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Ovarian Cancer (Expert Forum)
Carboplatin AND taxol, or JUST Carboplatin 4 recurrence
Answered by
Annekathryn Goodman, M.D. - Gynecologic Cancers, Complex Gynecologic, Surgeries, Palliative Care, Acupuncture
Massachusetts General Hospital Cancer Center
Boston - MA
Carboplatin AND taxol, or JUST Carboplatin 4 recurrence
by dargle, Aug 23, 2006 12:00AM
Hello,
My wife has stage 3 b Ovarian Cancer. She is in her 3rd year with this disease and in a recurrence right now...
During her relpase.which is about 1 year now..she has used Topotecan...(didn't work for her) Doxil ..(had stable disease for many months on Doxil) Then onto Gemzar..hasn't worked.
Long story short because of her time to relapse (10 months) after her inital surgery, and 5 cycles of Carbo/Taxol her
new Dr. is recommending platnum drugs for her again..saying he believes, she may be platnum sensitive. She is not doing well at the moment..and the mass has gotten very big..also some bleeding from a tumor or the tumor..from the vaginal area.
My question is would Carboplatin alone be as effective as the combination of carbo/taxol in a recurrence? If there is no strong evidence that carbo/taxol, is better than carbo alone for recurrence,we'd rather just go with 1 drug for quality of life issues!
Any info would be apprecitaed!!
Thank you!
Randy
My wife has stage 3 b Ovarian Cancer. She is in her 3rd year with this disease and in a recurrence right now...
During her relpase.which is about 1 year now..she has used Topotecan...(didn't work for her) Doxil ..(had stable disease for many months on Doxil) Then onto Gemzar..hasn't worked.
Long story short because of her time to relapse (10 months) after her inital surgery, and 5 cycles of Carbo/Taxol her
new Dr. is recommending platnum drugs for her again..saying he believes, she may be platnum sensitive. She is not doing well at the moment..and the mass has gotten very big..also some bleeding from a tumor or the tumor..from the vaginal area.
My question is would Carboplatin alone be as effective as the combination of carbo/taxol in a recurrence? If there is no strong evidence that carbo/taxol, is better than carbo alone for recurrence,we'd rather just go with 1 drug for quality of life issues!
Any info would be apprecitaed!!
Thank you!
Randy
Doctor's Answer
by Annekathryn Goodman, M.D., Aug 24, 2006 12:00AM
, Aug 24, 2006 12:00AM
Dear Randy,
Your questions are very good and important. In deciding on further therapy, there are two big pieces of information that are important.
First, it is important to know how a person is doing. Second, it important to look at what therapies a person has received and what are reasonable next choices.
There is a general assessment called "performance status" (PS). The score is as follows:
PS 0 - no symptoms, fully functional, (ie going to work, no restrictions on activities)
PS 1 - has some symptoms (ie: pain, or bleeding, or trouble with bowels) but able to perform all activities of daily living, go to work etc.
PS 2 - has more symptoms that prevent the person from doing all their activities. Is too sick to go to work but can get out of bed, perform limited activities.
PS 3 - extremely ill. Unable to perform most activities but can get out of bed, walk around a little.
PS 4 - unable to get out of bed, is unable to do anything for oneself.
This score is a rough estimate of prognosis. A person who has a PS of a 4 is close to the end of their life. A person who has a PS of 1 to 2 may still get better from their illness. For these people (PS 1-2), it is important to consider aggressive therapy. A person with a PS 3 is on the boundary of becoming extrememly ill. Whether that person should get more therapy will depend on other factors. You should ask your wife's doctor about what he thinks her PS is.
Next it is important to know about kidney and liver function. If these are abnormal, that will limit therapeutic options. Finally - what are other symptoms and how should they be addressed. For instance: you wife has vaginal bleeding. Why? Is this causing her to lose alot of blood? Does she have a tumor that is causing her pain, pressing on her bladder or on her rectum? If so, sometimes, it is reasonable to consider localized pelvic radiation to shrink that tumor before considering other chemotherapy. You should ask the oncologist about this.
As far as the use of single versus double agent chemotherapy. There is no wrong answer. It is not at all clear whether two drugs improves the remission rate and the survival rate when given as second line therapy. Both carbo and carbo with taxol have been given again. Since it has been three years since your wife's last platinum drug, it is reasonable to try the drug again. The decision to do one or two drugs does depend on PS, kidney function, signs of neuropathy. These are definitely good topics for discussion with her concologist.
best wishes to both of you.
Your questions are very good and important. In deciding on further therapy, there are two big pieces of information that are important.
First, it is important to know how a person is doing. Second, it important to look at what therapies a person has received and what are reasonable next choices.
There is a general assessment called "performance status" (PS). The score is as follows:
PS 0 - no symptoms, fully functional, (ie going to work, no restrictions on activities)
PS 1 - has some symptoms (ie: pain, or bleeding, or trouble with bowels) but able to perform all activities of daily living, go to work etc.
PS 2 - has more symptoms that prevent the person from doing all their activities. Is too sick to go to work but can get out of bed, perform limited activities.
PS 3 - extremely ill. Unable to perform most activities but can get out of bed, walk around a little.
PS 4 - unable to get out of bed, is unable to do anything for oneself.
This score is a rough estimate of prognosis. A person who has a PS of a 4 is close to the end of their life. A person who has a PS of 1 to 2 may still get better from their illness. For these people (PS 1-2), it is important to consider aggressive therapy. A person with a PS 3 is on the boundary of becoming extrememly ill. Whether that person should get more therapy will depend on other factors. You should ask your wife's doctor about what he thinks her PS is.
Next it is important to know about kidney and liver function. If these are abnormal, that will limit therapeutic options. Finally - what are other symptoms and how should they be addressed. For instance: you wife has vaginal bleeding. Why? Is this causing her to lose alot of blood? Does she have a tumor that is causing her pain, pressing on her bladder or on her rectum? If so, sometimes, it is reasonable to consider localized pelvic radiation to shrink that tumor before considering other chemotherapy. You should ask the oncologist about this.
As far as the use of single versus double agent chemotherapy. There is no wrong answer. It is not at all clear whether two drugs improves the remission rate and the survival rate when given as second line therapy. Both carbo and carbo with taxol have been given again. Since it has been three years since your wife's last platinum drug, it is reasonable to try the drug again. The decision to do one or two drugs does depend on PS, kidney function, signs of neuropathy. These are definitely good topics for discussion with her concologist.
best wishes to both of you.
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I just wanted to thank you for such a detailed and informative answer. It was VERY helpful to me and very useful.
We have decided to start with just one drug for now, Carboplatin.
The Dr. we are seeing told us perhaps if the carbo works..it will in turn, also stop the bleeding...so we are waiting on any radiation for the moment.
Thanks so much again for your time and your answer to my question.
You have a wonderful service here, and I'm sure you have already helped many women in their fight with this disease.
Thanks again!
Randy