Recurrent, resistant disease plus bowel obstruction

[7212]

My mother (a previously very healthy, active 73-year old) was diagnosed with IIIc ovarian ca in Sept 2006.  De-bulking was sub-optimal.  Received 8 cycles of carbo/taxol.  Finished in March 2007.  Had a complete response, as measured by CA-125 (down to 3) and lack of disese on scans.  Yay. Started maintenance therapy.  But then in mid-June 2007 -- just a few months after finishing her first-line chemo, the CA-125 jumped.  Scans showed abdominal fluid and maybe some pleural effusion.  Her oncologist started her in a trial with a VEGF-inihibitor (AZD-2171).  She became weak and anorexic and nauseated.  Bowel obstruction was diagnosed.  Fairly high up.  Surgeons think it's not a good candidate for surgery.  She was hospitalized to get assessed, and to get TPN.  Now she's home, still on TPN; perfomance status 3/4.  We've started Doxil.  The hope is that the bowel obstruction might resolve itself and/or the Doxil will shrink it.  We know the situation is dire, but we haven't really even tried a second-line chemo yet (just one infusion of Doxil).  We really don't want to give up yet.  Any hope that Doxil (or something else) or just nature will have an impact on the bowel obstruction?  Obviously the prognosis overall is poor but for Q of life the bowel obstruction is the main problem.  ALSO: she did so well with platinum before.  Despite the quick recurrence, is there an argument for re-challenging with platinum?  If so, any advice on how, when, and with what?

[t4art]

A related discussion, constriction on colon with recurrent ovarian cancer was started.

[alanpvegas]

You should be aware that even if she is 'platinum resistant/refractory', she can still benefit again from platinum based therapy.

Prior studies have shown that weekly cisplain or carboplatnim (or other platinum agents) given weekly produce a response even if the patient is resistant to monthly platinum.

Also look at combination therapy such as Doxil and Eloxatin which has a 68% response with another 30% stable disease (i.e. 98%) with only 2% with disease progression. Something to talk to you oncologist about.

Best of luck

[Annekathryn Goodman, M.D.]

Hi There,
I am so sorry for what your mother and you and your family are going through. It is really hard to get one's mind around such a dire situation.

I think your mother's doctors have given her excellent and appropriate care. I agree with their recommendations.

There are several factors in your mother's story that add up to a very bad problem right now.

We , in medicine, talk about 'prognostic factors'. This is a short hand term for describing medical conditions that either predict that someone will do very well or not well in their experience of having a cancer.

For ovarian cancer the prognostic factors that predict that a woman will not recover from her ovarian cancer and may die from her cancer within a year or two include:

-older age
-suboptimal debulking: that means that it was not possible to remove all the cancer and there is more than 1-2 cm of cancer left on the surfaces of the abdomen at the completion of surgery
-recurrence within 6 months of first line therapy - that is called 'platinum resistance' and that usually portends the cancer's resistance  to other  chemo agents.
-inability to surgically correct a bowel obstruction
-inability to eat
-performance status 3/4 (which means that she is not getting out of bed much or at all, and cannot perform the usual functions of self care)



This is really a hard situation. To see your mother go from being a fit and functional person to someone extremely ill.

You should ask your doctors about getting a consultation with the palliative care group at their hospital. These doctors can work with your oncologist to give recommendations to improve quality of life and symptom management. And they can help your mother and the family transition to hospice when that seems appropriate.

take care