Meeting with liver surgeon tomorrow

[hart2hart]

Hi!

Have you given any thought to getting an opinion from Dr Kemeny and the HAI pump
At Sloan?
Julie and Lete
Stamford, CT

[mpbser]

It's the standard dosage depending on where you look. NCCN guidelines say 130, other places 85.

[JJH]

It's the standard dosage depending on where you look. NCCN guidelines say 130, other places 85.

I think the standard oxaliplatin dosage for Xelox/capeox is 130 mg/m2. The standard oxaliplatin dosage under FOLFOX is 85mg/m2, however. The difference is due to the different cycle length for the two protocols. Xelox/capeox infusions are given every 3 weeks while FOLFOX infusions are given every 2 weeks so there are fewer infusions in a 6-month Xelox/capeox regimen than in a 6-month FOLFOX regimen (8 infusions vs. 12 infusions). Therefore, more oxaliplatin needs to be given in each Xelox/capeox cycle than in each FOLFOX cycle in order to insure that an equivalent amount of oxaliplatin is delivered in both protocols.

I think that the first two of DH's proposed infusion sessions are given at a reduced rate in order to follow a sort of desensitization protocol that gradually builds up the dose to full strength over the span of three cycles = 9 weeks

[CRguy]

Another consideration which must be factored into the equation of " what dosage ..." is body mass index versus body surface area.

BSA dosing is not equivalent for every patient if BMI is taken into account.
Many protocols need to be adjusted for "lean body weight" as opposed to just using the dose per body weight
OR the BSA equation without modification. ( There are a number of BSA calculations and metrics in use. )

Additionally, metabolic issues ( especially kidney / liver function ) MUST be factored into the equation before any drug, let alone chemo, is given to a patient.

A given "standard" protocol lists presumptive dosage ranges for consideration.
A specific chemo regimen requires detailed evaluation of the patient's EXACT history, clinical evaluation and comorbidities.

CRguy

[mpbser]

hart2hart, I didn't see your question for some reason until now. No, we are not interested in MSK and are very happy with Mass General.

Exactly, CRguy.

re:: Ox dosage... I think the people citing the 130 mg/m2 number are discounting my husband's comorbidities. 130 mg/m2 is the standard for the average person but 85 mg/m2 appears to be the standard for older patients and those with comorbidities (such comorbidities tend to go hand in hand with older chronological age, but of course unhealthy living quickens the biological age as it has for my husband).

[Beckster]

hart2hart, I didn't see your question for some reason until now. No, we are not interested in MSK and are very happy with Mass General.

Exactly, CRguy.

re:: Ox dosage... I think the people citing the 130 mg/m2 number are discounting my husband's comorbidities. 130 mg/m2 is the standard for the average person but 85 mg/m2 appears to be the standard for older patients and those with comorbidities (such comorbidities tend to go hand in hand with older chronological age, but of course unhealthy living quickens the biological age as it has for my husband).

I agree! My friend had high blood pressure, over 70, and type 2 diabetes.... they gave him a lower oxi dosage. I, on the other hand, had no comorbilities, and had the max dosage of 130. The only difference is that they put me of 3000mg a day for Xeloda. 3 pills in the morning and 3 pills in the evening.

[mpbser]

Hi Beckster, That's interesting re: 3000 mg of Xeloda. Did you do rounds of 3 weeks or 2 weeks?

Also, re: HAI pump (cc'ed from another thread I commented on): Someone on my thread "meeting with liver surgeon tomorrow" suggested we look into the HAI pump. I read some of these links and it looks very interesting. I'm surprised and saddened that it isn't more widely available. It appears to be used primarily for "nonresectable" liver mets. My husband's liver mets are resectable, so I can imagine that insurance would not cover this treatment if he sought it.

[Beckster]

Hi Beckster, That's interesting re: 3000 mg of Xeloda. Did you do rounds of 3 weeks or 2 weeks?

Also, re: HAI pump (cc'ed from another thread I commented on): Someone on my thread "meeting with liver surgeon tomorrow" suggested we look into the HAI pump. I read some of these links and it looks very interesting. I'm surprised and saddened that it isn't more widely available. It appears to be used primarily for "nonresectable" liver mets. My husband's liver mets are resectable, so I can imagine that insurance would not cover this treatment if he sought it.

mpbser,

As my signature states, I had stage IIA and was put on chemo for preventative measures. Onc is from MD Anderson...he said that it is based on your weight...I weighed 155 pounds when I started. I took the pills for 8 cycles...14 days on and 7 days off. However, because H&F started and got worse by the end of cycle 3, he lowered my dosage by eliminating 2 days. I took the pills for 12 days instead of 14 and 9 days off instead of 7. He said this was more effective than taking one pill away per day.