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Chemo options for 3d line
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Chemo options for 3d line

OVC in 2007 Dec, Stage 4 Neo-adj chemo with iv carbo + iv taxol 3 cycles followed by surgery then 3 cycles iv carbo + iv taxol Then 3 cycles of ip cisplatin ended JUL 08 Recurrence in Sep 09 She was treated with iv carbo + iv doxil  from Oct 09 to Feb 10 Recurrence in March 11

PET findings compared to prior  PET  March 2010 after 2d line

NECK : Reactive Bilateral cervical lymphnodes are noted few subcentimeter lymphnodes are noted in the neck on both sides at levels I-V, which are not significant  by size criteria
LUNG: The subcarinal lymphnode is increased in size, now measuring 21x22 cm previous 8x12 mm
LIVER: There are multyple peritoneal deposits along the hepatic surface  Largest of these measures about 23 x 32 cm which is infiltrating into the hepatic parenchyma  rest of the liver is unremarkable
SPLEEN:  There is an irregular peritoneal deposit along the superolateral splenic surface, new since prior study
GI TRACK & PERITONEUM: There is mild interval increase in size and number of previously noted residual peritoneal deposits in the mid abdominal mesentery, along the IC junction, left paracolic gutter and along the surface of sigmoid colon, the largest of them now measuring about 22 x 25 cm previously measuring 17 x 13 cm
A discrete slightly enlarged right external iliac lymphnode is noted just below the level of bifurcation measuring 13 x 10 cm, which was tiny subcentimeter node in prior study

IMPRESSION

*  Interval increase in the size and number of peritoneal deposits with interval increase in size of the subcarinal lymphnode
* Discrete enlarged metabloic active right illac lymphnode metastic
* Stable small lung nodules as described
* Other incidental and non-critical CT findings as described above

COMMENT: Consider progressive metastaic disease

Oncologist suggested to start her on gemzar + avastin + oxaliplatin  Just wanted to know your thoughts on this or other alternative regimens you have used with success
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Hi there
thank you for the followup
the treatment plan sounds aggressive. As long as her blood counts can manage that, it is reasonable.sometime something a bit lighter like avastin alone or avastin with taxol is another option
please keep in touch
best wishes
3 Comments
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Avatar_m_tn
Correction

My post removed the "." between numbers so the numbers should read 2.3 x 3.2 vs 23 x 32.

Thank You

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Avatar_m_tn
Dr Goodman,

Mom finished her 2 cycles with gemzar + avastin + oxaliplatin.  Her main side effect is extreme fatigue.  She had her CA 125 done today before her 3d cycle which starts tomorrow and it has come down from 185 to 30 (Lab normal is 21).

Her blook counts have been normal through these 2 cyles and he has not needed any transfustion or Neulasta shots during this time.

(1) Would you recommend staying on the current course of chemo?
(2) The oncologist does not intend to continue avastin after her planned 6 cycles.  I have read that we need to continue on Avastin after the completion of chemo unitl a documented Recurrence ?
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