Too much oxalyplatin?

Yes, it is common to cut back on the Oxaliplatin... maybe first to 75%, or even 50%. Sometimes it is removed completely, and the 5FU is continued... and the immunotherapy. But, while it is usually certain that the Oxaliplatin is the culprit for most nasty side effects... the 5 FU and the Opdivo can also be to blame. Sometimes just skipping a cycle can really help... or even just go 3 weeks instead of 2 weeks between infusions.

So... how good are things looking? Is distant spread no longer seen? Only in the esophagus now? Maybe a chance to now get some radiation to work hard on the solid esophageal tumor and nearby lymph nodes... maybe even get to surgery? I've seen these things happen... many times.

If switching chemo regimens... what is his oncologist suggesting? Folfiri... using Irinotecan instead of Oxaliplatin? Maybe Taxol? Just don't get the 5FU by Capecitabine pills versus the infusion... everyone says it's much harder on your digestive system.

Ok... keep us posted. Any neuropathy... or cold sensitivity... or mouth sores?

Hang tough.

Gary

Thank you @mrgvw. That is so kind of you to explain that. My husband’s pet scan in September was amazing and the cancer seemed to only be showing in the cardia and all of the lymph node activity and liver sports appeared to be clear. He had gone from not eating in June and being on a feeding tube to being off that and eating and thriving.

Long story he has an injection to boost white blood cells late September and his pleural area in his lungs filled with fluid. We had that resolved with a surgical procedure but since that time the last 3 chemo have been very bad running high fevers.

The PA (see dr in one week- PA saw us last minute due to lung issues before the holiday) is suggesting a change of chemo. I just feel like this one has been so successful. But the pet scan we had about a week ago wasn’t as successful. Showed some lymph node activity and metabolic activity but also says “no anatomical differences”. I am curious to speak with the dr. I may just be scared to switch chemo regimens because he had been so successful on this one. He is most likely going to recommend ramucirab and Paclitaxel (per PA convo)

Chemo regimens are discontinued for various reasons... and conversely, can be continued for opposite reasons.

If a stalemate... no progression of spread, or tumor growth... this is considered a win. Most likely going to stay the course. Chemo regimens are discontinued if cancer progression is still seen... or... side effects are too much for the patient to continue. The latter may be why a change is coming for your husband. Chemo regimens are also changed if, coming out of esophagectomy surgery, positive lymph nodes are seen. Then the neoadjuvant treatments will be abandoned (deemed a failure), and a new 2nd line regimen will be used adjuvantly.

I assume his feeding tube is still in place. Doesn't matter if he didn't need it for a month or two. Leave it be... the journey is long, we never know when we need to lean on it again for calories and hydration.

Ramu and Taxol is common these days for 2nd or 3rd line treatments. No spread to organs is important. The liver is a typical first offramp for EC spread. But a distant lymph node metastasis (like hip or spine) they will also be monitoring. Keeping things local is important. Probably won't happen, but palliative radiation on the solid esophageal tumor can help with swallowing (but not enough radiation to cause esophageal inflammation... which is often an unknown for each patient). The esophagus is ground zero for our cancer... I never mind seeing them burn the source tumor to a crisp... even while still attacking and spread seen with systemic chemo. But obviously your oncologist will elaborate on this option.

But go in asking questions... trying to understand. Believe me, it's a guessing game often, even for our oncologists. Our EC is an elusive sumbitch!