What Will You Do After Adjuvant Chemotherapy Is Done.
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Hi Percy,
I asked our oncologist about maintenance chemo when my wife finished adjuvant Gem/Cis. I asked specifically about Capecitabine (Xeloda) because it’s done at home.
He wasn’t open to that discussion at all. He was quite dismissive. He said he wasn’t aware of any evidence to support maintenance chemo in CC patients. If I recall correctly, he said something to the nature of, “show me a study supporting it… then we can talk”. Of course, I don’t have any CC studies to show him.
Assume for a moment that you can find an open-minded oncologist who is willing to prescribe maintenance chemo to CC patient in remission. I very much doubt that insurance will approve it, considering that we don’t have any evidence from the clinical trials. Our government insurance is highly unlikely to cover it.
You can think of maintenance chemo as a weak form of adjuvant chemo. As you know, the evidence to support adjuvant chemo in resected CC patients is not very strong. We don’t have a single Phase 3 randomized trial to support it. We only have small, non-randomized Phase 2 trials.
This may change once UK BILCAP trial is completed. If BILCAP trial proves the benefit of adjuvant Capecitabine chemo, Capecitabine will likely become the new standard of care in resected cases. If that happens, the next logical step would be to try Capecitabine as a maintenance chemo.
Percy, I agree with your line of thinking about maintenance chemo. I think it makes perfect sense. The only catch is, we need evidence specific to CC.
My very best wishes to you as always.
Hugs,
EliHi Percy,
I am on a break from chemo till October 5th when I will have a scan. The six week break makes me very nervous, it is like a love-hate relationship with chemo. I feel good not being on chemo but on the other hand I feel like I am not being proactive to fight my cancer. I changed my diet about a year ago and went to a vegetarian diet almost vegan and I drink a green juice most days. I do cheat once in awhile with a good steak but try to be good most of the time. I have read a lot of the cancer assassins website and do a lot of research on the food we eat. I loved forks over knives. I have done acupuncture which helped with pain. I am very interested to read what others have tried and what is working. Thank you for your thoughts.
LisaHi, everyone,
After resection and adjuvant chemotherapy was done,doctor say you are clean and you are a cancer survivor,if so then what will you do ?
May be you will do as most oncologists suggested,follow up with blood work every month and CT scan or MRI every 3 -6 months to monitor the cancer; when the cancer comes back,(which in our case of cholangiocarcinoma,the recurrence rate is about 50% for extrahepatic and 75% for intrahepatic CCA.);then start with different chemotherapy agents or targeted agents and fight it allover again since there is no CURE is available at this time.if you choose the above approach. do you think you may be just playing the “waiting game” or like “taking a long chemo break”? According to one study,90% of the patients,especially the educated one,who have a college degree will explore other options such as complimentary and alternative therapy (CAM) ;immunotherapy etc. to further their treatment needs. Most likely,even if we try hard, we will not find what we wanted except a few of those lucky ones.
How do you improve the odds to delay the recurrence of this cancer and may be the odds of longer overall survival?Then it comes to the topic of ” Maintenance chemotherapy ” or “Switch maintenance therapy”.
In short, that means after the assigned cycles of adjuvant chemotherapy, even if you are clear , you will follow with ” a lower maintenance dose” of the same chemotherapy or ” switch to a maintenance dose” of a different chemotherapy or targeted agent such as Capecitabine continuously daily right after you stop the adjuvant treatment. It has not been proven that “maintenance chemotherapy” had worked for hepatobiliary cancers but may have worked on other cancer like colon or lung cancer.
See link belowhttp://www.oncologypractice.com/fileadmin/content_pdf/co/5_CO_aug_247_smit_Review.pdf
http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=47633
In short I think this is a more active approach for me than like a sitting duck awaiting for the dismal outcome; besides, it is more like treating a chronic disease like hypertension or diabetes that required daily administration of medications to control the symptoms; in doing so, I hope it can provide a longer disease control period for me , a better quality of life and in time for the cure.
But please remember ,it is just a suggestion and you should discuss this unproven concept next time you see your oncologist.
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