1 (edited by JeffL Fri, 17 Jun 2011 14:56:28)

Topic: Targeted Therapies, Cetuximab

Hi all,

My mom has just started her GemCis treatments at Sloan Kettering. I've done quite a bit of research and am familiar with the prognosis of this treatment, but I am wondering about improving her chances with a targeted treatment. Below is a rundown on the most interesting things I've found.

I found this paper which gives a very good summary on the current state of affairs of targeted treatments and cholangiocarcinoma:

http://www.mdpi.com/2072-6694/3/2/2243/pdf


In particular interest are the studies on Cetuximab (Erbitux) with GemOx, particularly the Gruenberger 2010 study. They report a response rate of 63%, and more spectacularly a complete response rate of 10%. In comparison, the large scale GemCis ABC-02 trial has a complete response rate of 0.6%. I have a version of the full text in case anyone is interested (PM me).

http://www.thelancet.com/journals/lanon … 3/abstract
http://www.asco.org/ascov2/Meetings/Abs … ctID=33890

However this contrasts strongly with the early results of an ongoing larger randomized Cetux/GemOx trial (Malka 2009, the BINGO trial) which at 4 months shows only an 11% response rate (3 out of 18 with a partial response). Maybe 4 months just not enough time for the cancer to respond? Would be great if someone had more info on this.

http://www.asco.org/ascov2/Meetings/Abs … ctID=34761


I brought up the Cetuximab with our oncologist, Dr. Abou-Alfa, but he did not think it was a good idea, though he did not go into why. I didn't press the issue on the spot, but I was wondering if anyone had some more information on this, first hand or otherwise.

Do you think it is worth getting a second medical opinion on more experimental treatments? Should we be pursuing trial enrollments?

Also early studies on the MEK inhibitors like Selumetinib look interesting. I know they mentioned research on this in the MD Anderson video in the treatments part of this website. Anyone have information on this?

http://www.sciencedaily.com/releases/20 … 173832.htm

Thanks!
Jeff L

Re: Targeted Therapies, Cetuximab

Hi,
It is  a very good  summarization  and uptodate of  the current CC treatment plans.
If your mom has the combination type of CC and HCC; Can you ask the doctor why or why not using  sorafenib also.
The use of cetuximab and Gemox  that you quoted to have  a 63% response rate for the 30 patients;you also mentioned about the Malka study of the same regimen for 50 patients but only has a 11% response rate .I think it has a lot to do  with the patient's population in each study.  You may ask the doctor is this a good choice of regimen for your mom. But remember,targeted therapy like cetuximab or erlotinib or sorafenib do come with toxicity and drug resistance and these are  important things that needed to be consider before the use of them.
"Nine patients of the Gruenberger study had sufficient shrinkage to permit a later potentially curative resection,but long-term outcomes were not reported.further study of this combination is warranted"--from"systemic therapy for advanced cholangiocarcinoma" Jan 2011 uptodate.com .
Again, thanks for this concise info. for CC.
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Targeted Therapies, Cetuximab

Thank you for posting all of this interesting information.  You've done a lot of research.  My mom is also being treated at Sloan Kettering and I also have to say that her doctor is not very "creative" with different treatment options.  We've mentioned a few ideas to him but for now he seems to want to stick to the standard care therapies.  We did consult with Dr. Bruchner of Bruchner Oncology in NYC who has a great track record with CC patients and uses various treatment therapies tailored to individual patients.  Unfortunately, he is not covered by my parents' insurance so mom couldn't be treated by him.  I assume that you live in NYC area, so if you're looking for another opinion, this may be a good option. 
Thanks again for posting your research and all the best to you mom.

Re: Targeted Therapies, Cetuximab

A second opinion is generally quite helpful and I wouldn't hesitate to pursue that course. Good luck!