4th Recurrance of Cancer, Bone Marrow damaged

[snappy68]

Dear Dr Goodman, Pleas Help. My mum in 4th recurrance of advanced endometrial cancer, spread to ovaries, peritoneum(grade 3) hysterectomy in 05 then 6 cyles of taxol/carboplatin. CA125 1600- down to 89 cycle end. Same pattern for 06 and 07 chemo July-Jan then 6 mths of good health until CA125 rises and ascites..chemo dose reduced couple of times due to neutrophils being low. June 08 CA125 up to 700 and fluid building in tummy. chemo put on hold due to chest infection. after anti-biotics blood still showing neutrophils at 0.4 for whole of july. I thought it neutropenia but consultant said bone marrow prob permanently damaged due to too much chemo and has put her on Tamoxifen. Neutrophils at 0.96 2 wks ago and due back at consultant on 20th. Please advise if her neutrophils come up to 1.5 can she get more chemo? are any others less harsh on bone marrow? should she be getting neutrophil boosting drugs? many thanks

[Annekathryn Goodman, M.D.]

Hi There
thank you for your question. Your mother has been through so much. It sounds like she has received superb care. She has a very serious problem.

You should ask her doctor if there is any role in checking a bone marrow biopsy. She has received alot of chemotherapybut it is common to have a normal bone marrow even with all the chemo.

While it might be important to check that she does not have involvement  of her bone marrow by tumor, she may just have a fragile bone marrow.

Tamoxifen is a very reasonable option.
Another option to check with her doctor about is doxil. This chemotherapy drug has less effect on the marrow than taxol and carbo.
Another option is giving chemo directly into the abdomen to control the ascites. The side effects are the same , though, and it is important to have normal white count before giving IP (intraperitoneal chemotherapy).
Please let us know what happens
best wishes