New thread - am I getting enough???? (Page 2 of 2)

Hi Derin,

Re: the number of cycles

Several considerations:

1. ABC-02 trial used 8 cycles to treat nonresectable/metastatic cases. I think it's logical to conclude that adjuvant chemo should do less than 8 cycles.

ABC-02 is British Phase III randomized trial that proved Gem/Cis to be superior than Gem alone
http://www.nejm.org/doi/full/10.1056/NEJMoa0908721

2. Biliary Tract Cancer Treatment Protocols recommend the same protocol as in ABC-02 trial:

Up to 24wk = Up to 8 cycles. Again, this is for nonresectable or metastatic cases. Adjuvant chemo should probably do less.

3. Before my wife started Gem/Cis chemo, our oncologist said he wanted to do 4-6 cycles. I asked him why not 8? (based on the info above). He explained that they usually do adjuvant chemo for up to 6 months, including 5FU/Xeloda chemo done concurrently with radiation. Marina did 5FU chemo-radiation for 2 months. That left her with 4 months to do Gem/Cis chemo. Enough for up to 6 cycles.

4. As I mentioned in another thread, we were on the fence about continuing adjuvant chemo past the 4th cycle. We met our oncologist last week. We asked him if more cycles is better. He said they don't have any data to support any particular number of adjuvant cycles. For what it's worth, we decided to do the 5th cycle. We are scheduled to do CT scan after the 5th cycle. No decision on the 6th cycle at this point. One cycle at a time...

Hope this helps,
Eli

Hi Derin,

Sorry to hear about your daughter.  Seems like a lot of stuff going around right now.  I'm just getting over a bronchial infection, so I haven't slept in my bed for a month.  John has never really taken any extra precautions since he was diagnosed with ICC, but he had always been very healthy before.  Luckily, the kids don't get sick that often, although they're both stopped up right now.  I think our beautiful weather has something to do with it.  I'm glad that your counts went up and I hope your chemo on Friday goes well.  Sending well wishes to Sydney and positive thoughts to you,  PeggyP

Derin....excellent news.  Your CA 19-9 were in the normal range before and it continues to follow a downward trend.  Great to hear that Sydney is responding well to the antibiotics - looks life is taking on some normality. 
Hugs,
Marion

Well, that was fun... 12 sessions with Gemzar being injected and the 12th one the nurse decides to use a hand located IV... Man that stuff was not comfortable going in. I guess my arm veins are bigger than the hand ones... Added saline at 1000 ml/HR to stop the burn/pain. Saline ran out with 10 minutes to go of Gemzar, pain kicked in again and I pushed the stop button on the pump myself until the nurse could come over and get me another saline bag! 

I'm officially at my last chemo session with Gem/Cis. About 2.5 hours to go, half way through the first dose of Potassium/Magnesium.  Numbers from today's bloodwork:

wbc     2.3 (4.7 last week)
hbg    12.2 (13.1)
hct     37.8 (40.2)
Plat    220 (218)
ANC    0.9 (2.5)

Well, gotta pee, talk to you all later!

Well, officially done with chemo! Had a CT Friday last week prior to starting the radiation. This is the best part of the lab writeup: "Impression: Findings are not suspicious for tumor recurrence or metastatic disease." Gotta love that 7.5 months post surgery, that' for sure!!  I guess I'll start up a new post under Radiation once I start that up. Go tomorrow to radiation onc to get set up for the start of radiation, probably 2nd week of May as there should be 3-4 weeks between chemo and radiation...  BTW, my hand still freakin' hurts from that Gemzar, but at least it was the last time that it happened and not the first. Funny how that worked out, isn't it?

Got my first chemo today, the usual cis/gem but the dose is higher than anything else I have seen on this list: cisplaitin at 75 mg/m2 with gemzar at the usual 1000. Gemzar really got the vien hurting. Next time they'll try for a bigger vien. Nurse said she has even seen the cisplaitin dosed at 100mg/m2. She says at 25 or 50, no probable hair loss but at 75 highly likely. less side effects at the lower doses, easier on your kidneys. what I really don't want to lose is my hearing! I'm a musician!

Good luck with your adjuvant therapies. They probably don't need to be as high and of course, they are poison. Today I felt like the Norman Invasion - - every bit of firepower that could be mustarded was thrown at those beaches and the enemy was clueless.

Keep on hoping on.