pcl1029

Hi,Michele,

Common more potent antiemetics are as the following;

1. 5-HT3 receptor antagonist group- ondansertron (Zofran), dolasetron(Anzemet), granisertron (Kytril) are the first generation and palonosetron(Aloxi) is the second generation of 5-HT3 receptor antagonist.
2. the NK1 receptor antagonist like aprepitant (Emend) and others on the market are newer than the 5-HT3 receptor antagonists;they come as an oral capsule or tablet and injectable dosage form(fosaprepitant).Emend has to be taken with other antiemetics and on schedule for the maximum anti -nausea/vomiting control.

God bless.

Hi,
The recurrence rate is about 50-80% with the ICC on the high side of the range; extrahepatic CCA will be on the lower side of the range.

I believe when most of us diagnosed of CCA, the tumor had been there for quite a while.(ie: 2-3 years without symptoms in my case and the size is 6×5.5cm ,already stage III by the current new ICCA standard.)

I believe CCA is a slow growing cancer,in my case it grew from 2.5cmx2cm to 3.5-3cm in approximately 10-12 months for the 2nd recurrence roughly 20-22months after the 1st resection..The third recurrence again was 18-22 months after the 2nd recurrence. Both with adjuvant chemotherapy to follow for about 10-14 months.Therefore the growing rate should be the same before and after resections for the same person.

I do believe chemotherapy and targeted therapy and other options that currently available are all palliative in nature;even resections-the so call possible cure.
I believe chemotherapy is the most unfriendly treatment choice of them all;a lot of GI side effects which most of us spending a lot of time on the discussion ,but few,if any, mention cardiac ,neurological and kidney toxicity accumulation overtime.

I believe the longer a patient on treatments, the weaker the patient’s health defense will become due to the toxicity of the medications and the damage of the procedures (ie; resections, stent insertion,RFA ,and IMRT etc.)done to the body.Complementary and alternative treatments may help to relieve the symptoms and increase the quality of life to a certain extend.

To sum it up, CCA is definitely a chronic disease if the patient is lucky enough to discover it earlier before any symptoms showing up.

God bless.

Hi, Sandy,

If the time line was correct, that is from June 24 started to use FUDR pump and alternate with GEMOX and get 70% reduction on the Oct follow-up CT scan; that was a good progress in just 3 mnoths.
Then from Oct to about 3 weeks ago (middle of Nov.);In about just a month’s time,development like you described,–“She was beyond shocked to have found a second NEW tumor of good size in the liver and a lesion on the bone on his lowest left rib. She prescribed a PET Scan next week, and an appointment with a Radiologist December 18th to begin Radiation treatment.” It looks like the oncologist pretty much thought that the chemotherapy will no longer works, and depends of the PET scan result, they will use radiation like IMRT or SBRT for continuing treatment. If so, can you also ask them to provide a 2nd opinion on interventional radiologist (IR) for consult for chemoembo or radioembo possibilities.
Please mention to your oncologist if possible for her to prescribe targeted therapy agents like Tarceva or sorafenib .even though the tumor is unresectable.
Ask or insist the oncologist to recommend you for a clinical trial in your area . NCCN actually encourage patients to go through clinical trial for unresectable cholangiocarcinoma.
I know there are a few at Mass general and Sloan-kettering .
If your husband still have night sweat, tell the doctor too.

God bless.

Hi, Deborah,

the link below may help.

http://www.cholangiocarcinoma.org/punbb/viewtopic.php?id=10757

Age 68 is young if no other co-exist disease involved at the same time.
If I were you, if you have not done that, please get a 2nd opinion from Dr. Selby is at USC (Los Angeles) for surgical consult.

God bless.

Hi, Kerry,
Nice to hear you like Northwestern.
They are the pioneer of Y90 development.; there are a lot skillful interventional ridiologists there to help you out.
Please , after comparing of other options(ie: chemotherapy ,targeted therapy from oncologist; IMRT from radiation oncology and chemoembolization from IR and Liver surgeon from Dr. Kato.) ;sitting down and list the pros and cons before you finalize your decision.

Ask what if y90 don’t work and what will be the next opinion from Northwestern.
Can they do segmental radioembo to less the toxicity as compare to doing the whole liver all at once if there is a choice.

God bless.

Hi
Try to get a multidisciplinary team of liver surgeon ,medical onc,interventional radiologist , and oncology radiologist for a 2nd opinion at Mass General or Sloankettering . You may have to specify the above specialties you need to see to get a complete picture of the tumor situation.
God bless.

Hi, Gavin,

This exactly what I was told by Dr. Gores at Mayo that even the majority of patient may not response to Sorafenib beyond the short period of time of benefit; a sub set of patients can be of benefit from Sorafenib (a TKI-tyrosine kinase inhibitor)for a long time to control the cholangiocarcinoma .
My guess is that other small molecules or antibodies (TKI & MoAB) will do the same. It just take time to find out the one that will be the best one to begin with. And NGS( next generation sequencing) gene profile will provide a foundation for such search if the oncologist is experienced on using this route.At this time, few treatments are really standing out,but at least better than going thru a lot of traditional chemotherapy without a personalized therapy in plan.
I knew doctors and others may not agree on using this new technology to search for treatment, but there is one big difference ,the medical professional are not patients like us,we have a time limit and they don’t.

Again, be sure to say hi to your mum for me, you are right , here in Chicago is as cold as the feet of the BEARS and the sky is cloudy, with no chance of going to playoff or meat ball.

God bless.