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platinum resistant OC

Hallo, For 31 months I’m now treated for OC (IIIc). Cancer recurred 14 wks after Carbopl./Taxol and Doxil was given for the next 9 months before it lost effect. No bulky disease was found in PET/CT, but ascites required several paracentesis. I was put on Tamoxifen and had pneumonia. Then I developed bowel obstruction, that resolved upon chemo with Carbopl+Gemzar. CA125 only responded marginally (from 180 to 130) and chemo had to be stopped after 3 cycl. due to extreme liver enzyme rise and haematological problems. Topotecan/docetaxel weekly reduced CA125 level within 6 weeks to 40, but it increased thereafter and treatment was stopped because of alveolitis and CA125 had reached 70 again. Next chemo was taxol weekly with avastin biweekly, which led to a fast drop of CA125 (after 3 weeks down to 20!). But as with the former chemos, the effect was only of short duration. CA125 rose again and that time PET/CT showed active metastases: two small foci in the pelvis and one lymph node in the groin. Carbopl. 6AUC was tried, but 3 cyc. showed no effect on CA125 (meanwhile at 500!). The newest PET shows regression of the two pelvic foci, ascites and peritoneal carcinomatosis, but now there are 5  18FDG-active lymph nodes. For the moment Doxil biweekly has been started and we hope to see an effect…
Now my questions:
a) Under which preconditions is a secondary surgery a good option? I feel ok, only one of these lumps in the goin starts to disturb. My oncologist is reluctant for surgery in the absence of a good adjuvant chemo.
b) What about radiation or regional hyperthermia, to increase chemo effect?
c) I believe the cancer is heterogeneous by now, what about alternating a platinum(cis or oxi?) (maybe combined with avastin) with doxil and gemzar?
d) Is there any other drug (also experimental) that might show an effect (permetrexed, endoxan….??)
I know Im lucky to still feel rather well!
Thank you for your opinion and ideas about how to continue my treatment!
2 Responses
242604 tn?1328121225
MEDICAL PROFESSIONAL
Dear Igeli
thank you so much for your complete information. You have been through so much!
It seems to me that you have received excellent care. I agree with all the choices that your doctor has made in your therapy.

As you are very aware of, this cancer is not curable and the goals of care  are about trying to control the cancer and o not hurt you with intolerable side effects.

To answer some of your questions:
secondary surgery is usually considered in the following circumstances:
an isolated recurrence such as in the spleen.
-a bowel obstruction that can be surgically overcome. If a bowel obstruction  is due to blockage in one segment of the bowel and the remainder of the bowel looks good, surgery is appropriate

radiation is a reasonable option to treat a particular area of the body when the cancer is causing significant pain or bleeding. for instance, if there is cancer in the vagina and it is bleeding, radiation can alleviate the bleeding. If there is cancer in a bone or in a lymph node that is pressing on a nerve and causing pain, radiation can reduce the pain. It may be that radiation to your groin is worth exploring..

erlotinib has not had very much success in ovarian cancer. most cancers do not carry the EGFR mutation. Also if you have a bowel obstruction, an oral agent is unlikely to be well absorbed

however,  alot of our therapy for women with ovarian cancer is empirical. We try something and see if it helps  commonly even if there is not alot of biological information. This is one of the ways we fight for our patients. I wish the best for you
please let us know how you are doing
take care
Avatar universal
Hallo
I realized I forgot a few things. I am 52 years old, and basically feel ok. I live in Switzerland and that explains my poor Englisch, sorry. Main symptoms are frequent diarrhea since there is no colon left, and Im getting tired very rapidly, shortness of breath. My blood counts seem to be ok despite 12 month nonstop chemo by now. Looking at your forum I realised that it is uncommon to have so many different regimens during such a short period. 1 year ago I was sent home with total parental nutrition  and I was told life expectancy was about 6-8 weeks. But chemo hepled and now everybody is afraid to stop it, we dont want to face bowel obstruction again! Would you dare to try a chemo-free period?
My oncologist (notGYN/ONC) in addition to Doxil is thinking of Erlotinib oral, (apparently has good results with other types of cancer) what is your experience with this tyrosinkinaseinhibitor for OC? By the way, I forgot to say I am taking 40mg simvastatin daily. I am eating a complete fiberfree and calorie-dense diet, no fruit nor vegetable, but daily filtered juice (fruit, tomato, curcumber..).
Thank you very much for your precious time!  Maybe it also helps other women with early desease recurrence to hear, that even 2 years after platinum resistant recurrence one can still have a very good life quality - and maybe even longer???

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