Gemzar as Single Agent??

Doctor,
I have just completed 6 round of Doxil and my liver surface tumor is stable at 5cm x 1.8cm- not decreasing.  I am thinking about switching to Gemzar as a single agent. I know it is frequently teamed with Carboplatin but I am trying to take a good long break from Carboplatin - it has been 15 months since I last has carbo and it had stopped working for me. I was dx in 2003 and carbo has usually worked very well for me. Would it make sense to start with Gemzar as a single agent and add in Carbo only if the Gemzar was not working? What could I expect as results from Gemzar alone? I live in a rural area of Maine and the closest Gyn/Onc is 200 miles away so you input will be greatly appreciated. Thank you
pmac46

[Annekathryn Goodman, M.D.]

Hi There,

thank you for your question. Without knowing you, my instinct would be to suggest staying on the doxil.
I do not rec gemzar at this time.

I have never been impressed that gemzar as a single agent is very effective.however it most definitely will nuke your bone marrow. And sometimes , that makes it hard for you to get other chemo.

unless you are having unacceptable side effects to doxil, it can be a very good maintenance therapy. I have had some of my patients on it for more than 1 to 2 years!. I check a cardiac ultrasound every 6 cycles to check for changes in ejection fraction (the strength of the pump). Unlike adriamycin,I have rarely seen cardiac dysfunction with long term doxil use.
best wishes

[pmac46]

Thank you for you response on single agent Gemzar. Another option that has been presented to me by an Oncological Surgeon who specializes in Liver Mets is to istall  Chemo beads directly into the artery that is feeding this liver surface tumor - after a dye study deterines how it is fed. The only type of chemo beads mentioned were Andriamycin. Since Adriamycin is the partent drug of Doxil and Doxil is keeping things stabile do you think Andriacycin might work differently and more effectively? I am also being told that the liver capsular tumor will keep coming back - it has 4 times already - unless that area of the capsule is surgically removed. This would be possible once the tumor shrinks some and moves away from the diaphram. I have never  had any tumors other that this area of the surface of my liver since my first recurrance in 2005 and hope if I can solve this issue I may have a long remission. Thank you for helping me make these tough decisions.

[Annekathryn Goodman, M.D.]

Hi There,
that is definitely an option  to do what is called chemo embolization.
I do not think it will interfere with the doxil
however
You should have a very serious talk about the complications of this.
I have seen some people develop liver failure so I would want to know just how significant your liver mets are before proceeding.

here is a general link on the topic

http://emedicine.medscape.com/article/421608-overview

best wishes