Doctor Needed And Treatment Options

Hi,

I am a nurse and my mother in law was diagnosed with Stage IV "inoperable" stomach cancer (mets to liver 4 lesions, and nodes) in March 2007.  She was diagnosed via endoscopy and CT scan showed mets to liver and nodes.  She had a gastric stent placed and started with Irinotecan and Cisplatin and the tumor increased in size.  She was switched to Avastin, Xeloda, Oxiliplatin, with great results.  The tumors in her liver shrunk by almost 40% but then her neuropathy increased, she had severe Palmar-Plantar Erythrodysesthesia (skin on feet were red and peeling) and platelets were <75,000 and the chemo regimen was cut gradually to 50%.  The most recent CT showed tumor growth (one tumor increased by 2 cm).  Her doc is now saying that he feels she should try a clinical trial.  We asked him about liver directed chemo since the liver seems to be the worst area but they didn't feel she was a good canditate since she was Stage 4.  Has anyone with Stage 4 had liver directed therapy?  Also, we live in Maryland.  Anyone know of a great oncologist in the state or nearby states that has experience with gastric cancer?  It seems to be an Asian disease and it's hard to find someone with experience in our area.  Any help or suggestions are welcome. 

Hi-

My husband was dx in July 07- GE junction cancer with mets to the liver and lymph nodes also stage 4.  non operative so he started on oxoliplatin, xeloda and epirubicin 8 cycles good results with the first 6, liver cleared tumor decreased by 50% nodal disease remained unchanged. Figured the treatment was no longer effective and he went onto carboplatin and taxotere...2 cycles were very hard on him and unsuccessful. His last CT showed over 12 lessions to the liver and the disease has progressed.  We are now going to Stanford and on a clinical trial phase 2 of XL880. He has had one complete cycle and we can see improvement in his pain and energy. He will go through 5 cycles. Clearly too early to tell, but where he used to sleep most of the day- he is now up and feeling somewhat improved. His color is better and pain easier to control.  In all the research we did- the clinical trial was really our only option. We feel great about Stanford and have excellent Dr.'s working in the trial.

Best of luck to you and your family.

On 5/17/2008 nurseDIL wrote:

Hi,

I am a nurse and my mother in law was diagnosed with Stage IV "inoperable" stomach cancer (mets to liver 4 lesions, and nodes) in March 2007.  She was diagnosed via endoscopy and CT scan showed mets to liver and nodes.  She had a gastric stent placed and started with Irinotecan and Cisplatin and the tumor increased in size.  She was switched to Avastin, Xeloda, Oxiliplatin, with great results.  The tumors in her liver shrunk by almost 40% but then her neuropathy increased, she had severe Palmar-Plantar Erythrodysesthesia (skin on feet were red and peeling) and platelets were <75,000 and the chemo regimen was cut gradually to 50%.  The most recent CT showed tumor growth (one tumor increased by 2 cm).  Her doc is now saying that he feels she should try a clinical trial.  We asked him about liver directed chemo since the liver seems to be the worst area but they didn't feel she was a good canditate since she was Stage 4.  Has anyone with Stage 4 had liver directed therapy?  Also, we live in Maryland.  Anyone know of a great oncologist in the state or nearby states that has experience with gastric cancer?  It seems to be an Asian disease and it's hard to find someone with experience in our area.  Any help or suggestions are welcome. 

nurseDIL,

this is an excerpt from a man (randy pausch) who is fighting pancreatic cancer. his liver is also damaged by the disease. but i read on his blog that he was going to seek treatment in maryland. i hope this helps! stay strong!! i just lost my father to this horrible disease 13 days ago. i will keep you and your mother in law in my prayers. take care, kris

For the liver mets, maybe RFA or Cryo could be considered.

What is XL 880? My brother-in-law was recently diagnosed with G-E Juncture cancer, also stage 4. He has been offered and started with a clinical trial for cetuximab (C225) also known as Erbitux. He is approaching his first scan since beginning the trial and my sister is very concerned about where to turn if the scan results are not good. He is pretty young for this disease (49) and his youngest child is only 5 years old so we really are hoping for a miracle. His clinical trial could be that cure they are looking for and seems to be helping so far (he can swallow much better and he did develop the cetuximab rash that is supposed to mean it is working. We still have a lot of questions about availabe options for stage 4 and this message board seems to be the best place to ask questions so here goes:

1. Is G-E juncture cancer more like esophageal cancer or stomach cancer? (Currently, I read both message boards).

2. Is XL880 a trial drug and does it go by other names?

3. Once a person is diagnosed as stage 4 are they always stage 4 or is it possible to clear up the metastasis to other organs and become a stage 3? I ask this because I have heard success stories about stage 3 patients who were able to undergo surgery.

4. Does surgery increase your long term survival? I know that surgery is not an option with metastasis but if you could kill the cancer in the other organs (his is in one area on his pelvic bone), could you consider surgery and if you could, should you?

5. His clinical trial does not appear to have an end. He will be on the study until his cancer begins to grow, he becomes too sick to continue, or he no longer wishes to proceed with the study. Is this typical of clinical trials?

Sorry to hit you with all of my questions but there are very few people on this message board with a diagnosis of metastatic G-E juncture cancer, stage 4.

Thank you in advance for any help or advice you can provide.

On 5/21/2008 AttorneyAnn wrote:

What is XL 880? My brother-in-law was recently diagnosed with G-E Juncture cancer, also stage 4. He has been offered and started with a clinical trial for cetuximab (C225) also known as Erbitux. He is approaching his first scan since beginning the trial and my sister is very concerned about where to turn if the scan results are not good. He is pretty young for this disease (49) and his youngest child is only 5 years old so we really are hoping for a miracle. His clinical trial could be that cure they are looking for and seems to be helping so far (he can swallow much better and he did develop the cetuximab rash that is supposed to mean it is working. We still have a lot of questions about availabe options for stage 4 and this message board seems to be the best place to ask questions so here goes:

1. Is G-E juncture cancer more like esophageal cancer or stomach cancer? (Currently, I read both message boards).

2. Is XL880 a trial drug and does it go by other names?

3. Once a person is diagnosed as stage 4 are they always stage 4 or is it possible to clear up the metastasis to other organs and become a stage 3? I ask this because I have heard success stories about stage 3 patients who were able to undergo surgery.

4. Does surgery increase your long term survival? I know that surgery is not an option with metastasis but if you could kill the cancer in the other organs (his is in one area on his pelvic bone), could you consider surgery and if you could, should you?

5. His clinical trial does not appear to have an end. He will be on the study until his cancer begins to grow, he becomes too sick to continue, or he no longer wishes to proceed with the study. Is this typical of clinical trials?

Sorry to hit you with all of my questions but there are very few people on this message board with a diagnosis of metastatic G-E juncture cancer, stage 4.

Thank you in advance for any help or advice you can provide.

        

That is a lot to reply to:

 My 43 year old spouse was originally diagnosed with Stage IV in March of 07.  She had received 6 rounds (3 weeks each) of Epirubicin, Cisplatin, and 5FU (delivered via a continous pump).  In Aug of 07 she was in remission.  She had orginally had a 2cm tumor at her GI junction, and a 2-3cm tumor in her liver.  Both were gone. 

 We (it is more like she) continued on those drugs for another 2 rounds then we switched to Oxaliplatin and Xeloda; she remained on those two for the next six months.  Scans from yesterday show her to still be in remission.

 The question regarding surgery is a tough one as we get differing opinions; however, most of our consults have indicated that a surgical intervention would not be the advised approach and that the disease has to be beaten through the drugs.  This is of course with respect to our specific case and everyone's disease is different.

 Good luck and our prayers are with you and your brother in law.

Steve (aka momwithkids)

Hartford, CT