9 or 18 weeks of weekly taxol

[Aglaia2020]

Hello -

My mom has stage iv ovarian cancer.  She had three cycles of carbo/taxol (once every three weeks), followed by optimal debulking, and now chemo again.  They put her carbo/taxol every three weeks, plus taxol every week.  Looks like this:

Week 1: Carboplatin + Taxol
Week 2: Taxol
Week 3: Taxol
Week 4: Carboplatin + Taxol
Week 5: Taxol
Week 6: Taxol
Week 7: Carboplatin + Taxol
Week 8: Taxol
Week 9: Taxol

Thet said the gyne oncologist would decide after week 9 if my mom is to continue with another 9 weeks of chemo, for 18 weeks of this weekly taxol.  CA125 went from over 7,000 at diagnosis to 40 two weeks into this weekly taxol.

Does anyone know what would make them decide to stop after 9 weeks?  Would it be a CA125 level after the first 9 weeks?  Would you want some 'extra' chemo once CA125 drops to <35 to be on the safe side?  

Has anyone else had this weekly taxol?  They say they've only really been using it since last year and it's more for patients whoa ren't candidates for an IP port.

[jr1971]

My wife had this treatment at the end of 2009. She had 18 weeks of treatment.

It is worth explaining a little about this treatment to make sense of some of the things that the doctors say:

The standard treatment for OVCA is Carbo/Taxol 3 weekly - each if these treatments being called a "cycle". It is typical to give 6 cycles of treatment.

The weekly Taxol regimen (known as "dose dense" treatment) only differs in that the Taxol is given in a slightly smaller dose every week - the Carboplatin is still 3 weekly. The logic is that the tumour does not get a rest from the drugs and that you can administer slightly more taxol in this way. (3 x 50% dose = 150% of standard dose). Each of these 3 weeks is still regarded as ONE cycle - so in your Mom's case the Doctors are suggesting making a decision after 3 cycles.

Why would they do that? They are going to be looking at her in a number of ways. They will obviously want to see the CA125 coming down and remaining stable at a level under 35. Luckily, with the weekly treatment you get a CA125 result every week too, so you can really see the chemo at work and get a detailed view of the trends. The Doctors will also be looking to see how well she tolerates the treatment. Studies into this treatment schedule have shown that the treatment is as well tolerated as the standard 3 weekly IV regimen. In many case the treatment is better tolerated. It is worth noting that Anaemia seemed to be worse in this treatment so the need for blood transfusions during treatment is a little higher.

In the UK, IP chemo is not given as the doctors here are not convinced that the response data and side effects profile make it a better option than IV. (It is not cost related as my Wife goes to a private clinic who are not constrained by cost like the rest of the UK National Health Service) I have studied the data myself and there does seem to be benefit in IP treatment but the side effects can be pretty tough. I am not an expert on how this data is put together and much of the time the studies are hard to compare.

There was a study done in Japan which was reported in 2009 (while my wife was on this treatment) that showed that this regimen improved survival and recurrence times while providing a similar side effects profile. It was reported in detail in a UK Medical publication called The Lancet. That paper (Called "Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial") details the side effects profiles and responses of patients to treatment.

The Dose Dense treatment improved 3 year survival to 72% compared to 65% in the standard treatment. Progression free survival was 28 months compared to 17 months.

There was improvement in all types and stages apart from the Mucinous type of tumour. The results were no worse than with standard treatment with which Mucinous does not respond well in any case.

As long as the tumour is not Mucinous, then I think that this is best available first-line IV treatment for OVCA. If the tumour type is Mucinous then you should consider talking to your Mom's Doctors about alternatives.

My wife's tumour is Mucinous. She is now doing much better on FOLFOX and Avastin.

Good luck to your Mom and I hope this treatment continues to work for her.

[Aglaia]

Is no-one else getting this treatment or knows anyone who is?

My mom's now into week 4.  Side effects so far seem to be less than they were with the once-every-three-weeks carboplatin + taxol, though she's had one more chemo delayed due to low platelet counts.