After my initial diagnosis, I had a surgical consult to determine whether the tumor was resectable or not. I then sought a second opinion at MD Anderson Cancer Center in Houston (MDACC) which confirmed that the tumor abutted a portion of the left branch of the portal vein, which would have to be preserved in a resection. Surgery would require complete resection of the right lobe and preservation of the left lobe, but since the tumor was pressing against the branch of the portal vein that fed the left lobe, it was deemed inappropriate for the time being.
With surgery out of the picture for the immediate future I began chemotherapy at MDACC consisting of Gemcitabine (Gemzar®) and Oxaliplatin (Eloxatin®) – together a.k.a. GEMOX. I receive therapy every two weeks via IV and once it was determined that I was tolerating therapy well, I was able to return to my home in the Atlanta area and continue therapy at Emory University Hospital.
I also opted for some genetic testing to determine what other agents the tumor would be receptive to. I was found to be K-Ras Wildtype and then started erlotinib (Tarceva®) 100mg daily. Erlotinib is a Human Epidermal Growth Factor Receptor (HEGFR) inhibitor.
So far, I’ve tolerated the chemotherapy well – I’ve been very fortunate. Fatigue has been the most problematic adverse event I’ve experienced, but daily exercise and an improved diet has helped overcome that. Taste changes go with the territory while on chemo and I’ve lost all taste for red meat, but that is typical with the GEMOX routine. I have recently experienced some neuropathy, mainly as peripheral neuropathy in my fingers and toes but also some pharyngolaryngeal dysesthesia, a neurotoxic effect that causes a sensation of difficulty breathing. Both of these resulted from exposure to cold, which is typical on this regimen. It hasn’t helped that we’ve had some very cold days here in the Atlanta area this season.