How many more chemo combinations are there?

Dear Doctor

My mother has stage 4 OvCa, DX May 2005 and is now into her 4th year. She has recenly finished a combination of Avastin,Gemzar & Carboplatin (carboplatin on alternate weeks). and her CA125 is 8. Is there anything else to try after Avastin?, I get the impression that Avastin is the end of the line for this rotten disease. A few years ago she was taken off Carboplatin and Taxol due to it giving her tinnitus so what else can she try, would Avastin still work if it was combined with something else ? Over the years she has had Taxol & Carboplatin then onto Doxil & Gemzar together. I know time is running out for my dear mum but we are always hopeful of something else. Thankyou for your time.

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
There are many approved chemotherapy options still left. She appears to be platinum sensitive, as carboplatin is still being used.
According to the standard NCCN (National Comprehensive Cancer Network, nccn.org) guidelines, recurrent ovarian cancer may be treated with two drugs (one of which is a platinum), or a single agent like docetaxel, oral etoposide, weekly paclitaxel, pemetrexed, topotecan, cyclophosphamide, capecitabine, irinotecan, vinorelbine, hormonal therapy, local radiation, etc.
Avastin is certainly not the end of the road. Ovarian cancer is relatively chemosensitive, and many women with recurrent disease do well for long periods of time.
All the best, and God Bless!