Re: Use of Oxaliplatin for Cholangiocarcinoma?

farrell77 wrote:

> "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.
>

Thanks for answering my questions.
I understand. It's hard to know exactly where they'll be doing the radiation
therapy.
I'll watch for your updates.
Best,
J

.

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