Gemzar or Topotecan--please tell me whether it worked or not

Hi everyone,

My oncologist wants me to do Gemzar. I also have the option of Topotecan. She is in doubt of Carboplatin working and wants something else to "trick" the cells. Please let me know if either of them worked for you or not and the side effects you had.

Thanks!
Helen

[annie]

Helen,

I finished my carbo/taxol the end of Oct 2006 and after a rise in CA125 just started my 2nd session of the second round on Topotecan/Thalidomide today.
I have not had any side effects from the topotecan just a little bit of trembling hands from the thalidomide.  They told me to reduce the dosage.  Can't tell you yet if it is working or not - I sure hope so!

[Gina21]

Hi Helen,

I was initially diagnosed as Stage IIIC in Sept 2002 and went through the normal Carbo/Taxol treatment. In Nov 2004 I had a recurrence and was placed on the combination of Cisplatin/Gemzar. The Cisplatin caused extreme nausea and vomitting, so my oncologist placed me on Gemzar alone.

I had great results with Gemzar and very few side effects. I experienced quite a bit of fatigue, but otherwise felt pretty good. I finished treatment in May 2006 and have been feeling great.

If you have any questions, please don't hesitate to ask.  I'd be glad to help you in any way possible! I'll keep you in my thoughts and prayers ---- Gina

[Helmar]

Hi Helen... I've had both, and neither really worked for me. The Gemzar was very harsh on my blood... the only time I've needed transfusions for red cells and infusions for platelets.. and the results weren't worth it for me... Topotecan.. well I only had 2 treatments of that and the CA.125 doubled each time. My Oncol. theory was that this 'splits the cells' so therefore the CA.125 showed higher than the actual amount of cancer. He then put me on Taxotere/Carbo and that's working as he said it would... mopping up the work that the Topotecan did, so I'm happy with the results so far. My CA.125 has dropped from 7500 to 1030 in 4 treatments. Maybe a thought for you?
I hope you can find something that will work. How about Doxil? I had good results with that too.
I guess it's all trial and error, as we are all different.
Wishing you all the best... and let's know how you go....*hugs....Helen..

[freshair]

Hi Helmar--I did doxil last summer and it showed growth. The Carboplatin doesn't look good now.

I was wondering--is this your second Carboplatin?  I've already had two Carbo/Taxol's. Best of luck with continuing falling numbers! :)

Jatoo--The Avastin we're a little worried about. I am going to have them start working on that with my insurance. Get the Chief Gyn/Onc of my hospital (like you did) involved. But here's the thing--I may not be covered because of mets to the brain. My Onc said Avastin can cause bleeding. Is this with everyone or some people?

If Melody does surgery cause you said that was an option (Good--you have that option) how long will she have to be off Avastin to have surgery if that is done?

Thank you for your help and my prayers are with you.
Helen

[Jatoo]

Dear Helen:

We just came from UCLA for a second opinion. Although she will still have to undergo a PET CT scan, below are some findings:

1. Gemzar plus Avastin has been working for my wife in that it reduced CA 125 from ~500 to now which is 90 , the lowest in months. Ascites have been clearing up if not almost gone. Her tumors have not reallly progressed and may have shrunk a bit. She started using this combo since first week of January this year.

2. To continue the use of Femara, a hormonal drug.

3. My wife have other options and that UCLA right now has a new drug similar to Herceptin which my wife can use. Abraxane was also offered as another choice. Surgery is also a possibility but would depend on PET CT scan.


On Topotecan:

She had Topotecan before but she only did one cycle. And the Gyn Onc said the daily dosage of Topo for a week was harsh which I also suspected. I would have preferred a once a week or once every three weeks treatment. She had  platelets transfusion, Procrit and Neupogen while on Topotecan.

On Gemzar:

It is an easy drug for her. No transfusion at all. Just a few Neupogen and you can postpone or reduce the dosage. She's only using 10% less that the dosage of 800 mg. Dr. Goodman wrote that either one can or cannot tolerate Gemzar.

A current patient of our Onc who has cancer of the pancreas has been on Gemzar for eight(8) years. Of course he/she is still alive. It's not suppose to happen but it happens.

Topotecan is considered second-line and then Gemzar third. But nobody really knows which one will work. It is a question of increasing the possiblity of the drug working. That's why when Gemzar was offered to us, we refused. We could not accept another failure since her cancer was very aggressive. Only did we agree when Avastin was added and recommended by the chief GYN Onc of our hospital. We knew that the possiblity of these drugs working increased with this addition.

I hope this info. helps in your decision. Again I will keep you in my prayers.

Thanks too for your prayers,
Jatoo

[SimplyStar]

I am no expert by any means and reading your posts made me know you are all fighting so hard,  I do wonder though if any of you are considering asking your onoco to add an infusion of Vit C along with your chemo.  I spent hours reading and digesting those articles yesterday and am impressed with some of the data.  When Leslee asked about it at her last appt, they were surprised she knew about its useage.  They told her if she was having a recurrance they would contact Mayo and ask about the regimen of administration. After so many years of  independent research on Vit C and its usage by some, with questionable results, as far as the AMA goes, I wonder if this is one of the protocols that is being kept from the comman knowledge because it is cheaper. According to what I was able to understand, it acts as a aide when given with the chemo drugs. It produces H2O2 which has been proven to kill cancer cells. Less chemo is needed and the side affects are less harsh.  I really don't know, but I am trying my best to find out more.  let me know what you think.  My prayers are with you all always.

[Helmar]

Yes... this is the second time that I've had success with the Carboplatin. The first time was in '04 when the CA.125 dropped to 12...Carbo/Taxotere then too.
Just want to wish you all the best and hope things work out well for you...*hugs...Helen...

[Jatoo]

Dear Helen:

Gemzar alone can work. It's a better alternative when the cancer starts putting resistance to platinum drugs.

We were also scared of the GI perforations that Avastin can bring which could be fatal. But we know that the Onc has to give us that disclosure if not she won't be doing her job. But why did the Chief GYNONC recommend it? He based it on GOG studies. The last three(3) clinical trials ( one with Cytoxan, another one just on Avastin alone, then in combo with CarboTaxol did not report any bleeding or perforation). And I think there is still a lot of clinical trials going on, on Avastin right now that has not been stopped because of perforations. You can see it on the web: try MD Anderson, NCI, etc. I think at this point they have been able to get a control of the right dosage.

You need at least eight(8) weeks after the last Avastin treatment before you can be operated because of the healing process unless it is an emergency.

It's always good to be prepared for other better options just in case. Sorafinib is an interesting one. Abraxane ( a modified Taxol) is another one. If I were to choose Gemzar alone without Avastin I have an inkling that I would need a hormonal drug like Tamoxifen, Femara, Arimidex to increase its effectiveness. That's the reason why our Onc and the chief GYn Onc agreed on adding Femara (pill form) on top of Gemzar and Avastin. Ovarian just like breast are still hormonal. Plain common sense. Again you can click on this drug and Ovarian Cancer and you can see some info on the web.

It's funny that besides another one in this forum, it looks like my wife is the only one on Avastin while on the other forum where I go, Avastin has now become a regular alternative of choice.

Well, I'm just relating to you my research which can be fallible. I hope I have answered your questions.

All the best,
Jatoo

[freshair]

We gain so much knowledge from you! You are so helpful.
Keep us up to date with Melody and how she's feeling.
God bless,
Helen

[freshair]

Gina,

Could you tell me how your CA125 went down every month?
And what you got your count down to?
How many months were you on it? More than a year.
Did you have to have Neupogen?

Thanks!
Helen

SimplyStar,

I asked about Vitamin C drip. My oncologist dismissed it. I have to continue reading all the stuff on it also.

[Gina21]

Hi Helen,

You asked how my CA125 did on Gemzar. Well, my CA125 has never gotten enormously high. When I had my recurrence it had only gone up to 22. After the first two treatments of Cisplatin/Gemzar it dropped to 5. It remained at 5 after the Cisplatin was dropped and I was on Gemzar alone.

My treatments were once a week for 3 weeks and then one week off. That continued on and off for a period of about 18 months. The reason I say on and off is because treatment was interrupted twice for surgeries - once for gall bladder and another for a bowel resection. Neither surgery was related to the cancer. My gall bladder was just full of gall stones.

As far as Neupogen, I only had it once and that was after my very first treatment with Cisplatin/Gemzar. My oncologist had given me a fairly large dose of the Cisplatin, which had to be decreased and then eventually stopped because of side effects. I never had any problems with Gemzar affecting my blood counts. I was able to stay on track with my treatment schedule with the exception of having to delay because of the surgeries.

Personally, if I had another recurrence and Gemzar was still considered an option for me, I would do it all over again. I was able to keep my life as normal as possible while on it - much easier than when on Carbo/Taxol.

Take care and if I can help in any way, please don't hesitate to ask!   Gina

[lucymullis]

I am on a Phase III Trial with Avastin and hoping that I am getting it.

[freshair]

You know I thought they stopped the trials with ovarian cause of intestinal bleeding. How scarey does that sound but that was with a few women.

Where are you having the trial? Is it near your home or do you travel for it? How long have you been on it? And what were your treatments before? Sorry for the questions but I am scheduled for tomorrow to have Gemzar and am still fighting it!

I've been off chemo for a month and want to be off for another two months and to say the h--ll with it but then afraid. I don't have a negative attitude at all but a realistic one. And that being:  The paradox of it all---is it going to affect overall survival not just progression-free. And I know something else good might come up.

Much luck with you that you are getting Avastin!! Is it Avastin with Gemzar?

[lucymullis]

I started the avastin trial in October at my second chemo.  I am on #11 now and have had no problems at all.  Gemzar is not a part of the trial.  Again, I am just praying I am getting it.
I will send very positive prayers your way.