Are there any alternatives to caboplatin and Paclitaxel
My mother underwent her cyto reduction surgery and the Hystopath reports says poor response to Chemo. How much of a significance Hystopath report has vis-a-vis clinical symptoms.
She underwent 3 rounds of Chemo before surgery with a combination of Caboplatin and Paclitaxel.
Doctor is thinking of altering/changing the Chemo drug.
What are the alternate to Carboplatin and Paclitaxel incase we have to change the Chemo drug for adjuvant Chemo.
Has anyone faced a similar challenge or developed resistence to a particular family of Chemo drug in past.
Looking forward to options, lessons learnt and alternate therapies.
Regards,
Jagjit
Comments
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Jagjit~only carbo/taxol 4me-Hope others will share their stories
Dear Jagjit:
The Cytoreductive Surgery your mother has had is extensive and exhausting for her physically. I’m sorry to hear that she is not responding well to the Carbo/Taxol treatment regimen. I’ve had that neoadjuvant combo treatment prior to surgery, and an adjuvant regimen with the same drugs. The neoadjuvant treatment reduced the size and number of the tumors enough that I was able to have the CRS. The first series of treatments seem to be more effective than the adjuvant chemo regimen with the same drugs. My oncologist has mentioned there are other things he could “try”, and he mentioned Doxil. However, one would ideally wish that some of the immunotherapy drugs that are now in clinical trials for Ovarian cancer would become widely available for we Ovarian Cancer patients. In that regard, has your mom’s doctor mentioned her involvement in any clinical trials? There are trials going on now that she might qualify for. I would at least ask about them since you indicate the standard traditional treatment is not proving to be very effective.
In the link below my name there is a listing of drug regimens relative to the stage of Ovarian Cancer. My two different regimens of chemo have been Carboplatin and Paclitaxel (Taxol) given 3 weeks apart for a total of 6 treatments.
So personally, I cannot tell you that I’ve had other treatments that have been effective. The most I can help you would be to provide you with this link that does list different regimens. To be honest, I know that there is nothing that is going to make my cancer go away, separate from a miracle. In the list of drugs, I see one regimen that I simply will NOT take. That would be this one. (Specifically, “Paclitaxel + carboplatin + bevacizumab (Category 3)8–14” for stages 2 – to IV.)
I told my doctor that I would NOT ever take AVASTIN (Bevacizumab) because I knew of a lady’s husband who was on that drug and he died from Internal bleeding which AVASTIN can cause. I am almost a “free bleeder” anyway, and my doctor said for that reason alone, he would never recommend that regimen for me. For any drug that is recommended for me in the future, I am going to have to weigh the possible “positive and negative effects.” And that is what your mother will have to do.
My bottom line for decision making is, “How will undertaking another treatment regimen affect my present Quality of Life?” And that is the question your mother will have to decide. It’s not a time that any of us want to come, but such is the nature of a Stage IV cancer, no matter its name. Be sure to ask the doctors some very “pointed” questions, about the effectiveness of this drug, or any new drug, versus the “down side”, if it is mentioned for future consideration. Ask if there have been clinical trials that have shown the new combination to be more effective than the standard treatment regimen of Carboplatin and Paclitaxel (Taxol). And I would certainly show him the article referenced below and ask him to explain it to you more fully. I don’t know if you are serving as mom’s mediator, spokesperson, or whatever, or if she is making the decisions, but a good oncologist should take the time to talk in depth with you about future treatments.
Even if I weren’t so susceptible to internal bleeding already, the side effects of Avastin are such that I would not consider it. Now I’m not a doctor, I’m just telling you that this is something that has been added to some treatment regimens. Also, the trials that included the addition of AVASTIN (Bevacizumab) failed to meet the criteria set in the clinical trial. The researchers were disappointed. So I have listed that article below my name. There may be others here who are having Avastin as part of their treatments, but for me, it is a "no go!"
I am sorry that I have no good answers for you, but articles referenced below may serve to familiarize you with some of the options that your mom’s doctors may suggest. In any event, ask “lots” of questions. What is the best long term decision for my mother relative to her treatment history? Will these drugs improve her QOL Quality of Life, or merely extend her life? That’s an extremely important question that we Stage IV OC cancer patients must face. It’s a decision we wish we would never have to make. You may or may not have entertained the thoughts of what to do if there are no good options and your mother wishes to stop treatments. In that regard, I saved this article written by Mayo Clinic first written in 2006. I included it in my remarks in January of 2016. At some time you may want to read it. I find it very helpful.
http://csn.cancer.org/node/299199
For me as a Stage IV OC patient, there is not going to be a cure. It is a question of how long I can go between treatments and enjoy some real quality of life? The term is called “progression free survival”. (PFS). There will come a time for me that I will make the decision to have “no more treatments”. The most I can hope for is that there will be a long period of time between the last onset of symptoms and the next one. We can never be certain to which organs the cancer will spread. That’s why I had the Cytoreductive Surgery to begin with. At least it eliminated the possibility of a more rapid invasion of some of the organs nearby. And for that I am thankful.
I have now lived 3 years longer than doctors first envisioned for me. And I wish the same for your mother. I happen to be a firm believer that the number of days of my life are known only to my Creator God. So I’m not spending every day worrying about what’s next. I’ll get there soon enough. There are lots of joys that I am experiencing in the “here and now” and I don’t want to forfeit them and spend my time worrying about days that follow. When those fears start to creep in, as sometimes they do, I have to ask the Lord to keep me from falling into the worry pit. And He does. “Make no mistake, when my day of reckoning comes, it will be crushing, devastating, heartbreaking, and all other adjectives one can use when that day comes, even though I am ready to meet my God." There’s no time when we want to say goodbye to those we love the most. I’m a mother, grandmother and great grandmother! And what greater ties that bind than those of a mother and her children? And if I constantly lived in the world of “what if”, I would have no peace today. How I wish cancer were not so final for so many of us.
How I wish I had some positive suggestions to offer you, but rather just my own perspective on life as a Stage IV OC patient. God has given me 77 years on this planet, and it’s been good—all things considered. I wish the best for your dear mother. I would wish for her a very long interval of time when her cancer has not progressed beyond her present condition. And Lord knows, I wish there would be some immunotherapy clinical trial that would come in our lifetime that could “wipe out our cancer altogether.”
May God bless you as you endeavor to help your dear mother. Since she is only 56, most likely this has to be the heaviest burden you have experienced in your young years. I’m truly sorry. At least my cancer came in my seventies. It’s obvious you are doing all in your power to help. My prayers go out for both of you.
Loretta
Peritoneal Carcinomatosis/Ovarian Cancer Stage IV
Note: It might serve you well to print out this article and show it to your mother’s oncologist, and ask his opinion. That particular article I spoke of above is found here. It speaks of OC patients with Stage II and III OC that have had optimal debulking. In view of that, it seems to me that certainly there are no other treatments that would excel these for a Stage IV OC patient.
1. http://www.medpagetoday.com/clinical-context/GynecologicCancers/56872
“SGO: Optimal Chemo for Ovarian Cancer Fails to Emerge
No PFS difference among three regimens evaluated in key trial
SAN DIEGO -- A roomful of gynecologic oncologists walked away disappointed after results of a long-awaited ovarian cancer trial failed to show an advantage for any of three chemotherapy regimens.
The regimens -- involving combinations of intraperitoneal (IP) and intravenous (IV) chemotherapy plus bevacizumab (Avastin) -- led to a median progression-free survival (PFS) of 27 to 29 months in patients with optimally debulked stage II-III disease. An analysis limited to patients with optimal stage III disease yielded median PFS values of 31 to 34 months…”
________________________________________________________________
2. http://www.cancertherapyadvisor.com/gynecologic-cancer/ovarian-cancer-treatment-regimens/article/218127/?
“OVARIAN CANCER TREATMENT REGIMENS
Clinical Trials: The NCCN recommends cancer patient participation in clinical trials as the gold standard for treatment.
Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced healthcare team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These regimens are only provided to supplement the latest treatment strategies.
These Guidelines are a work in progress that may be refined as often as new significant data becomes available. The NCCN Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way…”
3. http://www.cancertherapyadvisor.com/gynecologic-cancer/ovarian-cancer-weekly-paclitaxel-every-three-weeks-treatment-risk/article/479106/
“…As compared with paclitaxel administered every 3 weeks, paclitaxel administered weekly did not prolong progression-free survival in patients with ovarian cancer, a study published in The New England Journal of Medicine has shown…”
________________________________________________________________
4. http://www.cancertherapyadvisor.com/gynecologic-cancers/category/158/0/
A checklist of drugs that are used to treat gynecologic cancers. One can compare one’s effectiveness as opposed to another.
Drug Name
There are several sites talking about Ovarian Cancer and I will list some of them below for your information. But I have found some sites that I use and recommend for specific info on Ovarian Cancer. Among them are these:
5. http://www.cancer.net/cancer-types/ovarian-fallopian-tube-and-peritoneal-cancer/introduction
6. https://www.oncolink.org/cancers/gynecologic/ovarian-cancer
7. http://www.mayoclinic.org/diseases-conditions/ovarian-cancer/basics/definition/con-20028096
8. https://medlineplus.gov/ovariancancer.html
9. http://www.cancer.org/cancer/ovariancancer/index
______________________End of references________________
0 -
Thanks!LorettaMarshall said:Jagjit~only carbo/taxol 4me-Hope others will share their stories
Dear Jagjit:
The Cytoreductive Surgery your mother has had is extensive and exhausting for her physically. I’m sorry to hear that she is not responding well to the Carbo/Taxol treatment regimen. I’ve had that neoadjuvant combo treatment prior to surgery, and an adjuvant regimen with the same drugs. The neoadjuvant treatment reduced the size and number of the tumors enough that I was able to have the CRS. The first series of treatments seem to be more effective than the adjuvant chemo regimen with the same drugs. My oncologist has mentioned there are other things he could “try”, and he mentioned Doxil. However, one would ideally wish that some of the immunotherapy drugs that are now in clinical trials for Ovarian cancer would become widely available for we Ovarian Cancer patients. In that regard, has your mom’s doctor mentioned her involvement in any clinical trials? There are trials going on now that she might qualify for. I would at least ask about them since you indicate the standard traditional treatment is not proving to be very effective.
In the link below my name there is a listing of drug regimens relative to the stage of Ovarian Cancer. My two different regimens of chemo have been Carboplatin and Paclitaxel (Taxol) given 3 weeks apart for a total of 6 treatments.
So personally, I cannot tell you that I’ve had other treatments that have been effective. The most I can help you would be to provide you with this link that does list different regimens. To be honest, I know that there is nothing that is going to make my cancer go away, separate from a miracle. In the list of drugs, I see one regimen that I simply will NOT take. That would be this one. (Specifically, “Paclitaxel + carboplatin + bevacizumab (Category 3)8–14” for stages 2 – to IV.)
I told my doctor that I would NOT ever take AVASTIN (Bevacizumab) because I knew of a lady’s husband who was on that drug and he died from Internal bleeding which AVASTIN can cause. I am almost a “free bleeder” anyway, and my doctor said for that reason alone, he would never recommend that regimen for me. For any drug that is recommended for me in the future, I am going to have to weigh the possible “positive and negative effects.” And that is what your mother will have to do.
My bottom line for decision making is, “How will undertaking another treatment regimen affect my present Quality of Life?” And that is the question your mother will have to decide. It’s not a time that any of us want to come, but such is the nature of a Stage IV cancer, no matter its name. Be sure to ask the doctors some very “pointed” questions, about the effectiveness of this drug, or any new drug, versus the “down side”, if it is mentioned for future consideration. Ask if there have been clinical trials that have shown the new combination to be more effective than the standard treatment regimen of Carboplatin and Paclitaxel (Taxol). And I would certainly show him the article referenced below and ask him to explain it to you more fully. I don’t know if you are serving as mom’s mediator, spokesperson, or whatever, or if she is making the decisions, but a good oncologist should take the time to talk in depth with you about future treatments.
Even if I weren’t so susceptible to internal bleeding already, the side effects of Avastin are such that I would not consider it. Now I’m not a doctor, I’m just telling you that this is something that has been added to some treatment regimens. Also, the trials that included the addition of AVASTIN (Bevacizumab) failed to meet the criteria set in the clinical trial. The researchers were disappointed. So I have listed that article below my name. There may be others here who are having Avastin as part of their treatments, but for me, it is a "no go!"
I am sorry that I have no good answers for you, but articles referenced below may serve to familiarize you with some of the options that your mom’s doctors may suggest. In any event, ask “lots” of questions. What is the best long term decision for my mother relative to her treatment history? Will these drugs improve her QOL Quality of Life, or merely extend her life? That’s an extremely important question that we Stage IV OC cancer patients must face. It’s a decision we wish we would never have to make. You may or may not have entertained the thoughts of what to do if there are no good options and your mother wishes to stop treatments. In that regard, I saved this article written by Mayo Clinic first written in 2006. I included it in my remarks in January of 2016. At some time you may want to read it. I find it very helpful.
http://csn.cancer.org/node/299199
For me as a Stage IV OC patient, there is not going to be a cure. It is a question of how long I can go between treatments and enjoy some real quality of life? The term is called “progression free survival”. (PFS). There will come a time for me that I will make the decision to have “no more treatments”. The most I can hope for is that there will be a long period of time between the last onset of symptoms and the next one. We can never be certain to which organs the cancer will spread. That’s why I had the Cytoreductive Surgery to begin with. At least it eliminated the possibility of a more rapid invasion of some of the organs nearby. And for that I am thankful.
I have now lived 3 years longer than doctors first envisioned for me. And I wish the same for your mother. I happen to be a firm believer that the number of days of my life are known only to my Creator God. So I’m not spending every day worrying about what’s next. I’ll get there soon enough. There are lots of joys that I am experiencing in the “here and now” and I don’t want to forfeit them and spend my time worrying about days that follow. When those fears start to creep in, as sometimes they do, I have to ask the Lord to keep me from falling into the worry pit. And He does. “Make no mistake, when my day of reckoning comes, it will be crushing, devastating, heartbreaking, and all other adjectives one can use when that day comes, even though I am ready to meet my God." There’s no time when we want to say goodbye to those we love the most. I’m a mother, grandmother and great grandmother! And what greater ties that bind than those of a mother and her children? And if I constantly lived in the world of “what if”, I would have no peace today. How I wish cancer were not so final for so many of us.
How I wish I had some positive suggestions to offer you, but rather just my own perspective on life as a Stage IV OC patient. God has given me 77 years on this planet, and it’s been good—all things considered. I wish the best for your dear mother. I would wish for her a very long interval of time when her cancer has not progressed beyond her present condition. And Lord knows, I wish there would be some immunotherapy clinical trial that would come in our lifetime that could “wipe out our cancer altogether.”
May God bless you as you endeavor to help your dear mother. Since she is only 56, most likely this has to be the heaviest burden you have experienced in your young years. I’m truly sorry. At least my cancer came in my seventies. It’s obvious you are doing all in your power to help. My prayers go out for both of you.
Loretta
Peritoneal Carcinomatosis/Ovarian Cancer Stage IV
Note: It might serve you well to print out this article and show it to your mother’s oncologist, and ask his opinion. That particular article I spoke of above is found here. It speaks of OC patients with Stage II and III OC that have had optimal debulking. In view of that, it seems to me that certainly there are no other treatments that would excel these for a Stage IV OC patient.
1. http://www.medpagetoday.com/clinical-context/GynecologicCancers/56872
“SGO: Optimal Chemo for Ovarian Cancer Fails to Emerge
No PFS difference among three regimens evaluated in key trial
SAN DIEGO -- A roomful of gynecologic oncologists walked away disappointed after results of a long-awaited ovarian cancer trial failed to show an advantage for any of three chemotherapy regimens.
The regimens -- involving combinations of intraperitoneal (IP) and intravenous (IV) chemotherapy plus bevacizumab (Avastin) -- led to a median progression-free survival (PFS) of 27 to 29 months in patients with optimally debulked stage II-III disease. An analysis limited to patients with optimal stage III disease yielded median PFS values of 31 to 34 months…”
________________________________________________________________
2. http://www.cancertherapyadvisor.com/gynecologic-cancer/ovarian-cancer-treatment-regimens/article/218127/?
“OVARIAN CANCER TREATMENT REGIMENS
Clinical Trials: The NCCN recommends cancer patient participation in clinical trials as the gold standard for treatment.
Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced healthcare team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These regimens are only provided to supplement the latest treatment strategies.
These Guidelines are a work in progress that may be refined as often as new significant data becomes available. The NCCN Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way…”
3. http://www.cancertherapyadvisor.com/gynecologic-cancer/ovarian-cancer-weekly-paclitaxel-every-three-weeks-treatment-risk/article/479106/
“…As compared with paclitaxel administered every 3 weeks, paclitaxel administered weekly did not prolong progression-free survival in patients with ovarian cancer, a study published in The New England Journal of Medicine has shown…”
________________________________________________________________
4. http://www.cancertherapyadvisor.com/gynecologic-cancers/category/158/0/
A checklist of drugs that are used to treat gynecologic cancers. One can compare one’s effectiveness as opposed to another.
Drug Name
There are several sites talking about Ovarian Cancer and I will list some of them below for your information. But I have found some sites that I use and recommend for specific info on Ovarian Cancer. Among them are these:
5. http://www.cancer.net/cancer-types/ovarian-fallopian-tube-and-peritoneal-cancer/introduction
6. https://www.oncolink.org/cancers/gynecologic/ovarian-cancer
7. http://www.mayoclinic.org/diseases-conditions/ovarian-cancer/basics/definition/con-20028096
8. https://medlineplus.gov/ovariancancer.html
9. http://www.cancer.org/cancer/ovariancancer/index
______________________End of references________________
Thanks! Ms Loretta for your insightful inputs and wishes.
You have been a great source of motivation for me all this while.
My Oncologist has recommended Cisplatin+Cyclophosphamide now.
Regards,
Jagjit
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Carbo/Taxol
Hi jsingh11,
I had a similar report. My Foundation One assay indicated that Carbo/Taxol would not work on the tumor. My doctor recommended a different treatment (Gemzar/Taxotere), but after the first round, there was little impact to my CA-125. I spoke to a couple of other doctors and their feeling was that Carbo/Taxol was the 'gold standard' of treatment for first line chemo, regardless of the assay. So, I requested that I follow that course of treatment and my doctor agreed to switch. He also added in Avastin. This was 7 years ago, so I don't really know if there is more recent research. I incorporated a number of integrative therapies and the Carbo/Taxol/Avastin combination worked for me. I was NED at the end of treatment. I wish you luck.
0 -
Thanks!Tethys41 said:Carbo/Taxol
Hi jsingh11,
I had a similar report. My Foundation One assay indicated that Carbo/Taxol would not work on the tumor. My doctor recommended a different treatment (Gemzar/Taxotere), but after the first round, there was little impact to my CA-125. I spoke to a couple of other doctors and their feeling was that Carbo/Taxol was the 'gold standard' of treatment for first line chemo, regardless of the assay. So, I requested that I follow that course of treatment and my doctor agreed to switch. He also added in Avastin. This was 7 years ago, so I don't really know if there is more recent research. I incorporated a number of integrative therapies and the Carbo/Taxol/Avastin combination worked for me. I was NED at the end of treatment. I wish you luck.
Thanks! Tethys
0 -
I just got my molecular
I just got my molecular analysis, and it showed the cancer would not respond to Taxol, and sure enough. I went through 18 weeks of dose dense taxol and no response
. Starting Doxil tomorrow.0 -
Good luck, Jodi!!!! You are
Good luck, Jodi!!!! You are in my thoughts
0
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