Whipple R1 resection, help really appreciated!
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Annabel….hope is what drives us. I have learned that in general and with current applicable chemotherapy, R1 patients (generally) don’t fair as well as those with negative margins.
The question then becomes: treat or don’t treat? We know that nearly all physicians prescribe one or the other drug (often times Xeloda) in post surgery settings. But, we don’t have a clear picture regarding the efficacy of using these drugs.We will know much more with data release of the below two clinical research studies. The trials are completed, but it takes several months to analyze the data. There has been some talk of possible data release in early June for ASCO, but if not so, then we expect to hear by fall.
UK: https://clinicaltrials.gov/ct2/show/NCT00363584
Do extrahepatic (hilar and distal) resected CCA patients benefit from adjuvant therapy with Capecitabine (Xeloda?France: https://clinicaltrials.gov/ct2/show/NCT01313377
Do extrahepatic (hilar and distal) resected CCA patients benefit from adjuvant GEMOX treatment?The ATTICA1 study is investigating whether the combination of Gemcitabine and Cisplatin is beneficial to the three cholangocarcinoma subgroups: intrahepatic, hilar and distal. The later refers to your Dad’s specification.
This is the trial: https://clinicaltrials.gov/ct2/show/NCT02170090Not sure how it is in Europe, but here in the US, targeted therapies are currently the focus of much anticancer drug development. All are under investigation for our cancer, hence we don’t yet know the outcome of these studies.
Adjuvant (post surgery) therapy has been a hot topic on this site going back to nearly the beginning of this forum and it will continue to be discussed until of course, an answer has been found..
I hope for many others to chime in on this very important topic and share with us the reason for their choices.Hugs,
MarionDear Annabel, Glad to hear your husband could have surgery. My husband had a Whipple 10 years ago and got the same results but with clear margins. I got the same story. For the most part they do not do Chemo/Radiation after a Whipple because of locations of the CC. The surgery bought Teddy 5 years and at the end of the 5 years the Surgeon told him he didn’t think Teddy was going to make the first year. HA, he didn’t know my Sicilian. I wish they wouldn’t concentrate on time frames as everyone is so different. We all really just try to stay realistically optimistic! Enjoy this interval of time and hope that in the interim something is found to help the Whipple patient. All we really need is time and a very clever Researcher! It will come as we are getting closer and closer.
At the end the ONC offered Teddy palliative chemo and Teddy opted to no chemo as it would only buy him a month. He chose quality. So if it comes to that your Dad might want to ask the ONC how much time could it buy and if he is not comfortable with the answer, let it be up to Dad. Oh, Teddy was 78 and asked the ONC what he would recommend if Teddy was his Dad.Hi everyone,
A while ago I posted a message about my father of 54 who’s currently healing from the Whipple procedure here in Amsterdam. I didn’t have all the information at that moment yet, so I would like to give you an update on his case and ask for some advice.
I’ve learned from the surgeon that they could only achieve a R1 resection, meaning that the margins aren’t clean in two places. Long story short: according to the doctors the survival rate is very poor with a R1 resection and chemo will make no difference. My father is now looking into the possibility to participate in an international trial called Acticca-1 with Gemcitabine and Cisplatin. He might be able to participate but we’re a bit unsure about whether this truly would prolong life or will only make things uncomfortable. Does anyone here know about this trial or is already participating?
Furthermore, I’m a little confused about the way the doctors spoke about chances of survival in this case. One doctor just mentioned the gloomy statistics while the other said the cells found in the margins could also be dead cells (because they did find a lot of those too) or just other non-cancerous abnormal cells. The last conversation felt a bit too optimistic, but still gave a little hope. I’m wondering what people at the discussion board think; is a future with positive margins really as bleak as the first doctor sketches or is there still some hope?
I hope you guys can help me out al little. After my last message I was blown away by the kindness and support in this forum, so thank you for that, It helps alot.
Annabel
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