From Bad To Worse...Again Tace, Etc. What Next

My husband was diagnosed with cholangiocarcinoma early this year when he urinated brown, pale poop, yellow.....achhhh ! He has had the stent in the bile duct which brought him back to the living. Tried chemo, gemcitabine and oxaliplatin, but dropped the oxal because the neuropathy was too severe.  He took a couple more weeks of gemcitabine alone, and had a scan showing Bob (the tumor) to be quite healthy and inviting friends over. They turned him loose, saying chemo was not helping and say the only recourse now is transarterial chemoembolization, but dont even know if they can do that since the portal vein may be compromised. WE are going for a consult to UW Seattle with Dr Whiting, and see if there is any hope anywhere. My husband feels good, now that there is no chemo running him down. But he looses spirit when he has no hope. This tumor is approx 14 plus cm, a big one and some more lesions now. Any one have some ideas or anything to share? We are being kicked to the curb. July 3 is our UW consult.  thanks  robyn

Hi,

Has the tumor shrunk at all?  I am not sure if it is resectable, but if it is at all, you might want to send your husband's file over to Lahey Clinic to be reviewed by Dr. Roger Jenkins.

Let me know if I can help. 

Sue

 

You must try new therapies like TACE. The leading expert is Dr. Andrew Kennedy at Wake Radiology in Cary, North Carolina. Also Davanat is a drug that increases the effectiveness of 5 FU dramatically and eliminates the side effects. I would also look into Tykerb. If your husband's cancer has not spread then contact Dr. William Chapman at washington University in St. Louis. They are doing a data collection study on this cancer with a liver transplant protocol developed at Mayo Clinic. Very impressive results but the tumor cannot have spread. Here is a recent artricle on TACE from another center.

 

TACE with microspheres preloaded with irinotecan in cholangiocarcinoma.

Sub-category: Multidisciplinary Treatment Category: Pancreas, Small Bowel, and Hepatobiliary Tract Meeting: 2007 Gastrointestinal Cancers Symposium

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Abstract No:	223
Author(s):	G. Fiorentini, C. Aliberti, M. Tilli, G. Benea
Abstract:	Introduction: Unresectable cholangiocarcinoma (UCH) carries a dismal prognosis, with median survival times ranging from 3 to 6 months from the time of diagnosis. Palliative therapies have been disappointing and have not been shown to significantly prolong survival. Conversely, TACE has been effective in prolonging the lives of patients with hepatocellular carcinoma but has been used not extensively against UCH. DC bead is new embolic microsphere product that is capable of being loaded with IRI just before administration in TACE procedure. Therefore, the purpose of the present study was to assess the safety and efficacy of this new embolic microspheres IRI loaded and administered as TACE in patients with UCH. Methods: Eight patients with UCH were observed and 7 accepted to be treated with one or more cycles of DC bead of IRI 100 mg-TACE between February 2006 and August 2006. Follow-up imaging was performed on all patients before, immediately after, and 4 weeks after each TACE procedure to determine tumor response and need for further treatment. Each patient received i.v hydration, antibiotics, and medications against nausea and pain before TACE. Survival was calculated with use of the Kaplan-Meier survival curve. Results: Response Rate of 100% followed RECIST criteria. All patients are alive, with a median survival of 6 months (range 2-8). The procedure was well tolerated by all the patients. Five cases experienced WHO grade 2 right abdominal upper quadrant pain (RAQUP) and grade 3 in 2 cases lasting 10 hours (range 3-24). All patients had grade 2 fever for 2 days (range 1-7) and nausea and vomiting grade 2 lasting 12 hours (range 3- 36). Other side effects were mild that quickly resolved with conservative therapy alone. No evidence of alopecia or marrow toxicity has been reported. Conclusions: The results suggest that TACE was effective at shrinkage of huge UCH and probably prolonging survival of patients even if our follow up is short. Therefore, for these patients, DC bead of IRI 100 mg-TACE may be an appropriate palliative therapy.

 

 

On 6/22/2007 Robynh wrote:

My husband was diagnosed with cholangiocarcinoma early this year when he urinated brown, pale poop, yellow.....achhhh ! He has had the stent in the bile duct which brought him back to the living. Tried chemo, gemcitabine and oxaliplatin, but dropped the oxal because the neuropathy was too severe.  He took a couple more weeks of gemcitabine alone, and had a scan showing Bob (the tumor) to be quite healthy and inviting friends over. They turned him loose, saying chemo was not helping and say the only recourse now is transarterial chemoembolization, but dont even know if they can do that since the portal vein may be compromised. WE are going for a consult to UW Seattle with Dr Whiting, and see if there is any hope anywhere. My husband feels good, now that there is no chemo running him down. But he looses spirit when he has no hope. This tumor is approx 14 plus cm, a big one and some more lesions now. Any one have some ideas or anything to share? We are being kicked to the curb. July 3 is our UW consult.  thanks  robyn

Hi Robynh,

My cousin (32) and I have been battling cc for 15 month's now.  We went 4 months before they said it was not responsive and told us to go home and ...  It was up to us try: do the research.  We started on (chemo based) cisplatin then and carboplatin for 3 months (3 weeks on 1 week off)  very small doses and made some great progress. Went from a dance party to just 1 guest who would not leave.  You will have to find a doctor who is willing to except the risks involved with these types of treatments.  Some places don't want to treat tough cases.  You have to find a treatment center in your area that will.  Please research if these will help you.

Carl