Topic: Xeloda & oxaliplatin, ?? Y90

Hi,
Just to remind u my mother has been diagnosed as inoperable ICC with bone metastases 3 months ago, since that she was on GEMOX (gemzar+oxaliplatin) (3cycles) and Erbitux (cetuximab)(6weeks), het CAT scan showed stationary disease ( the radiologist told me that some of the masses mildy increased in size but others are also decreased in size!!!) so it is considered as a stable disease, her tumor markers are CA19.9 183 to 540 but alfa feto protein was 596 and decreased to 303 which is really weird!!! her treating oncologist is not really satisfied with that result and he is planning to shift her to Xeloda+oxaliplatin and he consulted an interventional radiologist for Y90 and waiting for his reply.
Any body here has experience about that combination and Y90???
Is that possible that she may show better response (regression) after the next 3 cycles???
Thanks.

Re: Xeloda & oxaliplatin, ?? Y90

Fatema:
I think it all depends on the patient. Each person has different results with similar chemos, unfortunately.
I was on GemOx and it worked wonders for me. From what I've read Oxaliplatin and Cisplatin are the 2 main chemos for this disease. They mix with different other chemos for cocktails and sometimes they work great... sometimes they have to change the chemo treatments.
I hope the new cocktail works wonders for your mother.
Kris

KrisJ
"Don't just have minutes in the day; have moments in time."
Any opinions I give are based on personal experiences, and are not based on medical knowledge. I strongly suggest receiving medical care and opinions.

Re: Xeloda & oxaliplatin, ?? Y90

Fatema....until others have a chance to respond I thought to enclose a few links:
http://www.cholangiocarcinoma.org/punbb … hp?id=4170
http://www.cholangiocarcinoma.org/punbb … php?id=306
http://www.cholangiocarcinoma.org/punbb … hp?id=7491
http://www.cholangiocarcinoma.org/punbb … hp?id=3259
http://www.cholangiocarcinoma.org/punbb … php?id=938
Good luck,
Hugs and love,
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: Xeloda & oxaliplatin, ?? Y90

Hi,
Can you quote the impression part of the CAT scan report for me to know more about the details.?
Are they rule out the combination tumor type of HCC-ICC?
It does not make sense for  ICC to have AFP that high.
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: Xeloda & oxaliplatin, ?? Y90

Hi,
Percy this is the full report

REPORT
Compared to the previous CT scan dated 27/10/2011, the current scan revealed no interval changes regarding:
*The size, number and distribution of previously detailed hepatic masses.
*The associated mild segmental intrahepatic biliary dilatation noted around the main mass.
*The multiple celiac, para-aortic and retro-crural adenopathies.
*The multiple expansile lytic osseus lesions are noted at the lumbosacral vertebrae and right iliac crest, the largest at the right sacral ala, measuring 5cm.
There is however starting sclerosis of the DV12 lesion reflecting therapeutic response (healing).
*The multinodular thyroid gland.
*No other interval changes or denovo lesions.
OPINION:
Stable Disease (SD).

i thought about mixed type but when i asked her oncologist he said may be but we can't know, the interventional radiologist said it looks like cholangio rather than anything else!!!
When i searched the internet i found that ICC may be alfa feto prot. secrteting.
But if i supposed that it is mixed it doesn't make sense that alfa feto prot is declining and CA19.9 is increasing, as u know HCC is chemoresistant.
Could u tell me if u have any ideas abut Y90 or Xeloda??
Thanks.

6 (edited by PCL1029 Mon, 06 Feb 2012 14:58:27)

Re: Xeloda & oxaliplatin, ?? Y90

Hi,

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,
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: Xeloda & oxaliplatin, ?? Y90

my sister is about to start the same chemo treatment tomorrow. i have searched and searched for info about the xeloda-oxiliplatin treatment. i cant find much information on this. i found one small study that said this treatment showed positive results for extrahepatic cc but not intrahepatic cc. we are taking the study to the oncologist tomorrow to see what he says. i will post what ever we hear from him. i also found a clinical trial study that looks like it hasnt started but they are going to test xeloda-oxi vs gemzar-cisplatin to see what is more effective. it seems like they dont know much about the xeloda oxiliplatin combo yet.

Re: Xeloda & oxaliplatin, ?? Y90

Hi,
Thanks to u all for your replies.
Percy, i asked about mixed type (because i suspected it since the beginning since i saw the elevated alfa feto protein), i consulted her oncologist who said there is no method to diagnose it clearly, the interventional radiologist said that alfa feto protein is highly NON SPECIFIC and the CAT scan shows higher possibility of ICC or metastases rather than HCC.

He is replacing gemzar with xeloda as he thinks that it is not that effective (he isn't satisfied with the results of the previous 3 cycles), also he told me that we are waiting for the interventional radiologist till he comes back from a conference in France (about Y90) and he will consult them about my mom's case if they approved it in her condition she should be off Gemzar for 6 weeks as it increases hepatic sensitivity to radiation.

In Egypt CAT reports are as i posted, for further details i discuss them with doctors, her CAT scan were reviewed by the radiologist, the oncologist and the interventional radiologist.

Regarding Erbitux, when i asked the oncologist he said that he wasn't convinced by it from the beginning (he gave it to her because i asked him to do so...) but finally we decided to continue it till completing the 12 weeks.

BTW Percy, i asked him about sorafenib he replied that there are no recommendations to use it in CC, regarding panitumumab he told me that it is similar to cetuximab but "Humanized" so only less possibility of anaphylaxis.

Sallypa, thanks alot and waiting for your reply.

9 (edited by PCL1029 Mon, 06 Feb 2012 17:01:06)

Re: Xeloda & oxaliplatin, ?? Y90

Hi,

"BTW Percy, i asked him about sorafenib he replied that there are no recommendations to use it in CC,"
the sorafenib is a mutiple kinase inhibitor of many pathways.when i brought this subject up to the famed doctor about targeted therapy; that is what he thinks at this point sorafenib can  be  a good choice to use to attack mutiple pathways rather than one pathway just like  AKT (like MK2206) or mTOR( like everolimus);yes, the only one that aprroved for CCA is the Tarceva. all the others are for solid tumors. and it is not FDA approved indications for use  as such.
However, the purpose of my consult is for more understanding the current thinking of those who are at the top of their field .I was confused where I  start looking for research on the so many pathways of cancer biology.I don't know where to start and I don't want to waste time aimlessly. He told me AKT and mTOR are reasonable choices to look into. But just in case the newer drugs will not come out in time,sorafenib may be worth a look base on his research and becasue it is available on the market now.(the famed doctor is a hepatologist ; On the other hand the chief oncologist  when I consulted with him about chemo; the standard answers are given to me,Xeloda,Gem/Cis;Gemox;Taxol/carpoplatin and FOLFOX. none of the targeted agents are mentioned.)
So I will not blame your oncologist for his/her commend on that.
How is your mother,s health now? any side effects?
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: Xeloda & oxaliplatin, ?? Y90

Hi Percy,
I think that targeted therapy still has a very long way before it could be approved so we can only undergo the trials in addition to chemo.

My mother's general condition is better now except for the general fatigue after chemo cycles, she was sooooo scared before CAT scan and she cried much, you know what... that was the first time i realized that mom is caring about the illness (she is a pharmacist so she knows that she has a tumor but i thought that she doesn't know how serious is her condition), after CAT scan i was happy that she is stable but actually i was frustrated (also her oncologist) that there was no regression, i asked her doctor whether was the treatment stopped progression or it is the natural course of the illness and 3 months will not show progression, he replied that no body could answer that questions, when i asked him about his expectations, he said tha tshe may remain stable disease (which means he doesn't expect regression sad )

Re: Xeloda & oxaliplatin, ?? Y90

Fatema, I don't know a lot about Y90, but will share what I think is true.  I have a dear friend who has had one  treatment of Y90, and will be allowed only once more (I assume because of toxicity).  For her, it was pretty effective.  She had 15 external liver lesions.  The first scan following the procedure showed 12 were now 'dormant', whatever that means, but we took it as a good thing.  Three are now 'stable', which we read as still active, but no larger than earlier, which is good.  Side effects were mostly fatigue, which was not severe, and most have disappeared over time.  A mapping procedure precedes the actual Y90 procedure.  The mapping is to ensure no more than a small % of Y90 goes to the lungs or other organs.  If the criteria are not met with the mapping, the Y90 cannot be done.  My friend also did not have any known mets.

I hope this information is helpful to you.  Good luck in getting the right treatment for your mother.

Jim
Hospitals/Doctors Link,  Our Experiences:  http://www.cholangiocarcinoma.org/punbb/viewtopic.php?id=3126  See page 4 of thread for Dr. Tomoaki Kato info.
Major USA Cancer Centers:  http://www.cholangiocarcinoma.org/majorcancercenters.htm