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Medical Forum / Diseases and Disorders / Cancer / February 2005Seeking info on side effects-Xeloda and Gemcitabine
Hi all; My wife is getting ready to undergo chemo treatment for metastatic gall bladder cancer with Gemcitabine and Xeloda. She has been assured by 2 oncologists that the side effects should be minimal, but after reading information I've found on the internet, she's pretty worried. The fact sheets sound pretty dire. Does anybody have any personal experiences with these drugs they can share? Thanks in advance Jeff > Hi all; > [quoted text clipped - 8 lines] > > Jeff Most people tolerate them pretty well. A more important question is "What is the aim of the treatment" In February 2003, she had her gall bladder removed due to gallstones. It was sent for pathological examination and early stage 1 cancer was found. As a precaution, she had part of her liver and the nearby lymph nodes removed a month later. At the time, they didn't suggest either chemo or radiation, just semiannual monitoring. In September 2004, a spot showed up on the tip of her liver, which turned out to be malignant, a drop metastasis. One of her ovaries also had a similar lesion. Both ovaries and 20% of her liver were removed in late October. She had some infection after the surgery, with 2 wounds which we are packing daily and are shrinking quite nicely. The oncologist is recommending a combination of Gencitabine and Xeloda to make sure there is nothing left of the cancer. He seems pretty positive in his prognosis. BTW, I'll be offline after 4:30 EST and over the weekend, but I'll be back on Monday. Jeff > In February 2003, she had her gall bladder removed due to gallstones. > It was sent for pathological examination and early stage 1 cancer was [quoted text clipped - 10 lines] > to make sure there is nothing left of the cancer. He seems pretty > positive in his prognosis. What exactly did he say? Did someone write down or tape what he said? Did he use words like "response" or ???. J > In February 2003, she had her gall bladder removed due to gallstones. > It was sent for pathological examination and early stage 1 cancer was [quoted text clipped - 13 lines] > BTW, I'll be offline after 4:30 EST and over the weekend, but I'll be > back on Monday. How's the packing going, Jeff, Keep in touch as you are able. J The packing is going pretty well. One of the wounds is almost healed, less than a quarter-inch deep. The other is about an inch and a half long and an inch deep (give or take). A month ago, the large one took an entire 4x4 sheet of calcium alginate dressing and the other took a half sheet. Now one third of a sheet handles both. We go for a PET/CT scan and another meeting with the onco tomorrow. We'll see what he has come up with and we have a page of questions for him. We are pretty confident since everything that has shown up has been completely removed. Hopefully, the chemo is just a clean sweep to mop up any survivors. Since the escaped cells took a year and a half to become evident last time, the near term prognosis is pretty good I think. Jeff > The packing is going pretty well. One of the wounds is almost healed, > less than a quarter-inch deep. The other is about an inch and a half > long and an inch deep (give or take). A month ago, the large one took > an entire 4x4 sheet of calcium alginate dressing and the other took a > half sheet. Now one third of a sheet handles both. Well, that's progression. (this somewhat reminds me of Dash's husband's situation - a different type of liver cancer and subsequent healing from the surgery). I'm not sure I'd want to start chemo immediately (if it was me). > We go for a PET/CT scan and another meeting with the onco tomorrow. > We'll see what he has come up with and we have a page of questions for [quoted text clipped - 3 lines] > to become evident last time, the near term prognosis is pretty good I > think. A list of questions is a good idea. How did things go, Jeff? J PS I know that posting through Google isn't easy, but if you could bottom-post (post your reply below quoted text) and keep some of the quoted text at the top, it would help. J said: > Well, that's progression. (this somewhat reminds me of Dash's husband's > situation - a different type of liver cancer and subsequent healing from [quoted text clipped - 3 lines] > A list of questions is a good idea. > How did things go, Jeff? Things went very well. We got the answers we wanted to all of our questions. Dr. K said that with these dosages, there shouldn't be any real interferance with healing or any other significant problems. In fact, we have stopped packing one of the sores since it is too small to get any packing in there any more. After one day of just putting a dressing on top of it it looks excellent. The other one I think is so far along that nothing could stop the healing now. Of course, we'll monitor it closely. I've become an expert in wound care now (not that I ever wanted to). We've been given the go-ahead for all of our plans for the next few months, essentially anything she's got energy for is OK. This includes camping which surprised us. The chemo plan is: 6-8 21-day cycles of: Xeloda 1500mg twice a day for 14 days and 7 days off Gemzar on day 1 and day 8 This starts on Friday (Jan 21) On Thursday she is getting a port installed for the Gemzar. The doctor is pretty confident that this will handle things. At least as confident as it is possible to be with the dearth of literature on her particular situation. Gall bladder cancer is rarely caught at Stage 1; it's usually found at Stage 4, when it's time to get your affairs in order. All in all, we're feeling pretty positive about the whole thing. Thanks for listening Jeff BTW, is this a bit easier? I'm still getting used to the interface here. > We've been given the go-ahead for all of our plans for the next few > months, essentially anything she's got energy for is OK. This includes [quoted text clipped - 19 lines] > > Jeff Glad to see that you are planning some fun stuff to do. Positive attitude does help! Alex > Things went very well. We got the answers we wanted to all of our > questions. Dr. K said that with these dosages, there shouldn't be any [quoted text clipped - 23 lines] > Stage 1; it's usually found at Stage 4, when it's time to get your > affairs in order. Hello Jeff, Really I think your wife is metastatic gall bladder cancer, not Stage I, so it's good she's on a treatment plan. Let's see if we can get Steph to comment. I'm trying three ways. Given Barbara's description of how Chris is able to tolerate same treatment, there's no doubt in my mind that you'll be camping this summer. :-) That's excellent news. You did very well with the packing. The younger we are, the better we heal. I know from experience. I had the long incision type of gall bladder removal when I was 21 or 22. I was "raring to go" within two weeks of the surgery, but my body put some brakes on. I was back at work (IIRC) 4 weeks from the surgery, when they'd told me take 6. TThe female surgeron said she'd just started a new technique of "sewing up" and not to worry about scarring (which I'd never even thought of - I just wanted the dang thing out). She was right. Barely perceptible - someone would have to use a magnifying glass to see it's there. (sorry for digressing). Excellint on the quoting text. Thank you. Keep in touch, J I"ve added gallbladder cancer to the subject line (in case there's others reading). Some readers only check the subject lines (Something to remember if/when you start a new subject) > Hello Jeff, > Really I think your wife is metastatic gall bladder cancer, not Stage I, so [quoted text clipped - 5 lines] > :-) > That's excellent news. Yeah, I know it's metastatic now, but when her gallbladder was removed in 2003, it was early stage 1. > You did very well with the packing. The younger we are, the better we heal. > I know from experience. I had the long incision type of gall bladder [quoted text clipped - 5 lines] > out). She was right. Barely perceptible - someone would have to use a > magnifying glass to see it's there. (sorry for digressing). The doctors have been quite impressed with her healing rate. BTW, she's 47 and I'm 50. Her first time with cancer, my second as caregiver. My first wife passed away in 1992 from brain cancer. I also have a cat with one leg amputated from a sarcoma. I tell people that I'm a carrier; if not that, then at least a risk factor. > Excellint on the quoting text. Thank you. Thanks for the suggestion. > Keep in touch, > J > I"ve added gallbladder cancer to the subject line (in case there's others > reading). Some readers only check the subject lines > (Something to remember if/when you start a new subject) Thanks for the advice. BTW, my sister (who has at least as weird a sense of humor as me) thinks the meds would make a great fantasy show: Xeloda, Warrior Princess of Gemzar! Love it! Jeff > Yeah, I know it's metastatic now, but when her gallbladder was removed > in 2003, it was early stage 1. Thank you for clarifying Jeff. > The doctors have been quite impressed with her healing rate. BTW, > she's 47 and I'm 50. Now I'm impressed ! I thought you both were younger. After 50 they tell me it's all downhill... Naw..I'm just kidding, I'm only 29 <just kidding> but I have friends approaching 50 and they're getting a little creaky. ;-) > Her first time with cancer, my second as > caregiver. My first wife passed away in 1992 from brain cancer. I > also have a cat with one leg amputated from a sarcoma. I'm sorry to hear about your first wife Jeff. And your cat? I read and see they do quite well even after amputation. > I tell people that I'm a carrier; if not that, then at least a risk > factor. > > BTW, my sister (who has at least as weird a sense of humor as me) > thinks the meds would make a great fantasy show: Xeloda, Warrior > Princess of Gemzar! Did I say welcome? <smile> Humour is always welcome on this newsgroup. Some situations are so grim, it's hard to not get "down", so post anytime and update us about Xeloda, Warrior Princess of Genzar ! (lol) Best, J Now I'm impressed ! I thought you both were younger. After 50 they tell me > it's all downhill... > Naw..I'm just kidding, I'm only 29 <just kidding> but I have friends > approaching 50 and they're getting a little creaky. ;-) Some mornings I think I can actually hear my joints complain! > I'm sorry to hear about your first wife Jeff. Thanks > And your cat? I read and see they do quite well even after amputation. She's still the queen of the house, just ask her! > Did I say welcome? <smile> Humour is always welcome on this newsgroup. > Some situations are so grim, it's hard to not get "down", so post anytime > and update us about Xeloda, Warrior Princess of Genzar ! (lol) If I wasn't joking, I would be in the corner in a fetal position, sucking my thumb. Life goes on, and it's mostly good. Glad I found this place. It's a place to talk with people who really understand. Jeff > Some mornings I think I can actually hear my joints complain! > [quoted text clipped - 7 lines] > > Glad I found this place. It's a place to talk with people who really How are you Jeff and the Warrior Princess? J > How are you Jeff and the Warrior Princess? Not too bad. The Xeloda seems to be having very little in the way of side effects. The Gemzar, on the other hand, knocks her down on the second day following the treatment. She gets the IV on Friday and is flat on her back most of the day Sunday. We're hoping that will lessen as she continues to recover from the surgery and gets used to the drugs. Her spirits are good and we're making plans for the week between treatments when we figure she'll be more energetic. Jeff > Not too bad. The Xeloda seems to be having very little in the way of > side effects. The Gemzar, on the other hand, knocks her down on the > second day following the treatment. She gets the IV on Friday and is > flat on her back most of the day Sunday. We're hoping that will lessen > as she continues to recover from the surgery and gets used to the > drugs. Yes, well both mention tiredness and getting lots of rest (under "common side effects"). http://www.cancerbacup.org.uk/Treatments/Chemotherapy/Individualdrugs/Gemcitabine http://www.cancerbacup.org.uk/Treatments/Chemotherapy/Individualdrugs/Capecitabine Genzar also mentions "Temporary reduction in the production of blood cells by the bone marrow This can result in anaemia leading to tiredness; an increased risk of bruising or bleeding and an increased risk of infection." (whereas Xeloda mentions it under "less common"). I've had two major surgeries (with probably a lot of blood loss), one much younger, separated by 12 +\- years to the other. The first (gallbladder) by far was the worst to recover from, so there must have been more blood loss and they wouldn't let me eat < I keep harping on that<g> for 4 days. The mind wants to get going, but the body won't co-operate until the body's recovered. I imagine with your wife's surgeries, closer together comparatively (to mine) and the subsequent packing, would /might still be felt in fatigue, in light of the above side effects. And that's why they say everyone reacts differently to chemo. There'a a diagram here http://www.umm.edu/liver/liver.htm It also says "The liver holds about one pint (13 percent) of the body's blood supply at any given moment". I wonder if she's lost some of her liver, wher the blood is...in the rest of the body? Does removing parts of the liver, make the BP go up? (just wondering). Anyway, I think she should get lots of rest, even on the good days. > Her spirits are good and we're making plans for the week between > treatments when we figure she'll be more energetic. Oh I see, yes, The chemo plan is: 6-8 21-day cycles of. Hope so, Jeff, hope so. J > Genzar also mentions "Temporary reduction in the production of blood cells > by the bone marrow This can result in anaemia leading to tiredness; an > increased risk of bruising or bleeding and an increased risk of infection." > (whereas Xeloda mentions it under "less common"). Interesting. They put her on iron because she's slightly anemic. In fact, she was before the chemo. We've noticed a little bruising, but nothing major. Her wounds are continuing to heal, just a bit slower. I expect they'll speed up during the week break. > I've had two major surgeries (with probably a lot of blood loss), one much > younger, separated by 12 +\- years to the other. The first (gallbladder) by [quoted text clipped - 5 lines] > felt in fatigue, in light of the above side effects. And that's why they > say everyone reacts differently to chemo. Fortunately, the fatigue seems to last only a couple of days, at least the worst of it does. This morning she was feeling much better. Just 2 more days for this round of the Xeloda! I think frustration is playing a large part in things, too. She had the liver resection (and ovariectomy) on Oct. 27, was recovering nicely, then they discovered the infection on Nov. 8 and she was hospitalized for 3 days. Since then we've been packing the wounds daily (a visiting nurse for the first 4 weeks, then I've been doing it ever since). Then she had the port put in Jan. 20, just as she was starting to feel a bit energetic and the chemo started on the 21st. Like I said, frustrating. As soon as she gets to feeling decent, something else comes along. Oh well, there is an end in sight for the chemo. Of course, when she recovers, she has to go back to a job she hates. > There'a a diagram here http://www.umm.edu/liver/liver.htm It also says "The > liver holds about one pint (13 percent) of the body's blood supply at any > given moment". I wonder if she's lost some of her liver, wher the blood > is...in the rest of the body? Does removing parts of the liver, make the > BP go up? (just wondering). I don't know in general, but she had 20 percent of her liver removed, so that would only account for 2.6 percent of blood supply (20 percent of 13 percent), so I don't think there was any significant effect. I do know that her BP doesn't seem to have been affected; it's always been low. My meds are keeping mine in check; I've been on BP meds for 5 1/2 years now (Isn't getting older fun!). > Anyway, I think she should get lots of rest, even on the good days. Not much choice involved there. > > Her spirits are good and we're making plans for the week between > > treatments when we figure she'll be more energetic. > > Oh I see, yes, The chemo plan is: 6-8 21-day cycles of. > Hope so, Jeff, hope so. Thanks for the support. We're learning to deal with it as it goes. Fortunately, the people at the Oncology Center are really great. Jeff > Interesting. They put her on iron because she's slightly anemic. In > fact, she was before the chemo. We've noticed a little bruising, but [quoted text clipped - 17 lines] > chemo. Of course, when she recovers, she has to go back to a job she > hates. Well ! That's something to look forward to (not). Although they say "do what you love or (learn to) love what you". I expect many, these days are stuck doing the latter. [I'll skip a rant about the economy] > [snip my text] > I don't know in general, but she had 20 percent of her liver removed, > so that would only account for 2.6 percent of blood supply (20 percent > of 13 percent), so I don't think there was any significant effect. Good point > I do know that her BP doesn't seem to have been affected; it's always > been low. I'm a "low" too. Gee, I've don't think I've ever since comparison studies on fatigue/chemo and lower BP (compared to those who have normal BP or higher BP) on this or any cancer newsgroup. I could be wrong about that though. > My meds are keeping mine in check; I've been on BP meds for > 5 1/2 years now (Isn't getting older fun!). Well, it's different and sometimes funner... In some ways, we can become "the funny aunt" or "uncle", the ones the younger crowd don't always understand. Roller-blading in a suit; what a crock that was. I kept falling, so I'd aim for grass. <g> > Thanks for the support. We're learning to deal with it as it goes. > Fortunately, the people at the Oncology Center are really great. Hopefully next week, things will improve . Keep in touch, Jeff. J > Jeff:> My meds are keeping mine in check; I've been on BP meds for > > 5 1/2 years now (Isn't getting older fun!). [quoted text clipped - 4 lines] > Roller-blading in a suit; what a crock that was. I kept falling, so I'd > aim for grass. <g> Afterthought. That was approx 8 years ago. Now I'm wearing a basketball kneepad on my elbow...wear & tear problem, sort of [chuckle] J >> Things went very well. We got the answers we wanted to all of our >> questions. Dr. K said that with these dosages, there shouldn't be any [quoted text clipped - 29 lines] > it's good she's on a treatment plan. Let's see if we can get Steph to > comment. I'm trying three ways. I missed the earlier posts, but nobody would suggest chemo for a stage I gall bladder cancer. Surgery is curative. Met gall bladder cancer is incurable, so chemo is often proposed, but you should ask the "questions" > "J" <faked@privacy.net> wrote in message > > [quoted text clipped - 19 lines] > > I missed the earlier posts, In February 2003, she had her gall bladder removed due to gallstones. It was sent for pathological examination and early stage 1 cancer was found. As a precaution, she had part of her liver and the nearby lymph nodes removed a month later. At the time, they didn't suggest either chemo or radiation, just semiannual monitoring. In September 2004, a spot showed up on the tip of her liver, which turned out to be malignant, a drop metastasis. One of her ovaries also had a similar lesion. Both ovaries and 20% of her liver were removed in late October. She had some infection after the surgery, with 2 wounds which we are packing daily and are shrinking quite nicely. > but nobody would suggest chemo for a stage I > gall bladder cancer. Surgery is curative. We seemed to have cleared that up. Jeff is pretty quick on the replying. In case, you've missed it, some are using surgery(ies) first and/or when chemo seems to be stopping working. > Met gall bladder cancer is incurable, so chemo is often proposed, but you > should ask the "questions" So I guess ditto for surgeries... Thanks, J > > Met gall bladder cancer is incurable, so chemo is often proposed, but you > > should ask the "questions" > > So I guess ditto for surgeries... The mets were both very small and localized (smaller than a fingernail). They were also both accessible with one incision (although it seems a roundabout way to get to the ovaries), so I have no quarrels with the surgery decision. The chemo at this point is precautionary. If something else shows up, the decisions will be made based on the facts on the ground at that time. Jeff >> > Met gall bladder cancer is incurable, so chemo is often proposed, > but you [quoted text clipped - 10 lines] > > Jeff I understand, Jeff, but does the oncologist have any evidence that chemotherapy, even "precautionary", has any benefit? > I understand, Jeff, but does the oncologist have any evidence that > chemotherapy, even "precautionary", has any benefit? Not certain, but I trust his judgement. Jeff > Not certain, but I trust his judgement. > > Jeff Sounds good having a trusting relationship with your health provider is a positive thing, Alex >> I understand, Jeff, but does the oncologist have any evidence that >> chemotherapy, even "precautionary", has any benefit? > Not certain, but I trust his judgement. > > Jeff Fair enough, but just don't have unrealistic expectations Thanks for your support > "irishfolker" <irishfolker@yahoo.com> wrote in message > > [quoted text clipped - 5 lines] > > Fair enough, but just don't have unrealistic expectations Hi Steph, I've never been able to find a gallbladder cancer list at ACOR. (I wonder why - I would think that early stage GB cancer patients would be there somewhere).<rhetorical> Might there be another name for it? I looked under G (for gallbladder or gastro) and under C ( looking for bile duct cancer, I guess). And/or let me ask you this a different way. In 25 years, have you had met gallbladder cancer patients? Where does it spread to (other than the liver)? I think we had a patient last Fall, where it spread to the spine area... If you have had "met GB" patients, how many survived ? If none, recurrence occurs approximately (months, years)? Did some have chemotherapy? Did that change the prognosis? Sorry for all the questions. Thanks, J >> "irishfolker" <irishfolker@yahoo.com> wrote in message >> > [quoted text clipped - 26 lines] > Thanks, > J I see most GB cancer patients on the Island. 1-2 per year The majority are locally advanced and unresectable, and only palliative chemo or rads is appropriate. Liver mets, or direct invasion of the liver is common. The occasional early GB cancer is usually cured by surgery, but the surgery is usually being done for stones or some other problem, and the cancer is an incidental finding. Complete surgical resection is full treatment. There is no evidence of benefit from either radiation or chemo for those. If surgical resection is incomplete, cure is not possible, and for patients without symptoms, there is no evidence of benefit from either radiation or chemo. > In February 2003, she had her gall bladder removed due to gallstones. > It was sent for pathological examination and early stage 1 cancer was [quoted text clipped - 6 lines] > October. She had some infection after the surgery, with 2 wounds which > we are packing daily and are shrinking quite nicely. Hi Jeff, I saw your new post about being Stage I. I'm asking Steph about "drop metastasis". I'm wondering if they downstaged due to the surguries. Steph and I posted about downstaging just this past week, if I recall. <http://www.cancerhelp.org.uk/help/default.asp?page=8010> Most stage 1 gallbladder cancers are found almost by accident, when someone is having their gallbladder taken out because of inflammation or gallstones. If the cancer is found this early no further treatment is usually needed. " J First of all, a note to everyone. This is the "hblites" Barbara whose friend Chris has pancreatic cancer. AOL stopped their newsgroup service as of Jan 1, and I haven't been seeing nearly all the messages posted for some time, it turns out. I'm using google until I find a better way....it's difficult because I tend to use multiple computers to access the group. I'm using a different e-mail address for many reasons. anyhow, Chris takes Xeloda and Gemzar along with Taxotere. I can't really separate out the side effects, but they include some leg swelling (he thinks that one's mostly Taxotere, though), diarrhea and some nausea, and some burning and swelling of the feet and fingertips. He's had some low white counts and takes Neuprogen injections, but that is also usually after the Taxotere treatments. For the most part, he's been pleased with the chemo and the results, especially with regards to pain relief and gemcitibine, (Gemzar) has a reputation for being milder than most chemo drugs. He did not suffer any hair loss, that was important to him. Barbara > Hi all; > [quoted text clipped - 8 lines] > > Jeff Hi Jeff, My wife recently underwent three rounds of Gemzar (Gemcitabine), along with Cisplatin. Her red blood cell counts and platelet counts were hit pretty hard, and she had to have blood transfusions twice. She's had Cisplatin before without the Gemzar, and her counts held up much better then, so it would seem the Gemzar was the main factor in the low red blood cell & platelet counts. I'm sure her doctor knows to watch her counts closely. --Andy > My wife recently underwent three rounds of Gemzar (Gemcitabine), along > with Cisplatin. Her red blood cell counts and platelet counts were hit [quoted text clipped - 5 lines] > > --Andy Andy what does your wife's oncologist say ? I am sure the doctor does watch the blood counts closely that is why they take her blood prior to chemo, Alex > >...I'm sure her doctor knows to watch her > > counts closely. [quoted text clipped - 4 lines] > the blood counts closely that is why they take her blood prior to chemo, > Alex Hi Alex, I did not express myself very well... my wife's oncologist does watch her blood counts carefully. I meant, above, that I'm sure Jeff's wife's oncologist knows to do the same for her. --Andy > My wife is getting ready to undergo chemo treatment for metastatic gall > bladder cancer with Gemcitabine and Xeloda. She has been assured by 2 > oncologists that the side effects should be minimal, but after reading > information I've found on the internet, she's pretty worried. The fact > sheets sound pretty dire. Does anybody have any personal experiences > with these drugs they can share? Hello Jeff, I'm sorry to hear about your wife's cancer. When Steph mentions the goal of treatment, it's usually (not always), because of the prognosis and he wants you to consider the following. His algorithm for treatment decisions <http://groups-beta.google.com/group/alt.support.cancer/msg/1b25021ba108fca1?hl=e n&lr=&ie=UTF-8> Print it up and talk with your wife about it. http://author.emedicine.com/MED/topic2711.htm Gallbladder cancer. "Contraindications: As with all cancer operations, diffuse distant metastatic disease is a contraindication for resection except in rare cases when palliative resection improves the quality of life." I read your other post. There's a limit to how many times a person can get pieces cut out of them or what can be cut out. If cure isn't possible, you have to start thinking what will (or won't) help symptoms and quality of life, as difficult a decision that may be. http://tinyurl.com/5j3jr American Cancer Society Unfortunately, gallbladder cancer seems to be resistant to chemotherapy, and for that reason it is not widely or consistently used against this disease." Please stay with us. We can be there for you and your wife through these difficult times. J |
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