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Dr Goodmanoc would love your thoughts please
Hello Dr Goodmanoc
First I would like to say thanks for all you do here. It takes a strong person to juggle things in there life these days for an average person can’t imagine juggling things on doctor’s hours. That said it takes an even more special person to squeeze in and do what you do here.
Ok off to the question with a little history first.
My wife went thru surgery February 2009 not knowing before hand if it was cancer, after all she already had a complete hysterectomy many years ago (not due to cancer) and only had one ovary left. What are the chances we both thought. After surgery and an optimal debulking with zero disease visible afterwards she was staged at III C. It had spread to her small intestines with the section removed, live cells were found in her perinatal cavity and several lymph nodes were removed and all were negative. All other organs in the area were clear they said. The Doctors said the operation was very successful and felt confident they got it all. Her chemo regimen was IV and IP chemo which consisted of Cisplatin, taxatier and taxol. Her kidneys tanked towards the end of it and she ended up with debilitating neuropathy and only 40 % kidney function. We were never told nor have we asked type or grade.
Ok so fast forward to a month and a half ago her CA 125 went from 7 to 36 and her GYN felt a lump during an internal. CT showed NED but a vaginal US and found a mass. So surgery again and they found a chocolate cyst which they said would not come back cancerous during post op consult but low and be hold the path report said it was a recurrence. So the course of action decided was WAR (whole abdomen radiation). Do you think this was chosen because of her neuropathy and kidney function? Do you think it is reasonable? Could she do chemo again with these problems? The Radiation Dr ended up telling us the type and grade as Clear cell undifferentiated carcinoma grade 3 and told us it usually has a very poor prognosis.
First I would like to say thanks for all you do here. It takes a strong person to juggle things in there life these days for an average person can’t imagine juggling things on doctor’s hours. That said it takes an even more special person to squeeze in and do what you do here.
Ok off to the question with a little history first.
My wife went thru surgery February 2009 not knowing before hand if it was cancer, after all she already had a complete hysterectomy many years ago (not due to cancer) and only had one ovary left. What are the chances we both thought. After surgery and an optimal debulking with zero disease visible afterwards she was staged at III C. It had spread to her small intestines with the section removed, live cells were found in her perinatal cavity and several lymph nodes were removed and all were negative. All other organs in the area were clear they said. The Doctors said the operation was very successful and felt confident they got it all. Her chemo regimen was IV and IP chemo which consisted of Cisplatin, taxatier and taxol. Her kidneys tanked towards the end of it and she ended up with debilitating neuropathy and only 40 % kidney function. We were never told nor have we asked type or grade.
Ok so fast forward to a month and a half ago her CA 125 went from 7 to 36 and her GYN felt a lump during an internal. CT showed NED but a vaginal US and found a mass. So surgery again and they found a chocolate cyst which they said would not come back cancerous during post op consult but low and be hold the path report said it was a recurrence. So the course of action decided was WAR (whole abdomen radiation). Do you think this was chosen because of her neuropathy and kidney function? Do you think it is reasonable? Could she do chemo again with these problems? The Radiation Dr ended up telling us the type and grade as Clear cell undifferentiated carcinoma grade 3 and told us it usually has a very poor prognosis.
Dr Goodman thank you so much for the info as I said above you are indeed a very special person thanks for what you do. We live in NE PA but my wife's Dr is just across the boarder in NY state. Sorry if I'm seeming a little dense but I'm not sure I'm getting the jest of what you are saying. Do you think this is a reasonable treatment here in the US and at this point in time? Would the chemo be a better choice? She is starting her radiation today... ya I know a little late to be asking now. What would you do if this was your patient?
I ask this again sorry for repeating it but the Radiation Dr told us the type and grade was Clear cell undifferentiated carcinoma grade 3. That said I have read that this is worse than porrly undifferentiated like a grade 4 if there was one. Is this true? I was a little confused on this when I read it.
Thank you
Dave VG
I ask this again sorry for repeating it but the Radiation Dr told us the type and grade was Clear cell undifferentiated carcinoma grade 3. That said I have read that this is worse than porrly undifferentiated like a grade 4 if there was one. Is this true? I was a little confused on this when I read it.
Thank you
Dave VG
MEDICAL PROFESSIONAL
Dear Dave,
thank you for your question and for being such a good advocate for your wife.
What a hard path you guys have been walking. What I have noticed is that women who go through the journey of ovarian cancer ( and I am sure this is true for any illness) do better when they have advocates in their family and are surrounded by love.
Your wife had a perfect first surgery and chemotherapy.Now two years later, we (the gyn onc community) still feel that there is nothing better in terms of therapy than what she got in 2009
In fact, for a stage 3c clear cell cancer most are resistant to chemotherapy and rceu quickly. The two year remission is a testament to her excellent surgery.
Technically her cancer would be considered platinum sensitive and in most places, a platinum agent would be given again. there is good data to suggest that for women experiencing their first recurrence, a 2 drug regimen such as taxol and carboplatin or carbo and gemzar , or carbo and doxil.
with a history of neuropathy, probably the best combination would be carbo and doxil. there is some evidence that doxil reduces the neurotoxicity of platinum.
As far as WAR- do you live in Canada? That has been a popular ovarian cancer regimen in Canada due to data from the 1980s from Princess Margaret Hospital in Toronto. In general, most US based gyn oncologists have been reluctant to embark upon that because of the bowel toxicity. However there is data to suggest that it has efficacy in ovarian cancer. It has not been compared directly with the current chemo regimens used in ovarian cancer. I do not think one can argue that it is superior to chemo and not clear it is equivalent to chemo for recurrent disease.
here is a reference on chemo
best wishes
Oncologist. 2010;15(10):1073-82. Epub 2010 Oct 7.
Tolerability, efficacy, and safety of pegylated liposomal Doxorubicin in combination with Carboplatin versus gemcitabine-Carboplatin for the treatment of platinum-sensitive recurrent ovarian cancer: a systematic review.
Holloway RW, Grendys EC, Lefebvre P, Vekeman F, McMeekin S.
Florida Hospital Cancer Institute, Orlando, Florida 32804, USA. ***@****
Abstract
OBJECTIVE: To compare the tolerability, efficacy, and safety profiles of pegylated liposomal doxorubicin in combination with carboplatin (PLD-Carbo) with those of gemcitabine-carboplatin (Gem-Carbo) for the treatment of patients with platinum-sensitive recurrent ovarian cancer (PSROC) by reviewing the published literature.
METHODS: Using the PubMed database, a systematic review of peer-reviewed literature published between January 2000 and September 2009 was undertaken to identify studies related to the treatment of patients with PSROC with PLD-Carbo or Gem-Carbo. Studies reporting either response rate, progression-free survival (PFS), and/or overall survival (OS) were included. Treatment regimens, efficacy endpoints, and safety profiles were compared between the two combination therapies.
RESULTS: Ten studies evaluating 608 patients (PLD-Carbo: 5 studies, 278 patients; Gem-Carbo: 5 studies, 330 patients) were identified. The mean planned doses were: PLD, 34.8 mg/m(2) and Gem, 993 mg/m(2). The dose intensity reported in Gem trials was lower (75% of the planned dose) than the dose intensity reported in PLD trials (93.7% of the planned dose), suggesting better tolerability for the PLD-Carbo regimen. Among patients receiving PLD-Carbo, 60.2% achieved a response (complete, 27.0%; partial, 33.2%), versus 51.4% of patients treated with Gem-Carbo (complete, 19.2%; partial, 32.2%). The median PFS times were 10.6 months and 8.9 months in the PLD-Carbo and the Gem-Carbo populations, respectively. The median OS was longer for the PLD-Carbo regimen (27.1 months) than for the Gem-Carbo regimen (19.7 months). The hematological safety profiles were comparable in the two groups, although grade III or IV anemia (PLD-Carbo, 13.6%; Gem-Carbo, 24.5%) and neutropenia (PLD-Carbo, 45.5%; Gem-Carbo, 62.9%) were more common in patients receiving Gem-Carbo.
CONCLUSION: Results from this systematic analysis of peer-reviewed literature suggest that PLD-Carbo therapy is a rational alternative to Gem-Carbo for the treatment of patients with PSROC.
thank you for your question and for being such a good advocate for your wife.
What a hard path you guys have been walking. What I have noticed is that women who go through the journey of ovarian cancer ( and I am sure this is true for any illness) do better when they have advocates in their family and are surrounded by love.
Your wife had a perfect first surgery and chemotherapy.Now two years later, we (the gyn onc community) still feel that there is nothing better in terms of therapy than what she got in 2009
In fact, for a stage 3c clear cell cancer most are resistant to chemotherapy and rceu quickly. The two year remission is a testament to her excellent surgery.
Technically her cancer would be considered platinum sensitive and in most places, a platinum agent would be given again. there is good data to suggest that for women experiencing their first recurrence, a 2 drug regimen such as taxol and carboplatin or carbo and gemzar , or carbo and doxil.
with a history of neuropathy, probably the best combination would be carbo and doxil. there is some evidence that doxil reduces the neurotoxicity of platinum.
As far as WAR- do you live in Canada? That has been a popular ovarian cancer regimen in Canada due to data from the 1980s from Princess Margaret Hospital in Toronto. In general, most US based gyn oncologists have been reluctant to embark upon that because of the bowel toxicity. However there is data to suggest that it has efficacy in ovarian cancer. It has not been compared directly with the current chemo regimens used in ovarian cancer. I do not think one can argue that it is superior to chemo and not clear it is equivalent to chemo for recurrent disease.
here is a reference on chemo
best wishes
Oncologist. 2010;15(10):1073-82. Epub 2010 Oct 7.
Tolerability, efficacy, and safety of pegylated liposomal Doxorubicin in combination with Carboplatin versus gemcitabine-Carboplatin for the treatment of platinum-sensitive recurrent ovarian cancer: a systematic review.
Holloway RW, Grendys EC, Lefebvre P, Vekeman F, McMeekin S.
Florida Hospital Cancer Institute, Orlando, Florida 32804, USA. ***@****
Abstract
OBJECTIVE: To compare the tolerability, efficacy, and safety profiles of pegylated liposomal doxorubicin in combination with carboplatin (PLD-Carbo) with those of gemcitabine-carboplatin (Gem-Carbo) for the treatment of patients with platinum-sensitive recurrent ovarian cancer (PSROC) by reviewing the published literature.
METHODS: Using the PubMed database, a systematic review of peer-reviewed literature published between January 2000 and September 2009 was undertaken to identify studies related to the treatment of patients with PSROC with PLD-Carbo or Gem-Carbo. Studies reporting either response rate, progression-free survival (PFS), and/or overall survival (OS) were included. Treatment regimens, efficacy endpoints, and safety profiles were compared between the two combination therapies.
RESULTS: Ten studies evaluating 608 patients (PLD-Carbo: 5 studies, 278 patients; Gem-Carbo: 5 studies, 330 patients) were identified. The mean planned doses were: PLD, 34.8 mg/m(2) and Gem, 993 mg/m(2). The dose intensity reported in Gem trials was lower (75% of the planned dose) than the dose intensity reported in PLD trials (93.7% of the planned dose), suggesting better tolerability for the PLD-Carbo regimen. Among patients receiving PLD-Carbo, 60.2% achieved a response (complete, 27.0%; partial, 33.2%), versus 51.4% of patients treated with Gem-Carbo (complete, 19.2%; partial, 32.2%). The median PFS times were 10.6 months and 8.9 months in the PLD-Carbo and the Gem-Carbo populations, respectively. The median OS was longer for the PLD-Carbo regimen (27.1 months) than for the Gem-Carbo regimen (19.7 months). The hematological safety profiles were comparable in the two groups, although grade III or IV anemia (PLD-Carbo, 13.6%; Gem-Carbo, 24.5%) and neutropenia (PLD-Carbo, 45.5%; Gem-Carbo, 62.9%) were more common in patients receiving Gem-Carbo.
CONCLUSION: Results from this systematic analysis of peer-reviewed literature suggest that PLD-Carbo therapy is a rational alternative to Gem-Carbo for the treatment of patients with PSROC.
Oh and I forgot to mention that the last surgery was not successful in removing it all being that it was to close to the uretor and bladder.
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