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Ovarian cancer recurrence

Dear Dr. Goodman,

I am new to this site and this is my first posting on behalf of a friend of mine. She is 45 years old, diagnosed with stage IIIC in Sept of 2006. She went through the usual protocol that is surgical debulking followed by six cycles of Carbo/Taxol. Her CA 125 came to normal right after the 1st cycle and finally reached 3.5 after six cycles. She just had a recurrence after 14months. Her CA125 slightly shot up to 14 in November but came down to 10 in Feb and her MRI scans in Feb were clean. Her CA125 suddenly shot up from 10 to 358 end of April and a MRI showed a 2cm nodule close to her rectum. We were all quite shocked including herself since she was feeling just great and there were no symptoms at all. She just went through another debulking surgery and they did find "white" coating (as they called it) on her appendix (which was removed), sigmoid colon and a few spots in her pelvis. It all seemed to be focussed on her right side. Her lymph nodes were clean.  I must mention that they could not find the primary but said that it really did not matter since the treatment is the same for ovarian, fallopian or peritoneal. Now the following are my questions and would be grateful if you could answer them:

1. They are suggesting the same combo of Taxol/carboplatin again since it has been 14months and she should still be platinum sensitive. Does this make sense? What would you suggest?

2. Now that she has a recurrence, does it mean that she cannot have a long remission again?

3. Would you recommend the vaccine trial that is going on? Also, since it is confined to one region, is radiation an option?

4. I am reading a lot about Gemzar and its effectiveness. I have also heard that some patients have gone into a very long remission with Gemzar. Is this true? I hope it is.

Thanks so much for you time and looking forward to your reply.

Noble123

3 Responses
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242604 tn?1328121225
MEDICAL PROFESSIONAL
Dear Noble,
thank you for your questions. Here are my answers:

1- yes, re-using taxol and carboplatin for recurrences that occur more than 6 months later is a standard approach.

2. She can have a long remission again. It may be with the secondary surgical resection, this will give her a longer remission time. Unfortunately for some women, the length of remission will be shorter and shorter between each recurrence.

3. There are many interesting experimental protocols. By definition, experimental means that we do not know whether the therapy will be as good or better than standard therapy. for each individual, there are reasons to consider experimental treatments. That will be a long discussion for your friend and her doctor.

4. the combination of gemzar and platinum is another option. It is not necessarily better than taxol but is another good choice.

take care
Helpful - 2
242604 tn?1328121225
MEDICAL PROFESSIONAL
Hi There,
MIS has been looked at in animal studies but has not shown a tremendously good respond.

Tamoxifen can give durable responses in some patients. I have found that some women will have stabilization f their disease. It is probably more effective for cancers that are grade one or two  than in grade three tumors.
take care
Helpful - 1
Avatar universal
Dear Dr. Goodman,

Thanks so much for taking the time to respond. It is re-assuring to know that there is still hope that she could be in a long remission. I am reading a lot about the need to target cancer stem-cells which seem to be the culprit leading to recurrences. I recently read an article from researchers from Yale that they had identified and characterized Ovarian cancer stem-cells. I realise that this is still at the research level and may be a while before it can be translated to bed-side. But what are your thoughts on this and what is your opinion on the Mullerin inhibitng protein that I am reading a lot about? How far are we from these being used by patients?

One last question, do you have any success stories on the long-term use of Tamoxifen for ovarian cancer?

Thanks again and I join others in thanking you so much for taking the time away from your busy schedule to answer our questions

Noble
Helpful - 1

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