pcl1029

Hi,
H ow about Gemzar+ carboplatin?
Interventional radiologist consult for like IBRT if needed?
God bless.

Hi, Linda ,
Can you ask your doctor why not Gemzar+ oxaliplatin instead of just Gemzar alone.?
Unless pre-exist condition preclude the use of oxaliplatin(check out the contraindications) for oxaliplatin and you will find out.
Gemzar alone seems too mild a regimen when switch from FORFIRI. I had Gemzar for 18 months after the 1st resection with no tumor and clean margin.
As you know ,I am just like your husband, a patient,and not a doctor.

Hi,
After reading an article, there are no indication for using antibiotics unless patient has fever at diagnosis.
Therefore I believe to prescribe antibiotics BEFORE the evaluation of the content of the ascites fluid and the possible elevated neutrophil count in the fluid is more for PROPHYLAXIS purpose than the standard treatment protocol.

God bless.

Hi,
Well, as you know, it won’t hurt to ask or give him a call indicating that someone recommend him to you for a second opinion from the States at the recent ASCO meeting at Chicago, I gave my business card to him and I told him I am volunteer for The Cholangiocarcinoma Foundation as a moderator. I even asked him in Hongkong whether such Internet disease discussion board about liver cancer exist. He told me no. If he says yes, then you get his attention, if not ,then just do what you have desided. One more connection won’t hurt even if he says no. (I resided in the States for > 40years, but I think connection is the key to everything in doing business in Hongkong ,Am I still right ?)
The reason is I want to start one of such web site like this discussion forum to provide my experiences and help to people like you in Hongkong, Taiwan and Singapore who wants to know the most uptodate medical information about liver and bile duct cancer who otherwise do not know English. I tried the one web site for mainland China, but they screened my message and delete my entry; may be because I use the term ” patient Advocate” or ” God bless” in Chinese and they do not know what that actually mean.
BTW , you did not mention the stage of your wife’ tumor and where is it? Inside or outside the liver; The location counts a lot to determine what is the treatment approach. And what is the name of the oncologist that provide you the IMRT+Xeloda? Did you ask her in her guest that how much longer, timewise that your wife will have as compare to just having GEM/CIS OR GEM/OX even though the answers are without actual meaning in terms of the actual outcome for your wife.what I mean is progression free survival time(PFS)
God bless.

Hi,
That is a very good news indeed. A 20% partial response to the regimen.
So what will be your next planning ?continue the current regimen until it no longer works;than change to other systemic regimen?; or I noticed you are interest in radioembolization as you had mentioned before,since you get treatment with Stanford,they may recommend it to you sometime in the future when it is appropriate to do so.but before you say yes, please know that radiation Tx may preclude the patient for the next available CLINICAL trials or Tx if you decide to go that route in the future.( check out the clinical trials list on this board for the exclusion of trial in each of the trial) ; I know the glass bead type of radioembo is still not approval by the FDA but the resins type does. Ask lot of questions before say yes to radioembo. Base on what I can understand it, the overall result is average for our members who have radioembo done. I really think that they need more studies to rule out the residual radiation effects on the sensitive organ like LIVER. Did Dr.
kato reply to you? And what did you think of him? Again, do research on the outcome of the patients that He treated to get an idea of whether you can accept such level of risk with Dr. Kato,because most of his patients were at the very advanced stage of the disease and therefore the outcomes of his treated patients should be less optimistic .
God bless.

Hi, everyone,
My answer to Jason will be sensitive, so avoid to read my assessment may not be a bad idea . thanks

Hi, Jason,

I personally do not think there will be a time line for 3-5 years with regard to your question. 7-10 years will be a more optimistic expectation.
The key lies in the 50-75% recurrence after successful resections; Not to mention if the patients are unresectable or at the late stage of the game.

With regard to the new tyrosine kinase inhibitors (TKA) that are in the pipeline , the resistance will be developed relatively fast( 3-8 months approx.);And the chemotherapy agents as well if you account for the toxicity ,both acute and accumulative .
2011or 2012@ ASCO , the hot topic they were talking about were mRNA and using genomics as the basis for cancer research for the next 10 years.
This year at ASCO, they used the term panomics by adding patients characteristic to the equation of using genomics and genetic information.
What it means to me is that since there are a lot of mutations in even one gene expression, for example, EGFR, there are subset of mutations inside just that one receptor gene and therefore EGFR inhibitors like Tacevar may work for some but not the others for a few months then you have to find other TKA to keep one step ahead of the game to treat the CCA. You multiply that subset gene mutations for all the gene expressions like p13,VGFR1,VGFR2,HGF/SF;c-Met ,akt and mTOR pathway and hundreds of other gene expressions have already been found but not yet identified their usefulness. The answer for a magic bullet in the next 5 year seems impossible to me. The only bright spot is by adding or using the immunotherapy(anti-PDL-1) or antibodies agents in the future (like the antibody-drug conjugates,monovalent antibodies,dual-action antibodies and glycoengineered antibodies which all are under pre-clinical studies or in vitro studies at this point in Genentech Inc.and other big pharmas) to the equation then we may have a shot for either a prolong result of the treatment or maybe,just may be , like a beta blocker for the chronic disease of hypertension,take it daily and the CCA will not recur again.Yes, it looks hopeless, but it does not means it cannot be done. for example, for the immunotherapy agent called Anti-PDL-1 ;I think it will pretty closed to be approval by FDA for other solid tumors the end of this year or next year.
God bless.

Hi, Pam
Nothing can express my sorrow to the loss of your daughter .

I am truly sorry, sometimes God’s will is difficult to understand and accept but always has His purpose.
May His grace be with you and give you comfort and relief.
God bless,
Percy.