what next

[Dianerich]

Dr Goodman, I took six treatments of taxol and carboplatin and my numbers went to 24 after the fourth treatment. My scan was excellent. After second look surgery, they did find a little resdidual stuff, not much. By the time I had another treatment, my number was 167 which was 11 weeks after my last treatment. This time it was topotecan which surprised me, it went up to 230 after 4 treatments which were once a week, Now after number 6 it dropped to 191 but my oncologist poo poed that but left me on topotecan. I understand that is not atypical after that long off and that topo takes a while. My scan was excellent the other day but had one lymph node in uper peritoneum swollen- that was all. He just was so negative. I went to the gynecologic oncologist who did the second look and she said to give the topo a chance and said she still thought it was a favorable scan as no tumors were evident. She was very nice - upbeat. I read your opinions all the time and sure could use your expertise and insight Dr Goodman. Thank you

[Annekathryn Goodman, M.D.]

Dear Diane,
It must be really scary for you to see those numbers.

It is great that your scan looks good.

Let's just review:

first line chemo - 6 cycles of taxol/carbo
-second look surgery : small residual

second line chemo - topotecan once a week for 6 weeks so far

CA 125s
24
167
230
191


Here are my question:
did you receive IV or IP chemo?

My comments:
- I have not been overwhelmed by the effectiveness of once a week dosing of  topotecan. The initial studies in this drug gave a schedule of daily for 4-5 days then off 21 days . So it is a 3 week cycle.  that is alot harder to do and the weekly regimen is easy and has few side effects. I just do not think it is as good.

If this is only your second line of chemo, the question is - how hard to you want to push this therapy?
You should ask your gyn oncologist whether there is a role to give chemo intraperitoneal. She was recently there and can tell you if you had alot of adhesions or whether that approach would make sense.

As for your med oncologist - there are two issues:
philosophy - you probably need to have a discussion about prognosis. What are the goals of therapy? Is there a chance this will go away or can the cancer be controlled? I do not have enough info to answer that for you here.

actual therapy versus quality of life
-what other chemo options would your med onc consider?


let us continue this discussion
please keep in touch
take care

[PF_PVD]

I just have to say this was such a thorough, honest, complete response to this member's question.  If only all our doctor's would respond in kind.  Thank you.