Recurrence Forum

I may be starting Topetecan.  My CA125 has gone from 350 to 700 on Doxil after 7 treatments.  The doctor has mentioned this drug.  Would like any information from anyonee that has tried this drug.

Thanks
plady

[Jatoo]

Dear Plady:

1. It's great to hear from you again. I have been thinking about you. Do you still have the side effects? Probably what Doxil did was to stabilize you a little bit and delay your tumors from really growing. How does your scans look? Are they still microscopic? Do you have options based on your insurance to ask for a second opinion? We have gotten probably at least around five(5) opinions. So we knew that Avastin was the way.

2. Topotecan has almost the same success rate as with Doxil. While you know that Doxil worked for my wife, Topo did not. So again case to case. Some women are successful with it.

3. For platinum-resistant which If I'm not mistaken you are, the success stories I have been reading on the drug that really works which is non-chemo ( which is good for platimum resistant) is Avastin. But you very well know that it is not FDA approved, but just the same our GynOnc, the chief of our hospital recommended off label. You probably also know based on my posts that my wife is doing great on it (Avastin plus Gemzar). Your insurance may not also carry it, although I think it really depends on your persistence. I hope this helps.

All the best,
Jatoo

[Helmar]

Hello... Like Jatoos' wife, Melody... Topotecan didn't work for me either, as my CA.125 went through the roof... up 1800 after one treatment. I only had two treatments, but my Oncol. says it 'splits the cells' so the number showed much hirer than the actual amount of cancer. His theory was that he would put me back onto one that we knew worked 3 years ago...Taxotere/Carboplatin.. and after 2 treatments my number has dropped from a whopping 7497 down to 3533, so it's obviously working this time too. My Oncol. said it would 'mop up' the split cells that Topotecan had caused. The Doxil worked great for me too, but I did get 6 large sore mouth ulcers after the 4 treatment, and so the Oncol. took me off it, but we have that in reserve for later, if need be.
I hope you get something working well for you soon.
Best wishes....Helmar..

[plady]

Thank you both for your response. A lot has happened since I last posted.  I got a call from the nurse and she said they want me to come in Tuesday and talk about a clinical trial for Avastin/Tarceva.  I am really confused right now because the nurse told me that the study could be done in my hometown, but after talking to the study nurse she said that I would have to go to Tucson, Arizona.  I am in Texas.  Of course I will do whatever is necessary, but I need to gather all the information I can to decide what to do.  Jatoo, I am so glad you saw my post, because you are so knowledgeable and I would really appreciate your input on this.  Helmar, I have also been reading your posts and I know that you have been doing a lot and your input will be greatly appreciated.  I am so confused right now.  I have to make a decision if I have to go out state, that will be a burden, but I need to do what is necessary.  I have gotten my side effects under control from the Doxil.  I don't know what has helped, but I have tried the following:  Lower dosage, icing during chemo,
nicotine patch, icing feet and hands at home, covering the feet with Biafine cream, .  So far the side effects have much better.  I 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.  My CA 125 Started at:
9-9  233
9-14 480
9-22 1249
10-16 913
11-7 597
11-30-364
12-21-407
1-12-352
2-1-700

I have had the following Doxil Treatments;
9-14
10-5
10-24
11-16
12-7
12-28
1-19 (Reduced Dosage)

Like I say I really need your input and it greatly appreciated.  I know you are both busy, but any help is appreciated.

Best to both of you,

plady

[vfc]

Helmar,

I can see why your Oncol. says that Topotecan 'splits the cells'. Topotecan is a topoisomerase (topo-I)inhibitor. Topo-I is  an enzyme produced in the body and is involved in cell division of both normal and cancer cells. In order for cancer cells to divide, which leads to tumor growth, these cells must copy the genetic material contained in their DNA. Treatment with Topotecan interferes with this copying process, which results in the death of DIVIDING cancer cells.

Another topoisomerase inhibitor is Etoposide. But while Topotecan is a topoisomerase I inhibitor, Etoposide is a topoisomerase II (topo-II) inhibitor.

Your Oncol.'s theory that an Alkylating agent (in your case, also in combination with a plant alkaloid - Taxotere) would 'mop up' the split cells that Topotecan had caused, is the same theory behind the "classic" combination: Alkylating agent(such as Cisplatin) + Etoposide.

However, Alkylating agent + Etoposide combination has proven to be merely additive. On the other hand, Alkylating agent(such as Cisplatin) + Topotecan has proven to be very synergic (at least in vitro), where the whole is GREATER than the sum of the parts. The very same is valid for the Alkylating agent + Gemzar combinations.

plady,

Since an Alkylating agent(Carboplatin in your case) + Gemzar had proven to be very effective with you in the past, and since Jatoo's wife is getting very good results with Avastin + Gemzar combination, I would suggest that you ask your Oncol. about the following combinations:

1. Alkylating agent(well tolerated, slow acting oral drugs, known as alkylators) + Avastin + Gemzar;

2. Alkylating agent(such as Cisplatin) + Topotecan, (Topotecan alone didn't stop my rising CA125 also.)

[plady]

I will ask my doctor about the different combinations, but I'm not sure how you do this is the drugs are not approved.  The study nurse said this was the only study that I qualified for.  I am wondering how Jatoo's wife got this combination out of a study.  I guess I am confused as to how this works.

plady