What are the options when the chemo is 'palliative'?

Hello all,
This is my first time posting here though I found this a fantastic resource for the last 4 or so years as my mother has struggled with ovarian cancer. I thank you all for sharing your experiences and knowledge. I have a question about what sorts of palliative chemotherapy are avaible - or more generally, anything people can share about this.

My mother was diagnosed with OVCA in December 2005, Stage IIIC, with CA125 of 335 and spread to the bowels and omentum. Her initial treatment was surgery (only partial debulking due to interference from a pre-existing hernia) and standard six rounds of Carbo/Taxol chemo. The surgery resulted in a stoma, which was thankfully reversed in September of 2006. With chemo, Mum's CA125 dropped to 18, but it has been rising slowly but steadily since with her oncologist recommending a watch and wait approach. In June this year, the CA125 had reached 230, but the oncologist was still sticking with inconclusive CT scans (not PET) and deferring chemo, while sticking to an appointment every three months. At the last appointment the CA125 more than doubled to 630 - it has never even come close to doubling and now it almost tripled. A PET scan was ordered, and yesterday my mother's oncological surgeon (not her oncologist) told us the cancer had spread to four lymph nodes - neck, chest, pelvis, abdomen - meaning no surgical options are left for her. We were also told rather brutally that her only option now is palliative chemotherapy. The next appointment we have with a specialist is January 14, with her oncologist to sort out the chemo. We want to go to this appointment with some options if at all possible. It is our understanding that 'palliative' can encompass a range of second-line chemo options.

My mother is 69, has been experiencing some pain in the last month from the spread, but is in general sturdy health - ie. she looks very well, and is active. As her first grandchild is due in January, she is very eager to 'buy' some time and open to any possibilities. We live in Sydney Australia.

Thanks again, Zora

[milashka]

As far as I understand, treatment for every recurrence of OvCa is considered palliative, as it is usually incurable at that point. The word "palliative" is often associated with end-stage/hospice care, but I think what they meant is that treatment at this point is no longer to achieve a cure, but to provide a good quality of life while keeping the cancer at bay for as long as possible - and that can be years. I know someone who has been fighting this for 10 years, mostly palliatively, and she is alive and well today (in yet another treatment, but she sounded great when I last talked to her).

And while the doctors will not be able to predict how a patient responds to second line therapy, it does not necessarily mean the end of the road. It means chronic. Of course, that's bad enough to hear - I am possibly facing a recurrence after 4 years (dx Nov 2005, close to your mom's dx), and it's a hard pill to swallow, but it's something we have NO control over, so we need to work on coming to grips with it and still enjoy life.

There are many more options now for second line than there were even just 5 years ago. They are coming up with new ones almost yearly. Avastin is considered a new miracle drug which she may have access to already, at any rate it is supposed to be part of the golden standard of treatment by 2011 (FDA approval pending in 2010). Her oncologist will know how to best navigate the options given her health status. One thing that may work in her favor is the fact that she did not have any chemos since 2006.

I know that these days they don't treat the tumor marker, just symptoms and scan findings, but I am still a little surprised that they let her marker go up that high. Again, I would trust that they know what they are doing, though. Every doctor has a different approach but in the end, I don't think any of them are grossly negligent.

Best of luck and lots of strength!

[milashka]

Oh, and in regards to options - I wonder if the original carbo/taxol is what they would start with. Other options are doxil, gemzar, topotecan, tamoxifen, avastin, cisplatin, and others, either alone or in combination. What is chosen depends on your mom's response to chemo and the side effects. There are also clinical trials, and new generation drugs such as vaccines, to explore.

[kismetfarm]

I tend to agree with milashka that once you get a recurrance they stop trying to 'cure' you and move into palliative treatment to control and hopefully decrease the disease rather than looking at a cure. That certainly doesn't mean it is the end.

I was put back on Taxol and carboplatin when I recurred after four years as a first choice of treatment.  I was told I had a 65% chance of having a good response to that as I had apparently responded to it initially and had had a good long remission.  I was one of the 35% but for two out of three people it works...  There are a few options after that too.

All the best to you and your Mum.

[Zora73]

Thanks everybody, I do feel better after reading all of this, though my mum is in a fair degree of pain at the moment. Her doctor did suggest Avastin back in July before the CA-125 sky rocketed, but also advised us to wait until after mum had had hernia surgery to begin. We were just about to get that happening when the CA 125 ballooned to the 600s. I have also wondered Milashka, why the oncologist waited for the CA 125 to get so high before ordering a PET or suggesting chemo. I know the doctor subscribes to the 'don't treat until the scans show something serious' school of thought, but we have been pressing for a PET scan for at least two years, and she has stuck to CTs. She has a very good (though also inevitably mixed) reputation the oncologist, so we've opted to trust her and hopefully the next appointment on Jan 14 will be productive.

Kismetfarm, the oncological surgeons we've spoken to so far seemed to think Taxol/Carbo was no longer an option for my mother - perhaps because the cancer has spread to the lymph nodes outside the abdomen? Again, we'll have to wait to speak to the oncologist for the final word on that.

Thanks again everyone, and I wish you all the best fighting and maintaining control of this horrible disease. It has been very helpful to know that palliative is a word that applies across a whole range of experiences.