Diagnosed With Bile Duct Cancer. Prescribed With Cabozantinib. What Is Phototherapy Used For?

Posted on Fri, 13 Dec 2013

Question: My wife has Stage 4 Bile Duct cancer. Diagnosed 2/19/13. She has had Gemzar/Cisplatin...effective at first then not so switched to FolFox regimen. Total chemo treatments both protocols: 15-16. PET scan last week inconclusive as she has carcinomatosis--diffuse, hard to tell what's happening for sure. They say it is inoperable.We are being treated at Mass General Hospital by the head of Gastrointestinal Cancer Center. He has offered participation in a clinical research study using a drug approved by FDA for treatment of medullary Thyroid Cancer, Cabozantinib [XL-184]. Taken orally once per day. Have you heard this drug? Have you heard of phototherapy for this and where might that be performed? Also wondering about a procedure I read about that involves opening the abdomen, removing as much cancer as possible and bathing the abdomen in chemo. Our oncologist says he has talked with many surgeons at MGH and none will even consider the procedure for bile duct cancer. Why not? Just because it hasn't been tried does not mean it might not work. My wife is 61 and was in good health prior to this: normal weight, never smoked, doesn't drink. Rarely ever sick with more than a cold every couple of years.

Answered by Dr. Krishna Kiran Kannepalli (1 hour later)

Brief Answer: Unfortunately, surgery is of no benefit. Detailed Answer: Hi! Thanks for the query. As an oncologist, I can totally understand what you are going through. As per the reports your wife has stage 4 bile duct cancer. In such a situation, removing part of the tumor won't work as there will be no benefit in terms of extending survival or providing symptomatic relief. The tumor will grow more rapidly if it is meddled with due to opening up of tissue planes. The procedure which you mentioned is called intraperitoneal chemotherapy and it won't work for biliary cancer. After 2 courses of chemotherapy, it is better to enroll in a clinical trial as further chemotherapy won't be of much benefit. Cabozantinb is now under clinical trials for many cancers and it is worthwhile trying. Photodynamic therapy is available at select centres and it is usually done along with biliary stenting to relieve jaundice. At this point, providing your wife a good quality of life is more important. I suggest that she should not be burdened with aggressive therapies that are not only futile but are also fraught with dangers and might actually be counterproductive. My best wishes are with you. I hope I have answered you query. Please feel free to get back.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Krishna Kiran Kannepalli (22 hours later)

Thank you for your prompt and honest response. I suspected as much. I have read about a drug called Sorafenib. Is there any reason to inquire as to its efficacy versus a trial with Cozantinib? From my reading and limited understanding as a layperson, they appear to have similar approaches to inhibit the cancer but do not work on exactly the same pathways. I have also read about a procedure done at XXXXXXX Kettering to relieve pain[she has none as yet, Thank God]...some kind of solar plexus block or something...should I mention this to her oncologist as well should we get to that point?

Answered by Dr. Krishna Kiran Kannepalli (1 hour later)

Brief Answer: celiac plexus block is useful in intractable pain Detailed Answer: Sorafenib is approved for hepatocellular carcinoma. Not of proven benefit in bile duct cancer. The procedure you mentioned is known as celiac plexus block. It is indicated when there is intractable pain. It is widely available in all major hospitals. It is useful for pain relief should there be intolerable pain.

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Above answer was peer-reviewed by : Dr. Yogesh D