Chemotherapy – General:
“Chemotherapy” (Various Muti-Media Presentations), MedlinePlus Interactive.
“What is Chemotherapy?” Chemocare.com
“Chemotherapy Drugs,” Chemocare.com
“Chemotherapy Principles,” American Cancer Society.
“Chemotherapy: Drug treatment uses chemicals to kill cancer cells,” MayoClinic.com, March 29, 2007.
“Cancer Chemotherapy,” MedLinePlus.com, April 10, 2008.
“Chemotherapy for ovarian cancer,” CancerHelp.org.uk, March 19, 2008.
“How Chemotherapy Works,” CancerHelp.org.uk, May 3, 2007.
“Chemotherapy – Overview,” OncologyChannel, November 28, 2007.
“Treating Cancer With Chemotherapy,” Chemotherapy.com, Amgen
“Chemoembolization,” RadiologyInfo.org, February 1, 2008.
“Chemotherapy,” For Kids, KidsHealth.org, February 2007.
“Chemotherapy,” For Teens, KidsHealth.org, February 2007.
“Chemotherapy & Pregnancy,” Oganization of Teratology Information Specialists (OTIS).
“Menopause & Chemotherapy,” Consumer Health, The Cleveland Clinic, April 14, 2008.
Practical Considerations in Ovarian Cancer Chemotherapy, Therapeutic Advances in Medical Oncology, Medscape Today, Aug. 9, 2010.
“Chemotherapy for Older Patients with Ovarian Cancer: What You Should Know About the Risk of a Low White Blood Cell Count,” Cancer Tips, CancerConsultants.com, April 10, 2008.
“Venous Access,” VascularWeb (Society For Vascular Surgery), August 9, 2004.
Chemotherapy & Treatment “Glossary,” American Cancer Society, March 8, 2008.
“Fasting before chemotherapy may protect cancer patients, study suggests – The survival rate is much higher among mice that go without food before chemo — and they don’t suffer the side effects of the other surviving mice with cancer. A human trial is planned,” by Denise Gellene, Staff Writer, Science & Medicine, Los Angeles Times, April 5, 2008.
“Cranberries May Improve Chemotherapy For Ovarian Cancer,” Science News, Science Daily, August 26, 2007.
Intraperitoneal Chemotherapy (IP Chemo) & Hyperthemic Intraperitoneal Chemotherapy (HIPC):
“NCI Clinical Announcement on Intraperitoneal Therapy for Ovarian Cancer,” NCI Materials, Published IP Clinical Trial Results & Professional Education, National Cancer Institute, October 4, 2006.
“Review Confirms Effectiveness of Intraperitoneal Chemotherapy for Advanced Ovarian Cancer,” Clinical Trial Results Summary, National Cancer Institute, December 18, 2006.
“Intraperitoneal catheter outcomes in a phase III trial of intravenous versus intraperitoneal chemotherapy in optimal stage III ovarian and primary peritoneal cancer: A Gynecologic Oncology Group study;” Joan L. Walker,Deborah K. Armstrong, Helen Q. Huang, Jeffrey Fowler, Kenneth Webster, Robert A. Burger, Daniel Clarke-Pearson; Gynecologic Oncology 100 (2006) 27-32. .PDF download.
“Hot Topics In Ovarian Cancer – (1) Hyperthermic intraperitoneal chemotherapy in conjunction with surgery for the treatment of recurrent ovarian carcinoma, and (2) Intraperitoneal chemotherapy,” The Johns Hopkins Ovarian Cancer Center of Excellence.
“Results of the 2006 Innsbruck International Consensus Conference on Intraperitoneal Chemotherapy in Patients With Ovarian Cancer; Marth,C. MD, et. al.; CANCER (February 15, 2007) / Volume 109 / Number 4: 645-649. .PDF Download
“HIPEC for peritoneal cancer – Patient Information,” Stefaan Mulier, M.D., Surgical Oncology, Leopold Park Clinic, Brussels, Belgium.
Chemotherapy Sensitivity and Resistance Assays:
DiaTech Oncology MiCK Chemotherapy Induced Apoptosis Assay Shows Increased Response and Survival in Ovarian Cancer Patients, PR Newswire, May 26, 2010.
The Microculture Kinetics (MiCK) Assay for Apoptosis — Helps oncologist discriminate between effective and ineffective chemotherapeutic agents prior to their use in a patient’s treatment. MiCK assay helps oncologists to create an individual treatment protocol that includes a drug or drug combination that is most effective in killing tumor cells of an individual patient.
“Technology Assessment: Chemotherapy Sensitivity and Resistance Assays,” Patient Guide, Cancer.Net, July 2004.
“The Era of Individualized Cancer Treatment Has Arrived,” Oncotech.com.
“ChemoFX Overview,” PrecisionTherapeutics.com.
“Challenges, Personalized Medicine, Treatment,” Patient Guide, Rational Therapeutics.
Histoculture Drug Response Assay (HDRA), AntiCancer, Inc.
“Data Published at ASCO Find Correlation Between ChemoFx(R) Assay and Significantly Improved Overall Survival in Patients With Ovarian Cancer – Analysis Reveals Overall Survival Could be Extended if Patients Receive the Most Effective Treatment Identified by ChemoFx,” PrecisionTherapeutics Press Release dated May 20, 2008.
Chemotherapy and Coping:
“Managing Side-Effects of Chemotherapy,” American Cancer Society.
“Side Effects – Symptom and Solutions: Managing Chemotherapy Side Effects,” Chemocare.org.
“Eating Well During Chemotherapy – Managing Eating Problems,” Chemocare.org.
“Before and After Chemo,” Chemocare.org.
“Look Good, Feel Better — Facts & Videos” (Look Good, Feel Better is a free, non-medical, brand-neutral, national public service program created to help individuals with cancer look good, improve their self-esteem, and manage their treatment and recovery with greater confidence).
“Chemobrain,” American Cancer Society.
“’Chemo Brain’ Not All in Your Head – Chemotherapy May Alter Brain Metabolism, Study Finds,” Article, American Cancer Society, October 17, 2006.
“Possible Cause Of ‘Chemo Brain’ In Breast Cancer Patients Found,” Science News, Science Daily, March 20, 2008.
“Chemotherapy and Your Emotions,” American Cancer Society.
“Chemotherapy and hair loss: What to expect during treatment,” Mayo Clinic, January 23, 2008.
“Chemotherapy side effects: A cause of heart disease?” Mayo Clinic, August 7, 2006.
“Most Cancer Survivors Say Chemo Fears Unfounded Potentially lifesaving treatments are easier now, survey suggests,” MedlinePlus.com, HealthDay News Release dated April 4, 2007.
“Chemotherapy and You: Support for People With Cancer,” National Cancer Institute, June 29, 2007.
“Chemotherapy and Cancer Treatment, Coping with Side Effects,” MedicineNet.com, July 7, 2004.
“Helping Yourself During Chemotherapy: Summary,” National Cancer Institute, October 22, 2001.
“A Resouce for Caregivers of Cancer Patients,” Bymyside®, Amgen.
“Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®)(Patient Version),” National Cancer Institute, March 13, 2008.
“Side Effects of Chemotherapy on Reproduction & Sexuality in Women,” American Cancer Society.
“How Do I Pay For My Chemotherapy?” American Cancer Society, March 8, 2008.
Libby's H*O*P*E* 
Paul,
I am so impressed woth your website and your response to Ginger. I am checking into the assay labs that you listed for my mother. She started with stage 1a clear cell uterine adenocarcinoma in 2005. She had a radical hysterectomy (by the head of ob/gyn at Cleveland Clinic)with some of her omentum and lymph nodes removed. They felt they had got it all. Two yrs later, she had a swollen leg and it was found to be growing in various locations incl the pelvic cavity and her liver. She was put in a clinical trial with Avastin and did relatively well for almost 3 years. She was removed from the clinical trial in mid October and had an ablasion to kill the largest tumor in her liver on Dec 16th. This week a PET scan showed more growth in her liver about 1.4cm on a couple and growth in the sternum area. We are trying to decide what to do next. What would you advise? We will be meeting with her Dr. on Friday Feb. 11th and do plan to ask about assay testing. Do most main stream oncologists poo-poo this? I read that the Weisenthall Group needs you to be referred by your physician.
Thank you for your help!
Curious as to your profession since you are more than well-versed.
Sue
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Dear Sue,
Thank you so much for the kind words. As we mentioned to Ginger, Libby’s H*O*P*E* is an ovarian cancer educational website, so we try not to stray too far away from that disease. What you may not have noticed is that Elizabeth Remick, to whom this website is dedicated, lost her battle to clear cell ovarian cancer. From my perspective, the highest value that we can add is to point you in the direction of a few clear cell medical studies.
Potential Genetic Similarity Between Clear Cell Uterine, Ovarian & Renal Cancer
An NCI study conducted in 2005 suggests that solid tumors of clear cell classification may share similar (albeit not identical) genetic characteristics. Specifically, that study involved the evaluation of clear cell uterine, ovarian, and renal (kidney) cancers. Accordingly, solid tumors of clear cell pathology may share similar genetic characteristics, regardless of the organ of origin, unlike other subtypes of ovarian or uterine cancer. This point is potentially important because it suggests that drugs used for clear cell kidney cancer may potentially be used treat clear cell ovarian and uterine cancers.
The genetic similarity between tumors of clear cell classification has also been acknowledged in Society of Gynecologic Oncology (SGO) review article. In the context of clear cell uterine (endometrial) cancer, the SGO notes the following: “It shares many similarities with clear cell neoplasms of the ovary and kidney.” Much like clear cell ovarian cancer, uterine clear cell cancer (UCCC) is rare and more aggressive than endometrioid uterine cancer. In September 2010, we wrote an article about a major genetic discovery with respect to clear cell ovarian cancer. The discovery was reported in the New England Journal of Medicine. To view the article, visit https://healthinfoispower.wordpress.com/2010/09/08/british-columbian-researchers-make-groundbreaking-genetic-discovery-in-endometriosis-associated-ovarian-cancers/. In the middle of that article, we provide a general discussion of clear cell ovarian cancer and potential approaches to treating it. You should read it and pay particular attention to the accompanying footnotes that hyperlink to potential clinical trials.
Finally, we would recommend that you purchase a full text copy of a medical article that summarizes the findings of the 1st Ovarian Clear Cell Carcinoma Symposium, held in Vancouver, in June 2010. To see the article abstract, visit http://www.ncbi.nlm.nih.gov/pubmed/21276610?dopt=Abstract. Provide a copy of that article to you mom’s doctor(s) as further background on clear cell cancer, albeit ovarian. It may help your mom’s doctor(s) to brainstorm some potential therapies with you and your mom.
Chemosensitivity & Molecular Testing
You may want to consider both chemosensitivity (based on cell death) & molecular testing, as noted in my response to Ginger. The idea with both forms of testing is to place your mom’s doctor in the best possible factual position to treat your mom’s UCCC. Yes, most mainstream gynecologic oncologists do not recommend such testing because they have not been proven to increase survival in large, prospective, phase III clinical trials. However, you should note that the National Comprehensive Cancer Network (NCCN) recently added chemosensitivity testing to their recurrent ovarian cancer treatment guidelines. Molecular testing may also help in identifying specific genetic characteristics of your mom’s UCCC which may suggest potential avenues of clinical trial treatment. Neither form of testing is perfect, but it provides an alternative for recurrent cancer patients with solid tumors.
Please be aware that both forms of testing generally require a fresh (not preserved) tumor sample, although limited molecular testing can be performed on a preserved sample. It sounds like you (and the Cleveland Clinic) have done a wonderful job of managing your mom’s case thus far, given her low “tumor burden” or the amount of residual cancer remaining. With so little cancer present, it may be difficult to obtain a fresh tumor sample to use in both forms of testing. Check with the respective companies and find out what is possible within the context of your mom’s case.
It does not surprise us that at least one company requires a doctor recommendation, because the final results are best interpreted by the doctor, although you will receive a results report as well. Please check with all the companies to determine any prerequisites. The companies will assist any doctor in understanding the test results.
Potential Clinical Trials
We ran a quick clinical trial search using the phrase “uterine cancer and clear cell” and obtained an list of open clinical trials. To see that list, visit http://clinicaltrials.gov/ct2/results?term=uterine+cancer+AND+%22clear+cell%22&recr=Open. These search algorithms are not perfect, so please review the list to determine if a trial seems potentially effective given the facts of your mom’s case. A couple of the newer drugs include AMG 386, BIBF 1120, GDC-0449 and RO4929097.
Also, if chemosensitivity and molecular testing are possible, it may be possible to identify a potentially beneficial “solid tumor” clinical trial for her based on results from such testing. Again, these testing methods are far from perfect, so you should work with your mom’s doctor to make that determination.
Other Alternatives
Your mom is in great hands at the Cleveland Clinic. It sounds like they have done a fabulous job in keeping her residual cancer low. We assume that ablation can be used again as long as the lesions are few in number and small in size, so surveillance is key. If ablation can produce an “Avastin holiday,” it may be possible to get back on the drug at a later date through another clinical trial.
I hope this information is helpful. Please extend our very best to your mom, knowing that we will keep her in our thoughts and prayers. If you have any additional questions, please let us know.
Best wishes, Paul
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My mother is 58 yr old and was diagnosed with with borderline pancreatic cancer in April of this year. She went thru gtx chemo and 5 day radiation then onto an attempted but unsuccessful whipple. It was recommended that she continue with gemcidabine. She relocated and we have conflicting opinions on treatment. The most important thing to her is quality not quantity of life. It is being suggested to undergo fol fox iri. The side effects do not sound to lend to quality of life. Can you give your opinion.
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Dear Ginger,
As you know, Libby’s H*O*P*E* is an ovarian cancer website, and we do not have great familiarity with pancreatic cancer. Also, your comment is fairly brief and doesn’t answer several important questions such as:
What stage is your mom’s cancer?
What is the classification or histology of your mom’s borderline pancreatic cancer (i.e., what does the pathology report say)?
What are the reasons in support of continued gemcitabine (Gemzar) use? Did your mom respond to it as part of the GTX regime? How soon after initial treatment did your mom’s cancer recur?
That being said, I want to point out that I wrote a detailed pancreatic cancer response to a comment posted last year that may prove beneficial to you. Click here to review that response.
Although you may not want to use a potent combination therapy due to impact on quality of life, you should know that some of the best data available indicates that FOLFIRINOX (5-FU/leucovorin/irinotecan/oxaliplatin) has produced the best combination results so far.
Specifically, in a phase II study of 35 patients with good performance status and metastatic pancreatic cancer, FOLFIRINOX (5-FU/leucovorin/irinotecan/oxaliplatin) demonstrated favorable results, with a median OS (overall survival) of 9.5 months and a higher response rate compared with gemcitabine in the phase II part of a phase II/III trial (31.8 vs 11.4%, respectively). Now, results of the phase III part of the PRODIGE 4/ACCORD 11 phase II/III trial demonstrate a significantly longer OS for patients receiving FOLFIRINOX vs gemcitabine (11.1 vs 6.8 months, respectively). FOLFIRINOX also reduced the risk of disease progression by 53%. Moreover, the 12-month and 18-month survival rates were 48.4 vs 20.6% and 18.6 vs 6%, respectively. Significantly more patients receiving FOLFIRINOX experienced an objective response (CR (complete response) + PR (partial response)), 31% vs 9.4% with gemcitabine and disease control (CR + PR + SD (stable disease)), 70.2% vs 50.9% with gemcitabine. The incidence of grade 3/4 adverse events was higher in patients receiving FOLFIRINOX compared with gemcitabine (neutropenia: 45.7% vs 18.7%; febrile neutropenia: 5.4% vs 0.6%; and thrombocytopenia: 9.1% vs 2.4%. In addition, 42.5% of patients in the FOLFIRINOX arm required GCSF (granulocyte colony-stimulating factor) support vs 5.3% in the gemcitabine alone arm. Thus, despite the higher toxicity associated with the FOLFIRINOX regimen, the toxicities were manageable. Given these positive results, the clinical trial investigators recommend this regimen as a new global standard of care for patients with metastatic pancreatic cancer who have adequate liver function (bilirubin < 1.5 x upper limit of normal) and good performance status (ECOG PS 0-1).
If you want to use gemcitabine, you may want to consider adding nab paclitaxel (Abraxane) to it in an attempt to produce a positive response.
In my 2009 pancreatic comment response, I noted that researchers are currently looking at a number of potential genetic and cellular pathway targets so as to improve the pancreatic cancer response rate. These targets include: KRAS, PI3K, EGFR, hedgehog pathway, Notch, Heat Shock Protein-90 (HSP90).
To view a list of open pancreatic cancer clinical trials that are investigating drugs capable of hitting one or more of these targets, click here.
To view a list of solid tumor clinical trials that are investigating drugs capable of hitting one or more of these targets, click here.
Another new area being looked into is the impact of germ-line (inherited) BRCA 1 and BRCA 2 gene mutations on treatment for pancreatic cancer. If you mom tests positive for BRCA 1 or BRCA 2 mutations, it may make some sense to utilize so-called “PARP inhibitors” as part of a clinical trial.
For a list of open pancreatic cancer clinical trials using PARP inhibitors, click here.
For a list of open solid tumor clinical trials using PARP inhibitors, click here.
Because your mom is relatively young, I would recommend that you consider chemosensitivity testing and/or molecular profiling, as one way of attempting to select a drug combination that will work. Companies such as Rational Therapeutics, Precision Therapeutics, and the Weisenthal Cancer Group, perform chemosensitivity testing with various drugs and drug combinations, and measure cancer cell death as a result of this testing, prior to administration of drugs to the patient. The concept is to save the patient from potentially ineffective treatment(s) by testing such treatments in the lab in advance. A potential issue with chemosensitivity testing is that these companies require a fresh tumor sample usually obtained from recent surgery or biopsy (note: old samples preserved in paraffin will not work).
Companies such as Caris Life Sciences perform molecular profiling of tumor samples. This type of testing attempts to identify unique genetic mutations with respect to your mom’s cancer, so as to identify a drug(s) that may take advantage of such mutations. Various cancer centers are also performing molecular profiling on tumors as a means to direct patients to various clinical trials. These include Massachusetts General Hospital, Dana-Farber Cancer Institute and M.D. Anderson Cancer Center. I do not know if these cancer centers are testing pancreatic tumors at this time, but you may want to check.
Neither chemosensitivity testing nor molecular profiling is definitively proven science. But, when battling a lethal disease such as pancreatic cancer, it could make sense to have as much information as possible available for your mom’s doctors when they are making treatment decisions.
Ginger, I know there is a lot of information presented above. If you have any questions, please feel free to contact us. Please know that our thoughts and prayers are with your mom and your entire family.
Best wishes, Paul
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