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Hi,
Also,if you are belonging to the KRAS wild type genotype,your chance of your tumors response will be much better than otherwise.
God bless.Hi,
Below is a study about GEMOX+cetuximab.
But be careful when you read about the results;it does not provide the long term results of the study eg. drug resistance.Cetuximab, gemcitabine, and oxaliplatin in patients with unresectable advanced or metastatic biliary tract cancer: a phase 2 study
Dr Birgit Gruenberger MD a Corresponding AuthorEmail Address, Johannes Schueller MD b, Ute Heubrandtner MPharm c, Fritz Wrba MD e, Dietmar Tamandl MD f, Klaus Kaczirek MD f, Rudolf Roka MD d, Sandra Freimann-Pircher MPharm c, Thomas Gruenberger MD f
Summary
Background
Patients with biliary tract cancer have a poor prognosis, and, until recently, no standard palliative chemotherapy has been defined. We aimed to investigate the efficacy and safety of cetuximab in combination with gemcitabine and oxaliplatin (GEMOX) for first-line treatment of biliary tract cancer.
Methods
From Oct 1, 2006, to July 26, 2008, patients with unresectable locally advanced or metastatic biliary tract cancer were sequentially enrolled and treated at one centre in Austria. All patients received intravenous infusions of 500 mg/m2 cetuximab on day 1, 1000 mg/m2 gemcitabine on day 1, and 100 mg/m2 oxaliplatin on day 2, every 2 weeks for 12 cycles. The primary outcome was overall response rate. Analysis was by intention to treat. Adverse reactions were assessed according to National Cancer Institute Common Toxicity Criteria. The study is completed and registered with ClinicalTrials.gov, number NCT01216345.
Findings
30 patients with median age of 68 years (IQR 62—73) were enrolled and included in the analysis. Objective response occurred in 19 patients (63%; 95% CI 56·2—69·
, of whom three (10%; 3·2—16· achieved complete response, and 16 (53%; 46·2—59· achieved partial response. Nine patients underwent potentially curative secondary resection after major response to therapy. Grade 3 adverse events were recorded in 13 patients: skin rash (n=4), peripheral neuropathy (n=4), thrombocytopenia (n=3), nausea (n=1), diarrhoea (n=1), and neutropenia (n=1); no grade 4 adverse events were recorded.
Interpretation
Cetuximab plus GEMOX was well tolerated and had encouraging antitumour activity, leading to secondary resection in a third of patients. These findings warrant further study of cetuximab plus GEMOX in a large randomised trial.
God blessHi,
Can you tell us what stage and what do you have,intrahepatic CC or extrahepatic CC?
How long have you been on the clinical trial? and
where your are being treated now?Below are some info with regard to panitumumab and cetuximab,and you may look at GEMOX and cetuximab trials to get some insight into your treatment since the two agents are very similiar but there are more studies done on GEMOX+cetuximab than GEMOX+panitumumab
Two epidermal growth-factor receptor (EGFR)-targeted monoclonal antibodies are currently used as second-line or third-line chemotherapy for metastatic colorectal cancer: cetuximab, an IgG1 chimeric monoclonal antibody, and panitumumab, a fully humanised IgG2 antibody. Preclinical data suggest a similar mode of action for these two drugs.
another source indicated some difference between the mode of action as follows:
Although they both target the EGFR, panitumumab (IgG2) and cetuximab (IgG1) differ in their isotype and they might differ in their mechanism of action. Monoclonal antibodies of the IgG1 isotype may activate the complement pathway and mediate antibody-dependent cellular cytotoxicity (ADCC).[4]
God bless.Hi,everyone,
Below is the article by Neoptolemos JP,cited as reference by the above studyand dated as May 31,2009.
http://www.hemonctoday.com/article.aspx?rid=40436No survival difference between adjuvant 5-FU, gemcitabine in pancreatic cancer
2009 ASCO Annual Meeting
Results of the international ESPAC-3 trial indicated that there was no survival difference between adjuvant treatment of pancreatic ductal adenocarcinoma with the European standard of care, 5-FU/folinic acid, and the U.S. standard gemcitabine.
Story continues below↓
“There was absolutely no difference between the two regimens,” John P. Neoptolemos, MD, head of division of surgery and oncology at the University of Liverpool, said at the 2009 ASCO Annual Meeting. “This is extremely important because there has been a tendency to reject 5-FU in pancreatic cancer and now it is very much back on the stage.”
In the phase-3 ESPAC-3 trial 1,088 patients were randomly assigned within eight weeks of surgery to either 5-FU/folinic acid or gemcitabine for six months. The primary endpoint was OS. Median follow-up was 34 months.
Median OS was not significantly difference between the two arms (23 months vs. 23.6 months). However, patients assigned 5-FU/folinic acid reported more toxicities compared to patients assigned gemcitabine. The increase toxicities included grade-3/4 stomatitis (10% vs. 0), diarrhea (13% vs. 2%) and treatment-related hospitalizations (10% vs. 3.5%).
Given this safety profile, Neoptolemos said that gemcitabine is likely to be the preferred adjuvant therapy. – by Leah Lawrence
PERSPECTIVE
This trial suggests that there is no difference between 5-FU and gemcitabine if you give it after surgery alone, but it conflicts with other data suggesting a survival benefit with gemcitabine compared to 5-FU, as demonstrated in the RTOG 97-04. It is a negative trial. Their previous study, ESPAC-2, did suggest that adjuvant chemotherapy was beneficial with 5-FU. It doesn’t invalidate that adjuvant chemotherapy improves survival in pancreatic cancer it just suggests that there may not be as clear a difference between gemcitabine vs. 5-FU in the adjuvant setting as was seen in the ESPAC-2 trial.
– David Ilson, MD
Hi,Gavin,
thanks.
Below is the ASCO message about biomarkers usage.What to Know: ASCO’s Guideline on Tests to Help Choose Chemotherapy
Introduction
To help doctors give their patients the best possible care, the American Society of Clinical Oncology (ASCO) developed evidence-based recommendations on the usefulness of laboratory tests (called assays) to find out if a cancer might be resistant or sensitive to a specific chemotherapy treatment before it is offered to a patient. In 2011, this guideline was reviewed due to new research; this research continued to support the 2004 recommendations. This guide for patients is based on ASCO’s most recent recommendations.
Key Messages
Chemotherapy sensitivity and resistance assays are laboratory tests that have been studied to help predict how well chemotherapy may work.
However, these tests should not be used to determine treatment options for an individual patient.
Instead, the choice of chemotherapy should be based on the research on the drugs being considered and the patient’s health and treatment preferences.
For additional info, go to cancer.net,home,publishing and resources,what to know ASCO guidelines
God bless.Hi,Marion,
The agents of clinical benefit are based on the general understanding of the biomarkers used on studies or trials for other forms of cancers,like colorectal and lung cancer not from CCA ;The level of evidence or the criteria of the study validity and design is different among the agents.
For example;the level of evidence rated the agent cetuximab and panitumumab as level I/good, II-2/good and II-3/good in five studies.
GOOD means the studies that my report based on are judged to be valid and relevant as regard to results,statistical analysis,and conclusions and show no significant flaws.(there are 3 grades of study validity–good,fair and poor)
There are 5 levels of hierarchy of the study design(from I,II-1,II-2II-3 and III)
I means evidence obtained from at least one properly designed randomized controlled trial.
II-2 means evidence obtained from well-designed cohort or case control analytic studies,preferably from more than a single center or research group.
II-3 means evidence obtasined from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
“How much clinical response is expected from treatments focused on the specific biomarkers? ” I do not know yet,I need to read and study more before I can answer if anything at all.
Happy Thanksgiving to yuo all.
God bless.Hi,
If it is second opinion on surgical consult by Dr. Keto,make sure you bring the cat scan disk and report and ask him whether he can do surgery for your grandma.
I think if it is stage IV and only involved the liver and metastasized only to 2. Lymph nodes as you mentioned and not involved other organ or blood vessels,the chance will be pretty good if your grandma is in relatively good health.
If he said yes,he will tell you how long the surgery will take and how long she will be in the hospital and how long it takes for recovery.
If he said no, ask him why like is it because of metastasis to other parts of the body.Is it the location of the tumor difficult to get to? will chemo or radiation improve the chance for surgery later?
Keep in touch and
God bless.Hi, Mary,
I am so sorry to learn about Tom’s passing.
May God’s Grace be always with you and your family.Hi,
I am a patient of C CA too.But if you can tell us more about your mum’ condition(ie: intra or extra hepatic tumor?);any chemo in between the recurrence? And how long?What stage is your mum is in now?
Can she has resection again for the recurrence and where is the recurrence in the liver or the bile duct? If not,what is the doctor opinions on radiation treatment or chemo therapy?
Is she on any chemo or meds now?
How far apart is between the recurrence? And if I may,how old is your mum and her health condition?
I am not a doctor,but I wll try my best to answer the above questions and hopefully can give you some insight about this disease.
God blessHi,
The location of the lesions in the liver are difficult to get to especially the caudate lobe, it is relative small and located posterior and in between the blood vessels.
Segment V may be easier to put the biopsy needle thru and get the sample and of course the lymph nodes are small too. A 5 cm lesion indicated that you may have it for a year or two,but still relatively is a manageable size for surgery if no other organ,blood vessels involvement. Please find out the diagnosis and keep us informed.
I think based on the PET scan,you may have cancer in the liver and some lymph nodes involvement . But since you did not get biopsy to confirm you did have cholangiocarcinoma. Your intuition to go to Cleveland Clinic is absolute correct.And I suggest you do that as soon as possible.When you will be up in the Cleveland Clinic,they will do their cat or pet scan and their more experienced team of radiologist and surgeon and oncologists may tell you what you have without biopsy.
Your goal is try to have a resection(surgery) to get rid of the lesions before the lymph nodes involvement getting into the way(ie:disqualify you to have surgery).
So time is of the essence,Ohio State hospital cancer center in Columbus is also another place to look into,but I think they are a bit conservative in the surgical
approach.
I am not a doctor but just a patient like you.
Good luck and
God bless you.Hi,
Did they mention any maxSUV uptake value in the PET scan report?
If no value is given, or maxSUV
.7,
then the lesion may not be cancer.
The problem area is in the middle and lower right side of the liver(segment V).
a second opinion on radiology in a larger medical institution is recommended.
God bless.Hi,
Ursodeoxycholic acid (Ursodiol)(Actigall-Brand name) is indicated for prevention of gallstones in obese patients experiencing rapid weight loss;Primary biliary cirrhosis and gallbladder stone dissolution.It has been used for investigational purpose in liver transplantation.Long term use is not recommended. It is also used by physicians for bile acid reflux and helps the bile flow.
Proton pump inhibitors like protonix(pantoprazole), prevacid(lansoprazole) and Nexium(esomeprazole) which are used to block stomach acid production and used in the treatment of GERD ; may also help to reduce bile reflux;Among the three proton pump inhitors, protonix should be used if you are on Plavix(clopidogrel)-an antiplatelet agent used for angina(chest pain) or other peripheral arterial disease.( reason:less drug-drug interaction).
God bless.
