Anyone have GemCap chemo - Gemcitabine and Capecitabine (Xeloda)?

Nab-paclitaxel (Abraxane) is an expensive treatment with some hoops to jump through. I'm not sure if part of your issue is the combination of meds or just the price issue, but I'm on Gemcitabine+Abraxane+Cisplatin (GAC) now for a pancreatic cancer recurrence, and it's definitely working better for me than the Folfirinox did before my Whipple surgery.

When my medical team was getting me set up to restart start chemo, they immediately told me it would not be covered by insurance. I think that has become a standard response because the manufacturer (Bristol Meyers Squibb) has a compassionate use discount where you can basically get it for free if you meet certain income requirements, and the insurance loop can be a hassle sometimes.

Unfortunately on two counts:

1) The discount is all-or-nothing: If you're below a certain income threshold, it's free; if you're one penny above, it's full price. In my case, I just reported gross income on the first, and was over the limit. After that, I dug out my tax return, looked up the adjusted gross income, sent that in and qualified to get it free (no expense to me anyway) for a year.

2) BMS has observed that a lot of medical teams have taken advantage of this -- referring patients to the program without even trying to get insurance coverage first. BMS sent a letter to patients a few months ago they were going to be a lot more strict about it in the future.

I verified that Abraxane in conjunction with Gemcitabine and Cisplatin could be considered medically necessary for PC, and it was on my insurer's website as an approved drug in combination with the others to treat PC.

The compassionate use discount takes a few weeks to process, but your insurance company might have a similar delay. The first thing to do is find out whether your medical provider even submitted it to insurance, or just took the lazy route and punted it to the discount program.

An appeal might be required with either one, but the three-drug combo has worked well for me so far. I didn't complete the discount application process in time for my first treatment, so I only received Gemcitabine+Cisplatin that round, and my CA19-9 continued its upward trend. Two weeks later, everything was in place, I got the Abraxane with it, and my CA19-9 was down significantly two weeks later. Maybe a coincidence or delayed startup response to any med, but my CA19-9 has come down about 95% on this combo, and I can't argue with that.

I’m in Canada and after my Whipple my surgeon advised there was insufficient data to say that chemo was needed after clean edges and no spread but with 1 positive lymph node he recommended I discuss with an oncologist. I made the decision to proceed and had 6 rounds of Gemcitabine, an infusion once a week for 3 weeks then 1 week off along with oral Capecitabine (Xeloda), 21 days on, 7 days off for 6 months. I tolerated the infusion quite well but had my Capecitabine reduced from 3 to 2 pills twice daily after round 2 due to a hospitalization for extreme diarrhea. After 5 rounds my oncologist cancelled the last one as I had lost a significant amount of weight and continued to have issues with diarrhea. I also had some neuropathy in my toes due to treatment. But I had had my 3 year anniversary and so far so good. Routine surveillance found an early stage primary lung cancer which was treated but was not related to my ampullary cancer. I’m currently getting 3 month or 6 month follow ups depending on previous scans.

Just know that if you are having difficulty with side effects your prescription can always be adjusted. Looking back, while very difficult, I am glad a had chemo.

Hi @aceman66, The generic name for Xeloda is capecitabine. Thus the name of the chemo combination you are getting is often referred to as GemCap (Gemcitabine and Capecitabine). I updated the title of this discussion to reflect your question.

Have you started chemo yet? How are you doing?