Sadly, the effects are cumulative. GA is supposed to be "well tolerated" compared to folfirinox/oxalyplaten. From my perspective, it's largely a matter of how debilitated you get at each step of treatment and how much you rebound before the next treatment. When I wrote the post above, my wife was early in the GAC/GA treatments. Ultimately she had 18 treatments (I don't use cycles because it underplays the amount of chemo and time). What we learned from that experience is push back hard on the oncologist if you're not getting good results on scans and the side effects don't seem worth the results. By my records, my wife should have changed treatment plans after 8 treatments; the next 10 brought no improvements in mets and the side effects brought her to the point of giving up. Good luck and hope you can make your planned travel.