Side effects Folfirinox vs Abraxane/Taxane/Gemcitabine

[PKSwed]

Hello!

Long story, jump to the last paragraph for my question!

My father (76) was diagnosed with pancreatic cancer about a year ago. It was localised to the pancreas, no metastases to begin with, but inoperable.

He was started on Folfirinox in December of last year. He was spared side effects, only a bit of nausea on treatment day and he was a bit more tired than usual. In all, the portable pump he had to wear for two days was his biggest bother. After (about) 10 treatments he got a bit sensitive to cold. But in all he was lucky. (at least, that's what he has told us and the doctors)

He was not so lucky with the effects on the tumour. It continued to grow a little. The oncology unit gave him a treatment break for two months starting June. In August, after a follow up, they gave him another two month break. (There was nothing wrong in his tests and they saw no significant changes on the scans).

Late in September he started getting dizzy and was finally brought to the Emergency Unit with embolisms in his lungs. (The stubborn old man wouldn't have gone at all had my brother not thrown a fit and called the ambulance) He also had a very bad blood count and he went for blood transfusions a couple of times.

New scans followed and the tumour in the pancreas had progressed and now there were also metastases in his liver.

He is now up for a new round of chemotherapy, this time with the equivalent to Abraxane/Taxane/Gemcitabine.

The scariest part for the rest of the family is that my father is a very quiet man. He never complains about anything. And he's very reluctant to show any discomfort at all. On top of that, he has an extremely high threshold for pain. He simply doesn't seem to experience pain the way others do, he has always been like that.

So my questions are; are the side effects always worse with this combination compared to Folfirinox? What can we expect? What should we look out for? (since he is reluctant to tell both us and the oncology unit about any symptoms). Of course we have received a lot of information from the hospital, but I would appreciate personal experiences if anyone has the time.

/PK

[Skippy]

My brother (75) diagnosed Aug 2020 was fortunate enough to be offered the Whipple op very quickly.

After recovery (3 months) he was advised Gemcitabine chemo. Together with nauseous tablets prior to his chemo. He did really well on this. He sounds just like your Dad. Never recognised any ailments in himself until this disease arrived and a quiet gentle man.

He was extremely tired after each session for 3 days but we were overjoyed to find he had no other reactions to this chemo. After 3 days of just watching TV flopping on settee, he was upwards and moving around. positive in his thoughts.

Half his chemo halted in March due to Covid. His indigestion causes problems 13 months on post op. We take all advice on forums a day at a time.

[PCUK Nurse Rachel R]

Hi PKSwed,

It's Rachel here one of the Nurses at the charity. I am sorry to hear of your Father's diagnosis and that his pancreatic cancer has progressed despite having Folfirinox. I imagine this is a very hard time for you all. You will be especially worried if Dad is not the type to complain about things or want to bother people.

Generally speaking the combination of Gemcitabine and Abraxane is easier to tolerate than Folfirinox. This treatment regime is sometimes given to those patients who are possibly not as fit as those suitable for Folfirinox, or patients who may be a concern with potential side effects of Folfirinox. This regime of Gemcitabine/Abraxane is given once a week for 3 weeks of the month and then a week off - this equals 1 cycle, then this will be repeated again. As with any chemotherapy it is difficult to predict who will respond well to this treatment and who will struggle with specific side effects. I appreciate that it can be helpful getting peoples' personal experiences of this treatment and I hope others reply to you. It sounds as if you already have quite a lot of information, however if you did wish to look at anymore, we do have a factsheet on our website on Gemcitabine and Abraxane which also covers common side effects. Here's the link to this; https://bit.ly/2JG1Oij

Wishing Dad all the very best as he begins this next treatment. If you did wish to be in touch with us on our support line to discuss things in more detail, our contact details are in the signature below.

Kind wishes,

Rachel

Rachel Richardson

Pancreatic Cancer Specialist Nurse

Support Team

Pancreatic Cancer UK

email: nurse@pancreaticcancer.org.uk

support line: 0808 801 0707