Treatment Options

My Mom was diagnosed 6/2001 stage IIIC. Debulked and chemo. Great response. Chemo again in 2006. Given Carboplatn/Taxotere. BRCA2 + testing in 2008. PARP trial (MK4827) from07/2009 until 11/2010. One lesion grew just a little so she was dropped from the trial. Recurrence/symptoms unbearable, chemo started 04/2011. Carbo/Taxotere. On second cycle Carbo had to be stopped due to reaction, Taxotere continued.  Admitted to ICU yesterday to try Carbo again and failed. Awaiting CA 125 to see if Taxotere migh tbe working. If so will continue Taxotere only.

Question: Should we do Taxotere only or should we consider something else instead? I don't want to burn any bridges by going through the wrong treatment at the wrong time. I feel we are at an advantage with a BRCA2 positive status and would like to find another way to exploit this. Should we try Angiogenic drug?More PARP?Monclonal antibodies?Biological inhibitors?Different chemo and if so what drug?  I had also heard that there was the drug 6-thioguanine used to selectively kill BRCA2 defective tumors and overcome PARP inhibitor resistance. This is an FDA approved drug for Leukemia. Your thoughts on this? There is also a trial close to home using VEGF/EGFR inhibitors with Docetaxel. (Vandetanib).

My main concern is to just do the standard treatment of care when there is so much going on with genetics, etc. I feel we are so close to at least being able to exploit BRCA mutations.

Thank you and bless you for answering the questions posted here. Your time in invaluable and comforting.

SAM

[Annekathryn Goodman, M.D.]

Hi There
thank you for your question

when you say her symptoms became unbearable, what exactly does that mean?
where is her disease located?

in general I would say she has chemo sensitive disease.
to date , there is nothing as effective as conventional chemotherapy in the treatment of ovarian cancer.
her options include:
doxil
gemcitabine
platinum based therapy using desensitization

there are now many articles on reusing platinum drugs after allergic reactions
here is one link

http://www.sciencedirect.com/science/article/pii/S0090825801963310

while parp inhibitors are scientifically fascinating, the date has yet to confirm any advantage with them. data is maturing and time will tell

here is a link on an ealry phase 2 study
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60893-8/fulltext


as far as antiangiogenesis inhibitors such as avastin,

interestingly, there is very little new data on this since 2006. Most of the fcus has been the use of avastin in primary therapy.

we definitely do add avastin sometimes for recurrence. But there is little new information on its benefit

I know this must be a really hard time for you all
best wishes

[saemmert27]

Thank you for your response.

Most of my Mom's disease is located in her pancreas area. She has had blockage to her GB which has caused her continuous nausea, lack of appetite and pain.

At this time we are moving forward with chemo. However, seems Mom has become allergic to the Carboplatin. We are now going to try a desensitization procedure in Atlanta to see if she can receive the chemo that works so well for her.

Do you recommend anyone that would be best to provide this Desensitization procedure?

Thank you again for your time.

stephanie