Follow up on 2d recurrence treatment

1st line 6 cycles iv taxol + carbo & 3 cycles IP cisplatin consolidation (1 Year Remission)
2d line 6 cycles iv carboplatin + Doxil ( No surgery) and PET/CT at end of treatment showed NED ( 1 Year Remission)
3d line Gem: 1gm/m2  (total dose 1600mg on D1 and D8) Avastin 400mg q15 days Oxaliplatin 130mg / m2 ( 200mg D1)

She has undergone 3 cycles so far.

She has not been receiving any prophylactic hemopoetic agents. Following her last chemo she developed febrile neutropenia (ANC < 50) and she had to be admitted for a few days. She is doing better now with her counts back to normal. Her Ca -125 has reduced from 180 to 28 and PET CT shows significant improvement and good response to chemotherapy.  

This has been the harshest treatment for her so far she is very tired and unable to do her daily activities.  She has lot of nausea and dizziness from the treatment and has not experienced this in her prior 2 regimes.  

Her oncologist has given her a 3 week break and wants to push 3 more cycles.  He wants to discuss 2 options.  
(1) reduce dosage of current regime for next 3 cycle
(2) Move to weekly taxol + Avastin.  He said if we go down this path he wants to push it for 3 more months

He said that she has had a very good response to her current regime and is on a winning horse right now but developed febrile neutropenia on her last treatment and had to be hospitalized for a week due to an infection.
What would you recommend in such a scenario?  Also will reducing dosage on current regime reduce efficiency of the treatment?  

[Annekathryn Goodman, M.D.]

Hi there
thank you so much for the update.
as a general rule, if a certain regimen is working, I agree about trying to push it.

I would dose reduce as well and add a growth factor such such as Neulasta® (pegfilgrastim)

there is no good evidence that there is a dose response to chemo. so a dose reduction should not reduce it's efficacy
best wishes

[OVCIndia]

Thank you for your response.  We did meet with her oncologist again and he has decided to continue her on GEMOX-B.  He said he would dose reduce GEMOX 20 % and she will get Gemzar at 800 mg(D1 and D8), Oxaliplatin at 100 mg(D1) and Avastin at 400 MG(D1 & D15) along with pegfilgrastim.