On Friday, June 17, we met with Mom’s oncologist, Dr. Diggs, to talk about treatment options for dealing with her cancer. We came to the meeting having done a lot of research and full of questions about which treatment would be most appropriate for the stage and type of cancer Mom is facing. Dr. Diggs spent quite a while talking with us, and by the end of the meeting, we decided to go with the clinical trial: Gemcitabine and Radiotherapy Versus Gemcitabine, Fluorouracil, and Cisplatin Followed By Radiotherapy and Fluorouracil in Patients With Locally Advanced, Potentially Resectable Adenocarcinoma of the Pancreas
Early the week of June 20, Mom will be placed in one of the two treatment arms. She’ll get a chemo port placed in her upper chest, and may be starting her treatment by Friday.
The data manager for the clinical trial is Lisa Peronto. She met with us after Dr. Diggs, and we liked her a lot. I think she’ll help us navigate all the doctors and appointments and details of Mom’s treatment, and it’s good to know we’ll have someone looking out for her and helping us by serving as a clearinghouse for our treatment questions.
She’s planning to set up an appointment mid-week to have a catheter placed in Mom’s upper chest for chemo treatments and blood drawings. It should be a day surgery. For more info on this type of catheter, see this website.
Dr. Gibson (her surgeon) would normally be the one to do this procedure, but as he is out for the next couple weeks, Lisa was going to identify a different surgeon on his team to place the catheter. While I know she’s not looking forward to the procedure, the catheter will keep the doctors from having to poke her for blood draws or chemo drugs during her treatment.
Sometime this week, they will also assign Mom to one of the two arms of the study. There isn’t a clear “better” arm to be assigned to.
Here’s how the study looks:
Arm A (standard therapy arm)
- Gemcitabine and radiation therapy once a week for six weeks
- Four to six weeks of no therapy
- CT scans to see if the tumor is resectable and if so, surgery (if it’s not operable, potentially go back to the Gemcitabine and radiation therapy again.)
- After surgery, four to six weeks of recovery
- Gemcitabine once a week for two weeks followed by one week of rest. Repeat five times.
Arm B (the experimental arm)
- Gemcitabine days 1, 5, 29, 33
Cisplatin days 1-5 and 29-33
5-FU days 1-4 and 29-32
Erythropoietin day 1 of weeks 1-9
- Three weeks of no chemotherapy
- Radiation therapy and 5-FU for six weeks
- Four to six weeks of no therapy
- CT scans to see if the tumor is resectable and if so, surgery (if it’s not operable, potentially go back to the chemotherapy followed by radiation).
- After surgery, four to six weeks recovery
- Gemcitabine once a week for two weeks followed by one week of rest. Repeat three times.
Once we know which arm of the study Mom is assigned to, I’ll write up a calendar with her expected treatment schedule. The radiation therapy takes about 30 minutes per day. Chemo in Arm A takes about one hour per day and in Arm B takes about four hours per day.
Breastcancer.org
has some nice info on their website about what to expect from chemotherapy. Lisa did give us a gentle warning that this treatment regime isn’t an easy one and that Mom is likely to experience nausea, hair loss, loss of appetite, and fatigue. The chemotherapy also may cause low white blood cell count and low platelet counts (making her more susceptible to infection and bruising).
At this point, Mom’s Cancer Antigen (CA) 19-9
count is 450. The average is 37, and the standard for resectable tumors in under 1000. We’ll be tracking this number through her treatment and will be hoping that chemo and radiation help to drop it down. It can serve as an indicator of how well the treatment is working.
During the meetings with Dr. Diggs, we talked about two alternative drugs, Avastin (bevacizamab) and Erbatix. Both of these are currently being used to fight other kinds of cancers and may have applications for pancreatic cancer, but it isn’t clear that either drug benefits pancreatic cancer. They work by cutting off the blood flow to the tumor. For more info on Avastin, click here. For a general article on these studies, click here.
I also have the results from a variety of clinical trials that used
these drugs and can give you links if you’re interested.
OK, enough info for today! Take care,
Althea