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Medical Forum / Diseases and Disorders / Cancer / March 2004Prim. Liver Cancer
My mother was diagnosed with primary liver cancer, heptacellular carcinoma, last August. She had a resection done on Oct. 28 and they removed a 10cm tumor. Her afp's have started to go up again, indicating the cancer is growing again. The oncologist has suggested Thalidomide. I'm not sure what stage we are in or how long it takes this disease to take over the body. I'm wondering if I have months or years with my mom - does anyone have any experience with the Thalidomide? She is 67 yrs old, very healthy, no prior liver problems. I'd appreciate any feedback. > My mother was diagnosed with primary liver cancer, heptacellular > carcinoma, last August. She had a resection done on Oct. 28 and they [quoted text clipped - 4 lines] > - does anyone have any experience with the Thalidomide? She is 67 yrs > old, very healthy, no prior liver problems. I'd appreciate any feedback. Hello Shirley (or is it Shirley Lee?) I'm sorry about your mother. I would want to know where it has spread and/or recurred, before making treatment decisions. For instance, to the bone, I'd be looking at radiation therapy. http://www.nci.nih.gov/cancerinfo/pdq/treatment/adult-primary-liver/healthprofes sional/ The biologic marker AFP is useful for the diagnosis of this neoplasm. By a radioimmunoassay technique, 50% to 70% of patients in the United States who have hepatocellular carcinoma have elevated levels of AFP. However, patients with other malignancies (germ cell carcinoma and, rarely, pancreatic and gastric carcinoma) also demonstrate elevated serum levels of this protein. http://www.cancerhelp.org.uk/help/default.asp?page=4917 There is research combining the drug thalidomide with chemotherapy. Thalidomide is a drug that may be able to stop a cancer from growing its own blood supply. Without its own blood vessels, a cancer cannot grow much larger than a pea. Trials have been done using thalidomide to treat various cancer types. These generally haven't been as successful as was first hoped. So now, researchers are trying the drug with chemotherapy.[] Are they planning on combining therapies? Is it possible for you to go with her and ask some of these questions of her oncologist? J After the afp's started to go up, they did a CTScan, but nothing showed up on the scan. I believe that since the only place she had any cancer prior to the resection was her liver, that we are working on the idea that the cancer is growing in her liver again. The Dr.'s did tell us that the "fresh, new" liver was easy ground for the cancer cells to grow in. There are no plans to do any chemotherapy-we were told that with this type of cancer the chemo has not proven to be very effective. I do not belive that the cancer has spread beyond the liver at this point. I have done some research on the thalidomide and I understand what it is supposed to do - I'm just still wondering what kind of success can be expected with the drug...thank you very much for taking the time to respond. >>My mother was diagnosed with primary liver cancer, heptacellular >>carcinoma, last August. She had a resection done on Oct. 28 and they [quoted text clipped - 31 lines] > oncologist? > J > After the afp's started to go up, they did a CTScan, but nothing showed > up on the scan. I believe that since the only place she had any cancer [quoted text clipped - 7 lines] > supposed to do - I'm just still wondering what kind of success can be > expected with the drug...thank you very much for taking the time to respond. Hi there. Well I've checked this newsgroup's archives for the past 3 months and nobody's mentioned it for liver cancer. You may wish to ask on the ACOR mail list at http://www.acor.org/ (under L for Liver), first you "join" then send a message out. I have looked under clinical trials http://www.cancer.gov/clinicaltrials/developments/anti-angio-table and for Primary Adult Liver Cancer, only 3 results. - Two Phase II Trials, One phase I and all 3 combine chemotherapy. Perhaps someone else better than me (here) can find clinical trials of only thalidomide (or I'll try searching later). Or perhaps that's something to ask your oncologist, if (s)he has results of trials? Best wishes and keep in touch, J > After the afp's started to go up, they did a CTScan, but nothing showed > up on the scan. I believe that since the only place she had any cancer [quoted text clipped - 7 lines] > supposed to do - I'm just still wondering what kind of success can be > expected with the drug...thank you very much for taking the time to respond. Slaps forehead and asks which type of liver cancer is it? fibrolamellar ? J heptacellular carcinoma >>After the afp's started to go up, they did a CTScan, but nothing showed >>up on the scan. I believe that since the only place she had any cancer [quoted text clipped - 11 lines] > fibrolamellar ? > J > After the afp's started to go up, they did a CTScan, but nothing showed > up on the scan. I believe that since the only place she had any cancer [quoted text clipped - 4 lines] > this type of cancer the chemo has not proven to be very effective. I do > not belive that the cancer has spread beyond the liver at this point. If that's so (and you say she's in good health), is transplant not possible? http://cpmcnet.columbia.edu/dept/gi/carcinoma.html J The oncologist told mother after the resection, that he would not recommend any surgery for her. But, since you ask, I am a bit confused on this point. Her surgeon told us after the surgery, that is the cancer came back, we would have more healthy liver to work with... So, I just found out that Mom is going to see the original surgeon next week - we have to drive about 250 miles to see him. He wants to look at her CT Scan and examine her - I plan to go and will ask then if another surgery is not an option. My parents are not good at asking questions and at this time, they are putting all their hope in the Thalidomide - my Mom thinks it is going to kill the cancer...she is an optimist and I love her for that! Thank you so much for taking the time to discuss this with me, I really appreciate it! >>After the afp's started to go up, they did a CTScan, but nothing showed >>up on the scan. I believe that since the only place she had any cancer [quoted text clipped - 8 lines] > http://cpmcnet.columbia.edu/dept/gi/carcinoma.html > J > The oncologist told mother after the resection, that he would not > recommend any surgery for her. But, since you ask, I am a bit confused [quoted text clipped - 21 lines] > > http://cpmcnet.columbia.edu/dept/gi/carcinoma.html > > J From my experience and understanding J regarding cancer and the liver, a transplant is not an option due to the cancer cells...it could/would create more cancer cells in the "new" liver which would be a waste of a new liver. A surgeon's reply to us. Jenny (husband with primary liver cancer - FL-HCC) > From my experience and understanding J regarding cancer and the liver, a > transplant [quoted text clipped - 3 lines] > > Jenny (husband with primary liver cancer - FL-HCC) Yes, well, I realize it would only be buying time (probably), and there are risks to surgery and they can (I believe) take parts of someone's liver (who is compatible?) but it is mentioned at http://www.nci.nih.gov/cancerinfo/pdq/treatment/adult-primary-liver/patient So I just mentioned it FWIW J > The oncologist told mother after the resection, that he would not > recommend any surgery for her. But, since you ask, I am a bit confused [quoted text clipped - 8 lines] > optimist and I love her for that! Thank you so much for taking the time > to discuss this with me, I really appreciate it! Thalidomide is not curative treatment for any cancer, so don't put your hopes i it. You go with them, and you ask the questions > My mother was diagnosed with primary liver cancer, heptacellular > carcinoma, last August. She had a resection done on Oct. 28 and they [quoted text clipped - 4 lines] > - does anyone have any experience with the Thalidomide? She is 67 yrs > old, very healthy, no prior liver problems. I'd appreciate any feedback. High does Vitamin K therapy has been show to dramatically slow the growth of liver cancer, ask your doctor about it ------------------------------------- http://www.docguide.com/news/content.nsf/news/8525697700573E1885256BC80053B29D DDW: Vitamin K Therapy Slows Spread of Liver Cancer By Roberta Friedman SAN FRANCISCO, CA -- May 29, 2002 -- Portal vein invasion (PVI), seen frequently in patients with hepatocellular carcinoma, can be prevented in half treated with vitamin K, researchers say. They presented their results here at the 103rd annual meeting of the American Gastroenterological Association and Digestive Disease Week (DDW), held May 19-23. Diagnosis of PVI is a frequent event after diagnosis of liver cancer. Dr. Yukihiro Koike, of the department of gastroenterology, University of Tokyo, Japan, and colleagues previously showed a close association between levels of des-g-carboxy-prothrombin (DCP) in serum and development of portal invasion in patients with hepatocellular carcinoma. In Dr. Koike's study, 120 patients were treated with ablation, embolization, or both between February 1999 and November 2001at the University of Tokyo or its affiliated hospitals. All patients enrolled had low serum levels of DCP (60 IU/L or more). Half of patients were randomized to receive oral vitamin K-II at a dose of 45 mg/day. Dr. Koike said that 50 of the treated patients had hepatitis C, as did 52 of the controls. The groups were well matched on other criteria as well. Average follow up was 12 months. Patients had computed tomography scans every six months, ultrasound at three-month intervals, and DCP levels measured every month. Results show that 59 percent of patients treated with vitamin K-II were alive at two years compared to 29 percent of those who were not given vitamin K-II (p=0.14). Invasion of the cancer into the portal vein occurred in 2 percent of the vitamin K-II treated group at one year and in 13 percent at two years, compared to 21 and 55 percent of controls, respectively. Dr. Koike said that vitamin K-III, which was not available in Japan at the time of the study, might be an even more effective treatment for prevention of PVI. Vitamin K-III has been shown to interfere with the electron transport chain in mitochondria and thereby slow cell growth and cancer spread, he said. there is a clinical trial using a drug called Seocalcitol, which is a vitamin D analogue, I dont know if your mother could join this trial or not http://www.clinicaltrials.gov/ct/show/NCT00051545?order=2 Hepatocellular carcinoma is usually very resistant to chemotherapy and radiation, however seocalcitol has had some promising results, read this preliminary study ------------------ http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=12865912 A phase II study of the vitamin D analogue Seocalcitol in patients with inoperable hepatocellular carcinoma. Dalhoff K, Dancey J, Astrup L, Skovsgaard T, Hamberg KJ, Lofts FJ, Rosmorduc O, Erlinger S, Bach Hansen J, Steward WP, Skov T, Burcharth F, Evans TR. Department of Clinical Pharmacology, Rigshospitalet, Denmark [2] 2Department of Hepatology, Rigshospitalet, Denmark. dalhoff@rh.dk Hepatocellular carcinoma (HCC) is a common malignant tumour, which has a poor prognosis. Surgical resection can be curative but most patients are inoperable and most chemotherapy agents have minimal activity in this disease. Seocalcitol, a vitamin D analogue, induces differentiation and inhibits growth in cancer cell lines and in vivo. The vitamin D receptor is expressed in hepatocytes and more abundantly in HCC cells. In total, 56 patients with inoperable advanced HCC were included in an uncontrolled study of oral Seocalcitol treatment for up to 1 year (with possible extension for responders). The dose was titrated according to serum calcium levels. The treatment effect was evaluated by regular CT scans. Out of 33 patients evaluable for tumour response, two had complete response (CR), 12 stable disease and 19 progressive disease. The CRs appeared after 6 and 24 months of treatment, and lasted for 29 and at least 36 months (patient still in remission when data censored). Seocalcitol was well tolerated; the most frequent toxicity was hypercalcaemia and related symptoms. Most patients tolerated a daily dose of 10 micro g of Seocalcitol. This is the first study showing activity, by reduction in tumour dimensions, of a differentiating agent in patients with an advanced bulky, solid tumour. Seocalcitol may have an effect in the treatment of HCC, especially in early disease when a prolonged treatment can be instituted. The survival benefit with or without tumour response should be determined in controlled studies. Publication Types: Clinical Trial Clinical Trial, Phase II Multicenter Study PMID: 12865912 [PubMed - indexed for MEDLINE] |
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