Cisplatin

[Nelpe]

My sister has stage 111c ovarian cancer.  She just completed 6 rounds of taxol and carboplatin.  

She had surgery a couple of weeks ago to insert a type of port and take tissue samples.  The samples came back great, showing no cancer.

The doctor wants to do a 21 day cycle (with 3 rounds being the goal, perhaps 6)
Week 1 - cisplatin through port
Week 2 - taxol (IV, regular)
Week 3 - rest

My questions are:
What are the dangers to her health with the cisplatin? She faired good on taxol and carboplatin.
Are 6 rounds of the 21 day cycle better than 3 rounds?
The doctor told her this may lengthen recurrence or perhaps be a cure.  Can there be a cure?

Thanks,
Pene

[Annekathryn Goodman, M.D.]

Dear Pene,
thank you for your question. It sounds like your sister has had the best treatment that we know to give at this time. Even with that, there is a risk that the cancer could come back. We have all been looking for strategies to reduce the chance of recurrence of this cancer. Many "consolidation therapy" strategies have been tried. Presently, the most widely discussed option has been to consider a year of taxol given every 21 days. There is controversy among oncologists about whether this truly reduces the rate of recurrence. But it is an option.

Since the publication of the data on intraperitoneal (IP)chemotherapy in ovarian cancer, there has been alot of discussion about the use of this form of delivery of chemotherapy for ovarian cancer. Intraperitoneal means inside the lining of the abdomen. Standard chemotherapy is instilled into the abdomen through a port or tube. It is thought that the chemotherapy directly bathing the cancer cells may increase its ability to kill the cancer cells. Or the chemotherapy sets up an inflammation of the abdomen that then is important for the anticancer effect.

There are many problems with IP chemotherapy. It can cause abdominal pain. The catheter can get infected. The chemotherapy can go into the wrong area such as the fat layer of the abdominal wall and not into the abdomen at all. There can be problems with bowel injury. Finally, if there are too many adhesions within the abdominal cavity, the chemotherapy cannot freely flow around the abdomen and only one region will get treated. In the recent New England journal of medicine study on IP chemotherapy (please see my previous post on this last week), 58% of women were unable to finish the planned treatment because of these sorts of problems.

But having said that, there is probably a subset of women who experience ovarian cancer for whom IP chemotherapy is reasonable. This will be an individual decision based on the findings at surgery and the opinion of the gynecologic oncolgist who is evaluating the particular patient.

For your sister, I would say that the recommendations of her doctor are reasonable but we do not yet have strong data to know whether extra chemo will increase the chnace of curing this cancer. As long as she does not have a problem with neuropathy and or trouble with her kidneys, the extra chemotherapy is safe is give.

Yes - there are some women with stage IIIc ovarian cancer who do not have their cancer recur. Unfortunately for most women, this cancer will return. So we continue to push with extra therapy to prevent that.

best wishes