Chemotherapy Effectiveness in Advanced Stomach Cancer

Gastric cancer chemotherapy

Hello Dr.
Chen, my mother was diagnosed with stage 4 gastric cancer with ovarian metastasis in July of last year (it has spread to the diaphragm).
During surgery, only the ovary was removed, and a gastric bypass was performed.
Chemotherapy started in mid-August with the regimen of Carboplatin and Capecitabine, administered every two weeks.
She took one Capecitabine tablet after each meal.
Before chemotherapy, the abdominal fluid drainage tube was removed, and her CA 19-9 level was approximately 1700.
Two weeks later, it decreased to 600 (at this point, the sensation of abdominal fluid was gone, and her abdomen felt smaller).
The subsequent levels were 1700 (the doctor mentioned it might be a lab error) -> 600 -> 400, after which chemotherapy was stopped.
At this time, she felt well, her physical strength was normal, and her abdomen was not distended.
In late December, she returned to the hospital for a check-up (the CT scan indicated that the tumor size seemed stable, and CA 19-9 was 190).
In January, she began to feel increasingly unwell, her abdomen became distended, and her appetite significantly decreased, making it almost impossible for her to eat.
On February 1, she underwent the same chemotherapy regimen (Carboplatin and Capecitabine) again, with a CA 19-9 level of 300 before the treatment (at this time, 3000cc of abdominal fluid was drained).
Due to the Lunar New Year holiday, there was a three-week gap before the next chemotherapy on February 10, during which another 3000cc of abdominal fluid was drained.
Throughout the holiday period, the sensation of abdominal fluid continued, and she had trouble sleeping at night, experiencing persistent body pain.
On February 22, she had the second treatment after the chemotherapy interruption (CA 19-9 was 600).
On March 8, she had the third chemotherapy session (CA 19-9 was 800), and at this point, her body pain had significantly decreased, and the abdominal fluid accumulation had either stopped or slowed down, with an improved appetite (though still slightly less than normal).
On March 22, during the fourth chemotherapy session, CA 19-9 was 1000, but it had been over a month since the last abdominal fluid drainage, and her abdomen felt smaller compared to the holiday period, with a good appetite and decent energy levels, experiencing only occasional body pain.
Dr.
Chen, could you please advise if this round of chemotherapy is effective? What should we do if the levels rise again? I heard during the visit that it may take 3 to 4 months of chemotherapy to determine its effectiveness; is this a possibility?

Xiao Xiao, 20~29 year old female. Ask Date: 2010/03/22

Dr. Chen Junyi reply Oncology

Based on your description, it may be effective; however, it is advisable to discuss the specific situation with the attending physician.

Reply Date: 2010/03/22

More Info

Understanding the effectiveness of chemotherapy in advanced stomach cancer, particularly in a case like your mother's, involves analyzing various factors, including tumor markers, imaging results, and overall clinical condition.

From your description, your mother was diagnosed with stage IV stomach cancer that had metastasized to the ovaries and diaphragm. After undergoing surgery, she started chemotherapy with a regimen of Oxaliplatin (益樂鉑) and Capecitabine (截瘤達). Initially, her CA19-9 levels were significantly high at 1700, which is indicative of disease activity. However, after two weeks of treatment, her CA19-9 levels dropped to 600, and subsequently to 400, suggesting a positive response to chemotherapy, as lower levels of this tumor marker often correlate with reduced tumor burden.

The fluctuation in CA19-9 levels you reported—1700, then 600, then 400—indicates that the chemotherapy was initially effective in controlling the disease. However, the subsequent rise in CA19-9 levels back to 1000 after several cycles raises concerns about the effectiveness of the treatment over time. It's important to note that while CA19-9 is a useful marker for monitoring treatment response, it is not definitive. Some patients may experience rising tumor markers even when they are responding to treatment, due to various factors including tumor burden changes or the biological behavior of the cancer.

Chemotherapy effectiveness can sometimes take several cycles to fully assess. In many cases, oncologists will evaluate the response to treatment after 3 to 4 cycles, as you mentioned. This is because the full effects of chemotherapy may not be immediately apparent, and some patients may experience delayed responses. Imaging studies, such as CT scans, are typically performed alongside tumor marker assessments to provide a comprehensive view of treatment effectiveness.

In your mother's case, the fact that she experienced a reduction in abdominal swelling and improved appetite after the initial cycles of chemotherapy is a positive sign. The reduction in pain and the stabilization of her condition are also encouraging indicators. However, the subsequent rise in CA19-9 levels and the need for further drainage of abdominal fluid suggest that the disease may not be fully controlled.

If the CA19-9 levels continue to rise despite treatment, it may indicate that the cancer is progressing, and the current chemotherapy regimen may need to be reassessed. Oncologists often consider switching to different chemotherapy agents or combinations if there is evidence of disease progression.
In summary, while the initial response to chemotherapy appears promising, ongoing monitoring of CA19-9 levels and imaging studies will be crucial in determining the effectiveness of the treatment. It is essential to maintain open communication with your mother's oncologist to discuss any changes in her condition, the implications of her tumor marker levels, and potential adjustments to her treatment plan.
Lastly, it's important to focus on your mother's quality of life during this challenging time. Supportive care, including pain management and nutritional support, can significantly enhance her comfort and well-being as she navigates her treatment journey.

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