Re: Hey Percy, could you please give us your expertise?

This is a reprint message: it may provide some help\;

Hi,everyone,

This is the current philosophy and practice of using CHEMOTHERAPY in general for treating.CCA that I believe in which is the less,the better.. I think his assessment is reasonable too.The following is quoted from the link at the end of this message under the experts review section if you want to read it through  the whole thing even though it is for colon metastasis.

"As we take stock of what is now available, we need to clarify how these agents will be used to maximize outcomes. This might include optimizing RRs with at least three agents when curative resection is the goal, or maintaining quality of life with sequential therapy if exposure to all agents is a reasonable expectation. Sequential monotherapy starting with capecitabine or 5-FU/LV with or without bevacizumab and then proceeding to either oxaliplatin- or irinotecan-based chemotherapy as second-line therapy may be considered in patients who are asymptomatic, in those with relatively slow-growing disease and/or in those with multiple sites of disease that are deemed to be unresectable. This is in line with National Comprehensive Cancer Network guidelines. Additionally, monotherapy may be more appropriate in elderly patients and in those with significant comorbidities. In contrast, initiation with combination therapy is more appropriate in patients who have excellent performance status and clinically aggressive disease, in those with significant symptoms and/or in those who may be considered for salvage via surgical resection."

http://www.clinicaloncology.com/ViewArt … a_id=20050

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: Hey Percy, could you please give us your expertise?

This is a reprint message about ASCO's point of view about biomarkers at 2011.

Below is the ASCO message about biomarkers usage.

What to Know: ASCO's Guideline on Tests to Help Choose Chemotherapy

Introduction

To help doctors give their patients the best possible care, the American Society of Clinical Oncology (ASCO) developed evidence-based recommendations on the usefulness of laboratory tests (called assays) to find out if a cancer might be resistant or sensitive to a specific chemotherapy treatment before it is offered to a patient. In 2011, this guideline was reviewed due to new research; this research continued to support the 2004 recommendations. This guide for patients is based on ASCO’s most recent recommendations.

Key Messages

    Chemotherapy sensitivity and resistance assays are laboratory tests that have been studied to help predict how well chemotherapy may work.

    However, these tests should not be used to determine treatment options for an individual patient.

    Instead, the choice of chemotherapy should be based on the research on the drugs being considered and the patient’s health and treatment preferences.

For additional info, go to cancer.net,home,publishing and resources,what to know ASCO guidelines
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: Hey Percy, could you please give us your expertise?

Percy, just a note to say you are wonderful!!! We all really appreciate you and your research and all you are doing for this Board! We love you, yes we do!

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

29 (edited by PCL1029 Sat, 25 Feb 2012 18:35:33)

Re: Hey Percy, could you please give us your expertise?

Hi,Pamela,
First ,here are some guidelines or principles  from a chapter of the textbook of "Oncologic Disorders" title  "Cancer chemotherapy and Treatment."

"The underlying principles of using combination chemotherapy are to use
1. agents with different pharmacologic actions,
2. drugs with different organ toxicities,
3.agents that are active against the tumor and ideally synergistic when use together,
4.agents that do not result in significant drug interactions."

Even though the combination of 5 FU and Gemzar is not as strong as the Gemzar/Cis combo and at most may be in the same effectiveness as Gemzar alone as indicated by a couple studies.However, base on my research,the toxicities of the drugs in the platinum family like cisplatin will pop up around the 6 cycle time frame as the drug accumulated over the course of treatment;that include allergic reaction to the drug and other side effects like nephrotoxicity(decrease kidney function) and neuropathy( hand-and-foot symptoms) and low blood cells count(WBC,platelets and RBC). ;therefore as a whole, I think your oncologist's decision is prudent if she decided to eliminate the cisplatin .She is thinking ahead of how to treat your daughter before side effects pop up. this is especially true if the CAT scan or MRI will show STABLE response or tumor shrinkage on March 8.. You can always add the cisplatin back  if needed.

So base on what the principles of the text book and the toxicity of the platinum;and the sign of a prudent oncologist that knows what to do .
I will not recommend any change of the suggestion that provided by your oncologist.Also in doing so, you will reserve more options down the road if needed.
good luck in surgery.
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: Hey Percy, could you please give us your expertise?

Percy, I know it's beautiful when it is falling but I am so happy I am in Phoenix! It is 80o today although we are going down to 60o on Monday! Guess I will just have to suffer!  LOL

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.