CA 125 Doubled in 3 months again

[OVCIndia]

My mother was diagnosed with Stage IV Grade 3 OVC in Nov 2007.  At diagnosis her CA 125 was 4900.  She went through neo-adjuvant chemotherapy with IV taxol and carboplatin for 3 cycles and underwent complete debulking with no gross disease left behind.  She continued with 3 more IV cycles.  On completing her initial treatment her CA 125 was 17.  She was then given 3 additional IP cycles of cisplatin as consolidation.  At the end of that her CA was 14.

PET CT at end of consolidation came in clear

3 Months after treatment CA went down to 9.8 and CT came in clear
6 Months after treatment CA was at 10.1 and CT came in clear
9 Months after treatment CA came in at 27.
12 Months after treatment CA came in at 51.

She is completely asymptomatic at this time.  And all her blood-work and kidney function came in normal.

Her oncologist has called her in for an examination and said he might go in for a PET/CT after that.  We asked him what would his choice of chemo be if she required it at this time.  He said that since she is out of chemo for a year he  might consider re-treating her with taxol/carboplatin and add avastin to it this time around.

Since she has not had her PET/CT yet we do not know what her definitive treatment plan would be.

What would your choice of chemo be at this time?  

Also is recurrent OVC treated with surgery or radiation along with chemo?

I have read some recent reports that delaying treatment in a recurrent setting does not change the outcome as apposed to treating early.  What are your thoughts on that?

Thanks
OVCIndia

[OVCIndia]

Dr Goodman based on my prior post My mom had her  PET/ CT which showed multiple peritoneal deposits including the surface of the liver.  Her oncologist wants to start her on Liposomal Doxorubicin + Carboplatin this Friday.  We asked him if surgery was an option he said since she has peritoneal involvement he would want to wait and see how she responds to treatment and then see if surgery can be done at a later time.  He does not think adding Avistin would help and wants to hold that off for 3d or 4th line treatments.

What are your thoughts on this.

[Annekathryn Goodman, M.D.]

Hi There,
thank you so much for the update on your mother. As I have said before, she is getting excellent and aggressive care. It is good that she is asymptomatic.
I agree with her doctor's recommendations.

If she had an isolated spot that could be easily surgically removed, it would make sense to consider surgery.  With multiple deposits, surgery will not help. The cancer is probably leaving a coating on the surfaces of structures but with no big masses. This is very difficult to manage by surgery.

The choice of chemo makes good sense as well. Her doctor has decided to give her the best agent for ovarian cancer - platin plus an agent that she has not been exposed to .
Please keep n touch.
best wishes