pcl1029

Hi,
The half-life of Gemzar is about 30-90 minutes;that means half the amount of the Gemzar you were given will be out of your body after 30-90 min and so on.
The half-life of Cisplatin is about 24hr;that means about 50% of the Cisplatin is excreted in the urine in the first 24 hours following cisplatin administration.
So I do not think that your current symptoms of edema is related to the side effects of both medications which were given to you about 25days ago.
But if you are still taking dexamethasone or prednisone,then as you may know,edema is one of the side effects.
Lasix and Aldactone are the two diuretics that commonly use for edema in CC.
Even though Gemzar/cisplatin is the first-line regimen for CC;there are still other regimens that are used for systemic treatment of CC such as the 5FU based regimens(5FU +leucovorin iv;Xeloda +mitomycin) and the single or concurrent use of molecularly targeted therapy (Tarceva+Avastin;Xeloda+Avastin)
clinical trials are also good options too.
I hope the info. helps.
God bless.

the above link may not work ,here is another.

http://cancer.osu.edu/viewer/press/Pages/index.aspx?newsid=4770

I want to let people know that the Ohio state cancer research does provide some interesting research on bile duct cancer.
this web-site will let you to a research and clinical trial about a drug called
AZD 6244 (Selumetinib) ,I belive it is still in phase 2.
other research clinial trials related to bile duct cancer are :
Protocol OSU-09083;OSU-09092:OSU-09067 and SWOG-50809

For patients and caregivers in or near OHIO.this may b of value.

http://cancer.osu.edu/viewer/Pages/index.aspx?P=524

I asked the infection disease specialist doctor who practices in my hospital about how long can a patient be on antibiotics ? eg. for bone infection or chronic cholangitis.
He said in his group of practice, he has patients that are on long term antibiotics like vancomycin (for bone infection) for months and Cipro or Levaquin for years. It is not common but necessary for some patients.he prefers Cipro (ciprofloxacin)because it is much cheaper than Levaquin.
As a few of you mentioned above ,it is always a good idea to prepare and watch for signs like
fever(>39C or 102F);or even lower depend on patient.
persistent abdominal pain;esp. right upper quadrant.
jaundice.
For elderly CC patient and patient taking corticosteroids(eg. dexamethasone)add hypotension and confusion as symptoms to watch for and seek help accordingly.
I hope the above info.helps.

Please read under general discussion , the replies on “any advice on chemo treatments”.
it may provide you a general idea of what to expect about chemo treatment ;
and above all what kind of options that you may have when you discuss the matter with your medical professionals next week.

Listening to them closely and respectfully first ;if you don’t understand what new treatment they will recommend; kindly ask them to explain how it works;when it is your turn to speak ask what is his/her thinking of “the desired end point” of the new treatment if you father can tolerate the side effect and the treament works.(so you can avoid a common run around answer);and if the treatment does NOT work,what will he/she do next ? eg chemo or RFA or radiation.

At the end of the visit,doctors will always you “Is anything else I cando for you?” You then kindly mention just one or two of the options you choose to see what their opinions are. In this way,you ,as a patient,show your respect to them as doctors but you also make them aware you are on the top of things and may gain their respect for you and your father.

Anyway, my question is, does anyone know of other chemo regiments that have been successful with cc? I have been looking on the Internet and it seems that Cisplatin, Gemzar and 5FU are the main treatments for cc. Thanks for any thoughts – Sarah

Most systemic treatment (chemo) for CC are based on experiences in treating pancreatic cancer.
Chemo agents like mitomycin,doxorubicin,docetaxel,oxaliplatin,irinotecan also have been used for treatment of CC in regimens combined with Gemzar or 5FU.

Accordingto”systemic therapy for advanced cholangiocarcinoma”in uptodate.com
The “overall response rate”of the regimen
(which include partial and complete response) examples are as following.
Gemzar alone in two studys are 22.6% (2009)and 26.1%(2005)
Gemzar + cisplatin regimen in five studys are 17.1%(3/2007),27.8%(2009),27.5%(2005),32%(2006),34.5%(3/2006).
Gemzar+ capecitabine (GEMCAP)in 2 studys are 25%.(2008) & 31%(2005).
Gemzar + oxaliplatin(GEMOX) in 2 studys are 36%(bil.<2.5xnormal);22%(bil.>2.5xnormal)-(9/2004.);and 50% -including 1 complete response and 11 partial response in a population of 24 patients(Ann Oncol.2006 Jun17(suppl_7):vii68-vii72.
New systemic therapies using erlotinib -an oral tyrosine kinase inhibitor ,does provide good result.According to uptodate.com,in one study,42 patients with advanced biliary cancer,57% of whom had received prior chemotherapy,received erlotinib(Tarceva)150mg daily.There were 3 partial responses and 7 additional pts remained progression-free at six months.further experience with this drug is needed,particularly combined with cytotoxic chemotherapy.
Surgery provides the only possibility for a cure and among patients who undergo potentially curative resection,long term outcomes vary according to location and stage of the primary lesion,extent of surgery,associated comorbidities,and treatment-related complications.
Other” treatment options for locally advanced cholangiocarcinoma”as mention in uptodate.com include radiation therapy and chemoradiotherpy;local ablation,eg RFA;photodynamic therapy and orthotopic liver transplantation.
Clinical trials is another option too.

Under the Warning and Precautions of Byetta,
if you have persistent severe ABDOMINAL pain that will NOT go away,you should discontinue the medication and notify your doctor . He/She may change your medication to control your type II diabetes.
Because Byetta is primary cleared by the kidney,hepatic (liver)dysfunction is not expected.
As you may know, base on post marketing data Byetta has been associated with acute pancreatitis(abd pain,nausea and/or vomiting are part of the symptoms)
Byetta is manufactured by Amylin/Eli Lilly the phone # 1-800-868-1190.

Cipro comes in either 5% (250mg/5ml) or 10%(500mg/5ml)microcapsules for oral suspension. side effect of Nausea/vomiting=5% in general.
the other commonly use same class of antibiotics (quinolones) is Levaquin,it also comes in an oral liquid form. side effect of Nausea/Vomiting=7%/2%

Abdominal discomfort,diarrhea are among the GI side effects listed for both med.

if too expensive for the oral liquid form;you can try to crush the tablet,disolves in about 30ml(2tablespoonful) of water;give it with food.( exception is for CIPRO XR long acting tab)

For most antibiotics, it recommended to take them 1 hour before or 2 hr after meal to provide better drug absorbption;the above suggestion to give with food is to minimize the side effects but still provide enough drug tx for the pt’s need.