Ovarian cancer stage 4 - Need suggestions to keep WBC up

 Hello “Sundara”

 Welcome to a club you never wanted to be a part of, but you’ve come to a place where others understand your plight.  You can read more “about me” if you click on my name.  Since you didn’t elaborate, for tonight, I’ll just answer your question.  There are some helps for increasing the White Blood Cell Count.

 I, too, have been diagnosed first with Peritoneal Carcinomatosis, but a 2^nd opinion at University of Pittsburgh Medical Center, also revealed that the cancer was in my ovaries as well.  Now at this point, it doesn’t matter—which came first the chicken or the egg—It’s Stage IV and both diagnoses are treated the same in my case.  I, too, have had two different regimens of the chemo combo of Carboplatin and Paclitaxel (Taxol).  My first sessions were in early 2013 prior to my Cytoreductive Surgery (CRS) on July 1, 2013.  My second session began June 11, 2015 and ended in Sept. 2015. 

 In both instances, my oncologist, brought me back to the lab on the very next day after each chemo session, and administered some steroids, (Decadron), hydration, and a NEULASTA injection.  My first time around, the shot was Neupogen, and it produced some horrific bone pain approximately 4 hours after I got home.  So the next time, I said, “Nope”, don’t give me that again.  I had to go to the ER for some pain medication.  So from then on I received a “Neulasta” injection.  There were no side effects from that and I never missed a session due to low WBC.

 So, if I were you, I would suggest you ask your doctor about receiving the same kind of treatments the day after. 

 Also, I once had a letter from a fella named “Brian” asking for hints for chemo sessions which his mother was about to undergo.  So I will give you two references.  One for my letter to him, and one for the benefits of Neulasta.  And I can’t over emphasize the importance of the hydration because chemo “drains” us of a lot of energy.

 Here’s hoping that your sessions will “knock” the tumors into “submission” and it will be a long time before you have to undergo anymore, and in between time, you can enjoy some quality of life. 

 Remembering that “Life isn’t about waiting for the storm to pass—it’s about learning how to dance in the rain!”

 Loretta

 Peritoneal Carcinomatosis, Ovarian Cancer Stage IV

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1. https://www.drugs.com/neulasta.html

 “What is Neulasta?

 Neulasta (pegfilgrastim) is a man-made form of a protein that stimulates the growth of white blood cells in your body. White blood cells help your body fight against infection.

 Neulasta is used to prevent neutropenia, a lack of certain white blood cells caused by receiving chemotherapy…”

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 2.  http://www.cancer.net/navigating-cancer-care/side-effects/dehydration

 “Dehydration

 Approved by the Cancer.Net Editorial Board, 07/2016

 Dehydration occurs when a person does not take in enough fluid or loses too much fluid and cannot replace it. Every cell and organ depends on water, and without it the human body cannot function properly. The water in your body performs the following essential functions:

•  Removes waste and toxins

• Transports nutrients and oxygen

• Controls heart rate and blood pressure

• Regulates body temperature

• Lubricates joints

• Protects organs and tissue, including the eyes, ears, and heart

• Creates saliva

  Although it is possible to go for a long time without food, people cannot live without water for more than a few days. People receiving cancer treatment may be at a higher risk for dehydration due to treatment side effects, such as diarrhea and vomiting…”

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 3.  http://csn.cancer.org/node/301646

 “BRIAN from the North~Things I learned during my chemo treatments~Hope it will B helpful 2 U & Mom~Wishing her all the best!”

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sundaravalli said:

New diagnosis and low blood count

Hi Loretta, 

Thanks a lot for the information.My chemo cycle is day 1 carbo taxol and day 8 and day 15 taxol. My Oncologist said that she has to change regimen to every 21 days to give Neulasta.Does it make any differences,the chemo schedule?

 Good afternoon “Sun”

 How about if we just shorten you name to “sun” and hope that it describes the ultimate outcome of your chemo regimen?

 Okay, remember that I’m just another Stage IV OC sister who had good success with my chemo combination of Carboplatin/Taxol treatment schedule.   I went to the lab once every 3 weeks for these infusions.  I had a total of 6 infusions.  So my math says that I only had to go to the clinic ONCE every 3 weeks.

 Meanwhile, it looks like you are going ONCE a week.  Incidentally, I sure hope you have a mediport.  Some people’s doctors do not put in an implant and the poor people have to get stuck every time they go in for a treatment.  This results in a breakdown of the veins over time!

 So, I say, by all means ask the oncologist to change the chemo combo so that it is administered every 3 weeks, instead of incremental doses on a weekly basis.  Of course, that's what worked for me.  Seems according to the chart referenced below my remarks that the 3-wk. interval is the usual recommended treatment. 

 Now, with your present schedule, you have “lost” time in my opinion, when the chemo could have been working on a continual basis.  You never want the cancer to get ahead of the chemo!  So while you wait for your WBC to “come back up”, the cancer is moving on.  What’s the old saying, “When the cat’s away, the mice will play.”  Well, that’s what I think happens when people have to miss the customary chemo treatments because their immune system has been compromised, and they’re unable to have the infusion.

 Since chemotherapy has a 3-week residual effect, that’s the reason my oncologist prescribed the treatment on a 3-week interval schedule.  When I completed my treatment regimen, my follow-up CT scan was scheduled 3 weeks out.  That’s because it will still be working for 3 weeks from the last injection.  That was the same time frame for my husband, who had a successful Minimally Invasive Esophagectomy back in 2003.  Thank God we’re still in remission with his cancer.

 So what’s the problem with changing to a 3-week interval?  Looks like to me, you’d save yourself a lot of trips to the lab for chemo with the same outcome ultimately.  You could have the same “day-after” follow-up with the same routine my oncologist prescribed for me.  I never had a low WBC and it was attributable to the Neulasta treatments.  I’m not a doctor, but I can’t see any advantage in breaking up the flow of the chemo. 

 Moreover, when you view the way in which each chemical works as outlined in the Chemocare.com link, you will see that it lists a time when your WBC will be at their lowest ebb.  So it’s common to have this reduction if no Neulasta or Neupogen are ever given.  So I will put those links below and you can note the days that your white blood cell count would be at its lowest ebb.  It is listed as NADIR.  Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.

 So why risk that if you can offset it by having a Neulasta shot?

The reason I’m saying “Neulasta” instead of “Neupogen” is this. I understand that “Neupogen” starts to act in a few hours after the injection, whereas “Neulasta” works on a slower basis like 2 or 3 days.  But my bones ached and my spine “jerked” with that Neupogen shot until I had to go to the emergency room and get a shot for pain.  And instructions say if you have that type of reaction, you must see a doctor immediately.  I never had a problem with the Neulasta.  So it seems the only difference is the “time frame” involved for the injection to do its best work.  Now some may not have any side effects but I found the Neulasta worked best for me.  Note the comments I have placed below each web link I’ve provided.  And by all means, discuss this with your oncologist.  All we do as “sisters” here is to compare and contrast symptoms and treatments and try to “pick each other’s brains” as to what “worked” for them. 

 Hope this has been helpful, “Sun!”

 Love Loretta

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1.   http://chemocare.com/chemotherapy/drug-info/carboplatin.aspx

“…Carboplatin Side Effects:

 Important things to remember about the side effects of Carboplatin:

 Most people do not experience all of the side effects listed.

• Side effects are often predictable in terms of their onset and duration.
• Side effects are almost always reversible and will go away after treatment is complete.
• There are many options to help minimize or prevent side effects.
• There is no relationship between the presence or severity of side effects and the effectiveness of Carboplatin.
• The side effects of Carboplatin and their severity depend on how much of Carboplatin is given.  In other words, high doses may produce more severe side effects).

 The following side effects are common (occurring in greater than 30%) for patients taking Carboplatin:

 Low blood counts (including red blood cells, white blood cells and platelets)

 Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.

 Onset: None reported
Nadir: 21 days
Recovery: 28 days…”

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2.   http://chemocare.com/chemotherapy/drug-info/Taxol.aspx

 “…Taxol Side Effects:

 Important things to remember about Taxol side effects include:

 Most people do not experience all of the Taxol side effects listed.

• Taxol side effects are often predictable in terms of their onset and duration.
• Taxol side effects are almost always reversible and will go away after treatment is complete.
• There are many options to help minimize or prevent Taxol side effects.
• There is no relationship between the presence or severity of Taxol side effects and the effectiveness of the medication.
• The Taxol side effects and their severity vary depending on how much of the drug is given, and/or the schedule in which it is given.

 The following Taxol side effects are common (occurring in greater than 30%) for patients taking Taxol:

 Low blood counts.  Your white and red blood cells and platelets may temporarily decrease.  This can put you at increased risk for infection, anemia and/or bleeding.

• Hair loss
• Arthralgias and myalgias, pain in the joints and muscles. Usually temporary occurring 2 to 3 days after Taxol, and resolve within a few days.  
• Peripheral neuropathy (numbness and tingling of the hands and feet)
• Nausea and vomiting (usually mild)
• Diarrhea
• Mouth sores
• Hypersensitivity reaction - fever, facial flushing, chills, shortness of breath, or hives after Taxol is given.  The majority of these reactions occur within the first 10 minutes of an infusion.  Notify your healthcare provider immediately (premedication regimen has significantly decreased the incidence of this reaction)…”
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 3.   https://www.neulasta.com/learn-about-neulasta/

 “Strong chemotherapy can reduce your white blood cell count, weakening your immune system. A weakened immune system increases your risk of infection. Neulasta® is a prescription medicine used to help reduce the chance of infection due to a low white blood cell count, in people with certain types of cancer (non-myeloid), who receive anti-cancer medicines (chemotherapy) that can cause fever and low blood cell count. It does this by boosting the number of infection-fighting white blood cells called neutrophils, which strengthen your immune system…”

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 4.   https://www.neulasta.com/low-white-blood-cell-count-cancer/

 “Chemotherapy is one of many treatments used to fight cancer, so if your doctor suggests chemotherapy for you, it can be helpful to understand how it works.

Chemotherapy works by killing the fast-growing cancer cells in your body. At the same time, chemotherapy can also decrease the number of white blood cells in your body. White blood cells are needed to fight infections. Having a low white blood cell count can weaken your immune system, which increases your risk of infection during your chemotherapy treatment…”

Neulasta^® reduced infection risk by 94%

 In a key study of 928 patients with breast cancer, when given once every chemotherapy cycle, Neulasta^® helped protect against the risk of infection, reducing it from 17% to 1%—a 94% decrease…”

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 5.   http://www.cancertherapyadvisor.com/gynecologic-cancer/ovarian-cancer-treatment-regimens/article/218127/

 (“Sun”-- Note the different regimens listed for chemo treatments for Ovarian Cancer.  I chose these two categories for Stages 2-4, which appear to be the regimens my oncologist and your oncologist are prescribing.  The first one is the one that my oncologist follows—that being the carbo/Taxol infusion once every 3 weeks for a series of 6 treatments!  The “dose-dense” matches what you have told me.  The difference seems to be that you are going once every week, while I went once every 3 weeks.  If your oncologist can change the regimen, why not ask her to do so.  Then you could have the Neulasta shots and other helpful treatments the day following.  That was the regimen I followed with positive results. 

 My first chemo treatments began in early 2013.  Then Cytoreductive surgery July 1, 2013.  Then 2-year rest period before CT scan revealed “increased nodularity along the intestinal wall” so I underwent a second 6-treatment regimen beginning on June 11, 2015 and ending in September of 2015.  In Sept. of 2014, CT scan showed 3 tumors on the Caudate Lobe of my Liver for which I had successful “targeted radiation” via “Cyberknife”.  It was totally successfully in killing them!

 So we take it one moment at a time, one day at a time.  Especially with Stage IV, since all treatments are considered palliative, we want to have as long a period of “progression free survival” (PFS) as possible. 

 Now I just had a PET/CT scan yesterday because my tumor markers are rising considerably, and I asked my oncologist if he would schedule a PET/CT this time instead of just a CT. He said, “Certainly if the insurance will cover it.  I have a secondary insurance policy, Plan F, with Anthem of VA.  They approved it.  PET shows live activity.”  And so I will know the results of that on Friday.  Also I asked for a “copy” of the PET scan which they made for me and then “we” will decide what actions to take.  He and I work together.  I don’t just sit and listen, and ask no questions.  He takes the lead from me as to what I want to do.  I pray about what I should do and take his experience into full consideration.  I hope that is the kind of “interaction” you enjoy with your oncologist.  So note the two regimens below.  It seems that your current regimen opens the possibility of continual low blood counts because you are having a “new” infusion each week, and each chemo has its own NADIR result.)

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 6.   http://www.medpagetoday.com/clinical-context/GynecologicCancers/56872“Clinical Context 03.22.2016

"Optimal Chemo for Ovarian Cancer Fails to Emerge

1. No PFS difference among three regimens evaluated in key trial…”

   (Sun—this is my personal observation:  Note: I see that in one of the “regimens” listed in the chart of reference No. 5, is the additional use of Avastin.  In case that is mentioned, you would want to know about the following clinical trials.  The side effects of this drug did not warrant the addition of it based on the fact that it only extended the life of the average OC patient for 5 months.  Ultimately, it failed to meet the criteria outlined in the clinical trial.  Paraphrased, in effect the doctors said, “We shouldn’t spend any more time and money on this particular trial, and need to go in some new direction.”  So that is what this article is all about.  It was a disappointment for those seeking to improve the PFS of the patients. )

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sundaravalli said:

Hi Loretta, Thank you so much

Hi Loretta, Thank you so much. I will talk to my oncologist to change the regimen to every 3 weeks. it makes worry missing my chemo. Thanks again for all the information.

Sun

"Sun" ~ I think you will be much happier with the 3-week regimen.  Be sure to request the "follow-up" we discussed above.  I felt so much better after the hydration.  As you have probably experienced, chemo is not a piece of cake, but we're taking the long look of a better quality of life after the treatments.  I felt "washed out" as far as energy level goes during the treatments, so every preventative measure that can be taken to make us feel better during our treatments should be given.  And we shouldn't have to BEG FOR WATER!  Often it's just a matter of the patients not knowing what is available for the asking. 

Wishing you all the best!

Loretta