Topic: Gem/Cis Cycles

I am asking for comments/opinions. Is there a defined standard number of cycles of Gem/Cis ?

In meeting with our oncologist, she recommended 8 cycles of Gem/Cis and then switching to only gemcitibene because of the effects of cisplatin (and other platinum based drugs) on the kidneys.

We are currently in the 5th cycle and my wife (ICC) is managing the chemo well. As of Monday, July 30, all blood work looks good (even a significant reduction in the CA19-9 marker). And, as mentioned in earlier posts, the CT scan on July 1, after cycle 3, confirmed the chemo is having a positive impact on the liver tumors and lymph nodes.

I thought I've read posts from others who have gone through many more than 8 Gem/Cis cycles. I am not sure if her suggestion of stopping cisplatin is based on other studies, personal experience, etc.

As an aside, it has also been suggested by another doctor to switch to radioembolization after the 8 rounds of Gem/Cis. We are going to explore that option as well. The next scheduled CT scan will be after cycle 6 so we have some time to research our next course of action.

Thanks,
Carl

Re: Gem/Cis Cycles

Carl,

We are in a similar situation.  My wife (ICC) is starting round 6 of Gem/Cis today.  She had a positive scan after round 3 (20% shrinkage), and is getting another scan after this round.

She is being treated at Stanford.  Radioembolization is also available and encouraged at Stanford.  Evenso, there has never been any discussion regarding a max number of Gem/Cis cycles.  They do monitor kidney functions and we spend a lot of time and effort hydrating to help minimize the kidney impact.  While things can change, the current plan is to keep on with Gem/Cis until it no longer works and then likely move to radioembolization.

I would ask the doc the rationale for a max of 8.  Are more cycles less effective?  Are they seeing something in the liver function bloodwork they don't like?  Research out there supporting this approach (I haven't seen/heard of this)? Hunch? what?

Best,

Jason

3 (edited by thebompie4 Wed, 31 Jul 2013 10:47:44)

Re: Gem/Cis Cycles

fist can we define 8 rounds (i always get so confused)

are you counting a "round" as the 2 weeks on and 1 week off?

If so, my husband is done with Round 7 of gem/cis and will do TWO
more (so 9 total)...

at which point they are suggesting radioembolizion or chemoembolization.

When we asked they said the following:

* it's neither because he's doing good or bad on the current treatment.
he doing just fine.  BUT at some point EVERY CC patient builds up a resistance to this chemo and it quits being effective and does not work anymore.

*so they want to throw something else into the mix so that they can
GO BACK TO gem/cis if they need to in the future.

if it quits working, many times insurance will not cover the cost of it anymore
(at least that's how it was explained to us).

obviously if it's not working--we have bigger fish to fry. right?

FTR, my husband is stage 4 ICC--one large tumor in the liver with mets
to lungs and regional lymph nodes.

he has seen a 60% decrease in liver tumor size and then another 20%
decrease after two pets scans and almost 5 full months of this stuff.

hope that helps~ Dorien

Re: Gem/Cis Cycles

These are my thoughts:   There are numerous links re: the treatment with Gem/Cis.  This is one of many:
http://www.medscape.com/viewarticle/719863
The protocol established is used widely however; a physician will then determine what he/she feels best to administer additionally or how to change the protocol for a particular patient.
For example:  Phase I studies establish the toxicity level.  Phase II studies follow with a larger control group in order to evaluate the efficacy of the regimen.  Phase III studies (most often) compare a standard of treatment to the newly developed drug(s.)
In our case, given the fact that we don't have much to go by and the Gem/Cis study has emerged as the standard of treatment, physicians will focus on the response to treatment and tolerable side effects all the while knowing that within a certain time tumor response will be diminish and ultimately will cease to be effective.
The question we ask: do we know that the established cycles of dosage provides equal efficacy if it were to be increased or decreased?  For our cancer, these studies have not been conducted.  In fact, rarely (if ever) do we see studies that challenge the existing protocol cycles of administration. 
I agree with Jason in that I would ask the treating physician for his/her reasoning for changing the current approach however; I am not surprised by the decision because; we do not have a curative regimen for our disease. 
Hugs,
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: Gem/Cis Cycles

Thanks for the replies. The reason the doctor gave us for stopping after 8 cycles was because of toxicity to the kidneys. She said that all the platinum based drugs eventually can cause damage to the kidneys and she would rather stop the Cisplatin after the recommended 8 cycles than risk the possible impact on the kidneys.

And Dorien, the 8 cycles, or rounds, refers to 3 weeks (2 chemo weeks and 1 recovery week) for 8 consecutive time periods.

Thanks again.

Re: Gem/Cis Cycles

ok so my husband will have *9* rounds of this by the time he's done.
(of 2 weeks on/one recovery week)--

Re: Gem/Cis Cycles

Carl...the answer is not unexpected - platins are harsh on the kidneys.  Numerous others had to withhold the Cisplatin for the same reason.  Oxiliplatin is a bit less toxic.  Wishing for all good things to continue.
Hugs,
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