Change of Chemo

Posted by amchurch @amchurch, Mar 19 2:36pm has been on folfirinox for about 9.5 months. Recently...although no new spots...a couple of spots have grown a tiny bit. We are contemplating doing a clinical trial but his onc wants to change to gemzar/abraxane and he can't start that until we know it won't disqualify him from the trial (RMC-6236). Has anyone had success when changing from folfirinox to G/A? His Ca19-9 was creeping up but last one went down quite a bit. It's very strange. Looking for success stories to share with my brother. Thank you

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I did 2 rounds with Folfirinox which resulted in rising CA19 and tumor growth. Switched to Gem/Abrax and had wonderful results. After first round CA-19 went from 473 to 74. And continued downward. Also tumor size decreased quite a bit. I found Gem/Abrax easier to tolerate as well.


I did 12 of Folfirinox over 6 months with slightly rising CA19 and moderate tumor control before surgery. I've done 29 G+A+C treatments since the cancer came back, with much better results and tolerability. I'd prefer GAC any (every!) day of the week over Folfirinox. I know two people who had really bad reactions to G/A, but every patient is different.

You are wise to make sure switching won't disqualify him from a trial. It looks like the RMC-6236 trial is an oral med specifically targeting RAS mutations. That sounds far preferable to a broadly cytotoxic IV every two weeks. Best of luck to your bro!


I did a year of fulfurinox(stopped counting how many!). This got me to suegeries to clear my pancreas and my liver. Then in June2023 had reoccurrence. Two consults suggested Gemzar. That got me to a third surgery in an October.
I remain on it and my CA19-9 (which, for me, tracks my disease quite well) has been in normal range since January. This INCLUDES a month break from all chemo in February!
Very easy to tolerate.
Beginning March 1 we removed the abraxane so there would be hope to have hair again😊
(Stay tuned for that one!)

I, too, am at a crossroads now considering a trial that targets KRAS G12D; try Xeloda pills or continue with Gemzar.

A nurse navigator at one of the trial sites had some very sage advice. Would recommend speaking to multiple sources before making decisions.

So glad your brother is doing well !


Also-please remember that CA19-9 is never a sole determining factor of disease. In fact, the trial I am looking at doesn’t even use these markers for measurement since they can be affected by so many things.


@amchurch, you may also be interested in these related discussions:
- Anyone on Gemcitabine with Abraxane? How long? Effective?
- GemAbraxane Side Effects

When will you find out about his eligibility for the clinical trial? Or if he'll start gemcitabine and abraxane?


Also-please remember that CA19-9 is never a sole determining factor of disease. In fact, the trial I am looking at doesn’t even use these markers for measurement since they can be affected by so many things.

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@gamaryanne - Good advice that CA19-9 is not the only determinant of disease. However, in my case it's been the only determinant for twice cancelled Whipple surgery. Imagining results were good.
Regarding switch from Folfirinox to Gem/Abrax. During my 4th cycle of Folfirinox I had a severe reaction to Oxaliplatin. I was switched to Gem/Abrax for a few cycles, followed by three weeks of radiation. About six weeks later my Whipple was cancelled due to a sharp rise in CA19-9 value. A month later, with similar high CA19-9 levels and stable imaging results, I opted to postpone surgery again and return to chemo for two months before a third try for Whipple surgery. My current chemo treatment is 4 cycles of my original Folfirinox minus Oxaliplatin, I speculate that six months ago, had I continued with the modified Folfirinox rather switching to Gem/Abrax, my CA19.9 levels would have continued to fall and my Whipple would have happened in January as originally scheduled. However, teasing out cause and effect in our individual treatments is tough if not impossible to do.
Regarding chemo side effects. For me, side effects from Folfirinox were significant and sometimes severe, but side effects from Gem/Abrax were minor.
Last thought for what it's worth. @markymarkfl has suggested more than once to several people that moving near a cancer center of excellence for the duration of one's treatment is very important. In retrospect, if I had done so I'd probably be in a better situation than I am now.... though I'm not yet in a bad one.
@amchurch - Best wishes to you and your brother.

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