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Ovarian Cancer (Expert Forum)
chemo opinion
Answered by
Annekathryn Goodman, M.D. - Gynecologic Cancers, Complex Gynecologic, Surgeries, Palliative Care, Acupuncture
Massachusetts General Hospital Cancer Center
Boston - MA
chemo opinion
by unmai, Nov 15, 2006 12:00AM
Diagnosed in 2003 (age 48) with Ovca stage 3c.
Taxol/carbo 6 rounds immediately after optimal debulking
CA125 normal after first round continued 6 rounds with minimal side-effects/great quality of life
2004 1st recurrence 6 more rounds of Taxol/carbo. Again CA125 normal after round 1 good QOL
2005 2nd recurrence Taxol carbo again CA 125 decreased but got hypersensitive to carboplatin round4. Continued with Taxol only but CA125 increased after one round of taxol only. Switched to Gemzar. Took 4 times (once a week) CA125 went up. Gemzar was the worst chemo for her. Bad quality of life.
Recent CT scan (10/06) Extensive disease in the abdomen. Massive ascites. No major organs involved. Likely: spots on bowel.
Recent chemofx assay results from ASCITES:
Resistant to: doxorubicin, topotecan, carboplatin, cisplatin, gemzar
Intermediate response: doxetaxel
Sensitive to: Oxaliplatin, ifosfamide, etoposide, fluorouracil
Current situation: Massive ascites that needs to be drained every week (appr. 6L)
Bad quality of life in terms of fatigue, pain (back), lots of weakness
Weekly blood work RBC, WBC within normal range- PROCRIT weekly
Has taken one round of DOXIL a week back. Very fatigued.
Questions:
If the assay says she is resistant to Doxorubicin, does that mean doxil will not work?
Should we stay on Doxil and keep draining the ascites or change to another chemo.
Please advice - what should we do.
Taxol/carbo 6 rounds immediately after optimal debulking
CA125 normal after first round continued 6 rounds with minimal side-effects/great quality of life
2004 1st recurrence 6 more rounds of Taxol/carbo. Again CA125 normal after round 1 good QOL
2005 2nd recurrence Taxol carbo again CA 125 decreased but got hypersensitive to carboplatin round4. Continued with Taxol only but CA125 increased after one round of taxol only. Switched to Gemzar. Took 4 times (once a week) CA125 went up. Gemzar was the worst chemo for her. Bad quality of life.
Recent CT scan (10/06) Extensive disease in the abdomen. Massive ascites. No major organs involved. Likely: spots on bowel.
Recent chemofx assay results from ASCITES:
Resistant to: doxorubicin, topotecan, carboplatin, cisplatin, gemzar
Intermediate response: doxetaxel
Sensitive to: Oxaliplatin, ifosfamide, etoposide, fluorouracil
Current situation: Massive ascites that needs to be drained every week (appr. 6L)
Bad quality of life in terms of fatigue, pain (back), lots of weakness
Weekly blood work RBC, WBC within normal range- PROCRIT weekly
Has taken one round of DOXIL a week back. Very fatigued.
Questions:
If the assay says she is resistant to Doxorubicin, does that mean doxil will not work?
Should we stay on Doxil and keep draining the ascites or change to another chemo.
Please advice - what should we do.
Doctor's Answer
by Annekathryn Goodman, M.D., Nov 16, 2006 12:00AM
, Nov 16, 2006 12:00AM
Hi There,
What a rough road you guys have been on! It sounds like she has developed a very tough recurrence. Ovarian cancer is initially sensitive to many different types of chemotherapy. However when the recurrences occur with such a short interval, the cancer cells that are growing back are usually the ones that were not killed by the previous chemotherapy. Therefore those recurrent cancer cells can be resistant to other chemotherapy agents.
Chemosensitivity assays have been around for at least 20 years. There is controversy about whether the results of how cancer cells in a test tube get killed by chemotherapy correlates to how well that chemotherapy works in the human body. So despite chemosensitivity assays suggesting that certain drugs are not helpful, sometimes we try them anyway.
For instance, it sounds like this cancer is sensitive to carboplatin. There is a protocol for people who have a carboplatin allergy where the drug can be given very slowly and under careful observation.
As far as doxil goes, it is a very slowly working drug. it usually takes 3 to 4 cycles before an effect is seen.
Another option is to consider avastin (bevicizumab) with another agent such as cytoxan. Avastin seems very helpful in reducing ascites.
Finally , you should ask your oncologist about clincial research trials that maybe available.
What a rough road you guys have been on! It sounds like she has developed a very tough recurrence. Ovarian cancer is initially sensitive to many different types of chemotherapy. However when the recurrences occur with such a short interval, the cancer cells that are growing back are usually the ones that were not killed by the previous chemotherapy. Therefore those recurrent cancer cells can be resistant to other chemotherapy agents.
Chemosensitivity assays have been around for at least 20 years. There is controversy about whether the results of how cancer cells in a test tube get killed by chemotherapy correlates to how well that chemotherapy works in the human body. So despite chemosensitivity assays suggesting that certain drugs are not helpful, sometimes we try them anyway.
For instance, it sounds like this cancer is sensitive to carboplatin. There is a protocol for people who have a carboplatin allergy where the drug can be given very slowly and under careful observation.
As far as doxil goes, it is a very slowly working drug. it usually takes 3 to 4 cycles before an effect is seen.
Another option is to consider avastin (bevicizumab) with another agent such as cytoxan. Avastin seems very helpful in reducing ascites.
Finally , you should ask your oncologist about clincial research trials that maybe available.
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We would like to find more info about Avastin/cytoxan. Is it approved for ovarian ca - will insurance pay for it?
Thanks again!