Reduced Dosage of Gemzar

[Jatoo]

Dear Dr. Goodman:

1. Thanks for all your help in this forum.

2. My wife, Melody, had only one treatment of Avastin and Gemzar (One Third of a cycle) but her CA 125 went down from 500 to 250, weekly ascites tapped are gone, but is very weak from low blood counts that 2nd treatment of Gemzar alone was postponed. She had Neupogen and blood transfusions already.

3. I don't think she can manage a full dose of Gemzar. I know from the clinical trial at UC Irvine that Avastin alone had better results than Avastin with Cytoxan. Can Gemzar's dosage be reduced to half and not lose efficacy? I also know that there is very little data on this combination and she is receiving this combination not on a clinical trial.

4. Her partial bowel obstruction is also almost gone since she have been having regular bowel movements lately. I have a feeling that her tumor (8 x 10 cm) which is stucked between the gall bladder and rectum was reduced, since her tumor marker, CA 125, is very accurate for her and is directly proportional to the size of her tumor.

5. Any inputs would be greatly appreciated.

Melody, 52, Dx June 2005, surgery followed by 6 rds Taxol/Carbo recurred after 3 months, Doxil 5 rounds, partially responded, 3 x 3 cm tumor reduced to a strip, 1 rd Topotecan, not responded, tumor increased, 2 weekly Taxol, now on Avastin and Gemzar.

A Million Thanks,
Jatoo

[Annekathryn Goodman, M.D.]

Dear Jatoo,
I agree with you. It sounds like her cancer is sensitive to gemzar/ avastin combination. Our experience so far has been that avastin is very good at reducing ascites. Ascites is definitely associated with an elevated CA 125.

It makes sense to consider either dose reducing her gemzar or considering going to every other week gemzar. While the Gemzar dose by the books is 1200mg per meter squared, I usually start at 800 and work down depending on a person's counts.

You should ask Melody's oncologist about that. Avastin alone is another option and will not affect her bone marrow.
please keep me posted
take care

[Jatoo]

Again, I Thank you.

Jatoo