Recurrent, platinum resistant

Hi Dr. Goodman
I was diagnosed Ovarian Cancer IIIC May 2006, and had optimal debulking on May 16, 2006...total hysterectomy, omentum, small tumors on sigmoid colon, pelvic side wall and diaphram removed and ascites. I am 54 yrs. old. I completed 6 cycles of IV/IP treatments taxol/cisplatin on September 27th. I recurred in February with lung mets. CT scan showed 4 lensions all under 6mm. A repeat scan six weeks later showed an additional lesion and that the other four have increased in size, largest 8mm. My abdomen and pelvis are clear.  My CA-125 test came back today at 8.2.  The lowest it has even been.  It was 18 after two cycles of chemotheraphy, 13 after 4 cycles, and thereafter between 10 and 12.

My oncologist does not want to do any further testing or treatment before starting Doxil on a clinical trial with another drug. My quesions are: Should I not have a biopsy? and why would they not consider radiation, radiofrequency ablation or surgery first? Do you agree with the Doxil trial?

Would platinum therapy be a option after Doxil?

Thanks
Kristie

[Annekathryn Goodman, M.D.]

Dear Kristie,
Thank you for your complete information. What alot you have been through.
Lung lesions are tricky. Yes, they can be metastases from ovarian cancer. Other possibilities include a different kind of malignancy or an infection. i agree with you that it is important to know what you are dealing with.

It may be that the x-ray along is so convincing that no other evaluation is necessary. i cannot comment on that without seeing the films. Other strategies include watching and repeating the scans in 2 months to see if anything has grown, doing a biopsy, or getting a PET scan.  At the sized of 6 to 8 mm, it may be hard to biopsy the lesions without an open lung biopsy under general anesthesia. I agree that if you have had an elevated CA 125 in the past and it is now 8, it is important to question the diagnosis.

radiation is not used on the lungs except in emergencies because it causes tremendous scarring of the lung. Radiofrequency ablation in an option for a know lung metastases but usually one would do a biopsy first to confirm the diagnosis.
It sounds like you should check back in to your doctor with these questions.
Doxil is a fine choice. i would not recommend platinum at this time as it has been less than a year since you received it before
best wishes to you.

[Kristie5]

Sorry, forgot to mention my CA-125 was at 2000 at dx.