Anyone on Gemcitabine with Abraxane? How long? Effective?

So sorry to hear of your loss. Condolences to you and your family

@amchurch , I am confused about this like you are. HIPEC (the Heated IntraPEritoneal Chemotherapy) treatment is usually done in conjunction with CytoReductive Surgery (CRS) which is basically going in surgically and removing every metastatic tumor they can find -- the exact scenario for which they would close you up and not even perform a Whipple.

My gut instinct is they should do this first, but I think there's a selection process involved, in which they're taking extra time to make sure the patient is responding to the same chemo that would be used in HIPEC, and that the patient/disease is stable -- no rapid spread they would miss despite the CRS surgery.

As far as issues with other veins, arteries, and organs: I think that is a slightly separate case. The HIPEC/CRS is mainly focused on spread to the peritoneum, whereas the others might just be cases where the particular surgeon's skill at vascular reconstruction is far above average, and the affected organs with mets might be treatable by another method like radiation.

I really don't know much about this, but those are my questions and thoughts. I sincerely hope someone else can chime in with more experience, knowledge, and detail.

Looking forward to hearing from others regarding this. My diagnosis is PCAC, metasticized to liver, with the rarer KRAS G12C mutation.
Folfirinox was determined to not be effective enough after 4 months (still some progression in the liver.) I did not tolerate that regimen well. Made me increasingly sick over the 14 day cycle.
Wondering about others’ experiences were/are moving to Gemcitabine/Abraxane.
Did you tolerate Folfirinox well or not as first line? Did you/do you tolerate G/A well or better than Folfirinox?
My other option is a clinical trial that targets the mutation, but it is Phase 1 and there is no historical data on it particularly as it relates to Pancreatic Cancer. It might be more tolerated but total shot in the dark.
Many thanks for sharing your experiences.

Long story short:

I did 6 months (12 rounds) of Folfirinox before Whipple for PDAC. No obvious progression was ever detected on scans. Post-op analysis of the tumor rated treatment as a "partial response" (2 on a scale from 1-3).

I've done about 17 biweekly rounds of Gemcitabine + Abraxane + Cisplatin since my recurrence in January. I'm tolerating it better than I did the Folfirinox, and am seeing _much_ better reduction in CA19-9. FWIW, I have the ATM mutation.

My sequence of imaging reports are not totally consistent from one to the next. It seems there are more "lesions" noted on newer scans, but they've been calling it "stable disease" for the last 5 months. Will have more scans in 2 weeks and new data then.

As far as trials go, I'm keeping them on the future radar, but trying to stick with the most "conventional" treatments first. It seems like any of the treatments that alter your immune system (mRNA shot, CAR-T or NK cellular treatments) might disqualify you from other future trials.

mmpace - I have adenocarcinoma (Stage 1b) at the head of my pancreas. I had to discontinue neoadjuvant Folfirinox infusions after only four cycles. Though the Folfirinox was effective (some shrinkage of tumor and falling CA 19.9 numbers), I recently had to switch to Gemcitabine/Abraxane due to increasingly severe allergic reactions. The mostly different side effects of the Gem/Abrax have been easier to handle than those of Folfirinox. The effectiveness of Gem/Abrax for me has not yet been determined.

@mmpace, I hope you saw the helpful replies from @markymarkfl and @wjk. I moved your question about changing from Folfirinox to Gemcitabine/Abraxane to this existing discussion:
– Anyone on Gemcitabine with Abraxane? How long? Effective? https://connect.mayoclinic.org/discussion/gemcitabine-and-abraxane/

I did this so you can read previous helpful posts and connect easily with others who have experience with this regimen.

Did you decide to try the clinical trial or opt for Gemcitabine/Abraxane? How are you doing?

Well my friend's oncologist changed him to the Gemzar/abraxane combo after he received the all clear from the infectious doc regarding the mssa infection he had gotten as a result of the port being put in.. obviously the port was removed, on home IV antibiotics all last week, and got all clear on Monday...so yesterday he got his first treatment with the new combo and I gotta say he tolerated it a whole lot better..
One thing I am concerned about is his ca19 reading has gone up another 1000 in the past month... I get part of that is probably due to his only having the one treatment of chemo before the infection kicked up...Aug 31 it was 32040 yesterday it was 33080..should I be that concerned ?

I'm glad he's healed up and getting a more tolerable treatment. Make sure to take a picture before the Abraxane causes his hair to fall out! I'm still tolerating the Gem/Abrax with cisplatin thrown in after 19 treatments better than I tolerated 12 Folfirinox, so there's hope for him there.

On my first treatment, the Abraxane was missing (not approved yet), and my CA19-9 was also higher two weeks later. It started coming down after the Abraxane was added in, but we don't know if it was really the additional drug or just a delayed reaction.

Either way, levels over 30000 are definitely a cause for concern, but the increase was only 3%, which might be in the error range / variability of the test, or numerous other "noise" factors. I wouldn't panic just yet -- give it a few treatments to watch for the trend. But if you can, ask the oncologist to test CA19-9 as often as practical. (i.e., if they're testing CBC+CMP before each infusion, ask them to include CA19-9 as well.)

My mom started chemo about 6 weeks ago. The Dr. says it is to give her a better quality of life and slow the growth of her cancer. The doctor warned us that eventually the chemo would stop working. Does anyone know how long the chemo can keep a person alive? She is stage 4 and she is having scans tomorrow at Mayo Clinic to see if the chemo is even working. She is feeling pretty good , just weak and tired. Pain is under control. Her CA19-9 is 118,800 and has been the exact same number for two weeks. I can only think that at least it stayed the same. The previous number was 50,000. I’m so nervous for the news we will find out tomorrow.

Everyone responds differently, but I was confirmed Stage-4 last January, and have spent the last 8 months quite healthy (except for baldness, fatigue, and neuropathy) on Gem/Abrax/Cis. I'm very fortunate so far my only ill effects are from the chemo and not from the cancer, but I'll take that any day!

I've heard this regimen often becomes intolerable or ineffective after 6-9 months. I'm about to have my 19th biweekly treatment, but another member posted here not too long ago about doing well after #33 and counting.

There is a lot of hope for longevity if the right things go well, and pre-planning the next treatment option if they don't. A lot of that depends on things like genetic mutations she might have. For example, with the ATM mutation, it made sense for my oncologist to add cisplatin to the Gem/Abrax. I'm looking at every clinical trial possible for when/if this runs out of gas for me.

Make sure to ask the oncologists about the options and next steps when they go over the scan results with you tomorrow.

Best wishes to you both!