Topic: Gemzar/Xeloda combination

We went to an oncologist (specialist in hepatobiliary cancers) earlier this week for a second opinion.  Of course we just wanted confirmation that we were doing what was appropriate, cause we're pretty happy with our present doctor and his response to chemo at this point (appears that the disease is stable and he feels pretty good).  She questioned the decision of using xeloda with gemzar when gem/cis is the standard of care.  My understanding is that cisplatin is more toxic and therefore a more difficult treatment.  After some research, I'm not sure that it's all that much more effective.  My husband has struggled with this ever since we saw her because he wants to do the right thing, but is afraid to change anything at this point.
What are your opinions?  BTW, he is 50 with no comorbidities and in the 2nd oncologists opinion, he should be able to handle the cisplatin.

2 (edited by eli Fri, 22 Jun 2012 21:16:22)

Re: Gemzar/Xeloda combination

Gem/Cis is the standard of care because it's the only chemo combination that has been tested in a Phase III clinical trial.  All other combinations have been tested in Phase II trials. Phase III trials are superior to Phase II trials.

However, and this is very important...

Phase III trial of Gem/Cis proved only one thing: Gem/Cis combination improved survival compared to Gemcitabine alone.  That's it.  The trial did not prove that Gem/Cis is better than Gem/Xeloda, or any other regimen.

If you don't mind seeing the survival stats, take a look at this paper:

Targeted Therapy for Biliary Tract Cancer

Scroll to Page 3 of the PDF and find this table:

Table 1. Phase II studies of gemcitabine-based regimen for unresectable biliary tract cancer

The table shows the stats from three Gem/Cis trials and four Gem/Capecitabine trials (Xeloda is commercial name of Capecitabine). Keep in mind, these are Phase II trials. Sample sizes are quite small. Also keep in mind, patient characteristics can differ quite significantly between these studies. So it's not necessarily an apples to apples comparison.

One thing is sure: it's a very tough choice. You have my sympathy.

3 (edited by PCL1029 Fri, 22 Jun 2012 23:53:44)

Re: Gemzar/Xeloda combination

Just like your husband said before,"why rock the boat if it works so far"
Also, lately I see more combination therapy prescribed using Gemzar+5FU 48 hr infusion pump and Gemzar+  Xeloda (is the oral form of 5FU) . I will continue the same regimen of GEMCAP(Gemzar+capecitabine) until it does not work anymore. I will avoid the platin group at all cost until it is unavoidable.
BTW, the article mentioned by Eli is a good reference for those who want to compare most of the regimens used for this cancer.
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: Gemzar/Xeloda combination

Thanks so much for your quick responses and the valuable information!  I'm feeling much better now about the treatment he's on, I think we'll continue on this road until forced to do something else.  Quality of life is important too and he certainly has that right now.

Re: Gemzar/Xeloda combination

If the Gem/Xeloda is working, why rock the boat, as you are all saying... There are so many combinations out there now. CC is different because the cell structure differs even within the same body. So if you found a chemo regimen that works, keep it up!!!

"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: Gemzar/Xeloda combination

I agree with Percy and Kris:

Continue Gem/Xeloda as long as it keeps working. Meaning, the tumors are shrinking or stable. If and when it stops working, switch to a different regimen.

Re: Gemzar/Xeloda combination

We're very pleased to follow all of your wise advice.  It's what we hoped to hear quite honestly.  I'm thinking that perhaps if chemoembolization is in his future, that going out of town to this other facility (MUSC) might be a better choice.  I believe that being a large teaching facility, that the radiation oncologist there will have more experience.  Having said that, I know I've got to do my homework. Got to be careful with assumptions!