Xeloda or hospice care?

lcl_90

Hello, I previously posted about my mom being diagnosed with Grade III, ER+/PR-/HER2- metastatic breast cancer in March 2020 (originally metastasis to the bones and lung, now it's in the brain and liver) after being originally diagnosed in 2014. https://community.breastcancer.org/forum/8/topics/...

Many people in the forum had mentioned Xeloda as a drug that worked for them and that was also the drug the Dr. suggested so we were hopeful. She started on it Sept 20 on 3000mg daily but due to bad side effects (nausea, vomit, dizziness, etc.) she reduced to 2000mg for the second cycle -she's about to to go on the pill-free week of the second cycle. We noticed that a big lump that she had on her arm diminished in size. However, this weekend she had to go to the emergency room because of extreme pain on her lower right side abdomen --a CT scan ruled out infection and appendicitis -- the doctors don't know the exact cause of pain but think it's due to a big tumor in the area though they are not 100% sure. She was not due for another PET/CT scan til the after the 3rd cycle on Xeloda but this emergency-room CT scan revealed that some areas had gotten worse than before she started Xeloda. So Drs. now recommend hospice care. This is a big decision so had a few questions

1- For those who have been on Xeloda and saw that it worked, when did you start seeing improvements? is it too early to give up on it? Can it get worse before it gets better? That wouldn't be the only consideration since she's been really nauseous and dizzy on it, barely eating, and now with the excruciating pain, maybe it's just too long to wait (quality over quantity) but I'm curious what others' experience has been

2- The size reduction of the tumor on the arm was very noticeable so I'm confused about the CT scan results. Is it possible that a drug can work for some tumors but not others? My understanding was that one drug should deal with all tumors (if it works) because they are all the same type of tumor (breast cancer cells) but I'm not sure if that's correct. Can she have two types of cancer? When they biopsied a tumor to look at the profile, it was from the abdomen because it was easier to get (rather than the lungs for example) with the assumption that whatever tumor profile you get from the abdomen tumor it's the same in the lungs, bones, etc.

Thank you

moth

re #2, I can tell you that it is definitely NOT the case that treatment will work on all the tumors. The cancer is constantly mutating and the cells in the site of the metastases can vary from each other and the original site - they're still breast cancer, but various genetic markers can change. Even the hormone markers (ER,PR, HER2) can change. Usually it's more subtle changes in the various genes.

I've had some tumors responding to treatment while others grew a bit or new ones showed up. It's not uncommon.

re #1, Is she not a candidate for IV chemo at this point if they think xeloda is not effective? I haven't been on xeloda but generally speaking I was told chemo usually starts working quickly if it's going to work.

jhl

Lcl,

I'm so sorry your mom is having a hard time. Has your mom indicated what she wants to do? Since it's been several years since she was first diagnosed, she might have her own ideas on this stage of her illness. As far as how long it takes Xeloda to work - that is variable. Your mom's MO should be able to give you an idea based on your mom's clinical picture and his own experience. However, I feel he might have indicated that he/she does not think continuing will give your mom improvement because he suggested hospice. I agree with Moth that antineoplastics do not work on all cancer cells equally.

For right now, I hope you can help get her pain under control. Once that can be done, your mom might be able to articulate what her own desires are.

Be well,

Jane