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platinum refractory

kayandok
Posts: 1223
Joined: Jun 2008

Hi gals, I stumbled across this abstract on topo, and found it interesting.

It is on the PubMed site

Ovarian cancer is the fifth leading cause of cancer death in women. Most patients with ovarian cancer respond to first-line chemotherapy, but many relapse within 18 to 22 months. The development of efficacious salvage therapies that increase overall survival while maintaining quality of life is a great challenge in the treatment of this disease. Topotecan, a novel topoisomerase I inhibitor, is currently indicated for the treatment of recurrent metastatic carcinoma of the ovary. In patients with relapsed ovarian cancer, the overall response rates on treatment with topotecan range from 19%-33% in platinum-sensitive patients, 14%-18% in platinum-resistant patients, and 5%-11% in platinum-refractory patients. The proportion of patients achieving stable disease ranges between 17% in refractory and 48% in sensitive patients. In phase III studies, topotecan was shown to be equivalent in efficacy to both paclitaxel and liposomal doxorubicin as second-line therapy in patients with relapsed ovarian cancer. Further, non-cross-resistance between topotecan and paclitaxel was demonstrated in a third-line, phase III crossover study, suggesting that topotecan may be effective in the first-line setting with paclitaxel and/or platinum. Hematologic toxicities include neutropenia, thrombocytopenia, and anemia; however, these toxicities are usually short lived, noncumulative, and manageable with dose modifications, including low-dose topotecan regimens. Nonhematologic toxicities are usually mild to moderate in severity. These data support the use of topotecan for second-line therapy and suggest that topotecan may also be effective in first-line therapy. Further studies with topotecan alone and in combination with other agents are needed to fully characterize the role and sequencing of topotecan in the salvage and first-line settings.

What I found interesting, is that my doctor told me that I had a 5 -10% chance of topo working. So, in reading this, I realize that he is considering me a "platinum refractory" patient (recurring in 6 months). I recurred after 8 months, initially, but this last taxol/carbo didn't put me into remission. So, I assume that, what category you are in is determined by your last experience with platinum. By that definition, can we assume that our category (platinum-resustant, platinum-sensitive and platinum-refractory) can be always evolving? I suppose when you think that the cancer is always mutating, it makes sense. I had always thought of my self in the "platinum-sensitive" category, so am processsing all this at the moment.

Not that it makes any difference for my next step, LOL......

I welcome any input on this subject.

k

LaundryQueen's picture
LaundryQueen
Posts: 682
Joined: Mar 2011

Thank you for posting above info...very helpful and encouraging.

Just wondering if you have looked into "metronomic therapy"? The usual drugs just different dosage & frequency. I don't know anyone on the board who is receiving chemo that way (low dose in small frequent doses). If you investigate this delivery method for chemo, you will learn that metronomic chemotherapy works against the angiogenesis rather than against the tumor. When you stop feeding the tumors they go away, right?

The most exciting information about metronomic chemotherapy is that it has been shown to be effective in even in some chemo-resistant cases by using the same chemo in small daily doses. Now I have no idea if that includes platinum or not.

The delicate balance of risk vs benefit with chemotherapy must be honored as I believe just as many women are dying from the treatment for OVCA as from the disease itself. I think that is why oncologists may be reluctant to jump in with another chemo right away when there is obvious recurrence of disease preferring instead to allow the patient to recover from the previous chemo.

I don't see many comments on this discussion board about detoxing after chemo. I do know that seaweed is a natural detoxifier so I hope you are getting plenty of that in your diet.

Best wishes to you.

kayandok
Posts: 1223
Joined: Jun 2008

heard of it, although there have been some gals who received carbo or taxol on a slow drip for hours when they have had an allergic reacition. This is an interesting concept and would be good for me, regardless. I have had so much chemo, that my body won't take much more without getting a remission. I will print out the info I found on it, and ask my doctor about it.

I do eat lot's of seaweed! I live in Japan, and we love it.

k

Mum2bellaandwilliam's picture
Mum2bellaandwilliam
Posts: 414
Joined: Oct 2010

Hi k , you are right, I understand it to be platinum refractory- no remission, platinum resistant - less than 6 months and platinum sensitive - more than 6 months.
The quack explained to me the problem is that the cells that remain and are not killed off by chemo then divide and create more platinum resistant cells :(
However I have read somewhere online a about a study that revisited platinum further down the line after women being told they are platinum resistant and about 10% of the patients had a response!!! Not bad when you look at the figures!!!! Cancer is smart, but not that smart in a few cases!!!

djinco's picture
djinco
Posts: 87
Joined: Feb 2010

Hi Kathleen, I am trying to eat more healthy lately. This evening my husband took me to Whole Foods Grocery to buy some more Kombu. How do you use seaweed? I also am eating the roasted seaweed used in sushi roll making. Have you heard anything about it helping control cancer? I've been worried lately as I am starting to experience some of the same digestive issues I had before my initial diagnosis in February 2010. I came off of chemo at the beginning of November 2010. I get my next CA-125 test May 5. Anxiety is the worst.

kayandok
Posts: 1223
Joined: Jun 2008

Hi djinco, I only mentioned the seaweed, because lanudryqueen asked about it. I have always eaten it almost daily. It is good for a lot of things including cleansing toxins out of your body. We usually eat kombu in miso soup, but the fresh stuff is good in salads, or with any vegies. Roasted seaweed (nori) is great for onigiri (rice balls) or sushi too. The great thing about Japan, is we even have COSTCO, so we can get that regular Amerian style food too. I know I gained weight when COSTCO came to Japan!
Wishing you the best on your upcoming CA result.
k

Tina Brown's picture
Tina Brown
Posts: 1054
Joined: Nov 2009

Your article was a great interest to me. I believe I am the same as you. I have just finished my second line treatment - carbo/taxol and my numbers did a little rise after treatment #4. My oncologist suggested the chemo had stopped working and mentioned that Topotecan would be the next chemo to try. I will get my final numbers after #6 this Thursday and discuss the next plan of action. I only had 7 months inbetween my first line treatment and my second line treatment. So where does that put me with regard to platimum sensitivity?

There is nothing I can do about this so I have accepted I will need to have chemo on and off foe the rest of my life.

Good luck, Tina xx

kayandok
Posts: 1223
Joined: Jun 2008

I'm not sure the answer to your question, really, because I am not a doctor. I am a bit confused about where my doctor is putting me. I am now thinking that when they said I was "border line" that they menat "refractory" but not sure. I sometimes find myself obsessing over details that really don't make one iota of a difference.

I like your positvie attitude, Tina!

Take care,
kathlee

123missy
Posts: 26
Joined: Jan 2011

I understand that Refactory means the cancer grew during treatment.

kayandok
Posts: 1223
Joined: Jun 2008

it says in some definitions "Platinum-refractory disease was defined as cancer with documented tumor progression during platinum-based treatment or recurrence within 6 months after platinum-based chemoradiotherapy"
k

Mwee's picture
Mwee
Posts: 1316
Joined: Nov 2009

I'm one of those gals that has been getting the long (very slow) drips so that I could tolerate carbo. This past infusion I had another bad reaction and now carbo is out for me. They are going to try cisplatin instead.
(((HUGS))) Maria

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