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New chemo plan


SandraL

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Good evening all. My 2nd line treatment since developing spine mets has been radiation (on spine) and alimta. I have suffered pretty badly from alimta but the results were at least no progression. However, after reading information on this site I have been worried that alimta is not the drug for my paritcular type of cancer (squamous cell) and have been consulting with my medical oncologist about this . Trust me when I tell you Canadian treatment plans are not the same as in the US.

Finally, this week, there was an article in the Journal of Medicine saying that Gencitabine (Gemzar) is more effective for my kind of cancer than Alimta. My med onc read that and is in the process of changing chemo protocol at our clinic so I can start on this drug instead of Alimta.

This drug has been in use for awhile and I know I have seen many of you post that have been on it. I am looking for some insight on successes and side effects before I make my final decision on this choice next week. Thanks in advance for your help and your prayers that this is the right choice for me.

Sandra

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Hi, Sandra.

This is first I've read about Gencitabine (Gemzar) being eff. for squamous cell (which, as you know, is also what I have). Is the Journal of Medicine Canadian or English? Is it online?

Carole

PS As you also know, I've been out on "hall pass" so apologies to you et al in advance if my postings tonight and tomorrow are disorganized. :(

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Hi Carole. I have been searching for the article on line but am kind of useless at that kind of stuff. In any case I cannot find it but will ask my doctor for a copy when I meet with her this week. It was apparently in "a" Journal of Medicine this past week, like out just this past Monday. Perhaps someone else here has seen it and can post it for us. My understanding is that it basically concluded that gemzar more effective than alimta for squamous cell patients.

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Sandra-

Sorry that the Alimta has been so hard on you.

I, too, would be interested in info on Gemzar as that COULD be an option for me if and when the Alimta is no longer effective.

I know I have seen others here post on Gemzar and I believe it is not that hard of a drug. Hopefully, someone will come along soon who has been on it.

Wishing , hoping and praying that if you DO switch to Gemzar that is the drug that kicks your cancers butt BIG time!!!!!!!!!!!!

Hugs - Patti B.

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Sandra: Sorry I had missed your post last night before I sent you a pm. I know that Ned and some others were talking about that chemo recently but don't know if it was on this site or cancergrace.org. It goes by two names Gemzar and another longer name that starts Gen... or Gem..., that was the debate. I'd be happy to go online and research it for you but experience has taught me that usually you have to pay to get more than just a brief abstract on this medical journal articles.

What I'll do instead is go on cancergrace.org and ask Dr West.

Hang in there girl.

Judy in Key West

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Sandra: I'm a bit of a boob. I copied Dr West's reply and then copied a link to other posts on the subject. That effectively made me lose the copied reply. O.k., here's the link (I think):

http://onctalk.com/bbPress/topic.php?id=839#post-4068

You copy (Ctrl c) then remove whatever is in your main search window at the top of your screen and paste (Ctrl v). Hit the green arrow or whatever takes you where you want to go on your computer. Hope it works. I'll try it again myself and then go get Dr West's comments for you.

Judy in Key West

P.S. Right now I wish I was Ned.

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Sandra: Here's Dr West's opinion:

Gemzar doesn't have much of a track record in second line, but I suspect it's a fine alternative. It was approved as a first line treatment, and in general if a pharma company gets their drug approved first line, they are happy with that and don't to test their drug too much in later lines (pharma companies would prefer that doctors prescribe their drugs as earlier treatments, because many patients don't get to subsequent treatment). I suspect but don't know that gemcitabine would be very comparable as a single agent. On the upside, in the trial that compared cis/gemcitabine to cis/alimta, the cis/gem arm looked decidedly more favorable for squamous patients. Subsequent work that I've described in my recent posts has pretty convincingly shown that alimta just isn't effective for squamous cancers, so it's not clear to me whether gemcitabine is particularly good or just that alimta was especially ineffective for the squamous patients.

Otherwise, the better studied agents for second line or later include taxotere, which appears to be just as effective in squamous and non-squamous patients, or tarceva, which rarely induces significant responses in patients with squamous tumors but still overall provides a favorable survival benefit.

Dr West (then he has the standard disclaimer about not recommending any particular treatment etc etc)

Judy in Key West

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I did some searching earlier, but was in the middle of transferring a bunch of files and didn't copy down the links. By putting

gemzar squamous

in a Google window I did find a recent reference that in an esophagus cancer study Gemzar got about 3 times the response on squamous cells as it did on adenocarcinoma cells.

Also, a while back Dr. West made the comment that he never uses Gemzar concurrently with radiation since it really magnifies the effect of the radiation and it's easy to damage too much healthy tissue. I got that by putting gemzar in a cancergrace.org search window.

I think it's worth asking him if that's still his opinion (I haven't been to his site yet today).

Ned

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Here's the link to Dr. West's comment on Gemzar and radiation:

http://onctalk.com/bbPress/topic.php?id=538

Gemcitabine is often very well tolerated, primarily with decreased blood counts as the leading side effect (and associated fatigue, and some increased risk of infection), sometimes abnormalities in liver tests, but usually very manageable as a single agent. Given that there's really nothing that has a track record after topotecan-based therapy, I think your oncologist is right to say it's hard to predict, but it's something to try.

As a rule, I never, ever give gemcitabine at the same time as radiation. Gemcitabine is a very, very potent radiation sensitizer, which means that it can cause problematic toxicities in the radiation field. If there is spinal cord and nerves in the radiation field, I would consider there to be a worrisome risk of permanent damage if gemcitabine and radiation overlap.

Ned

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Hi, everyone.

I hope to spend some time this coming week looking into this further (what with my having "unstable" squamous myself), but in the meantime, thanks to all of you who have posted about it.

I do have one question in the meantime: Have anyone taken this chemo as a solo, and if so, what kind of side effects (what with my body being prone to every side effect in existence)?

Carole

Don't be afraid of death... Be afraid of the unlived life.--Tuck

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O.k. Ned, thanks for your fantastic recall! Dr West may have overlooked the mention of radiation in the first sentence of my post and just focused on the Gemzar question. Sandra, listen to Ned. He really pays attention to detail. If it were me I'd question my onc on that specific point.

Judy in Key West

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thanks Judy and Ned. I obviously have friends in "high" places (better than "low" places where the whiskey, wine and the beer chases my fears away...randy travis???) . And I am feeling way better tonight after a tough weekend. I am not getting any more radiation at the moment. I have also recently learned that too much radiation can have an adverse affect on chemo success. But thanks for the tip. Sleep well everyone.

Fondly

Sandra

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