My Treatment

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.

  1. Christa
    March 10, 2010 at 18:38

    Mark, Where are you in your timeline of chemo?

    • March 10, 2010 at 21:19

      CAT – March is month seven. Oh how time flies when you’re having fun, eh?

  2. Neville
    April 18, 2010 at 20:41

    Mark, who is your doctor at Emory? And what have your results been since you started treatment? I’m also undergoing treatment for cholangiocarcinoma at Vanderbilt. I am taking erlotinib (Tarceva) and am experiencing the rash. What has worked best for you in treating the rash?

    • April 19, 2010 at 19:48

      There are two physicians at Emory who see cholangio patients: John Kauh, M.D. and Bassel El-Rayes, MD – both of whom are very good. With respect to Tarceva skin rash, see my earlier post from February 22, 2010 on it – here’s the link below. I have had success with Cleocin Lotion, a Rx antibiotic cream (generic: clindamycin)

  3. December 3, 2010 at 04:11

    Thanks I finally came to a website where the webmaster knows what they’re talking about. Do you know how many results are in Google when I search.. too many! It’s so irritating having to go through page after page after page, wasting my day away with thousands of owners just copying eachother’s articles… bah. Anyway, thanks for the information anyway, much obliged.

  4. December 22, 2010 at 05:54

    Thanks for this! I’ve been searching all over the web for the data.

  5. December 22, 2010 at 13:19

    Fabulous posting bro. This important is just a tremendously nicely structured post, just the critical info I was looking just for. I praise you

  6. December 23, 2010 at 01:39

    Good piece of details that you’ve obtained on this web site submit. Hope I might get some a lot more of the stuff in your website. I will occur again.

  7. Iris
    December 27, 2010 at 21:03

    Hi Mark,

    I hope you are doing well.
    I was wondering about how you got around getting the ‘genetic testing’ you mentioned.

    • December 28, 2010 at 12:37


      Thanks for your question. Check with your doctor – it would require a tissues sample so if they have removed any specimens for surgery, there should be sample left over, if not then you would require a needle biopsy. This may or may not be a good option depending on your individual case. So much of this is individualized, so be sure and have this discussion with your oncology team. Needle biopsies are outpatient procedures and often done under CT guidance. Hope this helps. Best of luck to you! – Mark

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