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Chemotherapy resistance – what to do next?

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    Thank you very much for your help!!

    Fortunately, the Ca 19.9 dropped again so he will continue with GEMOX.

    Here in Portugal the doctors advised 4 weeks without chemotherapy before doing the Y-90 radioembolization but the idea of staying 4 weeks without any treatment doesn’t seem a good option for now for his oncologist.

    The Foundation One showed NRAS and MUTYH mutations. I didn’t see yet the report so I don’t know if there any available treatments for him.

    Thank you again for your support!!


    Hi Malepi,

    I will try to respond to the y90 question ( but I am not a doctor).  Mom had the one tumor when DX in Oct 2013( I think 3 x 4 cm).   They couldn’t remove, so we did 3 cycles GEM/CIS and then y-90.  Although Y-90 shrunk it significantly and there was a lot of dead tissue, we opted 9 months later (stable disease) to do the Y90 again but this time took xeloda 2 weeks before and after to make it more effective.  We were actually hopeful that Mom had beat this thing even without surgery; we went 3 years with No Evidence of Disease (NED).  It is unfortunately back again, but this time none of the doctors are saying things like “12 months”.  Instead they say we are in uncharted territory and we will be staring proton radiation treatments in Feb.

    Best wishes,




    Hi Malepi,

    Your news that your father has had a good response to the GEMOX was wonderful to hear.  Fingers crossed that the delay in his latest treatment is just a small bump in the road.

    What we see with this cancer is that treatments can sometimes lose effectiveness over time, so it is always smart to be thinking ahead to the next treatment, as you are doing.

    Your questions are best addressed to medical professionals, but here are some thoughts.  Regarding when it is time to repeat a biopsy/genomic testing out of concern the cancer may have further mutated, I have seen this topic discussed but without any specific guidance.  Some of our patients have had this test repeated in conjunction with participation in clinical trials.  In addition to the views of your father’s doctors, you might consider directing your question back to Foundation One.  The company website has email and phone contact information for clients – it may be that their experts have some guidance on this point.

    Regarding Y90, my impression is that the appropriateness of this treatment would be determined by the details of an individual patient’s status.  I did look at the eligibility criteria for a few of the clinical trials involving Y90, and they did not seem to explicitly exclude patients who had progressed under a chemotherapy.  This is also a question best directed to a medical professional.  A bunch of our folks have been treated with Y90 – if you search this term on our search engine, you will find stories about this treatment from other patients and their caregivers.

    I hope your father’s next round of blood tests brings good news.

    Take care, regards, Mary


    Dear all,

    My father was diagnosed metastatic intrahepatic CC July 2017 with a single metastasis on his back. He started GEMOX at the end of August and things got better. The Ca19.9 which started at 3100 dropped to 136 after 4 months, the pain stopped and the CT scan showed stable disease. He had to delay chemo for one week because of a cold and after that the Ca 19.9 rise to 245. He did another treatment (GEMOX) this week since his Oncologist wants to see if the change of the marker was only a result of the delay of the treatment – we will see next time he will take blood sample.

    We will receive the results of the FoundationOne next week which can help us in a treatment decision in case of confirmation of resistance of chemotherapy but I have one question. If it is a resistance of chemotherapy then the results from the genetic test are related to the first biopsy and don’t include the posible new mutations. Should we trust in the results or should we get another biopsy?

    Another question is related to radioembolization with Y-90. It should be done in the context of stable disease or it is an option after resistance to 1st line chemotherapy?

    Thank you very much for your help!!

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