Blood Clots from Chemo?

For background, I had Whipple February 9th 2024, then 12 rounds of Folfirinox during which my CA19-9 never rose above 11, but then CT-scan 2 weeks later showed liver lesions and subcutaneous belly tumor. I had SBRT the first week of March. Restarted Gemcitabene/Abraxane in late April. I had a CT scan yesterday and am waiting for results, however I started having pain under my bottom right ribcage a week and a half ago, and so of course I am terrified this is new and the treatments are not working. If that's the case, is lipsomal irinotecan my next shot, or do I try to get into an RM6236 trial somewhere? I know you are not doctors but appreciate your thoughts. My CA19-9 is 132 right now, has not reliably come down but more bounces around. I am unfortunately KRAS G12V, and adenosquamous (the most aggressive type).

@mnewland99
Naliri includes 5fu.
The difference is that the irinotecan is a lipsomal version.
The side effects are similar to folfuri. But it seems to be working. I’m hoping for two more rounds to get my CA19-9 back to normal OR to have the lesion small enough for SBRT. I will find out Thursday how small the area must be for SBRT. Hoping it’s already there !
As an aside, my surgeon removed my gallbladder when he was working on my liver. He said it was useless and just another area to attract cancer. Maybe just get it out?!

I’m in the exact condition you are in - had to face those choices of Naliri or 6236. My CA19-9 (289) and CEA are rising and had 4 types of scans and MRI showed nothing and CT and PET ID’d maybe very small lesion in liver and high uptake 4.9 on gallbladder. I’ve only been on gemzar since January of this year and my numbers only started to go above normal limits at very end of April; so we are on a “witch” hunt now. I didn’t take the 6236 phase 3 trial because it’s randomized and only 50% get the target drug (it has a name now but I forget offhand its name); the arm I believe is the liposomal chemo. I rather look for surgical options if in liver or gallbladder. If in peritoneal area then I might try Claudin 18.2 if I can get it. Trouble I have with Naliri is that it can cause someone with lung disease to get worse and I have history of asthma and interstitial lung disease. It’s all a personal and I’ll be praying you find the right solution for you.

My liver lesion was 0.9cm before SBRT and based on scans they say it worked, however a new lesion adjacent to old one may have sprung up - too small to see now to be sure. I’m seeing gallbladder specialist now.

I’m in the exact condition you are in - had to face those choices of Naliri or 6236. My CA19-9 (289) and CEA are rising and had 4 types of scans and MRI showed nothing and CT and PET ID’d maybe very small lesion in liver and high uptake 4.9 on gallbladder. I’ve only been on gemzar since January of this year and my numbers only started to go above normal limits at very end of April; so we are on a “witch” hunt now. I didn’t take the 6236 phase 3 trial because it’s randomized and only 50% get the target drug (it has a name now but I forget offhand its name); the arm I believe is the liposomal chemo. I rather look for surgical options if in liver or gallbladder. If in peritoneal area then I might try Claudin 18.2 if I can get it. Trouble I have with Naliri is that it can cause someone with lung disease to get worse and I have history of asthma and interstitial lung disease. It’s all a personal and I’ll be praying you find the right solution for you.

Well I just got my CT scan results and they are not good. 2 more lesions in the liver, and possibly others but hard to interpret. I am meeting with my oncologist tomorrow morning and hopefully she can suggest course of action.

I’m so sorry @dalegantous to hear your news. Based on your CA19-9 results it sounds like you caught this is early. My CA19-9 2 weeks ago was 284. You have a number of options available to you: histotripsy, new chemo drugs like Naliri, etc. New diagnoses are always difficult, as you mentioned in your last post we will pray for each other for a good outcome and hope for time and a cure.

Thank you @mnewland99! Plan is for me to try to get SBRT on new liver lesions, and my oncologist tomorrow morning is switching me to Naliri. Really appreciate this forum and your comments, that's how I learned about Naliri!