Recurrence Question

My wife was diagnosed in Apr 06, suboptimally debulked, and then did 6 rounds carbo+taxol combined with placebo or Avastin as part of a clinical trial.  Finished 6th treatment Sept 06, with remission and a CA-125 of 4, which lasted until late 2007.  Then, monthly CA-125 tests showed a gradual increase of 5, 6, and then 8 this month.  Did PET/CT scan which showed 4 small implants in the abdomen.

She is a school teacher and would like to finish off the semester and then have 2nd debulking surgery in June, followed by another round of carbo+taxol.  We are considering Avastin for the next few months to try to hold the disease stable with minimal side effects, with a plan to stop Avastin 6 weeks before surgery.  We'll monitor CA-125 response and change plans if it increases rapidly.

Is this a reasonable approach?  Are there other treatment options that would help to stabilize the disease with minimal side effects?  Tamoxifen?  Others?  What risk is my wife facing by delaying surgery and further carbo+taxol treatment until June?

Thanks in advance for your help!

[Annekathryn Goodman, M.D.]

Hi There,

Your wife's plan sounds just fine.  There are many apporaches to consider. She can consider avastin as she is.

Other options would include standard chemotherapies scuh as doxil, gemzar, topotecan.
She could also consider antiestrogen agents such as tamoxifen or arimidex.

Finally she could consider a laparoscopic surgery right now to further assess exactly what is going on with the cancer. Scans alone may not tell the whoel story. A laparoscopy can help decide if surgery is reasonable or if chemo alone is the way to go.


Here is a recent summary of avastin for recurrent ovarian cancer:
Data from two Phase II studies suggest that Avastin® (bevacizumab) is effective and reasonably well tolerated for the treatment of recurrent ovarian cancer. The details of these studies appeared in the November 20, 2007 issue of the Journal of Clinical Oncology.

Avastin is a recombinant humanized monoclonal antibody to vascular endothelial growth factor (VEGF). VEGF appears to play an important role in tumor angiogenesis, and blocking this activity should have an anti-tumor effect.
A Phase II trial carried out by the Gynecologic Oncology study Group evaluated Avastin in 62 patients with recurrent or refractory ovarian cancer. Two-thirds of patients had received two prior treatment regimens. Forty-two percent of patients were classified as platinum-resistant. All patients were treated with Avastin as a single agent for 21 days.

21% of patients experienced a complete or partial response.
The median duration of response was 10 months.
40% of patients survived at least six months without progression.
Median progression-free survival was 4.7 months.
Median overall survival was 17 months.
Prior responses to chemotherapy, age of the patient, number of prior chemotherapy regimens, or their ability to perform tasks of daily living were not associated with outcomes with treatment with Avastin in terms of cancer progression or death.

The second study involved 44 patients with ovarian cancer who had received one to three prior treatment regimens. Eighty-four percent of these patients were deemed to be platinum-resistant.

Partial responses were observed in 16%.
Median progression-free survival was 4.4 months
Median survival was 10.7 months.

[ILoveMyWifeForever]

Bump