Topic: Report from Japan on CC follow-on chemo treatment

Does anyone else have info on this Japan study or use of similar treatment for surgery survivors? 

This isn't the direct link. I had it once but I lost it. This article does recap the work done in Japan.  And I haven't seen it referenced on this forum, perhaps I just missed it.

http://www.allbusiness.com/health-care/ … 827-1.html

The bottom line is that the five year survival rate jumps from 23% to 57% if a course of gemcitabine is completed after liver surgery (partial removal) and radiation/chemo.  Albeit, this is a very small sample size of cases it is interesting information. 

Mary's Oncologist at Stanford, George Fisher, is apparently on top of all this for  he started telling us about it in September even though the paper was only published the prior month. He recommended this chemo as Mary's strength increased after she had completed the radiation+oral chemo in August. 

She started gemcitabine in October. 

The bottom line is that the gemcitabine destroyed Mary's bone marrow after only two injections (week 1 and 2). In week 3 they gave her a transfusion of 2 units of whole blood because her blood metrics were in such bad shape.  Subsequently, she will not restart the chemo because the impact to Mary is so negative. 

Apparently, in the middle of all this, Mary developed a horrible upper back pain.  They focused on that with xRay, MRI, bone scan and a simultaneous PET+CT combo scan plus tracking CA-19-9.  The conclusion is that there isn't cancer present in the vertebrae.  What is diagnosed is a "compressive fracture of a thoracic vertebrae."  The source is unknown, but we suspect 1) Mary's Osteoporosis history coupled with 2) six weeks of radiation and 3) some weakening of the bone due to the bone marrow damage caused by the gemcitabine treatments. 

Before the gemicitabine, she was darn close to being normal in her energy and behavior. One day she baked up dozens and dozens of cookies for the expected Thanksgiving visit by our adult offspring.  Now, she is on a fentanyl patch and Celebrex to manage the pain in the upper back which makes her sleepy and lethargic. And, the fentanyl messes up her digestive tract like all narcotics do to her. The patch makes it much less but still messed up.

The current recommendation is to give her the nominal 8 to 10 weeks to heal the vertebrae and then head back to the Oncologist to see if there is any new news...a surveillance visit as it is called at Stanford.

Does anyone else have info on the Japan study or similar treatment for surgery survivors?

Re: Report from Japan on CC follow-on chemo treatment

Hello Pat. ...my aunt (90 years old) had her compression fractures treated with Vertebroplasty/Kyphoplasty.  Is that an option for Mary?  I recall Mary being treated with Xeloda and radiation beads post surgery and I am wondering why Dr. Fisher had thought to include Gemzar in the follow-up.  Is it due to the negative margins?  From what I have seen on this board Gemzar has not always been tolerated well and it appears that Mary also is one of those people. 
Thank you for posting this link. It is always very much appreciated when others do the same because, I believe, all information regarding this cancer should be brought to the attention of the members.  Albeit, this was a retrospective study, the small sample size, and it had been conducted in Japan, I would assume for few patients to come forward and post on our site.  But, there may very well be someone who had been treated with Gemzar post-surgery and I am hoping to hear from that person or persons.
I will be attending the GI ASCO in January (I would not be surprised to see Dr. Fisher there also) and I will report back with any new discovery. 
In the meantime I am hoping for Mary to have less pain real soon so that she can get back to the "normal" she had experienced before the Gemzar treatment. 
All my best wishes,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: Report from Japan on CC follow-on chemo treatment

Oh, I forgot to mention Pat, I also reside in the Bay Area although, it is in the North- and East Bay.  (I switch back and forth.)
Best
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: Report from Japan on CC follow-on chemo treatment

Answering your questions:
Dr. Fisher did send (or at least he told us he would send) all of the test results to the IR (Interventional Radiology) docs to see if they thought they could do anything. It has been seven days as of today and we have not heard from the IR department. We are assuming they do not see a path of success given her situation.  After all, it took xRay, MRI, bone scan and a combo PET+CT to arrive at the "no cancer" verdict.  Mary's surgeon, Dr. Visser told us the artifact on the bone scan and MRI was classified by the pathologists as TSTC aka "Too small to classify."  The combo PET&CT simply excluded cancer, it apparently didn't give an unambiguous interpretation.  Which is why they sent all those results onto the IR doctors. 

Clarifying, after surgery, Mary had a full course of daily radiation plus Xeloda for a total of 28 treatments ending in mid-August.  She had some rough spots after radiation but by the end of September to early October, she was in the "feeling better than 80% of normal" league.  Then the Gemzar started.   

The follow on Gemzar was specifically ordered by Dr. Fisher because of the data from the Japan report and he cited the 5 year improvement rate as the reason for recommending the Gemzar.  We now know Mary and Gemzar are not compatible. 

We are very hopeful the vertebrae is capable of healing itself and Mary will be closer to normal sometime in early February.  We may still hear from the IR docs and if we do, we will have the consult. I cannot say if we will do any techniques depending on the info they provide.

You are probably thinking, "Why don't they call to find out why?"  Frankly, we are overloaded with visits and trips to see doctors and have tests and procedures run.  As Mary has said, "Its getting a bit too much when the lab techs in the blood department all know me by name."  A couple of quiet weeks and we may get back to it if Mary's pain isn't behaving.  In fact, that was Dr. Fisher's recommendation:  Stay away unless you need something from us.  We will leave you along so you can take the time to heal.  We'll see you in March. 

Thanks for responding,

Pat

PS: Do you live on the San Rafael Bridge?

marions wrote:

Hello Pat. ...my aunt (90 years old) had her compression fractures treated with Vertebroplasty/Kyphoplasty.  Is that an option for Mary?  I recall Mary being treated with Xeloda and radiation beads post surgery and I am wondering why Dr. Fisher had thought to include Gemzar in the follow-up.  Is it due to the negative margins?  ...  In the meantime I am hoping for Mary to have less pain real soon so that she can get back to the "normal" she had experienced before the Gemzar treatment. 
All my best wishes,
Marion

Re: Report from Japan on CC follow-on chemo treatment

Pat....Ha, ha....Good point. It always is a pretty ride crossing the San Rafael bride and I have yet to encounter a backup unlike the one experienced on either, the Bay Bridge, or the Golden Gate Bridge.  I am hoping for Mary to improve a bit each day and although, the Fentanyl patch causes her to be drowsy at least there is a break from the almost normal routine of having to drive to Stanford.
Thanks for the great explanations.
Best wishes,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER