Re: Use of Oxaliplatin for Cholangiocarcinoma?

"J" <colourful@xxxxxxxxxxxx> wrote in message
news:42ADCF87.4AC50911@xxxxxxxxxxxxxxxx
> farrell77 wrote:
>
> > > > Yes. Eight three-week cycles of gemcitabine and
> > > > capecitabine. A scan after the first few cycles in
> > > > December showed some tumor reduction. A scan
> > > > in April after the eight cycles were completed showed
> > > > stabilization but no further reduction. So two additional
> > > > cycles of the same drugs were used. Now he's on
> > > > cisplatin (rather than oxaliplatin) and gemcitabine.
> > > >
> > What kinds of symptoms, for example? He has extreme
> > fatigue at times, severe pain, poor appetite, and weight loss.
> > I presume that the chemo drugs aggravate, rather than
> > alleviate, these symptoms. He seems willing to tolerate
> > them for now.
>
> Well, it could be the cancer also and/or what other organs are involved.
> Does he have jaundice? Have they put in a stent?

Not being on the scene (I'm in WNY; he's in Honolulu),
it's sometimes hard for me to get info, which is almost
always second-hand, except for when I visited for a week
last November. I'll do my best below with your questions.

Yes, he's had jaundice. They put in two stents last summer
(one for each lobe of the liver). Recently (within the past
month), they had to replace both stents. His doctor has
expressed concern over the facts that (1) the stents have
to keep getting bigger - presumably to accomodate the
growing size of the tumor? - and (2) there's risk of very
dangerous infections from the stents.


> > So it may come to what are the chances that the chemo will
> > extend his life and inprove life quality over the longer run.
> > From your next reference, the chances seem very small of
> > extending his life. My impression now is that in the absence
> > of other alternatives, he's still willing to try the chemo. He
> > was frustrated when there was a month gap from the end
> > of the capecitabine / gemcitabine trial and the start of the
> > current cisplatin / gemcitabine trial. He wanted to be at
> > least trying something.
> > J wrote:> Here's another one about chemotherapy that you may not wish to
read,
> > but should
> > > be made aware of
> >
>http://groups-beta.google.com/group/alt.support.cancer/msg/4befa08191d468b3
> >
> > From that, the chemo approach sounds not very promising.
> > I just learned over the weekend that his doctors have now
> > determined that he's a candidate for radiation, starting
> > this week. The cisplatin / gemcitabine chemo treatments
> > will continue, and radiation will be used 5 days a week for
> > 4 to 8 weeks.
>
> Hello,
> I'm hopeful hearing that he's a candidate for radiiation therapy.
> I'd like Steph to step in here. I don't want to see your brother
over-treated
> (which happens in some countries).
> Could you please describe the extent of his disease?
> I'm assuming since he wasn't a surgical candidate, it's intrahepatic
(ducts
> inside the liver) ?
> Where else?

It started in the bile duct inside the liver. Initially, we were
looking at a liver transplant in Pittsburgh with me as the donor
(having a blood type that would work). However scans
showed metastasis and so the focus shifted.

Some other background: he had ulcerative colitis at age 17,
which apparently led to sclerosing cholangitis later and then to
cholangiocarcinoma, which was diagnosed last August. Scans
in September 2004 showed metastasis to one lung and to one
other site: either stomach or back. Other organs, such as gall
bladder and pancreas are *not* involved at this time as far as I
know.


> http://www.cancerbacup.org.uk/Cancertype/Bileduct/Bileduct (providing
these as
> prompters)
> # The cancer has spread into the liver, pancreas or gall bladder or to the
> nearby blood vessels, but not the lymph nodes.
> # Stage 2B The cancer has spread into nearby lymph nodes.
> # Stage 3 The cancer is affecting the main blood vessels that take blood
to and
> from the liver, or it has spread into the small or large bowel, the
stomach or
> the abdominal wall. Lymph nodes in the abdomen may also be affected.
> # Stage 4 The cancer has spread to distant parts of the body such as the
lungs.
>
> and now I'm a little confused (I'm not a doctor) because this webpage says
that
> "most bile duct cancers come from cancers that originated in the
pancreas."
> http://cancer.stanfordhospital.com/healthInfo/cancerTypes/bileDuct/
> (yet the other one, above, says that's where it can spread to, unless
they're
> referring to extra-hepatic).

His started in the bile duct, intra-hepatic.


> So what organs are involved? And where exactly is his pain(s)?

Organs involved are bile duct, liver (not sure if damage is from
metastasis or the duct tumors pushing on it), one lung, and either
stomach or back. Pain is in these areas and, as he puts it,
seems to move around.


> I guess I'm also wondering, if you think the chemo is causing some of the
pains,
> how will you know if the radiation therapy worked, if he has radiation and
then
> right back on chemo?

The plan as described to me last night is to do the two (chemo
and radiation) in parallel. The chemo has already been started
and last week he received his second dose. He continues with
this every third week. The radiation will start this Thursday and
take place 5 days a week. So there will be overlap in the two
approaches.


> So if you could please provide more details, then let's see what Steph
> contributes.
> Thank you.
>
> And of course, I'll keep you all in my thoughts.
> J

Again, thank you very much.



.

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