Connect
Importance of genetic testing for treatment
69 year old male with either pancreatic or periampullary cancer. Tumor is not well seen or measured by ct or pet scans which I guess accounts for the diagnostic confusion. My mother died of pancreatic cancer 20 years ago. I am now getting genetic testing done and was curious how those results might be important in my treatment. Have had five rounds of Folfirinox and I think they plan on doing eight and then doing a whipple. My other curiosity is how long after a whipple do people feel they can resume a chemo regimen and how many people had their cancers return during this post whipple period without chemo treatments.
Like
Helpful
HugInterested in more discussions like this? Go to the Pancreatic Cancer Support Group.
Connect
Genetic testing and tumor testing are vital for your long term care. It is widely know in this community that certain gene mutations respond very well to particular treatments. EG-if you are “lucky enough” to have the BRCA mutation many studies and correlations have been done for best responses.
I have KRAS G12D for which I find very little positive work so far, although there are clinical trials ongoing.
VERY very important to know your gene mutations to be able to advocate for yourself. Especially if you should plan for second opinions.
-
Like -
Helpful -
Hug
1 ReactionAgree w/ @gamaryanne completely. You need to know your mutations to determine eligibility and best fit for clinical trials. Two basic categories of mutations are germline (inherited from parents) and somatic (caused by environment or something other than inheritance).
I my case, I've been told the ATM mutation responds well to platinum agents. Although I didn't have a great response to the Folfirinox (which contains oxaliplatin) before Whipple, I've had a much better response (post-Whipple) to a cocktail which includes cisplatin.
After my recurrence, the local oncologist offered me Gem+Abrax w/o the cisplatin (he thought that would be too rough for me) or a clinical trial targeting ATM that didn't include cisplatin (and had 50% chance of containing placebo rather than the trial drug).
I'm now driving 2.5 hours each way for chemo (Gem+Abrax+cisplatin) that I'm responding very well to, while my care teams have time to look into newer trials more specific to ATM. There's a new maintenance therapy targeting BRCA1/2 and PALB2, which are similar to ATM, so drugs used on those might be my next option as well.
I look at genetic testing the same as any other data: It doesn't hurt anyone (at least not me) to know it, but it might hurt me to not know it.
--
As far as delay in resuming chemo after a Whipple... hard to say. I had an open Whipple w/ 22 lymph nodes removed at age 59. I was pretty miserable (digestion and fatigue) for a solid month after surgery. It was 7 months post-op before I returned to work, mostly from home, on a slightly reduced schedule that allowed time for some naps.
Depending on what else I had going on (work and family responsibilities), I think I could have handled more chemo beginning 10-12 weeks after Whipple. That also depends on which chemo you're getting -- maybe more time if you're getting Folfirinox again, less time if you're getting something milder. If necessary to resume sooner, you could always ask the oncologists if they can ramp you up from a lower starting dose as you're able to tolerate it, or just omit certain drugs from the cocktail at first, then add them later as you are able to tolerate.
Just wanted to thank you for your replies to my recent posts. Your time and effort are much appreciated. Best of luck to you.
-
Like -
Helpful -
Hug
2 ReactionsYou're very welcome. And...
Edit to my previous post:
7 weeks post-Whipple before returning to work, not 7 months. I would love 7 months off!