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Thread: Chemo after Whipple

  1. #1
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    Chemo after Whipple

    My husband's oncologist is not recommending chemo after his Whipple. The final pathology report did not find any cancer in what was removed. His ca 19-9 was normal for 6 months before the surgery but was 254 after. I was wondering when everyone else started their chemo after the Whipple. They plan on scanning him again in October/November.
    Judi
    9/16-68 year old husband diagnosed with Stage 3 unresectable pancreatic cancer
    9/16-12/16- Folfirinox 6 rounds of treatment
    12/16-CT scan, no signs of disease and normal tumor markers
    1/17-2/17- IMRT radiation 28 treatments with Xeloda
    3/17- CT scan, no signs of disease and normal tumor markers
    5/17- CT scan, no signs of disease
    7/17/17-Whipple
    7/31/17- Pathology report: "No residual tumor, complete response to treatment, grade 0. T0N0M0. NED

  2. #2
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    Judi,
    I had my surgery mid-June 2016 and started adjuvant therapy at the end of August 2016, about 2 months after surgery. I had 6 rounds of Folfirinox before surgery and 6 rounds of Folfox as adjuvant chemotherapy. My oncologist decided to continue Folfirinox as the tumor responded to it, but irinotecan was removed due to heavy side effects.

    Do you know why the oncologist chose no adjuvant chemotherapy? This is something I would want to know. Oncologists usually give adjuvant chemotherapy to remove any potential micrometastases not visible on imaging.

    Here are NCCN guidelines in terms of adjuvant therapy: "Patients who have received neoadjuvant chemoradiation or chemotherapy may be candidates for additional chemotherapy following surgery and multidisciplinary panel review. The adjuvant therapy options are dependent on the response to neoadjuvant therapy and other clinical considerations." https://www.nccn.org/professionals/p...guidelines.asp

    Brigitte
    __________________________________________________ ___________________
    1/12/2016 No symptoms except ongoing fatigue; blood test revealed elevated liver enzymes
    1/18/2016 Liver ultrasound revealed enlarged bile duct
    1/20/2016 MRI confirmed enlarged bile duct
    1/21/2016 ERCP and placement of a temporary stent
    1/28/2016 CT-Scan revealed a lesion on the head of pancreas
    2/09/2016 2nd ERCP + EUS + FNA
    2/12/2016 DX Borderline resectable pancreas ductal adenocarcinoma - Stage 3 @ 61
    2/24/2016 FOLFIRINOX 3 cycles (6 infusions)
    5/12-16/2016 CYBER-KNIFE Stereotactic Radiation 3 sessions
    6/16/2016 WHIPPLE + portal vein and right hepatic artery reconstructions - 0/19 nodes pos - no mets. Restaged to 1A
    8/31/2016 FOLFOX for 3 cycles (6 infusions)
    09/2016 Enrolled in Know Your Tumor - PANCAN.org
    11/4/2016 Quaterly monitoring for 2 years with CT Scan. CT Scan clear.

  3. #3
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    He told us there is no evidence of cancer and he wants him to recover from the surgery.
    9/16-68 year old husband diagnosed with Stage 3 unresectable pancreatic cancer
    9/16-12/16- Folfirinox 6 rounds of treatment
    12/16-CT scan, no signs of disease and normal tumor markers
    1/17-2/17- IMRT radiation 28 treatments with Xeloda
    3/17- CT scan, no signs of disease and normal tumor markers
    5/17- CT scan, no signs of disease
    7/17/17-Whipple
    7/31/17- Pathology report: "No residual tumor, complete response to treatment, grade 0. T0N0M0. NED

  4. #4
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    I ended up taking a break in my chemo regimen after an unfortunate incident with my stomach caused a week stay in the hospital. so my surgeon pushed for the break but i will be resuming chemo in a few weeks even though there is no evidence of cancer as of my last scan. Have they said anything about starting chemo in the future?
    1/8/17 Diagnosed with Operable PanCan
    1/31/17 Started Immune therapy clinical Trial at Hopkins
    2/13/17 Whipple Surgery
    5/8/17 Completed SBRT treatment at Hopkins
    5/16/17 Started first cycle of Chemo Gemcitabine and Xeloda
    6/1/17 Admitted back into Hopkins with Gas in Abdomen from perforated bowel
    7/5/17 After a week in the hospital and a months rest delay Chemo for 3 months
    7/21/17 Quarterly CT Scan shows no evidence of Recurrence

  5. #5
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    My MIL who had the Whipple in the beginning of June was told the same thing...no cancer present so no chemo for now.

  6. #6
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    Quote Originally Posted by edtude View Post
    I ended up taking a break in my chemo regimen after an unfortunate incident with my stomach caused a week stay in the hospital. so my surgeon pushed for the break but i will be resuming chemo in a few weeks even though there is no evidence of cancer as of my last scan. Have they said anything about starting chemo in the future?
    Getting CA19-9 and CEA done again in September. I would imagine if it is still elevated they will do a scan.
    Judi
    9/16-68 year old husband diagnosed with Stage 3 unresectable pancreatic cancer
    9/16-12/16- Folfirinox 6 rounds of treatment
    12/16-CT scan, no signs of disease and normal tumor markers
    1/17-2/17- IMRT radiation 28 treatments with Xeloda
    3/17- CT scan, no signs of disease and normal tumor markers
    5/17- CT scan, no signs of disease
    7/17/17-Whipple
    7/31/17- Pathology report: "No residual tumor, complete response to treatment, grade 0. T0N0M0. NED

  7. #7
    Moderator Top User ddessert's Avatar
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    My surgeon at MD Anderson also said that I did not need any adjuvant treatment. And my pathology was great, but nowhere as outstanding as your husband's!

    I have conflicting pieces of information about what to do.

    1. The statistics show that adjuvant treatment really does improve outcomes in patients, in general. For those who truly don't need it (& we don't know who they are), it is unnecessary.

    2. My oncologist (also at MD Anderson) said that she would not treat something that's not visible on scans (this was before my surgery). Chemotherapy works on actively growing cells and if the tumor's not active (on PET scan), chemotherapy will only work against the "good" cells in your body.

    3. If there is cancer left behind, this may be the best time to tackle it, although perhaps not with chemotherapy. It probably has little or no stroma to protect it and may be exposed to other treatments. It's thought that immunotherapy has been ineffective in treating PanCan because of the stroma. Your husband may not have this limitation. This would be one of the few situations where I'd recommend asking about immunotherapy in PanCan.

    If your husband is interested in clinical trials, this may be an ideal time to look into them. There's no urgency for treatment. You can be "risky" in treatment selection. It's like an insurance policy (at least that's how I looked at it). He can look for a trial that has a low treatment burden (few expected side effects, few/infrequent treatments) and if you don't find one, then you're still following the surgeon's recommendation.

    I'm very hopeful that you'll never have to come back to this board (but you're welcome any time, of course).
    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - Radiation+Xeloda, 25 days in 5 weeks
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IIA, PGP
    Sep 2012 - Whipple, T3N0M0, 0.5cm tumor, 0/16 lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-Dec 2016 - NED
    Mar 2013-present - NCT01088789
    @pancanology

  8. #8
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    I know i have been in a situation after surgery where my cat scan and MRI images came back NED but due to the high grade (how the cancer cells compared with healthy cells) and how poorly differentiated or and undifferentiated those calls are & how fast those cells were dividing (mitotic rate) doubling every 6 weeks, my oncologist was aggressive and wanted chemo treatments started promptly. Every time i hear a surgeon say he/she got it all, i know that is from a limited viewpoint and while it sounds positive, its no time to get complacent due to potential micro metastases.

 

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