rising ca-125

[Hazel30]

Hello Dr.
Last post to you was  few weeks ago about my mom's accumulation of ascites.  We just received her recent ca-125 and after 2 months of weekly taxol its going back up.  Within 5 weeks its gone up 123 points.  What would be the next course of treatment.  She has had topo, gemzar, doxil, avastin, cytoxane.  Her doctor mentioned a few months ago aboult Alimta.
What would you recommend

Thank You so Much
Fiana

[Annekathryn Goodman, M.D.]

Dear Fiana,
thank you so much for the update.  I am sorry that you and your family are going through this agony.

I do not have much personal experience with alimta.We had a clinical trial with it. But We do not use it routinely for women with ovarian cancer. Here is some nice summary info from this website:http://www.chemocare.com/BIO/pemetrexed.asp


PEMETREXED
Pemetrexed

(pem-a-trex-ed)

Trade names: Alimta®

Alimta is the trade name for the generic drug name Pemetrexed. In some cases, health care professionals may use the trade name Alimta when referring to the generic drug name Pemetrexed.

Drug type:  Pemetrexed is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. Pemetrexed is classified as an "antimetabolite".  (For more detail, see "How this drug works" section below.)

What Pemetrexed is used for:

•Pemetrexed is used in the treatment of malignant mesothelioma
•Locally advanced or metastatic nonsquamous nonsmall cell lung cancer.
Note:  If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

•How Pemetrexed is given:
•Premetrexed is given as an infusion into the vein (intravenous, IV).
•Patients treated with premetrexed will usually require folic acid and vitamin B12 supplementation to reduce treatment related side effects.
•The amount of premetrexed that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated.  Your doctor will determine your dose and schedule.
Side effects of Pemetrexed:
Important things to remember about the side effects of premetrexed:

•Most people do not experience all of the side effects listed.
•Side effects are often predictable in terms of their onset and duration.
•Side effects are almost always reversible and will go away after treatment is complete.
•There are many options to help minimize or prevent side effects.
•There is no relationship between the presence or severity of side effects and the effectiveness of the medication.
The following side effects are common (occurring in greater than 30%) for patients taking pemetrexed:

•Low white blood cell count. (This can put you at increased risk for infection.)
•Low red blood cell count (Anemia).
•Fatigue
•Nausea and vomiting
•Constipation
•Poor appetite
•Shortness of breath
•Chest pain
These side effects are less common side effects (occurring in about 10-29%) of patients receiving pemetrexed:

•Low platelet count.  (This can put you at increased risk for bleeding.)
•Increase in blood test creatinine.
•Fever
•Flu-like symptoms: Fever, chills, generalized aches and pains, headache, poor appetite.
•Mouth sores
•Numbness or tingling of hands or feet
•Depression
•Rash, skin irritation
Nadir:  8-10 days


here is also a recent scientific review article:

Expert Rev Anticancer Ther. 2009 Dec;9(12):1727-35.

Emerging role of pemetrexed in ovarian cancer.
Tomao F, Panici PB, Frati L, Tomao S.

Dipartimento di Ginecologia, Perinatologia ed Ostetricia, Università di Roma "Sapienza", Viale Regina Elena 324,00161, Rome, Italy and Dipartimento di Medicina Sperimentale, Università di Roma "Sapienza", Viale Regina Elena, 324,00161, Rome, Italy. ***@****.

The current treatment of choice of epithelial ovarian cancer involves aggressive tumor cytoreductive surgery followed by platinum- and taxane-based chemotherapy; however, despite the encouraging activity of these agents, most ovarian carcinomas relapse and many patients die from drug-resistant disease. After the failure of platinum- and taxane-based schedules, several cytotoxic agents have demonstrated activity in advanced ovarian cancer but none were able to induce significant and durable responses. Among the new cytotoxic agents, pemetrexed plays an emerging role in different tumors, demonstrating competitive activity and a promising safety profile. In ovarian cancer, pemetrexed has been investigated, with encouraging results, as a single agent and in association with platinum compounds; moreover, the drug has shown interesting activity both in platinum-sensitive and platinum-resistant ovarian cancer. According to these clinical results it appears reasonable to explore the combination of pemetrexed with other cytotoxic agents and also with targeted therapies in relapsed ovarian cancer patients.

PMID: 19954283 [PubMed - in process]

[Hazel30]

Today we met with my Moms doctors and they are recommending Alimta which she is due to start next week.  
Any stats on how well this drug works?  Have you treated anyone with this drug for ovca?
I know its pretty new for ovca.
Also, when or if this drug stops working what would you recommend as the next course of treatment?  I know we are running out of options and its tearing me apart.
Besides the disease being on the peritoneum, all of the other organs are clear of cancer.
thank you again for all your advise
Fiana