Must decide on new chemo treatment

[ehr]

Hi
I was diagnosed with stage 4 OC in late 2002, after taxol/carbo and some maintanance taxol, I had a 2 year remission. In Sept 2005 my rising markers started my voyage through multiple treatments, doxil, carbo (now allergic to platinums) gemzar (didnt work) and then back to taxol which plummeted my numbers from 3000 to double digits in no time at all. By the end on 2007 taxol and then abraxane stopped working and rising markers led me to Avastin which stabilized my markers in the 400 - 700 range for a year. we added Nexavar in January 2009. Now my markers are back on the rise (over 2,000) and we have to decide where to go from here. Please note my Pt Cts have been negative so we are really treating numbers. Plus I feel pretty good in general (the nexavar is a bit nasty) My question, I have some options, my doctor is suggesting Pemetrexed. But I was wondering whether you think it makes sense to go back to taxanes since I had amazing responses to them in the past. maybe not taxol again but maybe taxotere. Additionally i have heard alot of positives about VP16 or Etopeside.  Then there is always cysplatin which I never been on. Finally the parp trials ( if qualified) or the new vaccines ( again if I am a suitable candidate) are of interest. I did send slides to Roswell Park in regard to the vaccine  but they are so selective and trial is very small - it is unlikely. I live in NYC and currently treated at NYU

Based on my history of treatments that have worked and those that have not is there one specific chemo that would be most recommended?

Any feedback or additional info would be apprecaited

thanks very much - Judy

[ehr]

My docotor is leaning towards Alimta at this point because its very tolerable. I was just wondering since my responses to Taxol in the past was the most effective in reducing my markers would taxotere make more sense. Or is my logic not that good. as we all know cancer is rarely logical. Since I have had Avastin for the past 18 months, last last 6 with Nexavar would an oral cytoxin in place of the nexavar provide any positives or have I run the course on Avastin at this point

thank you so much -  Judy

[Kamal S Saini, MD, MRCP (UK), DM]

Hi Judy,
You seem to have a sensitive tumor, with a good anatomical control seven years after stage 4 disease. This gives makes me optimistic that in future too, you should continue to do well.
You have received carboplatin, Taxol (paclitaxel), Doxil (liposomal doxorubicin), Gemzar (gemcitabine), Abraxane (nab paclitaxel), Avastin (bevacizumab), and Nexavar (Sorafenib).
There are still many effective drugs that may be useful in your case (That is the beauty of the ovarian ca biology - in many women, it continues to be sensitive to many lines of chemotherapy even in advanced disease). According to the National Comprehensive Cancer Network (nccn.org), the effective drugs (apart from the ones you have already had) include cisplatin, Taxotere (docetaxel), etoposide, Alimta (pemetrexed), and topotecan. Several other potentially active agents are available.
In your case, single agent cisplatin, single agent Taxotere, or a combination of these two agents may be reasonable options at this time. You may like to keep other options for future use.
Please feel free to ask follow-up questions.
All the best, and God Bless!