Dear Dr. Puneet, May I know the palliative treatment for bone mets of stomach cancer after 6 cycles under capox regimen? more  

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First of all the drug manufacturers themselves should come forward to manufacture these medicines and supply at lowest rate. Secondly the government should also give some subsidy/relief to the drug manufacturers. Ravi more  
Dr. Puneet, thanks for clarification more  
Please provide email id for sending the reports for advise. Thanks n regards more  
Not sure if you are a doctor but here is an attempt to answer in a common language for all to understand: Bone metastases are a common for many types of solid cancers, especially lung, breast, and prostate cancer. This involvement can be extensive in patients with multiple myeloma. This condition can severely compromise quality of life. Events medically referred to as Skeletal-related events (SREs) that are common in bone metastases include pain, pathologic fracture, hypercalcemia, and spinal cord compression. Most bone metastases are asymptomatic, meaning they may not show remarkable symptoms, at least initially. Most patients with metastatic bone disease will develop significant pain at some point in their disease course. Neurologic symptoms may arise in patients with spine metastases causing spinal cord compression or spinal instability. Patients with osteolytic (issues relating to bone destruction of bone ) bone metastases may also present with hypercalcemia. An MRI (with back pain, contrast-enhanced spinal MRI is indicated, especially for evaluation of bone metastasis and spinal cord compression) or CT Scan (cross-sectional imaging with contrast-enhanced computed tomography )can help identify patients who are suspected to have near future fractures and can be supported with surgical supports if possible. Skeletal scintigraphy, generally referred to as a "bone scan," is the most widely used method to detect bone metastases because it provides visualization of the entire skeleton within a reasonable timeframe and at a reasonable cost. Patients who do not have remarkable symptoms but have widespread metastasis with no risk of fracture, and others who may have a limited life expectancy may not require any intervention. Two essential groups exist between bone met patients ones who have Vertebral bone metastases and others who do not have vertebral bone metastases. For patients - WITH vertebral bone metastases they may belong to a class who do not have symptoms and others who have symptoms as described above. In case of For patients - WITH vertebral bone metastases and no symptoms, either the chemotherapy is continued and observation is maintained and if required and if imaging shows changes in weight bearing areas of the vertebral system, EBRT: external beam radiation therapy is administered. Similarly, patients - WITH vertebral bone metastases and WITH symptoms, patients - WITH non-vertebral bone metastases and WITH symptoms are managed with Osteoclast inibitors such as bisphosphonates or denosumab or with EBRT, SBRT etc. more  
Not sure of the exact status of the patient. Also not sure why would you want to migrate from CAPOX (XELOX). is is due to severe neuropathy? or Progression or both? Did you evaluate any RAS WT status in the past? Last is the CAPOX the first line therapy or second line regimen? Thanks more  
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