Avastin/taxol not working what next??

clynn13

Well, been on this **** of a ride for close to 4 years now. Had avastin and taxol for a bout a year. What a wonderful combo. Low dose no hair loss pretty stable blood counts now for the 2nd month my markers are up to 43. So low, but I am so sensitive to the markers that even when they were 20 I still showed small disease on cat scan. Iget another one tomorrow. Yikes. I know whats there cause I feel it. Just dont want to belive in reality at the moment. My dr. suggested tamoxifn for now. And after the cat results probably oral etoposide. We discussed this etoposide even before rise. So, I am going to call him today and request a chemo assay test. I asked hem about it a few months back and he said "what is that?" Still dont get how the head of oncology doesnt know what it is. Ill keep you all posted what result of scan are and drs response to chemo assay. Another point to address - What would you do? I had carbo/taxol, topo, carbo/gem, avastin/tax (low dose) Everyone worked at getting # low, but petered out after a bit. Thanks clynn

lindaprocopio

Looks like you've had most of the drugs I've tried,...
I didn't see Doxil on your list of drugs already used; has that been suggested? I've done carbo/taxol, taxol dense dose, doxil, carboplatin as a single agent, and avastin/cytoxin. Once taxol stopped working for me, each of the other drugs we tried allowed disease progression even though I was getting treatments. (I always have the complication of low platelets & WBC on so many chemo combos, so some of the more powerful combos you have taken are out for me unless I get them later in very weakened doses.)

I am awaiting an insurance decision for a cutting edge attempt to use radioembolism because over 90% of my cancer mets are in my liver. This is a long shot, as Yttrium-90 is only approved so far for metastastic colorectal cancer to the liver or liver cancer, but if I get approved I'm rolling the dice that this procedure will buy me some time. Meanwhile I just started taking tamoxifen/megace.

I had a tissue assay done via a needle biopsy where they were able to get enough tissue. Turns out I am ER-, PR-, and HER2-. If you are ER+ and PR+, there is a BETTER chance that hormone inhibitors will work for you, but I read a study that I will paste in here that shows that sometimes tamoxifen given at the same time as megace can work for ER- and PR- cancers. 27% may not sound like a great response, but that is as good a chance as you get with most 2nd line chemo drugs, and tamoxifen and megace are easy on the body, a nice break from chemo. Here it is:

(http://www.medscape.com/viewarticle/586334_2 )

Tamoxifen Combined With Progestins. The Gynecologic Oncology Group (GOG) conducted two studies that combined progestins with tamoxifen using different schedules. This strategy was chosen to avoid the downregulation of PR that occurs with continuous treatment with progestin alone, the hypothesis being that intermittent treatment with progestin would permit tamoxifen to induce PR and thus enhance the effect of progestin therapy. In the first trial, patients received alternating 3-week courses of megestrol acetate and tamoxifen.[20] The overall response rate was 27%, the median progression-free survival was 2.7 months, and the response rate in patients with grade 1 endometrial cancer was 38%. Patients in the second trial were treated with continuous tamoxifen plus alternating weekly cycles of medroxyprogesterone acetate.[21] The response rate was 33%,with a median progression-free interval of 3 months. Although these response rates are higher than those reported for progestins alone, the progression-free intervals and overall survival rates are similar. A correlative study to this second trial explored the relationship between hormone receptor status and response to the combination of tamoxifen and megestrol. Interestingly, response rates were high even in patients with estrogen- and progesterone-negative tumors (a response rate of 26% for estrogen-negative tumors and 32% for progesterone-negative tumors).[22] The toxicities, which principally were weight gain and thromboembolic events, were tolerable with both regimens of tamoxifen plus progestin.

References:

20: Fiorica JV, Brunetto VL, Hanjani P, et al. Phase II trial of alternating courses of megestrol acetate and tamoxifen in advanced endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92(1):10-14.

21: Whitney CW, Brunetto VL, Zaino RJ, et al. Phase II study of medroxyprogesterone acetate plus tamoxifen in advanced endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92(1):4-9.

22: Singh M, Zaino RJ, Filiaci VJ, et al. Relationship of estrogen and progesterone receptors to clinical outcome in metastatic endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2007;106(2):325-333. Epub 2007 May 25.