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Thread: Mother had distal pancreatectomy T2N1M0. What next

  1. #31
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    Hey David,

    Been thinking about which regimen to choose for adjuvant chemo. Does use of S1/Capecitabine at adjuvant stage affect use of Folfirinox at later stage (tho i hope there's no later stage)? S1/Capecitabine are both essentially 5-FU, which is also in Folfirinox. So i would guess there should be shared drug resistance among them.

    Thanks!
    Oct 2017 - Mom's annual checkup found elevated CA19-9 (280 kU/L)
    Nov 2017 - Diagnosed. Pancreatic Adenocarcinoma on body/tail of pancreas, ~3cm mass
    Dec 2017 - Successful distal pancreatectomy, 3.5*3*2 mass removed, 2/17 lymph nodes. CA19-9 dropped to 30 kU/L 4 weeks after surgery.
    Jan 2017 - Elevated CA19-9to 70 kU/L before chemo. Now 2 rounds of S1

  2. #32
    Super Moderator Top User ddessert's Avatar
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    That’s a tough question. I used to think that 5-FU and Xeloda/Capecitabine are essentially the same. However, several things make me question just how similar they are.

    There’s nab-paclitaxel (Abraxyane) and paclitaxel. Abraxane, while packaged differently, seems to be far superior. Especially when combined with Gemcitabine. Perhaps there is some synergy with the combination?

    FOLFIRINOX is a 4-drug combination. However, 5-FU is given in two different ways: bolus (a quick injection) and a 46-hour infusion. The chemotherapeutic effect is quite different between the two. So much so that some call it a 5-drug cocktail.

    Capecitabine is a version of 5-FU. I’ve asked oncologists why we still do the 46-hour infusion if we could just replace that with a few pills. The answer I got was that the side effects of Capecitabine were much worse. I don’t have any studies to back that up, just their observations.

    Onyvide is a repackaged version of irinotecan. It received separate approval, although I’m not sure how they’d compare head-to-head.

    There’s a repackaged version of the generic drug Cisplatin in trials.

    For some of the new drugs I wonder if there’s a ‘pharma-bro’ aspect? Are companies taking effective generic drugs and repackaging them to make more money?

    The short answer is that I’m not certain, but I think that if I had to compare the options, I’d put the drug similarities in the ‘disadvantage’ column. But it’s not a deal-breaker.
    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-Nov 2017 - NED
    Mar 2013-present - NCT01088789
    @pancanology

  3. #33
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    A drug is not only the effective substance, but also a whole system that helps to improve delivery, prolong targeted concentration in blood and tissue, reduce side effect, etc. In my opinion, difference between nap-pac and pac, and between Capecitabine and 5-FU, is that the system to deliver substance to cancer cells is changed/improved. However, the central mechanism of how a certain substance kills cancer cells remains the same. So I would believe if cancer cells develop resistance to Capecitabine, they do to 5-FU as well. After all, its still ultimately 5-FU that works on cancer cells for these 2 drugs.

    I asked an oncologist in the hospital where my mom had the surgery about this question. What she said was that don't think about the future treatment (referring to chemo for stage IV) when you are not there yet. I'm gonna consult more doctors.

    Anyways, my mom is NOT physically fit, so we are probably gonna choose something easier to take.
    Last edited by mel109; 12-18-2017 at 07:51 AM.
    Oct 2017 - Mom's annual checkup found elevated CA19-9 (280 kU/L)
    Nov 2017 - Diagnosed. Pancreatic Adenocarcinoma on body/tail of pancreas, ~3cm mass
    Dec 2017 - Successful distal pancreatectomy, 3.5*3*2 mass removed, 2/17 lymph nodes. CA19-9 dropped to 30 kU/L 4 weeks after surgery.
    Jan 2017 - Elevated CA19-9to 70 kU/L before chemo. Now 2 rounds of S1

  4. #34
    Super Moderator Top User ddessert's Avatar
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    Yes, this could be. The other thing these encapsulations around the drugs may do is allow more of the drug to get into the tumor cells. If penetration is the problem, that is a good sign. If the cells have already developed a resistance, then it seems that the encapsulation will not help. Unfortunately, we'll never know which one is why the 'basic' drug stops working.

    That is an interesting choice: "mom is very physically fit, so we are probably gonna choose something easier to take". Most make the opposite decision. That said, I respect either decision.
    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-Nov 2017 - NED
    Mar 2013-present - NCT01088789
    @pancanology

  5. #35
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    Quote Originally Posted by ddessert View Post
    Yes, this could be. The other thing these encapsulations around the drugs may do is allow more of the drug to get into the tumor cells. If penetration is the problem, that is a good sign. If the cells have already developed a resistance, then it seems that the encapsulation will not help. Unfortunately, we'll never know which one is why the 'basic' drug stops working.

    That is an interesting choice: "mom is very physically fit, so we are probably gonna choose something easier to take". Most make the opposite decision. That said, I respect either decision.
    A terrible mistake. What i meant is that my mom is NOT physically fit..

    I'm so sorry.. I'm just under pressure with so many things going on in my mind.
    Oct 2017 - Mom's annual checkup found elevated CA19-9 (280 kU/L)
    Nov 2017 - Diagnosed. Pancreatic Adenocarcinoma on body/tail of pancreas, ~3cm mass
    Dec 2017 - Successful distal pancreatectomy, 3.5*3*2 mass removed, 2/17 lymph nodes. CA19-9 dropped to 30 kU/L 4 weeks after surgery.
    Jan 2017 - Elevated CA19-9to 70 kU/L before chemo. Now 2 rounds of S1

  6. #36
    Super Moderator Top User ddessert's Avatar
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    I understand.

    How we can make the 'best' decisions based on crappy information is of interest to me.
    I realize that fact that every treatment decision I've made thus far has turned out well is largely blind luck.

    I've tried to tell PanCan, Let'sWin, and others that we should try and learn from decisions that do not turn out well, too. I don't want to solely focus on the survivors. The idea behind those statements is that everyone's experience brings value to us all.
    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-Nov 2017 - NED
    Mar 2013-present - NCT01088789
    @pancanology

  7. #37
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    My opinion is that pan can is just a gross category. It has so many forms that respond to treatment differently, on top of variance of individual patients. Therefore, our current treatment system can't really differentiate such difference, and treat every patient almost in the same way (surgery + limited chemo options).

    My point is, even if a patient/doctor makes the best decision based on knowledge, it still has a high chance of not turning out well. So much luck there.
    Oct 2017 - Mom's annual checkup found elevated CA19-9 (280 kU/L)
    Nov 2017 - Diagnosed. Pancreatic Adenocarcinoma on body/tail of pancreas, ~3cm mass
    Dec 2017 - Successful distal pancreatectomy, 3.5*3*2 mass removed, 2/17 lymph nodes. CA19-9 dropped to 30 kU/L 4 weeks after surgery.
    Jan 2017 - Elevated CA19-9to 70 kU/L before chemo. Now 2 rounds of S1

 

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