MMMT Chemo / Radiation Regimen

MelissaJA

For MMMT, has anyone had a regimen of Carbo/Taxel (C/T), then radiation, then Ifosfamide/Taxel (I/T) as first line treatment? I think I remember reading member CMB had this regimen. There have been a number of studies on C/T vs I/T and while C/T has not been found to be superior, it is now the standard of treatment. I wonder why both regimens would not be used more regularly if the patient tolerated them.

 

NoTimeForCancer

Melissa, here is a link to

Melissa, here is a link to the NCCN standard of care to look through:

https://www.nccn.org/professionals/physician_gls/default.aspx#uterine

cmb

Carcinosarcoma/MMMT Treatment

Thanks, NoTime, for the reminder to check the NCCN Guidelines. I realized I hadn't looked at them recently and I see that an updated version for uterine cancer was issued last month.

I had radiation after all my chemo cycles, not as part of the "sandwich" treatment where radiation was given in the middle of chemo schedule. Other women here have had the sandwich treatment, but I don't recall if any had MMMT.

But as I've noted in my profile, my medical oncologist did decide on a four-drug regimen: four cycles of Paclitaxel/Carboplatin followed by four cycles of Ifosfamide/Mensa/Doxorubicin.

I must admit that I felt absolutely terrible after the first Ifosfamide/Mensa/Doxorubicin treatment. I honestly didn't think that I would be able to continue with the rest of the cycles. However, after I reported how bad I felt, the oncologist changed up the supportive drugs I received the last day in the hospital for the remaining cycles. I also took a decreasing dose of steroids for a few days after I was home and went into the infusion center a couple of times the week after treatment to receive extra fluids and antiemetics. I still didn't feel great the rest of the cycles, but I was able to make it through to the scheduled end.

My foot neuropathy occurred at the end of the Ifosfamide cycles, not during the Paclitaxel/Carboplatin treatments as most women experience. But I did not experience the central neurotoxicity that does occur occasionally with Ifosfamide and I did not get heart damage from the Doxorubicin.

You'll see in the NCCN Guideline that all four of the drugs I took are among the recommended regimens for MMMT. And as you noted, a recent trial and other studies have indicated that Paclitaxel/Carboplatin seems to be as effective as the older chemo regimens that included Ifosfamide.

The main drawback to Ifosfamide is the potential for severe side effects. Also, Ifosfamide is usually given as an inpatient treatment so that other treatment can happen concurrently to prevent kidney damage. That increases costs and complexity. And finally, there's been a shift in the medical world from categorizing MMMT as a type of sarcoma to a high-risk variant of endometrial adenocarcinoma because carcinosarcomas share more similarities in epidemiology, risk factors, and clinical behavior with endometrial carcinoma than with uterine sarcomas. Ifosfamide is more often used for sarcomas versus carcinomas.

MelissaJA

cmb said:

Carcinosarcoma/MMMT Treatment

Thanks, NoTime, for the reminder to check the NCCN Guidelines. I realized I hadn't looked at them recently and I see that an updated version for uterine cancer was issued last month.

I had radiation after all my chemo cycles, not as part of the "sandwich" treatment where radiation was given in the middle of chemo schedule. Other women here have had the sandwich treatment, but I don't recall if any had MMMT.

But as I've noted in my profile, my medical oncologist did decide on a four-drug regimen: four cycles of Paclitaxel/Carboplatin followed by four cycles of Ifosfamide/Mensa/Doxorubicin.

I must admit that I felt absolutely terrible after the first Ifosfamide/Mensa/Doxorubicin treatment. I honestly didn't think that I would be able to continue with the rest of the cycles. However, after I reported how bad I felt, the oncologist changed up the supportive drugs I received the last day in the hospital for the remaining cycles. I also took a decreasing dose of steroids for a few days after I was home and went into the infusion center a couple of times the week after treatment to receive extra fluids and antiemetics. I still didn't feel great the rest of the cycles, but I was able to make it through to the scheduled end.

My foot neuropathy occurred at the end of the Ifosfamide cycles, not during the Paclitaxel/Carboplatin treatments as most women experience. But I did not experience the central neurotoxicity that does occur occasionally with Ifosfamide and I did not get heart damage from the Doxorubicin.

You'll see in the NCCN Guideline that all four of the drugs I took are among the recommended regimens for MMMT. And as you noted, a recent trial and other studies have indicated that Paclitaxel/Carboplatin seems to be as effective as the older chemo regimens that included Ifosfamide.

The main drawback to Ifosfamide is the potential for severe side effects. Also, Ifosfamide is usually given as an inpatient treatment so that other treatment can happen concurrently to prevent kidney damage. That increases costs and complexity. And finally, there's been a shift in the medical world from categorizing MMMT as a type of sarcoma to a high-risk variant of endometrial adenocarcinoma because carcinosarcomas share more similarities in epidemiology, risk factors, and clinical behavior with endometrial carcinoma than with uterine sarcomas. Ifosfamide is more often used for sarcomas versus carcinomas.

CMB - thank you so much for

CMB - thank you so much for all of your insight!  I have my post-op doctor appointment on Monday where I will receive the staging.  I want to be as informed as possible when we start talking about the Chemo.

MelissaJA

NoTimeForCancer said:

Melissa, here is a link to

Melissa, here is a link to the NCCN standard of care to look through:

https://www.nccn.org/professionals/physician_gls/default.aspx#uterine

Thanks!  I read though this.

Thanks!  I read though this.

Forherself

How are you doing Melissa?

Just thinking of you and your smiling face.  I hope you are making it through your treatment ok.  

MelissaJA

Forherself said:

How are you doing Melissa?

Just thinking of you and your smiling face.  I hope you are making it through your treatment ok.  

I'm hanging in there.  I have

I'm hanging in there.  I have my 3rd Carbo/Taxol infusion next week.  My labs have been normal so far and the fatigue only lasts about 5 days.  I am hoping the cumulative effects don't get too bad.  Thanks for checking in and I hope you had a nice holiday and new years!!!

ConnieSW

Almost

Half through!

cmb

So far, so good

Melissa,

Glad to hear that you're doing as well as can be expected through cycle two. My main symptom from Paclitaxel/Carboplatin was leg pain from days 3-5. But after the first time it happened, I was prepared for it the next three times. So it was never as bad as the first time.

My nurse told me that the symptoms a person has the first time are typically the ones that will occur during the remaining cycles. I know that's not true for some of the women here, but it was for me.

 

Forherself

MelissaJA said:

I'm hanging in there.  I have

I'm hanging in there.  I have my 3rd Carbo/Taxol infusion next week.  My labs have been normal so far and the fatigue only lasts about 5 days.  I am hoping the cumulative effects don't get too bad.  Thanks for checking in and I hope you had a nice holiday and new years!!!

I guess as well as could be expected

NOt easy but I'm glad you are doing ok.  Nice to hear from you and yes we had nice holidays.   Low key, and I like that.

 

ConnieSW

I was lucky

That awful leg pain never returned after the first treatment (I wore a rut in the carpet pacing around my dining room table). Likewise the brain fog was only a one time thing.  I was in tears because I couldn't fix an easy mistake in my knitting and I had been a knitter for over 50 years then.  I really thought my poor brain was shot. My husband's response was typical male- just put it away.  My daughter, bless her, calmly fixed it, handed it back and on I went. Knitting is therapy for me-mentally and physically ( arthritic hands).  I needed it. 

Afoste3

Glad it's going ok

Hi Melissa I'm here for my mom, just wanted to let you know she's done with chemo and it did not get worse as she progressed through it.  I know it's different for everyone but some people are able to avoid the cumulative effects.  Hope that's what happens for you!

cmb

Afoste3 said:

Glad it's going ok

Hi Melissa I'm here for my mom, just wanted to let you know she's done with chemo and it did not get worse as she progressed through it.  I know it's different for everyone but some people are able to avoid the cumulative effects.  Hope that's what happens for you!

Thanks for checking back in

Thanks for checking back in with us to share the good news that your mother has finished chemo. Hope she has smooth sailing ahead.

Molly110

MelissaJA said:

I'm hanging in there.  I have

I'm hanging in there.  I have my 3rd Carbo/Taxol infusion next week.  My labs have been normal so far and the fatigue only lasts about 5 days.  I am hoping the cumulative effects don't get too bad.  Thanks for checking in and I hope you had a nice holiday and new years!!!

Congratulations, Melissa, on

Congratulations, Melissa, on being almost halfway through! As you've just read from others, some of us had side effects that were worse each time, and many of us did not. The fatigue did not hit me at all until between the 5th and 6th, and I was more fatigued after the final one, so I guess that was cumulative, but otherwise I had many side effects with the first chemo that happened only that once.

Whichever way yours unfolds, I hope it comforts you to know that you are almost done, and once you are done your body will be able to rebuild.

Good luck,

Molly