Thanks for the reply.

Her reaction to the first GAC treatment was so strong that the dose of all 3 components were cut by 20%. Her white count had dropped to 0 and was given 3 nupagen shots to counteract. Now she's getting nulasta after each day 8 treatment. She had ongoing issues with diarrhea which were manageable before GAC but have become non-stop since. Imodium and lomatil haven't helped at all and now she's been given tincture opium scrip but haven't started yet. Nausea which is treated with zofran, compazine and Ativan which doesn't always work during the first 4 days after treatment. Severe fatigue. She's bedridden for 4-5 days after day 1 treatment and 7-8 days after the day 8 treatment. The chemo brain and depression are severe. Neuropathy in hands and feet is worsening too.

The concern with dropping the cisplaten is that the molecular analysis of her tumor showed that platinum drugs were very effective. Her pre-surgery folfirinox included oxalyplaten and the tumor was actually necrotic at the time it was removed. This time there's no visible tumors so the chemo is underway because of the high CA19-9. Since nothing is visible we have to count on the chemo regimen to wipe out cells wherever they're hiding even if it's a low concentration of cells.