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Liver Mets
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Liver Mets

Dear Dr. Goodman... Please read my history on my profile page so that it will help you understand what I'm currently dealing with.  I had progression in the middle of cisplatin/taxol.   That was given about 1 1/2 months following progression of disease after gemzar/carbo.  I had very small disease after that.  While on cisplatin/taxol my disease went to my liver (again) but this time I have 30 spots some in and some on the liver and 2 in the liver approximately 2cm and 3 cm.  I also have a small spot in my pelvis and on my T9 spine.  This all progressed during a hell treatment that almost killed me!  Now I'm dealing with this.  I researched and I am going to appeal the denial for a SIRT procedure for my liver.  If that doesn't work I want to try RFA with chemotherapy.  If that doesn't work I looked into the Ciberknife and my insurance won't cover unless I do conventional radiation first for the two small spots.  He said the liver couldn't handle the Ciberknife at this point because there is too much disease.  My gyn onc and all the doctors in the office are routing for me to beat Anthem for the SIRT.  It is FDA approved for colorectal but not OVCA.  I can't find any definate information for liver mets.  I've had them 3 times (read my profile,please).  Now they are back and so much more cancer this time!  My gyn onc put me on doxil yesterday.  In your opinion will the doxil shrink the liver tumors and the two other spots?  I am desperately trying  to beat this disease.  I've been through so much!  I'm even going to consult a liver oncologist with my gyn oncologist about saving my liver.  I also am looking into chemoembolization.  I don't know if my insurance will cover that either.  I'm running into so may road blocks for this disease.  Are we orphans?  I'm not going to give up.  Please give me some answers.  Does Doxil really work?  I need to know.  Thank you very much....Cindy
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Dear Cindy,
thank you for your complete information. You have been through so much!  I have read about SIRT procedure and I have only had one patient with ovarian cancer try this. Unfortunately for her, the SIRT put her into liver failure and she passed away.  I do not have enough personal experience to know if her experience was unusual or whether that is a risk of SIRTs when there is alot of tumor in the liver.

I worry that doxil will not quickly be effective. I like Doxil. It is a great drug but it is a slow drug.It takes about 3 to 4 months to really see a response.

I would wonder abut the use of avastin (bevacizumab). I is not FDA approved for ovarian cancer either so it may be challenging to get it approved as well.  I have used this drug for my patients with liver mets and have been impressed as how many of them have had shrinkage of their liver mets

There is a fair bit of data on liver mets and avastin in colon cancer. I have pasted one report from last year's cancer meeting.
best wishes

ASCO: Neoadjuvant Bevacizumab (Avastin) Safe for Colorectal Cancer Liver Metastases
By: Peggy Peck
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
Originally published: June 7, 2007


CHICAGO, June 7 -- There were no unexpected bleeding complications when neoadjuvant bevacizumab (Avastin) was given before curative resections of liver metastases from colorectal cancer, researchers reported here.


Moreover, bevacizumab treatment up to five weeks before surgery did not adversely affect regeneration of liver tissue following surgery, found Thomas Gruenberger, M.D., of the at the Medical University Hospital in Vienna, Austria.


In a 56-patients phase II study "neither the rate of surgical or wound healing complications nor the severity of bleeding were increased compared with historical data of chemotherapy alone," said Dr. Gruenberger at the American Society of Clinical Oncology meeting.


The median age of the patients was 61.5, and 32 of the patients were men. There were 34 patients with node-positive tumors, as well as 34 patients with synchronous liver metastases, and 29 patients had bilirubinemia.


He said the data "demonstrate that with appropriate management, bevacizumab can be used in combination with chemotherapy, with minimal risk of bleeding and wound-healing complications, in patients with metastatic colorectal cancer and liver metastases undergoing liver resection."


Dr. Gruenberger said that chemotherapy prior to surgery has the theoretical advantages of destroying micrometastases, thereby reducing the risk of recurrence, and can downsize tumors, which could make the chances of complete resection more viable.


However, the use of bevacizumab in combination with resection in the highly vascular liver has not been attempted with great frequency so that the risks of the use of the agent prior to surgery were not known.


The neoadjuvant regimen combined bevacizumab at 5 mg/kg every two weeks plus capecitabine (Xelox) at 3,500 mg/m2/day for one week plus oxaliplatin (Eloxatin) at 85 mg/m2 of the first day of a two-week cycle), for six cycles of treatment before attempting surgery. The regimen was resumed five weeks after surgery and continued for six more cycles.


Within the cohort, 41 patients had liver resection surgery only, while 11 patients had synchronous primary as well as liver resection, he said.


Of the four patients who did not have surgery one patient had it suspended because of extrahepatic disease during laparotomy. The other three did not undergo surgery because of progressive disease and so received second-line therapy, Dr. Gruenberger said at his poster presentation.


Among the findings:

There was no peri-operative mortality.
Three patients required blood transfusions.
One patient required additional surgery to close a small bowel perforation.
Three patients developed sepsis, two developed hyperbilirubinemIa, one patient developed a wound infection, and one developed a wound hematoma.
Forty patients responded and 11 had stable disease
7 Comments
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Hi Cindy,

You are so inspiring.  It sounds like you have wonderful doctors that want to help you.
I am thinking and praying for you that you can get what you need and want.

How did you educate yourself about all these options?  I haven't heard of a lot of them and we have found it difficult for the doctors to think outside the box with my mothers cancer.  

Hoping and watching the Dr.'s response!

Chopps
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Avatar_f_tn
Thank you for the compliment.  Yes, I have wonderful doctors.  All the ideas that I come up with are researched by me.  I know I'm in a difficult situation and will do my best to try and keep this disease under control the best I can before my body gives out.  I'm 51 and healthy besides having the cancer.  Right now the Doxil is giving me some pain in the liver and back.  I guess it is working.  Who knows?  Hope the outcome isn't like the past two chemo's.  I went to a radioloist oncologist.  Radiation is not meant for ovarian cancer unless it is one spot (away from the bowels).  That is when I found the cyberknife (not approve for first line radiation for ovca with my insurance).  That would be perfect or someone like me that is now inoperable.  That is when the radiologist suggested SIRT which is not FDA approved.  So here is where the battle begins.  It will be a long battle and I don't have the time for that but will continue the appeals.  Right now I'm looking into RAF with chemoembolization.  My main question is about the doxil.  Hope Dr. Goodman has some answers for me.  There are not many approved options for ovca that cold help us fight this disease!!!  Most all stage 4 cancers wind up in the liver.  SIRT should be FDA approved.  There is no reason why it hasn't.  Thank you....Cindy
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Avatar_f_tn
Hi Cindy,

Do you know about Dr. Holt who has used radio waves in Australia?  It is worth looking into and not very expensive. He has a clinic and has had some success on many cancers, not sure about ovarian.  Not sure if quack or for real, but worth looking into. FDA not a factor in Australia.

One article below, can google more info:

Over the past 30 years, a qualified surgeon based in Perth, Australia has been treating cancer patients with a novel form of radio-wave therapy. A news story on the popular Australian television show "A Current Affair", hosted by Ray Martin has sparked great interest from the Australian general public and the wider Australian medical community.
The doctor has had some resounding successes with his radio-wave therapy, treating 1000's of cancer patients. His treatment is most successful when treating lymphomas, Hodgkin's disease, bladder and early breast cancers.

The radical treatment has not won Dr. Holt many friends in the Australian medical community, with many saying that there is no scientific basis for his claims.

Dr Holt's treatment works by giving the patient an injection of a glucose-blocking agent. He then bombards the body with "radio waves" at a specific frequency. Dr Holt doesn't offer any guarantees for curing cancer but many patients in the interview cited 'the last resort' scenario and a relatively cheap treatment cost (around U.S. $700 for a 3 week course) as reasons for initially going to the doctor.

Born in Bristol, England 80 years ago and a member of the Royal Colleges, Dr Holt has 26 medical letters after his name. He was also in charge of Western Australia's main cancer institute, until the late '70's, when he was blacklisted by his medical colleagues and politicians.

Doctor Holt in a humble manner claimed his treatment to be far superior to chemotherapy. Ray Martin closed the story with the news that the TV station had been subsequently overwhelmed by interest from the general public. Thousands of emails had been lost presumably due to web server overloads and Dr Holt's own surgery had been swamped in enquiries since the show aired.

Also, Cindy can you give me your thoughts on the type of scans you feel are most important having been throught so much. She has stage IIIC PPC/Ovaian cancer that is high grade (very aggressive).  Before surgery CA125 was 290, 4 weeks post op CA125 400 just before first chemo.  They did not do another CT Scan pre chemo, post op.  First CT Scan grossly underestimated the cancer.  Gyn/Onc says another CT Scan won't show it again most likely (what he had to leave near intestine) and don't need until after chemo.  They say don't need PET/CT scan after chemo and that it can have false positive areas.  I just need to know what is best to push for.

Thanks,
Chopps



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Avatar_f_tn
Thank you for all your information.  I truly appreciate it!!  It is very helpful.  CT scans are not a good scan for me.  You can read my profile.  They show the disease when it has progressed to the point of either surgery or what I'm trying to accomplish now.  My current problems is that I've had progression during two different platinum chemo's.  My last CT only showed mets to the liver and missed one larger tumor.  A PetCT was ordered the next day and it showed mets to the spineT9 and a spot in my pelvis that is surrounded by clips.  I have massive adhesions and scar tissue from all my surgeries.  I guess that is why the CT no longer shows all of my disease.  I know a PETCt will find the smallest spots.  The chances of a false positive are rare according to my gyn onc. If that happens it eventually turns into cancer.  Hope this helps...Cindy  ps. Dr. Goodman, any thoughts?

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Avatar_f_tn
Thank you very much for you response!  I have been offered Avastin two treaments ago with carbo/gemzar.  It was following my second cytorductive surgery where I had many complications.  Including septis twice and two bowel resections.  I've had bowel resections upper and lower for my first surgery in Mar06.  Also a pinched bowel following the surgery that resulted in an ostomy.  It was reversed feb07.  When my gyn onc suggested Avastin to me with the 4% chanced of a perforation I turned it down because I could die.  No more surgeries for me.  A few treatments down the line during an exam he informed me that he lost 3 patients that were on Avistan.  I think it works for some but with a weaken bowel  and it is not and option for me.  My bowel collasped when I had the emergency (10days after the first) and when my doctor saw it he at that time was very worried about it healing.  I guess what I am trying to say is it is not perfect for everyone.  I know many that have had success with it.  I guess I will give the doxil a chance to work and be patient.  I will rely on scans not ca125 this time.  I was turned down by the liver speicialist this week for RFA at this time.  Too much tumor.  My doctor seems we can address this down the line.  Without the option of another surgery I'm trying to seek out what works for other cancers with treatment options. I hope I can win some.  We do not have many choices for our disease.  We usually follow colorectal cancer and  colorectal cancer mets for FDA approval.  How sad and frustrating for us!!!  I know it frustates my doctor!  He would love to give other options for his patients instead of the "standard".  The cyberknife is a good thing and tagets tumors just like the sirt procedure.  What better way to treat ovarian cancer than targeted radiaton?  I know I am a small voice and it will be very hard for me to get these procedures done.  My insurance co. will not cover the cyberknife without doing convention radiation first.  Isn't that dumb?  Plain and simple.  I have a spot on my spine and it is so very small.  Why damage all the surrounding tissue?  Sure the radiation oncologist wants to do it, but at what cost?  Anyway, it sounds like you are not a complete fan of Doxil.  Have you had any success with liver mets with this drug after the 3 to 4 month wait?  I hope you come back and answer my question. Thank you, Cindy
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242604_tn?1328124825
Hi Cindy
thank you for the update. Yes it does sound like you have had too many bowel problems to consider avastin. Staying with doxil makes sense. As long as those liver mets are slow growing, Doxil will have a chance to work.
You have been through so much!
Please keep in touch. I have you in my prayers.
take care
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