Gemzar

Hello Doctor,

Im writing again in regards to my Mom.  She has been taken off avastin cytoxane regimen because her ca-125 started to creep up again 169 180 194 now and CT scan revealed slight increase in disease (new unremarkable spots on soft tissue and previous spots from 2008 in slight decrease) so overall not too bad.  This is enough for her doctor to want to switch treatments and suggested carbo/gemzar, but left it completely up to my Mom since she had severe allergic reaction 1.5 years ago to carbo.  Today before her first treatment we meet with another doctor that does her treatments and suggested that if she previously had the severe allergic reaction in most cases it will reoccur just as bad and maybe worse.  Again leaving it completely up to us weather we want to proceed with the carbo/gemzar or gemzar a s single agent.  We came to conclusion that we do not want to mess with carbo and my Mom was in complete fear of having to go through that incident again. My question is this true that in most cases the reaction is indeed the same or might even be worse even with a slower infusion.  Her doctor also said that in her case he does not recommend going through with carbo at this point but does not mean it cannot be tried again in the future.  We also spoke about maybe doing gemzar with avastin....he said he would speak with the main doctor in what he though about that and how to go about getting insurance to approve that for ovarian cancer since there is no evidence that it works for ovarian cancer.  Do you know if there is any evidence for avastin/gemzar combination being affective for ovarian cancer.  My Mom was on avastin/cytoxane for 6 months and her CT scan showed some decrease in disease so obviously avastin was working  and since its not a toxic drug it cant hurt adding that with gemzar....what is your opinion on this?  

Thank you SO MUCH
Fiana

[Annekathryn Goodman, M.D.]

Hi Fiana,
I would agree that once a person has experienced an allergy to a platinum drug, re-exposure will result in another allergic reaction (consider peanuts or bee stings). These allergic reactions can be life threatening. having said that, there has been alot of work on giving the platinum drug as a slow infusion with lots of steroid and benadryl. This is called desensitization. It requires an inpatient admission and is safe.  IF carbo is an important treatment option for your Mum, her doctor should consider this. I have pasted the abstract on one such study from my excellent colleagues at Harvard. There are many other articles on this.If you google "pubmed" and then search in pubmed for "carboplatin densensitization" you will see the work that has been done on this worldwide. You can then suggest this option to your Mum's doctor.
best wishes

Rapid inpatient/outpatient desensitization for chemotherapy hypersensitivity: standard protocol effective in 57 patients for 255 courses.
Lee CW, Matulonis UA, Castells MC.

OBJECTIVES: Hypersensitivity reactions (HR) to chemotherapy often prompt permanent discontinuation and deprive the patient of the most active regimen. We investigated the safety and effectiveness of a rapid desensitization protocol used in inpatient and outpatient settings for patients with HR to various chemotherapy and related agents. METHODS: A 3-solution, 12-step protocol delivered doubling drug doses by step, infusing the target dose over 5.8 h for inpatient and 3.8 h for outpatient administration. RESULTS: 57 consecutive patients who had moderate to severe HR to chemotherapy were evaluated for desensitization. All 57 patients successfully completed 255 courses of desensitization (127 to carboplatin, 114 to paclitaxel, and 14 to four other agents) where 16 patients received 51 courses in the outpatient setting (34 to carboplatin and 17 to paclitaxel). 225 courses (88.2%) were completed without any HR. 18 patients had breakthrough symptoms (BS) over 30 courses (11.8%) that were less severe than their initial HR. After management of breakthrough symptoms, these patients finished all 30 courses and tolerated subsequent desensitizations on a modified protocol. 21 of 26 patients (81%) with HR to carboplatin had positive skin tests to carboplatin. Cancer response to chemotherapy administered by desensitization was within the expected range after 1-3 years of follow-up. CONCLUSION: The rapid desensitization protocol was safe and effective in both the inpatient and outpatient settings and allowed appropriate patients with moderate to severe HR to continue chemotherapy. This study warrants the incorporation of the protocol into standard clinical practice.

Gynecol Oncol. 2005 Nov;99(2):393-9