recurrance

Jatoo,

At what point did the Dr put your wife back on chemo.  Was it the elevated CA125 or symptoms?  I was diagnosed early June 06 (3C)   Did well with carbo/taxol - down to 11 before 5th chemo and 5 after that.  Last one Oct 26.  Also was on Avastin trial.  Early Jan check-up Ca125 up to 102 and at 130 the next week.
Had a CT - nothing showed up.  Dr. put me on Arimidex.  I decided it was time for a 2nd opinion so went to the U.  My latest CT did not get transfered with my records but that Dr said she would probably put me back on chemo due to the #s.  She then sent me for a PET/CT which also did not show anything, but CA125 was at 334 that day.

I am seeing Dr #1"s nurse this afternoon and have an appt with the U Dr tomorrow morning.  Another Dr (gyn/onc)I talked to (just gave the general jist of what was going on)
said if I were her patient she would not put me back on chemo at this time  an save those drugs for a later time.

You seem to be the "man in the know".. Any insight you could give me would be most appreciated.

thanks,

Annie

[Jatoo]

Dear Annie:

1. I emphatize with what your feeling right now. Even if my wife has the OvCA, I feel that it is more mine than hers. But I'm no better than the opinions of the GynOncs you already asked.

2. You are in a better condition than my wife's when she was also diagnosed in June but '05. She finished chemo in Nov. 05 and recurred in February 06. Your trial with Avastin must have helped you stop tumors from growing which is really the role of Avastin. Her scan in February showed 1.5 x 1.5 CM tumor and ascites surrounding the liver and an elevated CA 125. That was scary then because I hardly knew a thing.

3. I have a funny feeling that Avastin (a non chemo drug)increases CA 125 when ascites are gone. It is not only a feeling but I have seen it in two patients already. Their tumors shrunk yet their CA 125 are still the same elevation. By the mere fact that Avastin attacks vessels, that's why there is a risk of GI perforation/ nose bleeds, etc. somehow it contributes to inflammation which increases CA 125. May not be too technical but a simple logic. I wish she had Avastin then, it would have delayed her recurrence.

4. There was a study of Tamoxifen (similar to Arimidex) and Goserelin (Zoladex - a hormone that reduces estrogen and testosterone in the body - also used by men for prostrate cancer) treating OvCA recurrence and had a 50% overall response rate. When you take Arimidex, you may have to ask your Onc whether there is a need to check whether your tumor (taken from your patholgy slides that they keep after your surgery) is estrogen positive.

5. Since your scans are clear, if you were my wife, I will follow what one of your doctors advice not to have chemo for now and reserve it for future use. I will also follow your own doctor's suggestion to be treated with Arimidex and then have a scan after a month.

6. My wife just finished the first cycle of Gemzar and Avastin. Her CA 125 was reduced from 500 to 250, ascites gone and no bowel obstruction (inferring that her tumor had shrunk).

I hope this helps.

Jatoo

[annie]

Thanks for the info.  I am hoping that the Docs are
somewhat of the same thinking when I talk with them.  It would make it easier to decide.  Doc #1 does not have a
wamr and compasionate feel to him whereas Doc #2 does.
That may influence my decision.  The Avastin trial was a placebo/Avastin trial.  I know I got the real Avastin on my 2nd one after regular chemo because they called me the next day and said whoops!

1st Doc said if he put me back on chemo again it would be carbo/taxol or carbo/gemzar.  I hear about the platnium sensitive people and wonder if that would work for me again?  I guess he should know.

[Jatoo]

Dear Annie:

You mean platinum-resistant which means you recur within six(6) months after Carbo/Taxol. And that means also that second line treatment would be Doxil or Topotecan. I would prefer Carbo/Gemzar than Carbo/Taxol again if you are platinum resistant or Carbo/Gemzar Avastin even better. My wife did well with Doxil in that it shrunk her tumors and reduced her CA 125 to normal. But again a normal CA 125 does not mean that she is cancer-free. The scan also has to be clear.

Again an elevated CA 125 can be misleading in your case since both your scans are clear. You will have been wasting chemo for nothing. I still think a hormonal drug like Arimidex or Tamoxifen with Goserelin is better for now to prevent recurrence.

Jatoo