Treatment

[chiku66]

Dear Doctor,

My mother was operated for ovarian cancer in May, 2007. The debulking was performed in Safdarjung hospital, New Delhi, India. It was an advance stage and the cancer cells had also attacked at the outer layer of unitary bladder and rectum. Through surgery uterus, omentum, overies, appendix and nodules present on the rectum and bladder were removed. At the time of operation the CA-125 level was 342 U/ml which came down to 69 U/ml after surgery. The chemo was started after the one month of operation and six cycles of paclitexal (260 mg) and carbolatinum (400 mg) were given. The chemo ended last year in the month of Novemeber, 07. After sixth cycle, the CA- 125 level came down to 7.25 U/ml. As per our doctor advised we were monitoring the CA-125 level on monthly basis and the same was progressively rising. It was like this: 7.60......8.30......9.30.....10.30.....9.70.....19.10......31.80........56.80 (dated: 23/7/08). Our doctor suggested for PET scan and the same was done on 4th July, 08. The findings of the PET scan suggested peritornial deposits on the anterior wall of the abdomen and in the pelvis area. Our doctor has now advised for surgery and chemo. Howver in case of surgery he also said there is 50% chance for callospy as well. For chemo they have suggested injection gemcitalonie and cisplatin. We have taken the second opinion also and advised for chemo (caelyx/nudoxa) only and suggested that it is too early to think for surgery at this stage.

Please advise what should we do now and what type of chemo would be better in such case.

Thanks & Regards
Chiku
    

[chiku66]

We have discussed with doctors in detail and as per them Nudoxa was launched recently i.e in 2005 and have little treatment history. Instead of this Gemicitabine and cisplatin are less toxic and have fewer side effects compare to Nudoxa and have reasonable patient treatement history. To these drugs (gemicitabine, cisplatin) the paitent responded very well and are easy to tolerate. They suggested to start with gemicitabine (which is also given in treating the re-occurred ovarian cancer) and after each cycle advised to check the CA-125 level. In case it drops the drug is effective to the particular patient otherwise advised to switch to Caelyx/Nudoxa as third line treatment. Further the difference in prolonging the patient life of all these drugs are mearly two to three months. Please comment.
Regards
Chiku  

[rash196]

Hallo. I live in gurgaon and am currently on caelyx and carboplatin for recurrent OVCA.
I was dx  3C in July2006. recurrence Nov 2007.
If u wish to speak to me, adv me on this forum and I will give you my contact nbrs.

best wishes,
rashmi

[OVCIndia]

Chiku,

From what i have read Nudoxa is a new drug developed in india and is similar to Doxil but with fewer side effects.  One of the major side effect of Doxil is the "Hand and Foot Syndrome" .

Some people on this forum have used Doxil and Avastin as part of their 2d line treatment.  If Nodoxa is same as Doxil talk to your oncologist about his view on adding Avastin to it.  I am not sure if Nodoxa has been tested in a combination chemo setting.

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Below is some info on Nodoxa for other readers who are not familiar with this drug
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Zydus Cadila has introduced an NDDS product 'Nudoxa' for the treatment of various cancers. One of the critical drugs used in chemotherapy, Nudoxa heralds a new approach in cancer therapy.

With chemotherapy being a common mode of treatment in cancers, there has been a long standing need for a drug that is stable and long lasting with reduced toxicity and side effects. Nudoxa addresses this need. A patented product in India and South Africa, patents for Nudoxa have also been filed in EU, US, Japan and several countries globally.

Doxorubicin, the first generation drug, was launched in 1960s and gave a new lease of life to cancer patients with its ability to combat aggressive and malignant tumours. This DNA-interacting drug, however, was discovered to cause life-threatening side effects in the form of cardiac abnormalities.

An advancement on this therapy resulted in liposomal doxorubicin in which the molecules of the drug are encapsulated in a fatty coating known as liposomes. The liposomes allow the doxorubicin to be delivered specifically in greater amounts to the cancer cells, while having fewer side effects on the healthy tissues. A further advancement in this line of treatment was the Pegylated-liposomal doxorubicin, a unique form of liposomal doxorubicin in which the liposomes are coated with polyethylene glycol, leading to a much longer half-life in the blood. However Pegylated-liposomal doxorubicin are likely to cause ‘Hand-Foot Syndrome,' characterized by skin eruptions on the palms of the hand or soles of the feet, leading to interruption in therapy.

A new variant of liposomal doxorubicin, Nudoxa with its unique drug delivery system is a breakthrough in cancer therapy as it offers the benefits of Pegylated-liposomal doxorubicin without its major side effects like the Hand Foot syndrome. Marketed by Zydus Biogen, Nudoxa is manufactured by Zydus-BSV Pharma Pvt. Ltd., the joint venture company of Zydus Cadila and Bharat Serums and Vaccines Pvt. Ltd. Founded in 2005, Zydus-BSV Pharma focuses on targeted therapies in the area of Oncology.

Nudoxa is being used as a chemotherapy drug to treat various cancers, particularly, breast cancer - the second most common type of cancer, ovarian cancer - the fifthleading cause of cancer death in women, and AIDS-related Kaposi sarcoma which develops in people who are infected with the human immunodeficiency virus (HIV).