IP chemo quetin

[msjazz]

I WAS DIAGNOSED WITH STAGE 3C (MOST LIKELY PRIMARY PERITONEAL CANCER )IN MAY 2006. i AM POST MENOPAUAL 53 YR OLD WT 138 BEFORE SURGERY, NOW WT 122. i went to memphis to get gyn ocologist, had debulking surgery. of 17 biopsies i has cancer attached on 14. they treated as ovarian. i have no family history of any cancer. i have done all but day 8 of round 3 OF taxol iv, cisplatin ip. and I do taxol ip next week.I AM 1 WK LATE FOR DAY 8 FOR THE SECOND TIME. THE CISPLATIN MAKES ME SO SICK WITH DIARRHEA, SOME HEAVING AND EXTREME NAUSEA AND DEHYDRATION. I USUALLY TAKE 3 NEUPOGIN SHOTS PLUS ALOXI WITH THE CHEMO, PHENERGAN, ZOFRIN, OR AMEND AT HOME,AND HAD HOME HEALTH 3 TIMES ON THE THURS. AND FRIDAY AFTER CISPLATIN,FOR IV ZOFRIN AND SALINE FLUID.  SHE WANTED TO GET ME THROUGH AT LEAST 4,THEN CARBOPLATIN AND TAXOL IV FOR 4 MORE. WHEN I SAW HER BEFORE THIS ROUND, SHE SAID SHE WOULD REALLY LIKE TO DO 5 ip. I DON'T KNOW HOW IMPORTANT ANOTHER ROUND WOULD BE, I JUST DON"T THINK I CAN DO IT. I READ THE FULL TEXT NEW ENGLAND JOURNAL ARTICLE ON THIS AND THEY SAID WOMEN WHO COULDN"T COMPLETE 6 DID BETTER THAN NOT DOING ANY, BUT DIDN'T SAY HOW MANY THEY DID. WHAT DO YOU THINK FROM WHAT LITTLE INFO I GAVE? NOW SHE MENTIONED 1 YR OF TAXOL MAINT. IS THAT IMPORTANT? I AM HOME ALMOST ALL THE TIME BECAUSE OF THE WAY I FEEL, FOOD IS TERRIBLE, AND I WANT TO GET THIS OVER IF I CAN. THANKS.

[Annekathryn Goodman, M.D.]

Hi There,
It sounds like it has been very, very tough for you. Cisplatin is very hard for some people. I like your oncologit's idea of changing over to carboplatin and taxol.

The paper in the New England Journal of Medicine: volume 354 2006
"Intraperitoneal Cisplatin and Paclitaxel in Ovarian Cancer"
reported on 415 women who were randomized to receive intravenous taxol and cisplatin or intraperitoneal taxol and cisplatin. Only 42% of the women assigned to the intraperitoneal arm were able to complete the 6 cycles of chemotherapy. The median time to recurrence was 18 months for women receiving intravenous chemotherapy and 23 months for women receing any intraperitoneal chemotherapy. The difference in median survival was 50 monhts versus 65 months.

Ok there are several problems with this study. When 58 percent of people have to drop out of one treatment arm, you have to ask yourself - what is going on? Then how can you really interpret the results? Remember - all the women who did not get 6 cycles of IP got alot of intravenous chemotherapy. How do you know it was really those few IP treatments that prolonged survival and not whatever chemo they got afterwards?
Another problem with the study is that the women in the IV arm of the study got a dose of taxol chemotherapy that is different than what we standardly give nowadays. We also use carboplatin and not cisplatin. Finally this is just one study. This study needs to be replicated. That is what we do in science, repeat studies to be sure the data is really real.

So for you, I would encourage you to talk to your oncologist about switching to intravenous chemotherapy. If you are so sick that you are not able to receive the chemotherapy and it is delayed, that is not effective therapy.
best wishes to you

[msjazz]

THANK YOU DR. GOODMAN FOR YOUR REPLY. I HAVE LOOKED AT EVERYTHING ON THE INTERNET SINCE THIS BEGAN AND IT IS SO CONFUSING. I READ PRIMARY PERITONEAL HAD A 100% MORBIDITY RATE SINCE I POSTED YOUR SITE. I NEED TO QUIT TRYING TO PREDICT THE FUTURE WITH STATISTICS, I KNOW EVERY ONE IS AN INDIVIDUAL CASE. BEST OF LUCK TO ALL WITH THESE CANCERS.

[akg]

Hi Jazz,
You are so right. Those statistics can be frightening and it is hard to know where you, as an individual fit in. I use statistics as a global guide to understand what is a reasonable option and what treatment options do not make any sense to consider. It is very clear to me that each person has a very individual journey.
Thank you for sharing your experience. Please keep in touch.
you take care.