Changing chemo regimen after 4 cycles of Folfirinox?

I have seen a lot of people switched and see better results. I only completed 2 rounds of Folfirinox before switching to Gem/abrax and then radiation. Recovering at Mayo right now from a total pancreatectomy. Gem/abrax made my CA19 plummet. And more tolerable than Folfirinox for me. My pathology report from surgery showed complete chemoradiation response and no signs of cancer at all.

ashley2235 - Thanks so much for your reply. Wow! Good for you to have such a good early outcome! Re CA 19.9, pre-Folfirinox mine was 641. Most recent results of 2 weeks ago show it dropped to 289.

A few questions for you, if willing to share. How many cycles of Gem/Abrax did you do? What is the time interval between Gem/Abrax treatments? How long was your radiation treatment... 3-4 weeks perhaps? Was your pancreatectomy done laparoscopically (Kendricks?) or with open surgery (Truty)?

Thanks again for your reply. Sincere best wishes to you.

I am 67 and was stage 1b following a distal pancreatectomy and splenectomy for an IPMN that had an adenocarcinoma. I had 12 rounds of Folferinox. I had side effects, but would not describe as severe. However, always had pre-meds for nausea and steroids, and post- meds for stomach issues. To battle neuropathy, the Oxaliplatin was reduced, then eliminated from treatment plan. Have your doctors considered modifying the meds? Best wishes.

ken240 - Like you, I have been receiving pre-meds prior to each infusion. Also, my Oxaliplatin dosage was reduced but side-effects continued to worsen. I'll hear what they have to say about their modified treatment plan in a few days. I'll also intend to get a second opinion this coming week. I've also considered returning to Mayo-Rochester earlier than anticipated.... the high quality of care there is of course superior to the quality of care here in Alaska, where there is no "center of excellence" for cancer. Thanks for weighing in... much appreciated.

In some patients on Folfirinox, one or two agents can cause adverse reactions. Oxaliplatin is known for causing peripheral neuropathy and if it progresses in intensity, it gets removed from the mix and a patient may then receive Folfiri.

The other agent being Irinotecan requires a specific enzyme produced in the liver to metabolize it. If the genetic sequence that codes for this enzymes is defective, insufficient enzyme may result causing toxicity in the body. The gene sequences are UGTIAI (TA)6 and UGT1A1 (TaA)7. I believe if only one copy of either or both of those genes are mutated, decreased levels of the enzyme it codes for result. If decreasing of dose doesn’t ameliorate the symptoms, then the chemo is switched to avoid serious toxicity and permanent liver damage.,This is the gene responsible for Gilbert Syndrome. A specific genetic test is done that is done to confirm Gilbert’s syndrome and this could be the cause of the reaction you were having.

Hello. I was scheduled to have Folfirinox 6 weeks after I had the Whipple procedure - stage 3 pancreatic adenocarcinoma. I had 1
Folfirinox treatment in the hospital but my reaction to it was so severe that I wasn't even able to complete the 2 days at home with it after the infusion at the hospital. I had terrible vomiting and a fever right away. I refused to take anymore and the oncologist switched me to gemcitabine and abraxane. which I tolerated for the 6 months that I was on it.
Since then. I have a new oncologist who told me they could have adjusted
The folfirinox cocktail, but my original oncologist never even mentioned that. The gemcidibine/abraxane wasn't too bad until about the last 6 weeks when the nausea became worse and I had a fever one day per week. Also, I could only do the chemo every other week because it really affected my
white blood cells.
I dont know if this helps you, but I know what you're going through.
God bless.

Yes, go back to Mayo.

lilliejane2 - Thanks for your input. Yes, it does help. Your severe drug reaction is different than mine.... I've had neither vomiting nor fever. I assume your white blood cell count was low, and the reason for getting the Gemcitabine/Abraxane every other week rather than once a week. My WBC has been rising. As of a few days ago, it was 22.3, two times above the upper limit of normal values. This apparently due to the Neulasta injection I received following my second and third infusions.

lvtexas - Thanks for the simple, straightforward advice. Considerations for heading back to Rochester ASAP include the quality of care of one versus another, the cost of staying there for a few months, the distance from here to there (3,200+ miles; about a six day drive or a $1,000 one-way airplane ticket), quality of life (separation from family), etc. I'll make the decision following a second opinion and my next week visit to my Alaska oncologist.

stageivsuvivor - Thank you. I was unaware of the substitution option of Folfiri for Oxaliplatin. Likewise, I was unaware of Irinotecan and associated enzyme issues secondary to specific mutated genes. I appreciate your input that makes me better prepared to discuss options with my oncologist nest week. I'll be exploring the Folfiri option, genetic testing and Gilbert Syndrome. Thanks.