Topic: Trying different chemos.

I met with Dr. Windham in Daytona to discuss the possibility of intraperitoneal chemo.  He said that I'm considered too high risk because of my liver transplant.  All this time I had vested much into the treatment with out much thought if it was going to work or not.  The best thing I can hope for is resection.

It's one thing to have it done and not know the outcome and another to not have it done because it does not yield any benefit. 

Which brings me to my question.  I am approaching my 10th treatment of Oxali/Gem.  I had imaging scans a couple weeks ago and things showed as being stable.  My cancer is mainly in the abdomen. 

I'd like to have a plan if and when the Oxali were to stop working. 

Is it possible to switch to Cisplatin or Carboplatin or are those too similar to Oxali???  I have read about Folfox as well being an option. 

This is a chemo driven cancer.  I think for many of us, where resection is not a possibility, it's best to focus on hitting- singles and doubles, knock the cancer back 3 or 4 months at a time until some better treatment comes along. 

Thanks again for your help!

Trevor

Re: Trying different chemos.

Trevor-I am a CC survivor due to a liver transplant, I am wondering have you had one or are you in the trial for a transplant? If you are in the trial for a transplant, chemo is really just part of the protocol and was told it would have little, if any effect on tumor, they just want to make it doesn't spread. I was told to not be suprised if it even grew!
Please post more about your story, this site is so full of "life expierences" and love.
Lots of prayers-Cathy

Re: Trying different chemos.

Hello Cathy, I had a liver transplant 2 years ago due to cholangio.  I went through the treatment protocol through Mayo in Jacksonville.  I experienced recurrence last June, in my abdomen.  I have come very far in 6 months, when I was I hospitalized and had a feeding tube stuck in me.  I wish to continue my progress and combat this awful disease. 

I'm thankful to have a great support system. 

Thanks for your thoughts. 

Trevor

Re: Trying different chemos.

Trevor...did you have the opportunity to follow up with another opinion from Wake Forest, NC?
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: Trying different chemos.

Dear Trevor,

My heart goes out to you. You have been through so much and still have a fighting spirit. I love that. I don't know much about the different chemos so I can't help you there. I did like what you said about hitting singles and doubles. That is what a lot of us are doing to try to keep going until another treatment comes along. All the best to you.

-Pam

My beautiful daughter, Lauren Patrice, will live on in my heart forever.

My comments, suggestions, and opinions are based on my experience as a caretaker for my daughter, Lauren and from reading anything I can get my hands on about Cholangiocarcinoma. Please consult a physician for professional guidance.

Re: Trying different chemos.

Hi, Trevor,

This was the reply to you not long ago from me if your former ID is " tnyjax34 ".

Hi,
If GEMOX(the regimen which you are having now) works like you say, I will continue the course of treatment until otherwise. You want to reserve more options for the future just in case. For me(as a patient),CC is  a long war and  not just a battle. You need to think far ahead of the game if God is willing to give His Grace to you and me to have that long the time frame to fight and learn about CC.
Gemox+ Cetuximab(a MoAb like bevacizumab-Avastin) have good results in objective response(63%) but long -term outcome were not reported.So when I read this article ,I ( as a patient)will think about what is next if this regimen don't work again after initial success and/or  if the CC recur again for the 2nd time . The other clinical protocol is Gemzar+Xeloda+Avastin which also provided good results but side effects  like colon perforation from Avastin has been reported.
In general "IF IT WORKS,DON'T FIX"
God bless.

The following is my response to your current questions.

If  currently your CCA is "stable" that means your CCA is  currently responsible to the GEMOX treatment . Carpoplatin and cisplatin(which you had before changing to oxaliplatin because of nausea/vomiting side effects) are more or less the same because they are all belonging to the platium family .
Gemzar+ carboplatin is mainly a regimen for bladder cancer. GEM/CIS and GEM/CAP are for biliary and pancreatic cancer.

If you have peritoneal metastasis GEMOX+ Avastin may be of value since I knew it has good objective response( partial response>30% for my sister-in law's peritoneal carcinomatosis in her omentum.) She had to discontinue the Avastin due to colon perforation caused by Avastin. But every patient is different and the incidence rate for GI perforation of Avastin is <1%-4%. 
Folfox is 5FU+oxaliplatin but  CAPOX--CAPecitabine(a prodrug of 5FU)+ OXaliplatin may be easier for patient since Xeloda is taken by mouth. If you had extrahepatic CCA before you had the liver transplant,a phase II study of CAPOX trial of 65 patients with advance biliary cancer shown more favorable results to extra than intrahepatic CCA patients.
Of course molecularly targeted agents like Tarceva and others are among other choices if you will need them in the future.

Again, please always keep in mind that ,the addition of other drugs ,in theory, will add toxicity too. so you have to weight the benefits against the adverse effects as well. good luck and
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: Trying different chemos.

Hello,

Marion- I just found out today about Wake Forest.  They said no because I am considered too high risk because of the transplant.  I didn't know what the results would bring, there has been no evidence that it has worked for cc...

Percy-Thank you for that information.  So would Cisplatin/Gem not work because it is too similar to Oxali???  Have you read of any cases where they have switched from Oxali to Cisplatin after one had worked and vice versa? 

I also read in your previous post that Gem/Xeloda/Avastin would be a possibility.  I know its different for everyone, but what would you say is the most logical choice if/when the Oxali were to stop working???

Thanks again. 


Trevor

Re: Trying different chemos.

Hi,

"So would Cisplatin/Gem not work because it is too similar to Oxali???"

Carboplatin and oxaliplatin  are sometimes called a “second generation” platinum drug. The first generation consisted of the drug cisplatin, which came to prominence in the 1970s.  Carboplatin was designed and planned as an improvement – a drug that worked in largely the same way with the same chemical mechanism, but with better biochemical properties that would not produce such nasty side effects.  The idea was that with a lesser side effect profile, higher dosages could be given .
So the answer is no.

"Have you read of any cases where they have switched from Oxali to Cisplatin after one had worked and vice versa? "
Sorry the answer is no again.

"I also read in your previous post that Gem/Xeloda/Avastin would be a possibility.  I know its different for everyone, but what would you say is the most logical choice if/when the Oxali were to stop working???"
The answer is yes;but as you know I am only a patient like you and not a doctor;therefore  you need to talk to the oncologist ,and please remember,
newer regimens may come up anytime ,so only ask the doctor at the time of need and not when your current treatment is still working.In that way ,you will not miss the boat of better treatment plans.
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.