Looking for hope

[jspslk]

My mom is 57 years old.  She was diagnosed with stage IV ovarian cancer last June, and underwent extensive debulking surgery resulting in an illeostomy bag.  She then underwent the platinum based chemo and was declared free and clear in December.  About twelve weeks later, her CA125 jumped up to 3000.  She had her first Doxil last week.  She was admitted to the hospital yesterday because her small intestine is not functioning.  Doctors told her it was the cancer causing that.

It is scary to me that Doxil is a slow working treatment and her recurrent cancer seems so fast growing.  Has anyone recovered from a situation like this?  Is there hope?  I feel like the doctors won't say anything.  (right now they do not even seem to have a plan to get her intestines working again - they are currently waiting to see if suppositories will work).

If my mom is dying I want to know.  But I am afraid to ask.

[Annekathryn Goodman, M.D.]

Hi There,

Thank  you, Paula and karikay , for your excellent comments.  It is a very scary time when a cancer comes back so quickly.

Ovarian cancer that recurs within 6 to 12 months of first line chemotherapy is labeled platinum resistant cancer. The significance of this is that your mother, jspslk, will have a harder time getting back into remission compared to women with ovarian cancer who have a recurrence over one year after their last chemotherapy.

For women with platinum resistant ovarian cancer , here are the various chemo options that have been tried (these drugs have been used for all women with ovarian cancer  - both platinum sensitive and platinum resistant):

doxil
toptecan
gemzar
cytoxan
taxotere
navelbine
hexamethylmelamine

hormone therapies:
tamoxifen
arimidex

experimental
avastin
avastin in combination with a chemo drug such as cytoxan, or taxol, or carbo

prognosis is tricky. It is unlikely that your mother will have the experience of a durable remission. It is possible that her cancer and symptoms could be controlled with chemo for a while. That does mean that she should expect to be on chemo chronically.

please let us know how she is doing
best wishes

[jspslk]

Thank you both for responding.  It is so nice to "talk" to other people who are going through this.  I needed to hear that about being patient and giving Doxil a chance to work if it's safe.  Also to hear that there are a lot of different chemo drugs.  According to my Dad's interpretation of doctor conversations there are only two left - Doxil and Topotecan, and neither one is very effective (according to my father's take on what the doctor is telling him).  I hadn't heard of carbo/gemzar.  That is something to ask my mom's doctor about.  

Her intestines did finally start working again.  Everything is looking better except her abdomen is bloated making her look about six months pregnant.  The surgeon says it's gas, the oncologist says it's the cancer - so frustrating!  The oncologist decided to stick with the Doxil for now since the intestines are working again.  

Thanks for your kind words.  Jennifer

[PF_PVD]

My experience as a stage iv somewhat parallels your mom's.  I started recurring within 1 month of finishing carbo/taxotere and ended up with a partial blockage and surgery a couple of weeks ago.  Before my hospitalization I was scheduled for Doxil, but as soon as they saw a new CT scan, they said we couldn't wait that long for something to work, so they switched me to carbo/gemzar.  This chemo can also take a couple of treatments to show any effect, but they said it is more aggressive than doxil would be and we need something to work fast for me.  I don't know if this is useful to you, as always remember every case is different.  Best wishes to you and your Mom.  Paula

[karikay]

Hi there. Sorry to hear you are going through such a scary time with your mom. I am not a doctor, so don't take this as medical advice. I'm another daughter of an ovca patient like you, and so that is the perspective this is coming from!
You're right that Doxil does often take a while to work. If you look at the webpage for the drugmaker here:
http://www.doxil.com/optimize_treatment/what_to_expect.jsp
They say that on average people need four treatments to see a response.  
My advice would be to talk to her doctors if they think her intestinal blockage can be managed long enough that she can afford to wait to see if more treatments of Doxil will help, or if they feel she needs to switch chemotherapy right away.
My reasoning for this is just that if Doxil is going to work for your mom, it would be a shame to give up on it too soon, if the doctors feel it would be safe to wait.

I know how horrible it feels to see your mom sick like this, but the bit of hope is that, yes, there are a lot of different chemo drugs that can be tried with ovarian cancer, and even if you try all the conventional drugs and nothing works, even then there is the option of trying a clinical trial (an experimental treatment that could possibly turn out to be more effective than the standard ones).
As a side note, I have been told by doctors that fast-growing cancers actually tend to respond to chemotherapy better because the faster the cells grow the more opportunity the chemotherapy has to interfere with their growing cycle. I know that is not much consolation, but it helps me to think about it that way.
All the best to you and your mom.

[jspslk]

I just realized that in the previous post, I typed 3000 instead of 300.  Her CA125 level was 300.

Also, I found out today that her doctor is thinking of switching to Topotecan.  Hopefully this is a faster working option.