Hey Percy, could you please give us your expertise?

Eli…I have not heard anything positive about chemo sensitivity tests for CC patients. Do you have personal experience?
Hugs and love,
Marion

Maybe ask about erlotinib? I take it, and Dr. Javle thinks its helping me. Its very easy….just 1 pill a day. Side effects are very little (face rash).

Pam:
I was on Gem/Ox and had to stop the oxaliplatin because of side effects. So I got Gemzar only the last few times. My onc says Gemzar is really hard on the blood counts especially the platelets. My numbers, although in the normal range, are still on the low side so until my surgery is completed she will not give me Gemzar. I don’t know about Cisplatin, but it might do the same thing.

Thanks Percy for all the information. I will definitely be bringing a printout of this to my onc for after the resection. I don’t think she is willing to do FUDR thru my pump anymore since I kept getting sick during the time period we were actually using it. She isn’t willing to take the chance that it wasn’t the FUDR. And I don’t know if she will put anything else thru the pump. I still have to find out a lot about “after”. I might have to find another protocol. This will help me a lot.

Kris

Hi, Pamela,

“Thanks Percy. Now when you have the time, can you explain the difference between each one and why they use some more than others”

This is a very difficult question to answer.but I hope my revision of the message will provide you some answers; if you need more info.
the best way to answer your questions will be if you can give me specific regimen to work with;like GEMOX or FOLFOX.

5FU and Gemzar are the FIRST line chemo agents to use; it is more or less like building a house;this two drugs are the foundation of the house(or in this case ,the regimens);the platinum family of drugs and others are adding to the 2 FIRST LINE drugs to provide the synergic effects of the regimens and that is why they(the add on drugs) are used less.

Gemzar and 5FU(like Xeloda) can be used alone by itself(mono therapy) too.

God bless.

Hi, Pamela

Here is the list of chemo agents that mostly used for CCA that I can find at this point. most of them are used in combination to get the best results (synergy) out of the combo that used in the regimen.

Taken by Mouth:(not necessary FDA approval indications for CCA but doctors can use them out of protocol)
1.Xeloda(oral form of 5FU)-see 5Fu below;diarrhea and hand and foot symptoms are the side effects.

2.erlotinib(Tarceva)—EGFR cell pathway inhibitor(tyrosine kinase inhibitor);
inhibit angiogensis (cut off blood supply to cancer cells and cause them to die);cause cell death by interrupting the reproduction of cancer cells;smoking will decrease the drug effects by 24% which may result in treatment failure.

3.sorafenib.(Nexavar)—Multiple cancer cell pathways inhibitor; inhibit cell proliferation and angiogenesis(cut of blood supply to cancer)
4. Celecoxib-an antiflammatory agent belongs to the COX2-an enzyme family.but use much less recently.

Taking as Infusion:
1. 5FU.—a chemo agent belongs to the Antimetabolite family that inhibits RNA synthesis and function ; may also on DNA synthesis but to the less degree. in doing so,cause cancer cell to die.

2.Gemzar—a chemo agent belongs to the Antimetabolite family that inhibits the DNA synthesis in the cancer cells;induce tumor cell death (apoptosis);
some study indicated Gemzar is more effective in treating CCA than 5FU,but both 5FU and Gemzar are FIRST LINE chemotherapy agents of choice to combine with other chemo agents in CCA regimens;other study indicated effectiveness of both agents are more or less the same.

3.Cisplatin—1st generation of the platinum family, an alkylating agent affects cell DNA replications thus causes cancer cell death(apoptosis);may cause kidney impairment and impairs hearing (ototoxicity);usually use in combination with Gemzar or 5FU to provide the synergic effect of the regimen of GEM/CIS or FOLFOX.
4.Oxaliplatin— the 3rd. generation of the platinum family;less kidney impairment than cisplatin but more patients experienced peripheral neuropathy
5.Carboplatin— the 2nd generation for the platinum family;decrease platelet production;much less toxicity on the kidney compare to others in the platinum family; cause less peripheral neuropathy than oxaliplatin.

6.Avastin(bevacizumab)-a VEGF cell pathway inhibitor— an angiogensis inhibitor to cut of blood supply to tumor cells.and cause cancer to die.

7.Erbitux(cetuximab)-an EGFR cell pathway inhibitor;blinds to the cancer cells surface receptor of EGFR and block their stimulation;therefore renders the cell pathway useless.

8.Leucovorin(it is not a chemo drug but used to enhance 5 FU effect)

9.FUDR(Floxurdine)-it is an analog of 5FU,belongs to the Antimetabolite family. Administered via the hepatic artery(pump);hepatic toxicity is high.

10.Epirubicin— a chemo agent belongs to the Anthracyclines family which is less used nowadays.
11.Adriamycin—a chemo agent belongs to the Anthracycline family;interrupt the DNA and RNA synthesis in cancer cells and cause cell death;used in chemoembo in CCA;major BOX warning by FDA is myocardial toxicity ;also neutropenia and leukopenia(75%)

12.Irinotecan(Camptosar)-inhibits DNA synthesis in tumor cells by inhibiting an enzyme called topoisomerase1 ; useful but tough to take.

13.Docetaxel-chemo agent belongs to the Taxane family,interrupt the mitosis of the cancers cells cycle to reproduce and cause tumor death.

14.Mitomycin- a chemo agent belongs to the Alkylating family; inhibit DNA and RNA synthesis and thus cause cancer cell death ;use in chemoembo for CCA and can be combined with 5FU for treating CCA too.

15.Panitumumab(similar to cetuximab ;but difference from them is that this is the first 100% HUMAN monoclonal antibody direct against EGFR cell pathway; therefore you may expect less allergic reaction from Panitumumab.

16.paclitaxel-(Taxol) a chemo agent in the Taxane family that primary inhibits the cell cycle during mitosis;thus the tumor cell cannot duplicated and die;Taxol should be given before cisplatin if both drugs are used at the same time for maximum benefit of the combo.;also inhibits angiogenesis but is very tough to take.

God bless.

To help Percy, I will post all chemo protocols listed in NCCN Treatment Guidelines.

Unresected And Metastatic Cases

Phase III clinic trial supports this protocol:

gemcitabine + cisplatin

Phase II clinic trials support the following protocols:

Combination protocols for patients with good performance status

gemcitabine + oxaliplatin
gemcitabine + capecitabine
capecitabine + cisplatin
capecitabine + oxaliplatin
5FU + oxaliplatin
5FU + cisplatin

Single agent protocols for patients with poor performance status

gemcitabine
capecitabine
5FU

Resected Cases

There are no Phase III clinical trials to support chemo protocols for resected cases.

Phase II clinic trials support the same protocols as listed above for unresected cases.

=================================

The protocols refer to drugs by their “proper” medical names.
Here are the trade names of the same drugs:

Gemcitabine = Gemzar
Cisplatin = Platinol
Oxaliplatin = Eloxatin
Capecitabine = Xeloda
5FU = Adrucil, Carac, Efudix, Efudex, Fluoroplex

Pam, thanks for bring it up and Percy, thank you for posting the list.