disease.
Good luck,
Hugs,
MarionThanks all for the responses. Lainy, at first that is exactly what I was thinking, if it’s working why stop
Jason thank you so much for sharing and everything you said makes perfect sense. Like I said my next scan is December 9th and we will probably figure from there what the next step will be after my 8th cycle of chemo. As always blessings and strength to you all.
PorterI think Jason summed it up well.
Remember, chemo, in most cases, will eventually become ineffective.
Also remember, chemo will continue to work on the tumors for a while after discontinuing treatment.
If the tumor is responding, there may well be other therapies that will work better now, while saving the gem/cis in case it is needed.
Congratulations on shrinkage! And soon you get to find out what the next step will be.Porter, Jason did a FAB job now I understand. I told you I wasn’t a genius, now I know. Thanks Jason.
pfox…..then you might be eligible for another type of treatment. I think that Jason did a great job of explaining that other treatment options may become available to you. It is so very individual based on the presentation of the disease.
Hugs
MarionPorter, now I am NOT a genius when it comes to chemo but I was under the impression they use it until it stops working. Why fix it if its not broken?
My wife is doing 12 cycles of gem/cis.
The tumors have shrunk and the remaining lesions look inactive on a PT/scan. The plan after 12 cycles is to do IMRT radiation on the main tumor region and switch to xeloda chemo.
I think different institutions have different theories about what to do next after success with Gem/Cis. Some would say keep on a chemo that is working (we had an oncologist with this philosophy). The advantages I see for switching up the strategy are:
1 – The radiation can hopefully kill cancer cells that are developing some chemo immunity before they become fully immune.
2 – My wife gets a break from gem/cis (improves blood counts and hopefully quality of life since Xeloda is milder for many people).
3 – We have a chemo that is known to be effective in our “back pocket” if things go sideways in the future. (i.e restart gem/cis)
4 – Some evidence that survival times independently associated with number of different chemo regiments employed (although this is speculative imo).
I am comfortable with our strategy, but by no means do I think it is necessarily best. After success with gem/cis, I think there is very little in the science that is definitive. We all just have to work with our docs and make a call on what approach we feel most comfortable with.
Jason
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