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    Posted: Sep 12 2009 at 2:10pm
Everyone...(and CONNIE ),
      I'm  **recuperating from the second cycle of my 14 day "on" and 7 day "off" capecitabine cycle...
     I stopped it on the 10 day (Sept. 2 ?)...after severe Diarrhea. (careful eating). On the 14 day-  Sunday-- I had liquid I -V  at the cancer agency (dehydration/low potassium) I was told by a another oncologist during my onc.'s holiday/conference to ABORT  on 10 day but at full strength -especially during the second cycle
  On Friday at my clinic appt....was told that this PILL had reduced the CA 15-3 -- a lot. (58 to 22)....**however....
Will probably resume on the 21 (with break now)..with 3/4 dose at my lower weight of 10 pounds less
I think they should also factor in for the DOSE-- "anticipated" weight loss for a next cycle!!   ??
As they FORGOT on Wed. to take my electrolyte blood test!!...I did it yesterday-Friday -after appt...and we'll see!
 I Wish there was a liquid infusion of it!! ( to bypass gastro stuff ! )
Any ???
Cheers!   Janice
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cg--- Quote  Post ReplyReply Direct Link To This Post Posted: Sep 12 2009 at 5:45pm

Dear Jan,

This is a good news/bad news kind of post.  How wonderful the Xeloda is working and so sorry about the gastrointestinal issues.
 
The interesting thing about Xeloda is that it can be effective at much lower doses than the recommended manufacturers regimen! You know it is beating back the cancer...now it is the time to 'tweak' your dosage so it will work for you without wiping you out in the process.
 
You must drink 6-8 glasses of water a day while taking Xeloda.  Avoid caffeine, carbonated beverages....apparently carrot juice is very good for gastrointestinal problems. Chicken/beef broth ensures your sodium(salt) electrolytes are kept in balance.
 
Secondly, BANANAS is the natural cure to correcting the gastrointestinal imbalance plus it corrects the electrolyte imbalance of potassium loss because it is high in potassium.
 
A B.R.A.T. diet is your new grocery list and is the prescribed anti-diarrheal diet.
 
B - Bananas.
R - White Rice.
A - Applesauce.
T - Toast/Crackers.
 
Apparently they find the week on week off schedule is more tolerable - and Sloan-Kettering have been doing trials with Xeloda using different dosing schedules.  It seems that higher doses are able to be tolerated better on the week on week off schedule rather than the 14 days off.
 
A change in dosing schedule and a lower dose could also be questions that you could ask - since Xeloda is working.
 
Steamed or boiled chicken is something else to consider for your protein intake. Boilet carrots, boiled potatoes.
 
Do not eat any fatty foods or spicy foods.
 
I think if you had some better/more medical support for the side effects rather than allowing you to become so weakened it would give Xeloda a better chance.
 
Please let me know how you are feeling.
 
Love,
Connie
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Post Options Post Options   Thanks (0) Thanks(0)   Quote janinvan Quote  Post ReplyReply Direct Link To This Post Posted: Sep 13 2009 at 11:12am
Connie, ..thanks for your support/suggestions!
   Of course I'm very careful about what I eat, etc.   That's why it's worrisome, etc.
   Also any imodium, or later some lomotil med. can cause more fatigue, light headedness,...dry mouth. ** And I took them "not a lot"  I want my system to kick in.  The imodium isn't that terrific.
   I wonder if any patients have to seek out gastrointestinal Dr.  -while on this....... my oncologist would love that suggestion....
   I have some blistering/peeling on thumbs.....
 With all of this....I don't really know "where you are "  on this journey.
 I hope you're doing very well.....
 ** How are you so knowlegable re the pill ?..and ?  sloan kettering
      Have you researched it? or did a friend /tnbc forum person tell their story?
  THANKS,  JANICE
 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cg--- Quote  Post ReplyReply Direct Link To This Post Posted: Sep 13 2009 at 12:06pm

Jan, I hope this will be of some help to you.

New treatment schedule for Xeloda? The new protocol regimen is called the Norton-Simon Model (Dr. Norton is the doctor that discovered that the dose dense AC + T was more 28% more effective than the every 3 week regimen....This is his reply to a woman taking Xeloda...

Page last modified on: August 1, 2008
Question from Joan: I've been on Xeloda for a year now and it is working, but the side effects are somewhat debilitating hand-foot syndrome. What do you consider to be a good schedule for the drug 7 days on, 7 days off at a higher dose? I understand that this is a new protocol.
 
Answer Larry Norton, M.D.: Yes, that's a treatment that we've developed at Memorial Sloan-Kettering. The conventional schedule for Xeloda (chemical name: capecitabine) is 14 days on and 7 days off. However, by analyzing lab experiments, we have determined that most of the cancer killing activity of the drug is in the first 7 days of exposure. Hence we have explored 7 days on and 7 days off instead of 14 days on and 7 days off. This allows a higher dose to be administered safely, and seems to remarkably reduce the incidence of hand-foot syndrome. Currently this regimen is being tested in various settings; however, because of the reduction in toxicity many oncologists are already using the 7 on/7 off schedule as their preferred method of administration. The important thing is to stay away from the drug until the hand-foot heals completely. You can go to other anti-cancer medications for weeks or months until the hand-foot syndrome heals, and then go back to the Xeloda with the new schedule and get anti-cancer activity with reduced side effects.

 

 

 

 

 

 

 

 

 

Hand-Foot Syndrome

Other terms: Palmar-Plantar Erythrodysesthesia;  PPE

What is hand-foot syndrome?

Also called hand-foot syndrome or hand-to-foot syndrome, Palmar-Plantar Erythrodysesthesia  is a side effect, which can occur with several types of chemotherapy or biologic therapy drugs used to treat cancer.  For example, Capecitabine (Xeloda), 5-Flurouracil (5FU), continuous-infusion doxorubicin, doxorubicin liposomal (Doxil), and high-dose Interleukin-2 can cause this skin reaction for some patients.  Following administration of chemotherapy, small amounts of drug leak out of very small blood vessels called capillaries in the palms of the hands and soles of the feet.  Exposure of your hands and feet to heat as well as friction on your palms and soles increases the amount of drug in the capillaries and increases the amount of drug leakage.  This leakage of drug results in redness, tenderness, and possibly peeling of the palms and soles.  The redness, also known as palmar-plantar erythema, looks like sunburn.  The areas affected can become dry and peel, with numbness or tingling developing.  Hand-foot syndrome can be uncomfortable and can interfere with your ability to carry out normal activities. 

Things you can do if you suspect hand-foot syndrome (Palmar-Plantar Erythrodysesthesia):

Prevention:  Prevention is very important in trying to reduce the development of hand-foot syndrome.  Actions taken to prevent hand-foot syndrome will help reduce the severity of symptoms should they develop.

  • This involves modifying some of your normal daily activities to reduce friction and heat exposure to your hands and feet for a period of time following treatment (approximately one week after IV medication, much as possible during the time you are taking oral (by mouth) medication such as capcitabine).
    • Avoid long exposure of hands and feet to hot water such as washing dishes, long showers, or tub baths.  
    • Short showers in tepid water will reduce exposure of the soles of your feet to the drug.
    • Dishwashing gloves should not be worn, as the rubber will hold heat against your palms.
    • Avoid increased pressure on the soles of the feet or palms of hands.
    • No jogging, aerobics, power walking, jumping - avoid long days of walking.
    • You should also avoid using garden tools, household tools such as screwdrivers, and other tasks where you are squeezing your hand on a hard surface.
    • Using knives to chop food may also cause excessive pressure and friction on your palms.


Cooling procedures:

  • Cold may provide temporary relief for pain and tenderness caused by hand-foot syndrome.
  • Placing the palms or bottoms of your feet on an ice pack or a bag of frozen peas may be very comforting. Alternate on and off for 15-20 minutes at a time.

Lotions:

  • Rubbing lotion on your palms and soles should be avoided during the same period, although keeping these areas moist is very important between treatments.   
  • Emollients such as Aveeno, Lubriderm, Udder Cream, and Bag Balm provide excellent moisturizing to your hands and feet.

Pain relief:

  • Over the counter pain relievers such as acetaminophen (Tylenol) may be helpful to relieve discomfort associated with hand-foot syndrome.  Check with your doctor.

Vitamins:

  • Taking Vitamin B6 (pyridoxine) may be beneficial to preventing and treating Plantar-Palmar Erythrodysesthesia, and should be discussed with your doctor.

Hand/Foot Syndrome

  • (Hand-foot syndrome is a side effect of some chemotherapy drugs that results when a small amount of drug leaks out of the blood vessels, damaging tissues. This tends to happen in the hands and the feet because of the increased friction and heat that your extremities are exposed to through daily activities. Symptoms can be prevented by avoiding friction and heat. Treatment consists of reducing or stopping treatment with the drug that caused the syndrome. You may
    be able to prevent symptoms by avoiding friction or heat).
  • Reduce exposure of hands and feet to friction and heat by avoiding the following:
  • Hot water (washing dishes, long showers, hot baths)
  • Impact on your feet (jogging, aerobics, walking, jumping) \
  • Using tools that require you to squeeze your hand on a hard surface (garden tools, household tools, kitchen knives)
  • Rubbing (applying lotion, massaging)
  • One metster has gotten good results by covering creamed feet with plastic wrap then sox
  • Biafine Helps heal the skin on peeling feet and hands. Available at CVS, in the pharmacy, may have to ask for it. www.biafine.orthoneutrogena.com/
  • Dimethyl-sulfoxide (DMSO)
  • Balmex (in the grocery store with diaper rash products) just added to the list in 3/07
  • Butt Paste also with diaper rask products
  • oral dexamethasone
  • Vitamin B 6 100 mg (200 mg twice a day recommended for nails by one metster)
  • Vitamin B--100mg of each, B1, B6, and B12
  • White cotton gloves/sox to wear over cream at night
  • Wedge shaped cosmetic sponges in the heels of shoes provide cushioning
  • xeroform petrolatum dressing-for dressing cracks-great when refrigerated and cold
  • hydrogen peroxide and tea tree oil to clean lifting nails
  • Vicks Vaporub for toenail fungus
  • ResQ cream by Dr. Burt for hands & Almond Milk hand cream by Dr. Burt for feet
  • Working Hands lotion from the drugstore
  • Bag Balm
  • DiabEase, an OTC product made for diabetics with foot issues, available at Target, soak feet in it
  • Aquaphor Healing Ointment
  • Super glue on cracks-change daily
  • Neutrogena Norwegian Formula Cracked Heel Moisturizing Treatment.
  • wet washcloth in a ziplock bag and put it in the freezer. Partially defrost and cover with light towel when you need a cold pack for feet or hands
  • Epsom salts soak (2 T to 1 Gallon of lukewarm water), 10 min or so, 2x/day.
  • wet/dry dressing for raw areas-- Have a stock of 2x2 sterile guaze bandages. Take one gauze 2x2 and dip it in the epsom salt solution, then wring it out. Put that directly on the open wound. Take a dry 2x2 and put it on top of the damp one. Hold it all on not with tape, which can damage the skin more, but with the stretchy kind of bandage that sticks to itself. There are two kinds, the "band-aid" colored kind and the white kind

 

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Post Options Post Options   Thanks (0) Thanks(0)   Quote janinvan Quote  Post ReplyReply Direct Link To This Post Posted: Sep 13 2009 at 12:17pm
THANKS !!
I wish there was a similar "blurb" for the GASTRO part!
AND again--are you in the med field?
Janice
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cg--- Quote  Post ReplyReply Direct Link To This Post Posted: Sep 13 2009 at 1:06pm
Dear Jan,
 
I was trying to fix my cutting and pasting skills (alas, failed) and forgot to answer your questions! 
 
I have been a medical transcriptionist for the past few decades (okay 3) and law of averages ensures I remember some of the stuff I type every day.
 
The gastro part - first you must ask your oncologist how he would feel about prescribing a probiotic? There is a prescription one called Bacid.
 
Hopefully, the side effects will become bearable and you will be able to continue with the Xeloda.
 
Love,
Connie
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Post Options Post Options   Thanks (0) Thanks(0)   Quote janinvan Quote  Post ReplyReply Direct Link To This Post Posted: Sep 14 2009 at 1:54pm
Thanks, Connie....
I'll ask Dr. G. if she would (probiotic).....but she is NOT usually into .......
Again, ..was your tnbc --grade 3?
Janice
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cg--- Quote  Post ReplyReply Direct Link To This Post Posted: Sep 14 2009 at 3:05pm

Dear Jan,

 
Oh yes....grade 3, high Ki-67 in the high 80s, vascular space invasion, 3 positive nodes. It was 1 x 1 cm at biopsy and 3 cm x  3 cm at the time of mastectomy 2 weeks later.  I am EGFR positive. 
 
 
If Dr. G. will not do the probiotics - then just put yourself on a diet of bananas, white rice, applesauce, toast and steamed or boiled chicken breast and see if that works.
 
Please keep in touch to let us know how you are doing.
 
Love,
Connie
 
If Xeloda is working - we have to find a way to let it keep working without harming you with the side effects.
 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote janinvan Quote  Post ReplyReply Direct Link To This Post Posted: Sep 16 2009 at 8:51am
CONNIE,  thanks!!
      WHAT is Ki-67 ?....(80's)
      WHAT is EGFR ?
       I feel ??  not knowing!!
        Dr. G. phoned that my potassium is a little low (voicemail)
         I'll take bloodwork this Monday...but I'll also find out if they expect me to start pills again pre- that result !
        JANICE
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Post Options Post Options   Thanks (0) Thanks(0)   Quote janinvan Quote  Post ReplyReply Direct Link To This Post Posted: Sep 18 2009 at 8:58am
CONNIE---I feel quite stupid/marginalized....thought I was informed....
WHAT IS KI-67-- and EGFR ??
 ***I will try to find out ---as my strength slowly returns......
I have important family dinner tonight --and lunch tomorrow--for holiday-- and will eat a little and cautiously  -- the food is awesome
Dr. G. said to see how I feel next week......
JANICE
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Post Options Post Options   Thanks (0) Thanks(0)   Quote janinvan Quote  Post ReplyReply Direct Link To This Post Posted: Sep 18 2009 at 9:03am
epidermal growth factor...????   skin>>>
Janice
  Ki-67 ??
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KI-67..... tendency to increase ???
 WHO takes that ???
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cg--- Quote  Post ReplyReply Direct Link To This Post Posted: Sep 18 2009 at 10:03am

What is the Ki-67 Tumor Marker Test for Breast Cancer?

By Pam Stephan, About.com

Updated September 05, 2008

About.com Health's Disease and Condition content is reviewed by the Medical Review Board

Question: What is the Ki-67 Tumor Marker Test for Breast Cancer?
Ki-67 is a cancer antigen that is found in growing, dividing cells but is absent in the resting phase of cell growth. This characteristic makes Ki-67 a good tumor marker. This test is done on a sample of tumor tissue, to help predict your prognosis.
Answer:

About the Ki-67 Tumor Marker

Although the Ki-67 test is not always used for breast cancer, many studies have been done to determine its value as a tumor marker test. The researchers agreed that high levels of Ki-67 indicate an aggressive tumor and predict a poor prognosis. A British study found that breast cancers could vary in regards to hormone-sensitivity, lymph node status (positive or negative), but if the tumor tested positive with high levels of Ki-67, the risk of recurrence was higher than average.

Do I Need The Ki-67 Tumor Marker Test?
If your cancer appears to be aggressive, your doctor may order this test to see if Ki-67 is affecting your tumor growth. Other tests must also be done for hormone receptors, HER2 - neu and metastasis, and these results, along with your Ki-67 Labeling Index (test score) will affect your treatment plan.

Benefits of The Ki-67 Tumor Marker Test
A breast tumor that scores high for Ki-67 is made of cells that are rapidly dividing and growing. Chemotherapy drugs target cells that are growing beyond the normal rate, and so these drugs can be effective on aggressive cancers. Knowing your Ki-67 score helps you and your doctor decide what treatment will work best for you.

Balancing Prognosis With Your Response to Treatment
A study in the Journal of Clinical Oncology found that tumors that had higher levels of Ki-67 had a good response to chemotherapy. This study noted that a high index of Ki-67 usually means a poor prognosis (shorter survival), but if the cancer responds particularly well to appropriate chemotherapy, long-term survival is achievable. They also speculate that if the Ki-67 test were done according to consistent standards, the results of a Ki-67 test might be helpful in determining whether or not neoadjuvant chemotherapy (given before surgery) would be effective for some tumors.

Ki-67 and Other Cancers
Ki-67 is found in several types of cancer, some of which are breast, bladder, brain, colon, and prostate cancer.

Sources:

Ki-67 as prognostic marker in early breast cancer: a meta-analysis of published studies involving 12,155 patients. British Journal of Cancer (2007) 96, 1504-1513. E de Azambuja, et. al. Published online April 17, 2007.

Proliferation Marker Ki-67 in Early Breast Cancer. Journal of Clinical Oncology, Vol 23, No 28 (October 1), 2005: pp. 7212-7220. Ander Urruticoechea, Ian E. Smith, Mitch Dowsett.

EGFR as paradoxical predictor of chemosensitivity and outcome among triple-negative breast cancer

Authors:
Hiroko Nogi, Tadashi Kobayashi, Masafumi Suzuki, Isao Tabei, Kazumi Kawase, Yasuo Toriumi, Hisaki Fukushima, Ken Uchida

Affiliations:
Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, Tokyo 105-8461, Japan. nogi_h@jikei.ac.jp

Pages:
413-417

Abstract:

We retrospectively analyzed the expression of epidermal growth factor receptor (EGFR) as a prognostic marker to predict neoadjuvant chemotherapy response and survival among breast cancer subtypes. We used immunohistochemical profiles to subtype the patients. EGFR expression was determined using immunohistochemistry. All patients received an anthracycline-based regimen preoperatively. Ninety-three patients also received docetaxel. Of the 117 patients tested, 28 (24%) were triple-negative breast cancer (TNBC) and 73 (62%) were hormone receptor-positive (luminal) subtype. Among the TNBC patients, a significantly higher incidence of EGFR expression (50%) was observed (P=0.002), and EGFR expression was related to a less favorable response to chemotherapy (P=0.03) and poorer survival (P=0.17); in contrast, among the luminal subtype patients, positive EGFR expression was related to a favorable clinical response (P=0.06) and better survival (P=0.11). This retrospective analysis demonstrated that EGFR expression may represent an adverse prognostic marker in patients with TNBC and may provide a valuable tool for selecting appropriate treatment regimens for patients with TNBC.

Oncology Reports

February 2009
Volume 21 Number 2


Dear Jan, These tests are only of value if the oncologist wants to order them or tailor treatment....I had these tests done in 2007 by a laboratory in the States, by ex-onc would not even look at them even though the PhD thought especially in TNBC with my high Ki-67 (weekly chemotherapy would have been good...or discussing the merits of an anthracycline).....but until we change the mind set of the medical community to tailoring our treatment on specific characteristics of our tumors rather than the chemotherapy du jour - everyone gets the same....we will not improve our gains over TNBC.  I got the most aggressive treatment I could get in Ontario at the time - even outside of their established guidelines of 4 positive nodes for radiation after mastectomy...I got turned down 4 times by four doctors even for a consultation to a radiation oncologist...now ASCO released the 20 year study findings identifying the overall survival benefit for women especially the stage IIB (that is me) if they have radiation post mastectomy.
 
 
Just my humble opinion.
 
 
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THANKs !
WELL,....now I developed a blood clot on a clavicular ?  sub clavean artery in neck...on my good side near port o cathe!!      good thing I caught it soon....
I'm taking daily blood thinner injections......what a journey!!
The hematologist explained that it could evolve from chemo, etc. ??
Luckily my vitals, blood pressure are good.....
capecitabine..?   or nuclear stuff......
I'll be fine !
 **BY THE WAY.....has anyone (Connie?) heard of chemo affecting the vascular system ....by causing a clot ?   Capecitabine apparently causes blood thinning, and my hemoglobin was a little low.
There doesn't seem to be an "answer"....
 Sincerely --Janice


Edited by janinvan - Sep 26 2009 at 2:48pm
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