Post to vfc

Dear vfc:

Jatoo posted me and told me that you have gone MD Anderson.  I am very seriously considering going to talk to them about a clinical trial.  In fact, I think I will be at their door Monday morning, just to get things going faster.  My nurse has kind of turned it over to me to get the information.  I don't know if this normal or not, but after waiting a week and nothing done, my husband has said we will go to MD Anderson and see if they will talk to us personally.  It is only about a 3 hour drive.  Jatoo also said that your insurance covered Avastin.  You are so knowledgeable, I would appreciate any input that you can give me.  My options at this point seem to be to fly to Arizona every two weeks for Avastin/Tarceva.  They said they don't know whether Insurance will cover extra expenses beside drug.  My other option will be to try to get into MD Anderson trial with Topotecan/Iressa.  Any insight to MD Anderson will be helpful, since you have been there.  Thank you for your time.  I am at a loss and kind of frustrated.  It seems like it has kind of been turned over to me to find out whether I qualify, etc., and I don't know what I'm doing, but I am sure going to try to do something.

Thank you,

plady

[vfc]

Dear plady,

You said:

"...had a cat scan done on January 5. It showed stable, no change, except for what they callled a minimal nodule in the right pelvic area, less than l centimeter. The doctor said it could be related to the inflamation (inflammation) of the feet. He said he would keep a check on it by scans and exams. I hope this is the right thing to do. Since my ca125 went up, of course I am now afraid this might be the cancer showing up. Everything else so far is microscopic."

Can you please tell on what base did you say "everything else so far is microscopic"?

It seems you have been having a lot of inflamation (inflammation) due to the side-effects of your Doxil treatment. This alone can explain some of the fluctuations on your CA125 count. It started to go down after your 2nd treatment but not consistently after your fourth one.

I wouldn't worry so much about your CA125 count right now unless something different shows on CAT scans or you start to experience any disease related symptoms.

I would recommend, however, that you go to MD Anderson, like I did, and talk to them in order for them to get you on Avastin + Cytoxan combination, on the solely basis that it is a VERY well tolerated treatment, one that you can carry on living your life to the full. The CA125 absolute value doesn't matter in that context as long as you don't have significant symptoms. The whole idea of the treatment is to reach some equilibrium point between disease progression and its symptoms which can be obtained virtually with any CA125 absolute value, provided it keeps more or less stable at some point during the treatment.

I'm portuguese and the National Health Care System in Portugal is different from yours in US. It is the State that is paying for my treatments. As long as I keep paying my taxes I will benefit from it, although I can do any private health insurance to complent it, if I want to.

I wento to MD Anderson International (in Madrid, Spain) in order to get a second opinion. However, I still do all my treatments in Portugal. But, because Avastin is not FDA approved for ovarian cancer here in Portugal as well, I must do the Avastin treatment in a private institution that is willing to do it, although the State will pay for it. It is weird but it is true.

Since I've been hospitalized in a public hospital I'm not able to do the Carbo + Gemzar + Avastin treatment which had been recommended to me by MD Anderson International(Spain) when I had contacted them by phone, telling about my bowel obstruction.

I'm now on Carbo + Gemzar only (third cycle).

[plady]

Thank you for your response.  The basis that everything is still microscopic is a PET Scan done previously in January 06 that showed microscopic cells.  This was done because the ct scan showed nothing.  The ct scans has been stable since then except for the lcm nodule seen on the last one that I mentioned.

plady

[vfc]

plady,

There is NO evidence that Avastin is effective against microscopic disease (most likely it is NOT). Because microscopic cells don't vascularize as extensively as tumors do, Avastin cannot kill them by stopping their blood vessels to grow.

However, as long as Avastin is able to keep the disease microscopic, which it can do, and as long as you don't have any related symptoms, then Avastin is doing its job!

Cytoxan(cyclophosphamide) will then kick in to try to deal with the microscopic disease. Remember that Cytoxan is a slow acting, well tolerated oral drug, which is taken daily.

I would go with Avastin+Cytoxan combination. Then you can go from there...

[plady]

Dear vfc:

Thank you for the information.  I have never heard of the drug Cytoxan.  Can you give me some information on this.

Again thanks alot,


plady

[plady]

Do You know anything about Topetecan/Iressa combination?  This is what the trial may be at Md Anderson.

Thank you

plady

[vfc]

Just one more thing:

One strategy to improve the therapeutic efficacy of the antitumor alkylating agents is to add nontoxic adjuvants, such as Avastin, to sensitize the tumor to those agents.

[vfc]

Cytoxan is a cyclophosphamide.

Cyclophosphamide belongs to a class of drugs known as alkylators. Examples of alkylators are: Chlorambucil; Melphalan; Cyclophosphamide; Ifosfamide.

The alkylators are the oldest class of anticancer drugs and the most widely used, being major components of the combination chemotherapy regimens for disseminated solid tumors.

Alkylators are also known as alkylating agents. Cisplatin and Carboplatin(platinum compounds) are ALSO alkylating agents.

The main difference between alkylators and platinum compounds is their toxicity. Alkylators are much more tolerable even though they are much slower acting drugs.

Cyclophosphamide and Chlorambucil can be taken orally on a daily dosing.

Don't forget that quality of life IS the most important factor.

[vfc]

Dear plady,

No, I had never ever heard about that combination. But, Jatoo seems to know some things about it.

Only I can tell you about Topotecan is that while on it I never had bowel obstruction, or any related symptoms (the same is true for Doxil, in fact Doxil took me out of one bowel obstruction, they are both topoisomerase inhibitors) but, I had liver metastases. And also, Topotecan never made a tumor next to my left iliac artery disappear or shrink. Both disappear with Avastin.

Nevertheless, Topotecan was a much more easier chemo than Doxil, with significantly less side-effects.

So, here are the things you should know:

1. Avastin is a proven nontoxic drug. Avastin's most common side-effect is high blood pressure. I believe this being the reason for nose bleeding in some people;

2. Avastin can be taken in combination with virtually all toxic chemotherapeutic agents, Topotecan being one of these possibilities;

3. Topotecan is MUCH more toxic than any daily dosing, oral alkylator - Cyclophosphamide or Chlorambucil;

4. Topotecan alone can ONLY be a temporary solution;

5. MD Anderson International(Madrid, Spain) recommended me Avastin + Cytoxan outside of any clinical trial;

6. I myself, I'm only considering Avastin + Topotecan combination in the future because I have an history of bowel obstructions and Avastin + Cytoxan didn't solve that problem, and also because Topotecan was a very easy chemo for me BUT not as easier as Avastin + Cytoxan;

7. Quality of life IS the most important factor.

[plady]

Thank you for all the information that you have taken time to give me.  I am studying everthing given to me and will make my decision after I talk to MD Anderson and my doctor again.  

Many thanks,

plady