1. Avastin and Ulcers and 2. Iressa+Taxol

Hi, Dr. Goodman. I have written questions in the past about my mother who has already been treated with the standard treatment, Doxil + Carbo, Gemzar + Carbo, Taxol Alone, and Carboplatin+5FU. She was to begin treatment with Avastin+Cytoxan, however a gastroscope revealed an ulcer in her duodenum and her doctor is reluctant to go forward with the Avastin.

The doctor is now contemplating Taxol + Iressa. (My mother's tumor has not been tested for EGFR) Do you have any thoughts pertaining to this combo? Would it be more useful to use Abraxane since my mother has already seen taxol? I'm afraid this combo won't be as effective as the avastin and will also not allow for her ulcer to heal.

Is there anything that can be done to heal ulcers or protect the GI lining to prevent a bowel perforation?  

[Annekathryn Goodman, M.D.]

Dear Jen,
I am so sorry to hear about what yoru mother is going through. You should ask your doctor if there is any role to resecting the segment of intestine with tumor growing into the bowel. There may be be. But if this is isolated disease, surgical excision is the best treatment.

If your mother is experiencing the much more common situation in ovarian cancer of having multiple areas of involvement of the bowel by tumro, surgery is not appropriate.

I agree with your mother's doctor that avastin would be dangerous because of the risk of bowel perforation.  Your mother is at risk of - just from having cancer growing into her duodenum-  bowel perforation, obstruction, and bleeding into the bowel.

I did a search on Iressa in ovarian cancer. The data is not comelling. The best review is:Doctors Palayerkar and Herzog Internation J Gyn Cancer 2007
you can google pubmed and then search iressa ovarian cancer
take care

[Jen Y]

I've just been informed that my mother actually has an invasive tumor in her duodenum (not an ulcer), which I am told would make the avastin very risky.

As for the Taxol/Iressa, would it be possible for this regimen to shrink the tumor enough to use Avastin at a future date?

[Annekathryn Goodman, M.D.]

continued....
either abraxane or taxol are reasonable.

The standard agents used to protect the stomach from ulcers are antacids, omeprazole, nexium, or zantac.  You should also have a frank discussion with your mother's oncologist and yoru mother about what yoru mother's prognosis is, what would your mother's risks about care be if she gets sicker. Also a discussion about what to do is hse develops an obstruction. Should she now consider the placement of a gastrostomy tube to drain her stomach if necessary.
these are all very tough questions.

please keep in touch
take care