Anyone on Gemcitabine with Abraxane? How long? Effective?

Posted by helenar @helenar, Aug 17, 2022

Hi, I'm Helena from South Africa. I have been diagnosed with PC, stage 4, in March. Tumour between body and tail and with one lesion on my liver.
I have been on Folfirinox for 3months, but it had no effect, allthough my markers came down from 3091 to 357, the tumour increased in size and there is another lesion on my liver.
I have started Gemcitabine with Abraxane.
Has anyone been on Gemcitabine/Abraxane?
If so, how long and how effective is this treatment?

Interested in more discussions like this? Go to the Pancreatic Cancer Support Group.

@colleenyoung

@mommacandy, I think you'll appreciate these related discussions:
- Anyone on Gemcitabine with Abraxane? How long? Effective?
https://connect.mayoclinic.org/discussion/gemcitabine-and-abraxane/

- Changing chemo regimen after 4 cycles of Folfirinox?
https://connect.mayoclinic.org/discussion/changing-chemo-regimen-after-4-cycles-of-folfirinox/

Regarding wild fluctuations in CA-19, see these discussions:
- Pancreatic cancer and CA19-9
https://connect.mayoclinic.org/discussion/pancreatic-cancer-and-ca19-9/
- CEA and CA19-9 Results as Predictors of Treatment Outcome
https://connect.mayoclinic.org/discussion/cea-and-ca19-9-results-as-predictors-of-treatment-outcome/
- CA-19 has elevated even more
https://connect.mayoclinic.org/discussion/ca-19-has-elevated-even-more/

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Ty I did read through those (one was one of my own post lol) and it was interesting reading some others... the Gemzar/abraxane has definitely been easier for him to tolerate and he's at least eating a little more. My biggest issue ATM is making him realize he's diabetic and needs to take insulin regularly..
This week's treatment wasn't terrible on him so we'll see how he does
Ty for sharing thise

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@ken240

I am on Gem/Abrax currently, 3 weeks on, 1 off. I, too, receive Decadron as a pre-med with Aloxi or Zofran. I was thinking about asking my oncologist to reduce the Decadron dose because I think it causes insomnia. May I ask why your dose was reduced?

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The Decadron dose was reduced due to the thinking that the swelling in my feet & ankles & whole body might be related to it as it is a steroid. Not sure if that changed much for the swelling. I too have insomnia the first and sometimes second nights of getting the Decadron. That did not change when I got the lower dose. I was still "wired" the night of chemo and the next. Lack of sleep & steroid equals one cranky person 🙂 Try to stay away from people who do not get it & that ends up being most people 🙂

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@bella71

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.

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Yes! First night(Friday) I’m ready to go out to dinner stay up all night! But Saturday afternoon when the Onpro shot goes off it’s downhill for two days. Very predictable. I guess the steroid gets us out of the doctor’s office with no complaints until Monday!

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@bella71

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.

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@gamaryanne and @ncteacher -- Your comments are right on, LOL! I have chemo on Fridays and get home feeling OK, relax on the weekend, then crash and have to take Monday off work.

I did reduce the decadron in my pre-meds by about 1/3 several months ago because of its impact on my blood sugar. That and a long drive home might be suppressing my insomnia. I do have dexamethasone tablets at home as a backup to Zofran. I rarely take them, but if so, only in the morning because of the insomnia.

@sprinter345 and @199 -- You are true marathon champions. Have your oncologists discussed switching treatments or reducing/eliminating any of your chemo meds?

I've heard the Gem/Abrax (+/- cisplatin) is usually only good for 6-9 months before it either becomes intolerable (neuropathy) or ineffective (cancer develops resistance). My docs have said they have an answer for every side effect but neuropathy, which I accept as a tradeoff for the other positives of treatment.

My CA19-9 leveled off around 40 for about 8 weeks, and two oncologists both started discussing "maintenance therapies" for me, suggesting the Abraxane/cisplatin had done all they were going to do. This would mean reducing/eliminating one/other/both and likely going to nothing but Gem. And then, my CA19-9 this week dropped to 33 -- two points inside the normal range! (Previous week's scans still report "stable disease" and Signatera detects no ctDNA.)

I don't think this regimen has run out of gas yet. I fear if I back off of anything it will give the cancer a chance to regroup and spread. 19 treatments haven't killed me yet. I was ruled out as a candidate for HIPEC, and I might be a candidate for some trials in the distant future, but I don't see anything on the horizon with more promise than what I'm currently on.

Would love and appreciate your insights on this.

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@markymarkfl

@gamaryanne and @ncteacher -- Your comments are right on, LOL! I have chemo on Fridays and get home feeling OK, relax on the weekend, then crash and have to take Monday off work.

I did reduce the decadron in my pre-meds by about 1/3 several months ago because of its impact on my blood sugar. That and a long drive home might be suppressing my insomnia. I do have dexamethasone tablets at home as a backup to Zofran. I rarely take them, but if so, only in the morning because of the insomnia.

@sprinter345 and @199 -- You are true marathon champions. Have your oncologists discussed switching treatments or reducing/eliminating any of your chemo meds?

I've heard the Gem/Abrax (+/- cisplatin) is usually only good for 6-9 months before it either becomes intolerable (neuropathy) or ineffective (cancer develops resistance). My docs have said they have an answer for every side effect but neuropathy, which I accept as a tradeoff for the other positives of treatment.

My CA19-9 leveled off around 40 for about 8 weeks, and two oncologists both started discussing "maintenance therapies" for me, suggesting the Abraxane/cisplatin had done all they were going to do. This would mean reducing/eliminating one/other/both and likely going to nothing but Gem. And then, my CA19-9 this week dropped to 33 -- two points inside the normal range! (Previous week's scans still report "stable disease" and Signatera detects no ctDNA.)

I don't think this regimen has run out of gas yet. I fear if I back off of anything it will give the cancer a chance to regroup and spread. 19 treatments haven't killed me yet. I was ruled out as a candidate for HIPEC, and I might be a candidate for some trials in the distant future, but I don't see anything on the horizon with more promise than what I'm currently on.

Would love and appreciate your insights on this.

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@markymatkfl;
Where is your metastises?

Gem/abraxane has shrunk my 2 tumors and brought CA19-9 to normal range. Surgery next week to remove them One is a definite, one is very very small and not in a sweet spot. But back up plan is to manipulate the area so it can be radiated. This time I WILL go back on chemo. I have not developed resistance to Fulfurinox or Gemzar so will be listening to recommendations from docs here and elsewhere. But, I will not delay for long!

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@markymarkfl

@gamaryanne and @ncteacher -- Your comments are right on, LOL! I have chemo on Fridays and get home feeling OK, relax on the weekend, then crash and have to take Monday off work.

I did reduce the decadron in my pre-meds by about 1/3 several months ago because of its impact on my blood sugar. That and a long drive home might be suppressing my insomnia. I do have dexamethasone tablets at home as a backup to Zofran. I rarely take them, but if so, only in the morning because of the insomnia.

@sprinter345 and @199 -- You are true marathon champions. Have your oncologists discussed switching treatments or reducing/eliminating any of your chemo meds?

I've heard the Gem/Abrax (+/- cisplatin) is usually only good for 6-9 months before it either becomes intolerable (neuropathy) or ineffective (cancer develops resistance). My docs have said they have an answer for every side effect but neuropathy, which I accept as a tradeoff for the other positives of treatment.

My CA19-9 leveled off around 40 for about 8 weeks, and two oncologists both started discussing "maintenance therapies" for me, suggesting the Abraxane/cisplatin had done all they were going to do. This would mean reducing/eliminating one/other/both and likely going to nothing but Gem. And then, my CA19-9 this week dropped to 33 -- two points inside the normal range! (Previous week's scans still report "stable disease" and Signatera detects no ctDNA.)

I don't think this regimen has run out of gas yet. I fear if I back off of anything it will give the cancer a chance to regroup and spread. 19 treatments haven't killed me yet. I was ruled out as a candidate for HIPEC, and I might be a candidate for some trials in the distant future, but I don't see anything on the horizon with more promise than what I'm currently on.

Would love and appreciate your insights on this.

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Our oncologist intends to keep him on the gemabraxane with pamrevulab as long as he has stable disease and no bad side effects. Then the current plan is for Fulforinox, then there is hope that the KRAS studies will pan out- they are very promising but not currently being tested in his lab articulation variant.
I am with you - I wouldn’t stop - cancer is very aggressive- I wouldn’t take a chance if it were up to us.

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@199

Last week I finished my 38th chemo with Gemcitabine & Abraxane for stage 4 inoperable pancreatic cancer started in tail & went to lungs. I started end of July 2022. My CA 19-9 is within normal limits at 18. My CT shows improvement. The worse pains I have had are bone pain and neuropathy from the chemo. I am bald & due have fatigue, but I am still here 🙂 Just had my dose of Abraxane and Decadron reduced, and the schedule changed from 2 weeks on & one off to one on & one off. Will see how that goes. I get Decadron & Aloxi prior to the Abraxane, then normal saline flush & gemcitabine. Would love to have a break soon but will see what my oncologist says. Only taking Percocet & Tramadol for pain so far. Lately I have been taking one of each in the morning, mid-afternoon & 2 in the evening either together or spaced depending on the severity of the pain.

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Did your tail tumor size decrease significantly? Did they find it in the lungs because they were looking for it or did you have symptoms?
I’m always afraid it’s going somewhere and we won’t realize unless he has other symptoms. It had metastasized to the liver when he started.

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@bella71

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.

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@sprinter345 -- Thank you for that! Is the pamrevulab approved yet, or just part of a clinical trial?

@gamaryanne -- It's hard to follow all the radiology reports because of changes in terminology and landmarks, and nothing has a definitive, positive biopsy, so everything is just based on imaging, but there are suspicious lesions or nodules or masses or deposits at the original surgical site (head of pancreas); tail of pancreas; central mesentery; peritoneal wall; liver; spleen; paracolic gutters, and other parts of the anatomy I've never heard of!

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@markymarkfl

@sprinter345 -- Thank you for that! Is the pamrevulab approved yet, or just part of a clinical trial?

@gamaryanne -- It's hard to follow all the radiology reports because of changes in terminology and landmarks, and nothing has a definitive, positive biopsy, so everything is just based on imaging, but there are suspicious lesions or nodules or masses or deposits at the original surgical site (head of pancreas); tail of pancreas; central mesentery; peritoneal wall; liver; spleen; paracolic gutters, and other parts of the anatomy I've never heard of!

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It’s an arm if the Precision Promise Trial. Results should be in early next year I think. Not sure if it’s the trial drug helping or if he would be responding with just the standard of care.
But as long as he’s responding to something I’m thankful !

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@sprinter345

Did your tail tumor size decrease significantly? Did they find it in the lungs because they were looking for it or did you have symptoms?
I’m always afraid it’s going somewhere and we won’t realize unless he has other symptoms. It had metastasized to the liver when he started.

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My CT last month showed that the tail tumor has significantly decreased in size; in fact, it said there is no evidence of disease recurrence. The lungs were found because I had some nodules on a CT done to see what happened after having not smoked for 15 years; then PET scan showed a problem with my pancreas which trumped the lung nodules. The lung nodules some shrank and others disappeared in response to the chemo.
As my oncologist explained I will always be a stage 4 pancreatic cancer patient because there will always be some minute cell wandering around that could cause a recurrence so monitoring will be needed.
The only symptom I could relate to would have been mid-back pain just before the diagnosis & that was attributed to "arthritis". That is why this is still so surreal.

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