Pancreatic Cancer

Hi,

My husband has been going through treatments for pancreatic cancer on and off since August 2020. His tumor is non-resectable (can't be removed) but it hasn't spread beyond the pancreas (as far as they can see). He is 60 years old and had no other serious health issues before diagnosis.

His first treatment was 6 months of Folfirinox, which is a combination of some of the drug you will receive, plus others. He received treatments every other week (with the exception of once or twice when his blood counts were too low for a week) and after 6 months his tumor had shrunk by almost 30%... but they were not able to remove it because it is growing around major blood vessels). This treatment is one of the strongest and most difficult for people to receive because the drugs used can cause a lot of side effects.

He also went through other treatments with varying success but when his tumor began to grow again this year, he needed to start a new treatment. They tried 5-FU with irinotecan and this seems to have knocked his tumor back down to the size it was after his initial 6-month treatment with Folfirinox. Unfortunately, the treatments were very hard on him and his blood counts were often too low for treatments, so they gave injections of a drug called Filgrastim to increase blood cell production. This drug apparently caused internal bleeding and he had to stop after just a few treatments. Keep in mind that this was the third chemotherapy treatment regimen that he has been on and his body has been through a lot.

Now that you have my background dealing with my husband's illness, let me try to answer your questions as best as I can.

You are wondering about holding off on adding Oxaliplatin and just receiving the 5-FU... from what I understand, 5-FU is not very effective by itself and it works much better in conjunction with other chemo drugs.

You asked if you hold off on Oxaliplatin, is it likely that the 5-FU will cause an increase in side effects as you start your next cycle. The oncologist explained to us that every chemo drug that a patient receives will build up in their system as they receive more treatments. So you are more likely to see an increase in side effects from any drug that you receive, as it increases in your system. Having said that, you are more likely to have an increase in side effects if you add another drug to the treatment because that drug has its own set of potential side effects. Keep in mind that the side effects don't necessarily mean that the drug is working, so be sure to tell your oncologist about all side effects that you experience.

As far as what Oxaliplatin adds to the success of killing the cancer... I found one research paper that states a finding of 50% reduction in disease progression when used with 5-FU in metastatic colorectal cancer. So they are saying that the addition of Oxaliplatin increases the effectiveness of 5-FU. I can't decide for you, of course, but if I were in your situation, I would make the decision to receive the additional drugs in hopes that it will increase efficacy.

I can't speak to whether or not 5-FU has been used to successfully treat cancer without any other drugs given in addition. However, I can tell you that my husband has adenocarcinoma of the pancreas, with very rare genetic markers in his tumor. He has survived 2 years after 6 months of Folfirinox, nano-knife surgery, MRI-guided radiation treatments, Gemzar and Abraxane, and 5-FU with Irinotecan and Oxaliplatin... and now he is starting Keytruda (immunotherapy)... and after all of these treatments he is not cancer-free but the doctors are attempting off label use of Keytruda, with plans to try other chemotherapy drugs if this treatment doesn't help. His cancer has not metastasized at this point and that is the main goal right now... keep it from growing and keep it from spreading.

My assumption is that your oncologist is concerned about starting you off on all of the drugs right away and wants to introduce each drug one at a time to reduce the difficulty of side effects on your body. With the plan that they have in place right now, they will be able to determine if one drug is causing too many side effects and they can either reduce the dose or try a different drug that might not cause so many side effects. This seems like a good idea and it sounds like they are trying to treat your cancer without causing you to become so sick that your body can't fight.

I hope that this helps you make the best decision for your health.

Hi,

I'm sorry that your mother is going through this. This chemo regimen is also called the 'Folfirinox' regimen. My husband was started on the same regimen when he was first diagnosed. He had to take the antinausea meds to help him keep food down and he needed a lot of rest during that treatment. After several days, he would start to feel better and gain more energy. To help with fatigue, your mom must get plenty of water to flush the toxins from her system and she will need to eat, even if she doesn't feel like it. These steps were very difficult for my husband to follow because he felt sick and didn't want water or food. Let her eat whatever tastes good to her and try to vary her diet if possible. Add some fruit juice to her glass of water if that helps her drink more (as long as she does not have problems with sugar and her insulin levels). She can still have some coffee if she wants it and that can help a bit with energy levels. It can be difficult to get your loved one to get up and move about, but it is good for their circulation, digestion, and mental health. It also helps to increase appetite and thirst.

There aren't isn't any magical advice that I can give you other than... keep her moving, and keep whatever foods she can tolerate on hand (don't stock up because her tastes may change and something that sounded yummy yesterday may sound like crap on cracker today). Encourage her to drink lots of liquids and if she isn't getting enough... make sure you tell the oncologist. They may send her in for IV hydration if she is dehydrated.

Hubby's palliative care doctor also gave him some prescriptions to help with energy levels and appetite. They prescribed Marinol for appetite and Ritalin for energy... these may not be good options for your mom, but talk to the doctor to see if they have any suggestions for something to help give her more energy. I hope this helps.