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Dana Farber should be a good place. Think about reaching out to Johns Hopkins for a 2nd opinion, if you want one. Right now, I would ask the new MD about a Gemzar combo, as your mom seems to be a candidate for this. The best patients for the combos (ie. the ones that do the best) are those with good functional status, which your mom must have if she is still working. The ones that have the best evidence at the moment are combos of Gemzar + oxaliplatin (or cisplatin) vs. FOLFIRINOX (no Gemzar - but 5-FU/leucovorin/irinotecan/oxaliplatin). Folfirinox will likely have more side effects, but a clinical trial just showed that patients using this treatment survive TWICE as long as those treated with Gemzar alone. There is also some interest in Gemzar + Abraxane but the studies are still being done with this combo. Many patients on this board are treated at Columbia (and elsewhere) with GTX (gemzar + Taxotere + xeloda) and we are still awaiting the publication of the Phase 3 trials using this combo.
As you may know, many patients do not respond to Gemzar at all, and your first set of scans after starting treatment will be important.
But don't forget the fatigue issue as this is critical for quality of life. Have a thorough discussion with the MD about the use of Epo or Aranesp for her anemia - a controversial topic now, but as her Hematocrit is so low this should be considered - vs. when to give a transfusion. Additional options include treating any depression (common in this setting) and considering a trial of ritalin or provigil.
As you guys are quite proactive, I would also discuss the issue of
prophylactic anti-coagulation (eg. lovenox/fragmin). Evidence is starting to
show that these meds not only decrease chance of blood clots (which is very
high with pancreatic CA), but may lead to increased survival. Most doctors
will not start these initially though until you have a clot, but I am
certainly happy that my mom had another indication - one episode of Afib
while she was in the hospital getting her initial work-up.
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