2nd recurrence - what chemo options available?

Dear Doctor,

My sister-in-law (aged 56 at diagnosis, no other medical problems) was diagnosed IIIC ovarian cancer in early 2009. Has gone through 2 surgeries and chemo (carboplatin + taxol). Chemo completed in August 2009 and then in remission.  Recurrence in Feb/Mar 2010 and started another course of chem. (6 times of “Caelyx + carboplatin”). CA125 dropped to 29 just prior to 6th chemo, but then after chemo completion in late Oct, CA 125 has risen to 60+ in late Dec 2010. Doctor suggested CT scan, which was scheduled in early March, before deciding on next step. Doctor lightly mentioned Gemzar as 3rd line of treatment. I asked if she would restart Carbo + taxol as it is more than one year since using this combo chemo, but doctor said no and said that the same chemo drug used before would not be used again.  My questions are -

1.  what are the possible chemo drugs that could be used for 2nd recurrence? What are the options available and how to choose?
2.  How effective are these 3rd line chemo drugs?  Is combo chemo more effective than single agent chemo? Should carboplatin be used in conjunction with Gemzar?
3.  Is it that chemo drug tried before will no longer be effective for recurrence? Is it advisable for my sister-in-law to try again carbo + taxol?
4.  Could you kindly share your views / recommendations on what chemo drug(s) to use for 2nd time recurrence?
5.  It seems that Caelyx +Carbo is not very effective to my sister-in-law as her CA125 started to rise once chemo was stopped. Given her current trend, what is her prognosis?
6.  Can you offer any advice on the possible treatment forward?

I understand that response to chemo varies among patients and we could not tell how effective one drug is on a patient until he has tried. We however want to get more information / expert opinions before meeting our doctor again in March to discuss the next step and options available. Many thanks in advance for your attention and advice.

[Annekathryn Goodman, M.D.]

Hi There
I put my thoughts below next to your questions


1.  what are the possible chemo drugs that could be used for 2nd recurrence? What are the options available and how to choose?
carbo, taxol, taxotere,gemzar,topotecan.
there are many drugs - we usually try drugs that have not been used before or have not been used for at least a year


2.  How effective are these 3rd line chemo drugs?  Is combo chemo more effective than
single agent chemo? Should carboplatin be used in conjunction with Gemzar?

there is no strong evidence that 2 drugs is better than one for third line chemo
side effects are much worse with combination therapy


3.  Is it that chemo drug tried before will no longer be effective for recurrence? Is it advisable for my sister-in-law to try again carbo + taxol?

I would hold the carbo for now . weekly taxol as a single agent at a low dose can be effective with low toxicity

4.  Could you kindly share your views / recommendations on what chemo drug(s) to use for 2nd time recurrence?

as above.It depends on the person and how ill they are.

5.  It seems that Caelyx +Carbo is not very effective to my sister-in-law as her CA125 started to rise once chemo was stopped. Given her current trend, what is her prognosis?

recurrence so quickly is very worrisome. It may be that if she has a response to the next type of chemo, she should stay on it as long as possible. The time of remission gets shorter and shorter with each recurrence.


6.  Can you offer any advice on the possible treatment forward?
as above.
occasionally it can be helpful to get a second opinion at this point. not to change doctors but to reassure yourself that the recommendations are similar

I know this is very tough.
please let us know how things are going
take care