Gemzar with Cytoxan for recurrence?

I was dx May 06 stage 3c. Did 4 rds cisplatin/taxol i.p.. then 4 rds carbo/taxol i.v.. Finished Jan.07. Ca125 started rising slowly in Aug.07. ptct in Sept clear. Oct. 19 appt. found intestinal (small int) blockage had same day surgery. Onc/gyn did not see cancer, blockage was adhesion twisting intestine. Pathology slides and fliud positive for ca. Started Gemzar/carbo day 1, with gemzar day 8. First rd, could not do day 8 until day 14 because of red blood and platelets. Rd. 2 could not do day 8 until day 21 same reason ( had aranesp shots) Rd 3 carbo reaction they said, although it didn't happen until i finished the carbo and gemzar drip. How do they know was it? Could not do day 14 of Gemzar again thursday for platelets. come back next thursday. Had ct this past thursday, clear. Dr. said she was adding cytoxan on rd. 4. I never heard of this combo, Looked it up and now I am worried that it will make platelets and red blood even worse. Platelets were 71 on valentines>  What do you make of this? I am really worried. I stay so tired and weak i don t go anywhere except chemo. I go to west clinic in memphis, 110 miles drive.I take neupogen (3) at home for white blood.My ca125 is now 28. (was 265 oct.) Is my dr. aggressive by not just using gemzar?Thanks

[Annekathryn Goodman, M.D.]

Hi Ms Jazz,
thank you for your complete information. I have had the same experience with many of my patients when they are taking gemzar/ carbo. I think the gemzar is very hard on the platelets.

I am not familiar with the combination of adding cytoxan to the mix. Cytoxan is definitely a great drug and has been used in many combinations - most famously : cisplatin/cytoxan (CP), or cisplatin, adriamycin, cytoxan (CAP). Most recently oral cytoxan given daily at 50 mg a day is well tolerated.

I think you need to sit down with your good doctor and go over your appropriate concerns about bone marrow toxicity.  It may be reasonable to just give carboplatin by itself, cytoxan alone, or even gemzar alone.  Another option is stop now and watch closely.
Please let us know what you decide
take care