Chemo alternatives

LouDy22

Mom is currently in the hospital for pain management , she is 59 years old and was diagnosed in March , she has had 3 chemo treatments carbo/taxol and her main tumor has shrunk by 60% and her lungs are now clear of nodules BUT she also had disease progression and a new growth was detected on one of her lymphnodes cause hydrophensis and will be having a stent put in Monday , her regular oncologist says he doesn't know what else to do and that he is out of his comfort realm so we have an appointment at UNC Chapel Hill for a second opinion , I know first line treatments are the best to work but is there any hope with second line chemo ?

Afoste3

hi LouDy22

I'm so sorry your mom is going through all this.  I hope her pain is controlled soon.  I'm also here to support my mom (she has an MMMT tumor too).  I've learned that there are alternatives after the frontline chemo, but it might depend on the properties of the tumor.  For example, my mom's tumor is estrogen-receptor positive.  This means that certain non-chemo drugs might work to help control spread.  There are also other targeted immunotherapy treatments that work for some women (Keytruda and Lenvima is the most common for this cancer I think), since your mom's tumor has spread that might be an option.  For my mom, her tumor testing showed that a drug called Ibrance (palbociclib) might work, so that's on our list if needed.  I'd see what the dr says about that for your mom.

For my mom, testing was done on the tumor after surgery to see what might work if the chemo didn't.  Since your mom hasn't had surgery, the process may be different. I'd ask the doctor about that too (i.e. can they do any testing on whatever was taken for the biopsy/was that done already?).

Some other ladies here have had raditation to hit one lymph node (they will know much more than I do if they chime in), so perhaps ask about that too.  There is a targeted radiation tool called SBRT that I'm sure a big cancer center like UNC Chapel Hill has available.

Please keep us all posted on how it's going if you feel up to it.  You are a wonderful son and your mom is lucky to have you by her side.

Forherself

Second opinion?

Is a very good idea. I agree with  Afoste that mutations and immunotherapy are choices for your mother.  Immunotherapy is different than chemotherapy in that it treats specific mutations.   Prayers for your mother.  

Sue

 

cmb

Other therapy options

There are other chemo drugs that have been used for carcinosarcoma, as well as the immunotherapy that Afoste3 and Forherself referenced.

The following are listed in the NCCN clinical guidelines available with a free account at https://www.nccn.org/login?ReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf

See that report for more details.

Systematic therapies for Recurrent, Metastatic or High Risk Disease

Carboplatin / paclitaxel (category 1 for carcinosarcoma)

Carboplatin / paclitaxel / trastuzumab (for stage Ill/IV or recurrent HER2-positive uterine serous carcinoma)

Other Recommended Regimens

Carboplatin / docetaxel

Cisplatin / doxorubicin

Cisplatin / doxorubicin / paclitaxel

Carboplatin / paclitaxel / bevacizumab

Cisplatin

Carboplatin

Doxorubicin

Liposomal doxorubicin

Paclitaxel

Albumin-bound paclitaxel

Topotecan

Bevacizumab

Temsirolimus

Docetaxel (category 2B)

lfosfamide (for carcinosarcoma)

lfosfamide / paclitaxel (for carcinosarcoma)8

Cisplatin / ifosfamide (for carcinosarcoma)

 

Biomarker directed systemic therapy for second-line treatment:

Pembrolizumab (for TMB-H or MSl-high [MSI-H]/MMR deficient [dMMR] tumors)

Nivolumab

Dostarlimab-gxly

Larotrectinib or entrectinib for NTKR gene fusion-positive tumors (category 2B)

 

I'm glad she'll be getting a second opinion. Depending upon your mother's current health, the doctors may rule out one or more of these treatments since some can have more severe side effects than carboplatin / paclitaxel.

For me, the ifosfamide/doxorubicin therapy was very difficult to get though, although I did complete the planned four cycles, which occurred after the initial four cycles of carboplatin / paclitaxel.

LouDy22

You always come through

CMB thank you so much you always come through ! and thank you to all the other lady's for the useful info ! I will be printing this