Newly Diagnosed, Traditional Chemo, Immunotherapy, and Other Targeted Therapies

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This topic contains 4 replies, has 2 voices, and was last updated by  beatriz 1 year, 4 months ago.

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July 21, 2016 at 7:13 pm  #1274759    

beatriz

Greetings!

My father is yet to be diagnosed and staged with what seems to be a GI Cancer (Cholangiocarcinoma). In watching your videos, I wanted to ask if all patients have to go through standard Chemo (I heard the onco nurse say that most insurances want traditional chemo treatments first before showing they are ineffective before moving to other therapies).

So my question is can oncologist start with immunotherapy or other target therapies? or chemo has to be first.
I know the onco ordered a liquid biopsy (results are not in yet)
I paid for a chemo-sensitive test (ex-vivo) from RGCC Labs in Europe and I know he has MDR1 expression, there is chemo sensitivity towards Cisplatin, Oxaliplatin, Docetaxel,Abraxane,Gemcitabine,Fudr.
There is sensitivity towards Tarceva and Nexavar.

I am still not clear what is the best way to start (whether surgery is an option or not) with this information if the onco accepts it at face value from RGCC Labs.

Any advice will greatly be appreciated as I need to learn and then translate all this information to my father so he understand what is going on.

With Much Appreciation.

July 22, 2016 at 11:04 am  #1274764    
JimC Forum Moderator
JimC Forum Moderator

Hi beatriz,

Welcome to GRACE. Usually insurance will pay for any approved treatment, as opposed to investigational therapies, which they may not cover in any case. So if there’s an approved immunotherapy for his cancer, they are likely to pay for it. Note that some newer treatments may be approved only as second-line therapy.

On the other hand, unapproved drugs in clinical trials are usually paid for by the trial sponsors, so they may be an option as well.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

July 22, 2016 at 7:10 pm  #1274770    

beatriz

Thank You Jim,

Sorry for my ignorance but what does second-line therapy means? after chemo or radiation? after the first treatment has failed or stopped working?

Beatriz

July 23, 2016 at 9:19 am  #1274776    
JimC Forum Moderator
JimC Forum Moderator

Hi Beatriz,

No need to apologize, we all start the cancer journey (whether it’s ours or a loved one’s) with a fairly blank slate, and we learn by asking questions.

Generally, second-line treatment refers to systemic treatment (chemotherapy, targeted therapy or immunotherapy) given after the initial systemic therapy. As you state, this is usually after first-line has been ineffective or the cancer has subsequently progressed.

One issue I meant to address in my previous response was that of the chemo-sensitivity test. These tests predict the performance of chemo agents as tested in the lab, but the experience in the human body (a vastly more complex environment than the equivalent of a petri dish) can be much different. So although you might choose a drug from the list if all other considerations are equal, if a particular drug seems to be the most appropriate under the circumstances, I wouldn’t let it’s exclusion from the list influence that choice.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

July 23, 2016 at 9:41 am  #1274778    

beatriz

Thank You will keep you posted.

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