What to expect from Gemcitibine chemo/radiation?

Posted by krfinlayson @krfinlayson, Jun 18, 2023

I was diagnosed with stage III pancreatic cancer in Jan 2021. Whipple surgery was performed the following month, followed by 12 treatments of Folfirinox. All was well, until Ca19-9 marker started climbing. CT scans were showing nothing, PET scan confirmed “localized relapse” at the same location ,close to the liver and a nearby lymph node. Surgery is not an option. Treatment plan calls for 3 months of Gemcitibine (weekly for 3 weeks then a week off, repeated for 3 months) followed by 5 weeks of daily radiation and chemo. Scans/bloodwork to monitor results.
What has been your experience with either treatment? I live 4 hrs away from treatment centre. My hope is this will buy me more bonus time with family. Thanks for any input!

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@jk77

Hi, ken240. Sorry to ask you a q? that should be addressed to my onc., but so far I get very little time with him.

My cancer (diagnosis in Feb. 2023; chemo began 4-4-23) hasn't been staged bc there's still some ambiguity about the nodules on my lungs (i.e., are they metastatic?). I've finished six rounds of Folfirinox, will have at least another two, and will learn, probably next week, what comes next (radiation, or surgery, or radiation plus surgery).

I too have five bad days from Fol., with days 1 and 2 the worst and days 3, 4, and 5 gradually becoming tolerable. Do you know why there's a lag between infusion day and the really bad days? For me, the lag is always four days -- chemo on Tuesday, feel lousy on Sat. and Sun.

Thanks for taking the time to read this, and best wishes to you.

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Hi,
Hope you're doing ok. I will try to give you an answer to your question based on my experience, but it can be frustrating because everyone has different experiences. The thing that delays my bad days is the pre-meds that they give me before treatment. I get Zofran for nausea and Decadron (sp?), a powerful steroid that makes feel better than I actually am, until it wears off. These are the pre-meds that I presently get with the Gemzar Abraxane chemo. It was similar, but different brands, that I received with the Folferinox. This, I think, explains my delay of the bad days. Additionally, I have found side effects to be cumulative, where bad days might stretch out a little longer, the more treatments you get. I had dosage lessened to guard against that. I hope is helpful. Best wishes.

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@ken240

Hi,
Hope you're doing ok. I will try to give you an answer to your question based on my experience, but it can be frustrating because everyone has different experiences. The thing that delays my bad days is the pre-meds that they give me before treatment. I get Zofran for nausea and Decadron (sp?), a powerful steroid that makes feel better than I actually am, until it wears off. These are the pre-meds that I presently get with the Gemzar Abraxane chemo. It was similar, but different brands, that I received with the Folferinox. This, I think, explains my delay of the bad days. Additionally, I have found side effects to be cumulative, where bad days might stretch out a little longer, the more treatments you get. I had dosage lessened to guard against that. I hope is helpful. Best wishes.

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Thank you. I have had two treatments so far. Some mild nausea on day after treatment - it makes sense that it would be after premeds have worn off. I am in better shape now than when taking folfirinox so hoping that will help. Best wishes!

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@ken240 : That's extremely helpful, and thank you. And "d-uh" to me -- I too get those premeds, plus I take 2 tabs of dexamethasone 4mg on each of the two days after chemo. I even noted my steroid rash today (1st day after chemo), yet I didn't make the connection that this powerful steroid is holding the side effects at bay. And, yes, I've thought that the chemo is cumulative with regard to side effects being worse or lasting loner -- thank you for that confirmation.

I'm trying to get more info on my own, but it can be daunting. Thank you for being so generous with your time and your info. Wishing you all the best.

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@jk77

Hi, ken240. Sorry to ask you a q? that should be addressed to my onc., but so far I get very little time with him.

My cancer (diagnosis in Feb. 2023; chemo began 4-4-23) hasn't been staged bc there's still some ambiguity about the nodules on my lungs (i.e., are they metastatic?). I've finished six rounds of Folfirinox, will have at least another two, and will learn, probably next week, what comes next (radiation, or surgery, or radiation plus surgery).

I too have five bad days from Fol., with days 1 and 2 the worst and days 3, 4, and 5 gradually becoming tolerable. Do you know why there's a lag between infusion day and the really bad days? For me, the lag is always four days -- chemo on Tuesday, feel lousy on Sat. and Sun.

Thanks for taking the time to read this, and best wishes to you.

Jump to this post

@jk77 ,
Are you counting Day 1 as the first infusion day, and then taking home a pump with 46 hours of 5FU (flurouracil) that you return on Day 3?

If so, your feeling lousy on Day 4 might just be the culmination of Day 1 pre-meds wearing off plus the 5FU, plus two nights of lousy sleep with that pump around your neck?

Also, dehydration is common with chemo, and makes one feel lousy. Maybe you could inquire about getting one more infusion on Day 3 before they disconnect your pump? It seems like a liter of saline (for hydration) plus some Palonsentron (Aloxi) might get you through the next two days. Aloxi is similar to Zofran, but remains active a good while longer. (I'm getting Aloxi instead of Zofran in my pre-meds now with the Gem/Brax/cis). I avoid the dexamethasone as much as possible because of its impact on my blood sugar and sleep quality.

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Re:Gemzar side effects-is anyone getting Neulasta shot along with treatment? I’m slated for one every other week. I also had it with Fulfurinox.
My first round of Gemzar gave me horrible body aches that started a few days after infusion. Was told it was the Neulasta but that didn’t occur before. Wondering if anyone else has experienced?
I’m told for next round with Neulasta to take Claritin for 7 days to ward off aches.
Other than that, no nausea or fatigue.

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@markymarkfl

@jk77 ,
Are you counting Day 1 as the first infusion day, and then taking home a pump with 46 hours of 5FU (flurouracil) that you return on Day 3?

If so, your feeling lousy on Day 4 might just be the culmination of Day 1 pre-meds wearing off plus the 5FU, plus two nights of lousy sleep with that pump around your neck?

Also, dehydration is common with chemo, and makes one feel lousy. Maybe you could inquire about getting one more infusion on Day 3 before they disconnect your pump? It seems like a liter of saline (for hydration) plus some Palonsentron (Aloxi) might get you through the next two days. Aloxi is similar to Zofran, but remains active a good while longer. (I'm getting Aloxi instead of Zofran in my pre-meds now with the Gem/Brax/cis). I avoid the dexamethasone as much as possible because of its impact on my blood sugar and sleep quality.

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Good suggestions. When I was on Folferinox, the Friday that I had pump removed, I had IV fluids that helped me get through the weekend without feeling totally wiped out. Still trying to get a handle on the Gemzar Abraxane treatment which gives one solid day of flu-like symptoms, and several days of fatigue, brought on by chemo- induced anemia.

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@gamaryanne

Re:Gemzar side effects-is anyone getting Neulasta shot along with treatment? I’m slated for one every other week. I also had it with Fulfurinox.
My first round of Gemzar gave me horrible body aches that started a few days after infusion. Was told it was the Neulasta but that didn’t occur before. Wondering if anyone else has experienced?
I’m told for next round with Neulasta to take Claritin for 7 days to ward off aches.
Other than that, no nausea or fatigue.

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I get Udenyca three days after chemo. (I'm told Udenyca is basically the same drug as Neulasta.) It is dosed at least 24 hours after the FU-5 pump is removed. Dosing schedule is dictated by insurance; if the injection is given less than 24 hours after the pump is removed, insurance won't pay. I'm told the injections can cause long-bone pain as the bone marrow activates. I was told to take Claritin a few hours before the injection and then 2-3 days afterward to minimize the bone pain. I was also told Zyrtec works. Why antihistamines work, I don't know, but there you go. Anyway, I am fortunate in that I haven't had the bone pain in six cycles. I took a Claritin yesterday before my injection, but haven't had one today--forgot all about it.

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@markymarkfl

@jk77 ,
Are you counting Day 1 as the first infusion day, and then taking home a pump with 46 hours of 5FU (flurouracil) that you return on Day 3?

If so, your feeling lousy on Day 4 might just be the culmination of Day 1 pre-meds wearing off plus the 5FU, plus two nights of lousy sleep with that pump around your neck?

Also, dehydration is common with chemo, and makes one feel lousy. Maybe you could inquire about getting one more infusion on Day 3 before they disconnect your pump? It seems like a liter of saline (for hydration) plus some Palonsentron (Aloxi) might get you through the next two days. Aloxi is similar to Zofran, but remains active a good while longer. (I'm getting Aloxi instead of Zofran in my pre-meds now with the Gem/Brax/cis). I avoid the dexamethasone as much as possible because of its impact on my blood sugar and sleep quality.

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Thank you very much for this info. Yes, I count infusion day as Day 1; pump comes off on Day 3; the worst side effects begin on Day 5.

I have noticed that hydration helps, so I'll ask about IV hydration. And, I didn't know about Aloxi; thanks for mentioning it.

Thank you very much! Wishing you all the best.

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