Topic: Example & Experience of A 2nd Opinion-@ Mayo Clinics
the following is for someone who wonder what a 2nd opinion is and how ,in general, what the experience is or will be.
After 2PET scans (2 month apart each) indicated "Stable" after microwave ablation; and Ca19-9 went up from 37 to 61; I called Mayo for a 2nd opinion on what to do next. Here was what happened:
1. Fasting the night before.
2. 1st day upon arrival in the morning went to the lab and get the lab work CBC,BMP ,Ca19-9 etc. done. then eat lunch at the cafe.
3. MRI @ 5pm.-last about an hour( no food were allowed 4hr prior to the scan.)
4. the next morning at 1pm,started with GI specialist Dr. Roberts Lewis for consult to map out the plan of treatment after seeing all the specialist below .Dr. Roberts suspected the microwave ablation that I have had done at the local hospital was not complete and therefore the tumor started to grow again even the PET scan indicated the tumor was "STABLE".(base on MRI scan)
5. 2:30pm saw liver surgeon to rule out resection due to lymph node mets. But he indicated Microwave ablation may be an option for the tumor in the liver and the result is comparable with surgery ; in the future,may be SBRT for the lymph node mets but now was too small to do so.chemotherapy should take care of the lymph node.
The most important thing he said is to keep the liver function normal as long as possible and therefore the lymph node metastasis was not a big concern at this moment.
6. 3pm Dr. Roberts were back in again and had a phone consult with the interventional radiologist and both agreed with microwave ablation as an option;but they would wait for the opinion of the medical oncologist and the radiation oncologist to make the final decision.
7. Next day at 9am, medical oncology consult started with a nurse practitioner(NP) to gather medical history,medication list etc.and discussed chemotherapy options including recommendation for GEM/CIS; but I refused and asked how about Gemox? She said there were not enough good responses from patients who got GEMOX at Mayo, so she will not recommend GEMOX. she mentioned I could use Gemzar and Xeloda again but in combination with other chemotherapy agents and not as monotherapy as I did before.Currently, there is NO clinical trial at Mayo for cholangiocarcinoma Irinotecan ,Taxol are other options she had mentioned.
Since the NP knew I preferred a more personalized medicine approach base on Target NOW and Foundation ONE ,(NGS-the next generation sequencing gene profile.)after she consulted with the medical oncologist for a while,He,
the oncologist came in and told me that both the lymph node mets and the tumor in the liver would have impact on my life span; combination therapy would be used for the maximum effects. Tarceva may not be a go to drug now but I should continue it until they(the oncologists) will make the final decision by e consult with Dr. R. Mcwilliams next Monday. I think he is the go to guy for finding actionable treatment plan base on those NGS reports if there is any. Therefore NO chemotherapy will be recommended at this time.I asked about immunotherapy like PD-1; He told me the future of immunotherapy is bright and will be a promising potential treatment agent for other cancers . In the next 1-2 years, some of them will be approved and the oncologists can use them "off labels" for cholangiocarcinoma. But he indicated that immunotherapy for GI cancers did not have a strong record of success(ie: IL2 in colon cancer);and it may due to the low volume but consistent recurrence and the difference in each patient's case .
8. 11am; saw radiation oncologist, he indicated SBRT treatment was not recommended this time; microwave ablation would be appropriate.They also explained how SBRT would be done if needed.
9. Dr. Roberts e mailed me later indicated they will make a final decision after Dr. McWilliams 's consult. Most likely I will have the microwave ablation done up at Mayo followed by systemic chemotherapy and/or targeted therapy