Next Steps and Adjuvant Therapy

So far, everything was going as well as it could go I suppose. We felt lucky that our Mother was able to have the Whipple and that her path report came out reasonably good. However, the odds are very high for a recurrance with surgery alone. The stats seem to indicate an 80-90% recurrance rate for surgery alone. Now we started to investigate the different adjuvant treatments available.

This part was very confusing. We spent a lot of time on the web and also calling up different institutions that were running clinical trials. One survivor from the Hopkins message board was also very kind to share her experiences with the Virginia Mason Protocol. The two things that stood out in our research were Dr. Picozzi's Virginia Mason Protocol and the Hopkins GVAX Vaccine. Both of these treatments have had very interesting preliminary results from single institution trials. Standard treatment seems to provide overall 5 year survival rate of about 15-20%. Johns Hopkins has data showing that resected patients without spread have 5 year survival of 40%. I'm not sure if my mother falls into that category. The Virginia Mason Protocol (VMP) shows an overall 5 year survival rate of about 45-50%. The patients in the study also mostly had poor pathology reports so that seemed pretty impressive. The Hopkins Vaccine showed 1 and 2 year survival at rates even better than the VMP. The downside that we have heard about the VMP is that it is very toxic and difficult to get through. The downside with the GVAX vaccine is that it does not seem to be available at the moment. The other two drugs that sounded interesting were Avastin and Tarceva. Both of these have had some success with treating advanced pancreatic cancer and are currently in testing for adjuvant therapy.

The Hopkins oncologists were recommending what I consider fairly standard treatment. They recommended radiation with Xeloda followed by chemotherapy using Gemcitabine. We could participate in a trial to add Tarceva as well.

We decided to set up appointments with oncologists at Georgetown, Johns Hopkins, Virginia Mason and locally at Fairfax. It was time to go oncologist shopping.

Our mother has been very anxious about the chemo plan. But she's preparing herself and has already bought a very nice wig.