Recurrent ovarian cancer

Recurrence with ascites

by Help4ovarian, Oct 31, 2009 12:59AM
Dear doctor. My mom is 65 y/o who wad diagosed with stage III-c ovarian cancer in November of 2006. She had tah/ bso with debulking and omentectomy. She underwent six chemo treatments of taxol/carboplatin and kept normal ca125 for 7 months. Her ca125 rose and had a couple of suspicious areas perisplenic. Therefore, they elected to repeat six more treatments of taxol/carbo and again her ca125 came back to normal with clear cat scan. Then six months later her ca125 began to rise again and she was begun on doxil which wad working great but she developed adverse side effects and had to stop treatment. She was then begun on avastin and she had some reduction in ca125 but not a complete response. Therefore, gemzar and cistplatinvwas added to her regimen. This stablized her ca125 but did not bring to normal range. She had to have break from chemo as it was totally taking her life away. Her ca125 was at 80 and she had a completely clear cat scan. She had eight-week break and then her ca125 shot up to 400 and then 742. She was begun on topotecan and had one treatment and then the ascites developed and caused bowel obstruction. She had to have a paracetesis to remove 1600 cc. Now they r wanting to start etoposide orally at 50 mg bid. I have read about ip therapies, infusing warmed chemotherapy into abdominal cavity, etc. What options do we have and what should our next step be???

[Annekathryn Goodman, M.D.]

Hi There
I am sorry to hear about the tough time your mother has had
I am just going to list her therapies below as follows - roughly:

1-November of 2006. tah/ bso with debulking and omentectomy
2- Nov 2008 - May 2007  6 cycles taxol/carboplatin
3-January 2008- June 2008 6 cycles taxol/carboplatin
4-December 2008  doxil
5-winter 2009 avastin
6-early spring 2009  avastin, gemzar, cisplatin
7- September 2009 topotecan
8-ascites and bowel obstruction

so in summary over the past 3 years, she has had 5 lines of chemo including 3 lines with a platinum agent.

if she has a bowel obstruction, I would be reluctant to try on oral agent as it may not get absorbed well unless her obstruction is completely resolved.
If she still has a bowel obstruction, placing any therapy into the abdomen directly is dangerous and could cause a bowel injury.

the two questions you could ask her doctor:

- what about taxol again.sometimes taxol as a weekly agent at low dose (like 80 mg per metered squared) can be helpful
-has she been gene tested for BRCA 1/2? if she has a gene mutation there is an investigational; parp inhibitor drug to consider

please let us know how things go
best wishes

[Help4ovarian]

Mom is still in hospital. The fluid keeps coming back and the doctor says it professing rapidly.  I suggested taxol and if we can get her build up enough she is going to try a chemotherapy treatment. He also mentioned hospice but mom says she still wants to fight. I would take her anywhere to get treatment it is so hard and this disease is so horrible. If u have any suggestions they would be most welcomed. She has had braca1/2 done and this was negative.

[Annekathryn Goodman, M.D.]

Hi There,
it is very, very hard to make a transition from active therapy to best supportive therapy.. This is a really hard time for your mother and you and your family.  There are situations where a person is just too sick to safely receive chemo. I cannot assess that via this forum. You should ask her doctor about that.

If she is too sick for chemo right now, working on symptom management is very important. Ask her doctor about a palliative care consult to help manage pain, nausea, depression, fatigue. Different hospitals have different cultures about this. In someplaces the primary oncologist manages everything.In other hospitals, there can be a team approach.( I do not want to step on any toes)

please keep us posted as to how things are going
best wishes

[Help4ovarian]

I'm interested in a team approach. She needs nutrition and vomiting management. She is not having any pain. Any suggestions on where to get a team approach as  where my mom goes it is handled via gym/ onc only.

[Annekathryn Goodman, M.D.]

I would start by talking to her doctor. But it can be tremendously useful to talk with the primary nurse caring for her. You can also ask to speak to the social worker on the service. All these professionals make up the team for your mother. From there, the decision to add other specialists follows (such as the palliative care service , chaplaincy, nutritional services)
please keep us posted
take care