According to the article " Liver and bile duct cancer " by Amal Samy Ibrahim, between 1999-2001 , there were 345 patients microscopically confirmed to have liver and bile duct cancer; 61 were female patients; out of that 61 pts, 80.3% had liver cancer and only 11.5% were dx as cholangiocarcinoma.
In short, there are almost 8x of more chances having HCC than ICC especially in FEMALE patient in Egypt.unless this study is out of date.
I think the combination of HCC-ICC is worth a second look based on the above stats and the abnormal AFP values unless chronic infection with HBV or HCV or aflatoxin contamination of food products can be ruled out.(this is purely my guess only and could be of no significance at all).
HCC is more chemo resistant ; but time has been change. I think when they do that studies,a lot of those targeted agents are still in infancy and thus may not include in the equation.
The increase of CA19-9 may be related to "*The associated mild segmental intrahepatic biliary dilatation noted around the main mass."
THE report is a bit different than the ones used in US, I want to see the tumor relationship related to its surrounding (ie vascular infiltration or just intraductal )
After almost 4 cycles of Xeloda(1500mg BID, 14days on/7days off as one cycle) that I am on now,
Hand-foot syndrome(redness and minor peeling of the skin on the palms of hands=2/10-on the scale of 1-10,10 being the worst));
fatique(=6/10); diarrhea=2-3 times/day(grade 1);
decrease in neutrophil(=2/10); increase lymphocyte(=1/10);
minor decrease in serium potassium and magnesium(=2/10)
minor increase in Bil.total=0.4(0.2-1) from 0.3.
Oncologist suggested to reduce the dose to 1000mg BID starting next cycle.
Relatively speaking, I tolerate the Xeloda mono therapy well.
CAPOX(capecitabine+oxaliplatin) : (1000mg/m2 BID Xeloda on day 1-14 + 130mg/m2 over an hour oxaliplatin on day 1),in one study had a overall response rate of 16% and a substantial number of patients had prolonged periods of STABLE disease. survival was not reported.
In another study,CAPOX treatment was well tolerated with only mild hematologic toxicity,grade 3 and 4 peripheral neuropathy. however,for unknown reasons, more favorable results were noted in the extrahepatic CCA group than intrahepatic CCA group.There were no complete or partial response for the ICCA group as compare to 2 complete and 8 partial responses in the ECCA group.(pts pop=65 )- review of systemic therapy of CCA ,uptodate.com.
Ask the oncologist why he or she want to change to CAPOX .What is his logical approach for using this regimen which seems favorable more to ECCA than ICCA that you mom has.
Base on what I can understand;the best option for your mom at this point may be radioembo with Y90 (using glass particles);and if so, make sure you ask whether there is a waiting period between switching treatment .
Interventional radiologist consult is highly recommended . Fatique is the major adverse reaction for the radioembolization with y 90.that may last for a week or two.Please read Rick.Kamp's experience on this board for week by week reports; mostly fatigue is the problem.(just type his name under the user list choose member and click his entry, start around message 43.)
Actually Radioembo with Y90 glass particles is recommended to me by a famed hepatologist recently on my 2nd opinion consultation for the future just in case . He also recommended sorafenib as targeted therapy for future consideration for my ICCA recurrence if it will be happened again.
I hope the above information helps.
BTW, how's the overall health condition of your mom compare to the pre-treatment level; I am a bit surprised by the STABLE response of your mom since I thought at least,the cetuximab will add benefit to the overall response of the treatment plan.
Keep in touch,
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.