1. < Pancreatic Cancer

Is a 2-week break between adjuvant radiotherapy & chemo okay?

Posted by kslayer @kslayer, Nov 29, 2023

My relative has been diagnosed with stage 2b and has undergone whipple on July with 3/15 nodes positive and one area with close margin. Adjuvant FolFirinox is started in August and after the fourth cycle, adjuvant radiotherapy with 5FU has started in October. Since the adjuvant radiotherapy is coming to an end, doctor suggests to continue with the 5th cycle of Folfurinox next week right after radiotherapy ends, but my relative is worn up. May I know will resting 2 weeks between the end of adjuvant radiotherapy and the start of adjuvant chemotherapy will bring a large impact on the results ? Since the CA19.9 is less than 30 now but with my relative work out I’m not sure if it’s possible to take a rest for 2 weeks before continuing the intensive adjuvant chemotherapy. Thank you very much.

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marienewland | @mnewland99 | Aug 17 3:14pm
In reply to @ncteacher "Hello! You're kind to inquire after me. I check into the board daily, but backed off..." + (show)
@ncteacher

Hello! You're kind to inquire after me. I check into the board daily, but backed off from posting for a few reasons, including health. I'm hanging in there. I've had a rough summer, no thanks to a gastric output obstruction. I could consume and digest food, but the blockage kept it from moving into my small intestine. A duodenal stent didn't help; as it turns out, the pinch point was below the stent. Anyway, since the beginning of June, I've had two surgeries (duodenal stent and replacing the ureteral stent), 15 days of higher-dose radiation to shrink the blockage, a short hospital stay for TPN, and reduced nutrition and hydration, all of which have left me weaker than I was in May. I'm getting fluids twice a week, and I received 2 units of blood on Wednesday because my hemoglobin stays too low.

The radiation did help, as my stomach is better and I'm eating solid food. (Thank heavens--I couldn't tolerate the "full liquid" diet, AKA mush.) But the problem hasn't been permanently solved, of course, so we're going to consult with an HPB surgeon next week to discuss options. My oncologist is campaigning for a GJ (gastric-jejunum) bypass, in which the bottom of the stomach would connect to the jejunum (small intestine), bypassing the duodenum and pinch point below it. Meanwhile, chemo (Folfiri) is set to resume on Tuesday 8/27, and I hope we get a good response. My CA 19-9 is up to 217, in part due to inflammation from radiation, so I'd like to knock it down again for a while. My brain wants to do things--the library reading tutor program starts next month, for example, and I'd love to volunteer--but my bod just hasn't been cooperative. I'm hoping for better days ahead. Or, to quote my blood type, B positive--that is, be positive!

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That’s great news ncteacher! Always good for us to hear positive news about our fellow pancreatic cancer survivors. Keeping active helps, though recently I decided to take a break from work. I’ve opted to start doing jigsaw puzzles just to keep my mind off the cancer at hand and to keep my mind active with something positive. Thinking good thoughts and praying for a positive result for you!

REPLY
gamaryanne | @gamaryanne | Aug 17 3:47pm
In reply to @ncteacher "Hello! You're kind to inquire after me. I check into the board daily, but backed off..." + (show)
@ncteacher

Hello! You're kind to inquire after me. I check into the board daily, but backed off from posting for a few reasons, including health. I'm hanging in there. I've had a rough summer, no thanks to a gastric output obstruction. I could consume and digest food, but the blockage kept it from moving into my small intestine. A duodenal stent didn't help; as it turns out, the pinch point was below the stent. Anyway, since the beginning of June, I've had two surgeries (duodenal stent and replacing the ureteral stent), 15 days of higher-dose radiation to shrink the blockage, a short hospital stay for TPN, and reduced nutrition and hydration, all of which have left me weaker than I was in May. I'm getting fluids twice a week, and I received 2 units of blood on Wednesday because my hemoglobin stays too low.

The radiation did help, as my stomach is better and I'm eating solid food. (Thank heavens--I couldn't tolerate the "full liquid" diet, AKA mush.) But the problem hasn't been permanently solved, of course, so we're going to consult with an HPB surgeon next week to discuss options. My oncologist is campaigning for a GJ (gastric-jejunum) bypass, in which the bottom of the stomach would connect to the jejunum (small intestine), bypassing the duodenum and pinch point below it. Meanwhile, chemo (Folfiri) is set to resume on Tuesday 8/27, and I hope we get a good response. My CA 19-9 is up to 217, in part due to inflammation from radiation, so I'd like to knock it down again for a while. My brain wants to do things--the library reading tutor program starts next month, for example, and I'd love to volunteer--but my bod just hasn't been cooperative. I'm hoping for better days ahead. Or, to quote my blood type, B positive--that is, be positive!

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So good to read your post; even though you are not at your best just now.
This may be a dumb question-but how did you know what was going on with you? Was it more than bloating? A hernia? Very delayed emptying?

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1 reply
ncteacher | @ncteacher | Aug 17 4:45pm
In reply to @gamaryanne "So good to read your post; even though you are not at your best just now...." + (show)
@gamaryanne

So good to read your post; even though you are not at your best just now.
This may be a dumb question-but how did you know what was going on with you? Was it more than bloating? A hernia? Very delayed emptying?

Jump to this post

To me, the blockage happened very suddenly. We went on vacation just before Memorial Day, and I was able to eat anything I wanted without problem. I started having fullness and bloating during Memorial Day week. I was unable to cross my arms and rest them on my stomach, and I was struggling with reflux, especially when I bent forward. On June 3, I had a CT scan to set up radiation treatments, which were supposed to start later that week. The radiation oncologist asked how my stomach felt, and I told him I felt a little full and bloated, but was still eating and drinking. Well, it turns out that my stomach was unbelievably distended with digested food. He contacted my oncologist, and we canceled radiation in order to address the problem. I had a duodenal stent installed on June 11, but as I described in the earlier post, it didn't help because it turns out the pinch point was below the stent. By the time we got back to radiation in late June, I was so uncomfortable that the radiation oncologist rethought his treatment plan. He originally was going to do 25-28 treatments, but in order to treat the blockage more aggressively, he increased the radiation and did 15 treatments. I also took capecitabine (Xeloda) on radiation days. I can tell I'm better, but I can also tell the problem isn't completely solved. We're meeting with an HPB surgeon next week to talk about options. My oncologist is suggesting a GJ (gastric-jejunum) bypass. We'll see what the surgeon says.

REPLY
gamaryanne | @gamaryanne | Aug 18 9:51am

I hope you will take the time to keep us informed. Teachers are and have been a special gift to us all. We hope the gift will be paid back to you in the form of great advice and wisdom!

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1 reply
marienewland | @mnewland99 | Aug 18 2:54pm
In reply to @gamaryanne "I hope you will take the time to keep us informed. Teachers are and have been..." + (show)
@gamaryanne

I hope you will take the time to keep us informed. Teachers are and have been a special gift to us all. We hope the gift will be paid back to you in the form of great advice and wisdom!

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Gamaryanne, do you have any updates on the clinical trial you are in? Do they do any testing of CA19-9 while in trials?

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1 reply
gamaryanne | @gamaryanne | Aug 19 7:05am
In reply to @mnewland99 "Gamaryanne, do you have any updates on the clinical trial you are in? Do they do..." + (show)
@mnewland99

Gamaryanne, do you have any updates on the clinical trial you are in? Do they do any testing of CA19-9 while in trials?

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My first cycle of the trial I am in (RMC 9805 and 6236 doublet) ends this week. My scans are tomorrow (Tuesday).

I had a ca19-9 when the trial began and one in the interim. The first was 233 and second was 100. I was very excited at the time but was reminded this is not thought to be curative. Instead it is hoped to stabilize and slow progression. We shall see!
I will report back

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2 replies
marienewland | @mnewland99 | Aug 19 7:10am
In reply to @gamaryanne "My first cycle of the trial I am in (RMC 9805 and 6236 doublet) ends this..." + (show)
@gamaryanne

My first cycle of the trial I am in (RMC 9805 and 6236 doublet) ends this week. My scans are tomorrow (Tuesday).

I had a ca19-9 when the trial began and one in the interim. The first was 233 and second was 100. I was very excited at the time but was reminded this is not thought to be curative. Instead it is hoped to stabilize and slow progression. We shall see!
I will report back

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That’s wonderful news! I would definitely take a slow down at this point in time. Prayers for good results on your scans tomorrow.

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marienewland | @mnewland99 | Aug 19 10:34am
In reply to @gamaryanne "My first cycle of the trial I am in (RMC 9805 and 6236 doublet) ends this..." + (show)
@gamaryanne

My first cycle of the trial I am in (RMC 9805 and 6236 doublet) ends this week. My scans are tomorrow (Tuesday).

I had a ca19-9 when the trial began and one in the interim. The first was 233 and second was 100. I was very excited at the time but was reminded this is not thought to be curative. Instead it is hoped to stabilize and slow progression. We shall see!
I will report back

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Thank you, I appreciate the progress notes. I looked up your trial and I didn’t see any California.

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2 replies
gamaryanne | @gamaryanne | Aug 20 6:41am
In reply to @mnewland99 "Thank you, I appreciate the progress notes. I looked up your trial and I didn’t see..." + (show)
@mnewland99

Thank you, I appreciate the progress notes. I looked up your trial and I didn’t see any California.

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Did you look for it in NCI?
I was there last night and surprised how many sites have it. Will look again today for California sites.

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gamaryanne | @gamaryanne | Aug 20 9:20am
In reply to @mnewland99 "Thank you, I appreciate the progress notes. I looked up your trial and I didn’t see..." + (show)
@mnewland99

Thank you, I appreciate the progress notes. I looked up your trial and I didn’t see any California.

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Hello Marie,
For California, it says UC Sacramento will be recruiting for this trial.
NCT06040541

Site was updated 7/25 and says 17 sites.

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