Hey Percy, could you please give us your expertise?
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Percy, I know it’s beautiful when it is falling but I am so happy I am in Phoenix! It is 80o today although we are going down to 60o on Monday! Guess I will just have to suffer! LOL
Hi,Pamela,
First ,here are some guidelines or principles from a chapter of the textbook of “Oncologic Disorders” title “Cancer chemotherapy and Treatment.”“The underlying principles of using combination chemotherapy are to use
1. agents with different pharmacologic actions,
2. drugs with different organ toxicities,
3.agents that are active against the tumor and ideally synergistic when use together,
4.agents that do not result in significant drug interactions.”Even though the combination of 5 FU and Gemzar is not as strong as the Gemzar/Cis combo and at most may be in the same effectiveness as Gemzar alone as indicated by a couple studies.However, base on my research,the toxicities of the drugs in the platinum family like cisplatin will pop up around the 6 cycle time frame as the drug accumulated over the course of treatment;that include allergic reaction to the drug and other side effects like nephrotoxicity(decrease kidney function) and neuropathy( hand-and-foot symptoms) and low blood cells count(WBC,platelets and RBC). ;therefore as a whole, I think your oncologist’s decision is prudent if she decided to eliminate the cisplatin .She is thinking ahead of how to treat your daughter before side effects pop up. this is especially true if the CAT scan or MRI will show STABLE response or tumor shrinkage on March 8.. You can always add the cisplatin back if needed.
So base on what the principles of the text book and the toxicity of the platinum;and the sign of a prudent oncologist that knows what to do .
I will not recommend any change of the suggestion that provided by your oncologist.Also in doing so, you will reserve more options down the road if needed.
good luck in surgery.
God bless.Percy, just a note to say you are wonderful!!! We all really appreciate you and your research and all you are doing for this Board! We love you, yes we do!
This is a reprint message about ASCO’s point of view about biomarkers at 2011.
Below is the ASCO message about biomarkers usage.
What to Know: ASCO’s Guideline on Tests to Help Choose Chemotherapy
Introduction
To help doctors give their patients the best possible care, the American Society of Clinical Oncology (ASCO) developed evidence-based recommendations on the usefulness of laboratory tests (called assays) to find out if a cancer might be resistant or sensitive to a specific chemotherapy treatment before it is offered to a patient. In 2011, this guideline was reviewed due to new research; this research continued to support the 2004 recommendations. This guide for patients is based on ASCO’s most recent recommendations.
Key Messages
Chemotherapy sensitivity and resistance assays are laboratory tests that have been studied to help predict how well chemotherapy may work.
However, these tests should not be used to determine treatment options for an individual patient.
Instead, the choice of chemotherapy should be based on the research on the drugs being considered and the patient’s health and treatment preferences.
For additional info, go to cancer.net,home,publishing and resources,what to know ASCO guidelines
God bless.This is a reprint message: it may provide some help;
Hi,everyone,
This is the current philosophy and practice of using CHEMOTHERAPY in general for treating.CCA that I believe in which is the less,the better.. I think his assessment is reasonable too.The following is quoted from the link at the end of this message under the experts review section if you want to read it through the whole thing even though it is for colon metastasis.
“As we take stock of what is now available, we need to clarify how these agents will be used to maximize outcomes. This might include optimizing RRs with at least three agents when curative resection is the goal, or maintaining quality of life with sequential therapy if exposure to all agents is a reasonable expectation. Sequential monotherapy starting with capecitabine or 5-FU/LV with or without bevacizumab and then proceeding to either oxaliplatin- or irinotecan-based chemotherapy as second-line therapy may be considered in patients who are asymptomatic, in those with relatively slow-growing disease and/or in those with multiple sites of disease that are deemed to be unresectable. This is in line with National Comprehensive Cancer Network guidelines. Additionally, monotherapy may be more appropriate in elderly patients and in those with significant comorbidities. In contrast, initiation with combination therapy is more appropriate in patients who have excellent performance status and clinically aggressive disease, in those with significant symptoms and/or in those who may be considered for salvage via surgical resection.”
http://www.clinicaloncology.com/ViewArt … a_id=20050
God bless.
eli….most of what I see is dated back to 2009; only one is dated in 2003. I would like to see something on hepatobiliary cancer or, colon cancer, or pancreatic cancer, and I would like to see something more current.
I agree in that we really don’t know what will work best for each individual. Gem/Cis has become (I don’t believe that it has officially been declared yet) the standard treatment for CC. Endpoint: increased life expectancy. This study clearly demonstrated that those patients receiving Gemzar plus Cisplatin faired significantly better than those receiving Gemzar only. It also was the largest study ever conducted on CC patients – multinational – close to 3000 patients – the majority of patients were of Asian descent.
So, dear Eli, we need to continue and put our trust in the current treatment options. We stay vigilant, informed, and most of all, we need to keep up the hope that it will work for us.
Hugs and love,
MarionMarion:
CS/CR test cannot rely on blood testing. It requires a fresh tumor sample.
I agree with you that, for most CC patients, it’s hard to take advantage of chemo-sensitivity testing. Patients undergoing resection are very unlikely to have the information about the test. If and when they learn about the test, their resected tumor is no longer fresh, so it can’t be tested. Patients not eligible for resection face the difficulty of obtaining biopsy that meets testing requirements.
That said, a small minority of CC patients might be able to undergo the test.
You are right we only have a few protocols to choose from. But, we do have a choice…
gemcitabine + cisplatin
gemcitabine + oxaliplatin
5FU or capecitabine + cisplatin
5FU or capecitabine + oxaliplatin… and a few others, less common ones. Today, there is no way to tell which protocol is the best for the given patient.
My wife is doing Gem/Cis chemo. Is it the best protocol for her? We don’t know. Is it possible that Gem/Ox would be a better choice? Or 5FU/Cisplatin? Yes, it’s possible. We have no way to find out.
CS/CR testing promises to change that. The sales pitch is extremely appealing. Can they deliver on their promise? I don’t know.
Susie:
I don’t know much about insurance coverage in the US (remember, I’m in Canada).
Chemosensitivity / Chemoresistance test that I described is called ChemoFit. You can read more about it here:
http://act-inc.net/index.php?cID=94
On the right hand side, there is a link to Reimbursement Information. The cost is $2500.
Eli….retrieving tumor tissue from those people ineligible for a resection is complicated and in many instances prohibitive. Considering that only 20 percent of CC patients are eligible for a resection, the other 80 percent then have to rely on blood testing, which I believe does not make good sense. It does not tell much because; it compares likelihood of response in comparison to the rest of the population.
We only have a few drugs available, evoking varying responses within the patient group. So, we work with what we have and we continue to see fantastic results for many.
It all leads backs to the issue of needing accelerated research for this disease.Marion,
Chemo-sensitivity / Chemo-resistance testing does *not* use tumor markers. At all.
Here’s how the test works:
1. the lab receives *fresh* tumor sample from surgery or biopsy.
2. the lab grows live cancer cells in a tube.
3. the oncologist tells the lab which chemo combinations to test.
4. the lab applies the requested chemo cocktails to *live* cancer cell cultures.
5. the lab measures the response of *live* cancer cells.
As you can see, they don’t need to know molecular blueprint of the tumor. It’s an experiment in the dish. By observing the response of live cancer cells, they can tell the oncologist…
Chemo protocol A worked well
Chemo protocol B was ineffectiveThey don’t need to explain why protocol A worked or why protocol B failed.
That’s the sales pitch. I don’t know how well these tests work in practice.
Hi Percy
Thank you for all the work you did to explain all the chemo drugs. I found it very interesting that so many are paired together and my oncologist has only given me one at a time and they have not been effective. I wil be bringing this up with him. Thank you again
LisaEli…. For other cancers, the unique molecular “blueprint” has been identified; that is not the case for Cholangiocarcinoma. Also, CC has not been researched enough to identify specific “markers.” We only have a few drugs identified (via clinical trials) to provide a probability of response. And, we work with these drugs.
Hugs and love,
Marion
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