Doxil/Avastin after recurrence

Welcome to the board. Sorry you are having to be here. Under went 6 rounds of carboplatin and taxol for my cancer a agressive one also. It was 8 months and the cancer was back for me. The fight was on again as with you. I so get what you're going through and the unknown that goes with it. I am now under going IP chemo (The peritoneum is the membrane (thin tissue) that lines the abdominal cavity and surrounds your abdominal organs. Chemotherapy can be administered directly into this space to treat cancers of the abdominal region such as gastric (stomach), appendiceal (appendix) and ovarian). The doctors thought is in my case it will give me the best chance. I am told they think they can get me in remition but it will return. 

Praying for you and a good out come. 

I have just finished 10 months of 1 @ month IV doxil.  I was told the max amount is a 550mg so I'm done.  It was effective for me in that it stablized my CA 125 around the 150 mark and that I guess was a good thing  The best part was minimal  side effects and I have felt good and we had time inbetween for fun travel.  What is next is the question that we, my medical team, and I are trying to fiqure out.  Avastatin was not given along with my Doxil and I wonder why, as well as Dosxil was IV not IP.  I know everyone is different  and different treatments are given but questions are always there of is there a better way!  I will raise these questions next meeting with oncology.  This carcinomatosis of the peritoneal cavity is a tricky and persistemt thing.  Blessings to you all.

Noelle, visitor from the Uterine board here.  Wanted to say if you can't get your oncologist and want answers - I agree with you to get a second opinion.  You have to be your own advocate to PUSH for answers to your questions and concerns.

I am happy to hear you are getting a second opinion. You have to be able to trust your doctor if you don't trust them then they need replaced. 

You may want to keep going to chemo till you get the second opinion. I know how hard it is to keep going to chemo when your sick and just don't know if you want too. I just finished round 4 of 6 and it's hard for me to go. In fact my BP was high for the first time in years at my last chemo treatment do to knowing what was coming and just not wanting to be there. It seems to me that common sense tells us to run from things that hurt or make us sick. Chemo makes us sick so of course we don't want to go. We do it knowing that we will get better. However if you don't trust what your doctors are saying to you then it's hard to go to chemo and be made sick. 

I wish you luck with what ever you decide to do. 

I am so sorry for the problems you have faced.  Stress and problems are not what you need.  .  Your medical treatment should be directed by you not a nurse. Advice from an oncologist yes, but the decision should be yours without an arguement from anyone. You know your body better than anyone else.   A good quality of life is the goal for all of us.  Hope, support and optimism are among the many positve prayers coming your way as well as traveling mercies.  

Dear AMartin:

Would I be correct in assuming that you have had Cytoreductive Surgery?  You have written on both the Peritoneal and Ovarian links.  Often oncologists will say, “We have other tools in our box that we can use!”  You might want to ask if your doc has anything else in his/her “tool box”!  You’re not the first one that has had adverse side effects with the use of DOXIL…sore mouth, blisters on feet till they can’t walk, skin peeling on fingers, etc.  Those are symptoms that several have expressed here.  I’ve just mentioned a few of late that are “suffering” side effects from Doxil.  And Avastin doesn’t have a 5-Star rating either! 

“Guitardiva” has had her share of both Doxil and Avastin – Below are a few comments from ladies here about the effects of Avastin/Doxil as well as some medical info from clinical trials. 

My chemo combo of Carboplatin/Paclitaxel (Taxol) has had good effects in affording me some extra time, but none were ever intended to be curative.  My last CT scan on September 5, 2017 shows a gradual increase in the size of previous nodes, more pleural effusion, new node on Caudate lobe of liver, plus other things.  My oncologist gave me a list of other “tools” we could “try”, plus some clinical trials.  He mentioned both Doxil and Avastin.  Based on what my “OC sisters” are suffering from those two “tools”, I threw up my hands and said, “No way!”    And if Doxil/Avastin haven’t worked out so well for many others, then why do I want to jump in?  My oncologist explained to me that all the other choices fall in line below the standard recommended treatment for both Peritoneal and Ovarian Cancer which is Carboplatin/Paclitaxel (Taxol).  Now we know that some are resistant to the “platin” family, and have to try something else.  But for the most part, clinical trials have shown that the Carbo/Taxol regimen has worked well for the highest number of women diagnosed with Ovarian Cancer.  He also explained that the others would carry with it a higher level of toxicity for me.  He gave me a list of about 8 options. 

So that’s where I find myself.  Out on a limb and not certain what to do next.  So for now, I’m just “waiting” because I’m not happy about any of the choices.  And I may just opt for some immunotherapy trial—after all, aren’t they all in essence just that—TRIALS?

The old expression, “I’d rather dance with the devil that I do know rather than with the one I don’t know” applies here for me.  Since I’m in the “guinea pig” category anyway, I’d just as soon climb out on another limb.  But there again, how many pigs survive when they attempt to climb a tree, and go out on a limb?  That’s how I feel as far as “which tool, if any at all, should I choose?”  I don’t consider myself a fatalist, just a realist.  It’s just that I’m not fond of any of the “choices” that I am free to make. 

However, as a woman of faith, I do agree with the Psalmist David’s sentiments in Psalm 139.  I firmly believe in an omniscient, omnipresent and omnipotent God Who watches over me.  I am convinced that I will not die one day sooner than the number of days allotted to me on this earth.  Further, I am grateful for the days afforded me so far since being diagnosed with Peritoneal Carcinomatosis/Ovarian Cancer in November & December of 2012.  It has not been without many “trials”.  But when I last checked the definition of “terminal”, it did indicate a cessation of activities at some point.  My ultimate destination is Heaven, so why should I expect “Heaven on Earth?”  I am constantly praying that the Lord will lay on my heart which decision to make, as well as guide my oncologist in advising me along the way.

I absolutely agree with you that “Quality of Life” takes priority over “Quantity of Life.”  All the while remembering that… “Life isn’t about waiting for the storm to pass—It’s about learning how to dance in the rain.” Now that’s not to say that I voluntarily signed up for this course.  I do find the slippers pinch my toes quite often! 

Loretta

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1.       https://csn.cancer.org/comment/1589259#comment-1589259  “Guitardiva” stopping Doxil/Avastin because of such severe side effects

2.       https://csn.cancer.org/node/310562 - Pattie asking about Doxil/Avastin

3.      https://csn.cancer.org/node/311458 -   advantages vs. Disadvantages of AVASTIN

4.      https://csn.cancer.org/comment/1590482#comment-1590482 – Severe blistering

5.      https://csn.cancer.org/node/206203   Carole’s experience with Avastin

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6.       http://www.webmd.com/cancer/cervical-cancer/news/20140219/avastin-shows-mixed-results-against-different-cancers?page=2

“Avastin: Mixed Results against Different Cancers…”

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7.      http://www.medpagetoday.com/MeetingCoverage/SGO/50720?xid=nl_mpt_DHE_2015-03-31&eun=g67937d0r&userid=67937&mu_id=5067363

“Meeting Coverage 03.30.2015”

“MIXED RESULTS FOR AVASTIN PLUS CHEMO IN OVARIAN CANCER

Regimen improves survival but study misses cutoff for statistical significance… Patients who received carboplatin, paclitaxel, and bevacizumab had a median overall survival (OS) of 42.2 months compared with 37.3 months for platinum-taxane doublet. Nonetheless, the 5-month difference just missed the trial's cutoff for statistical significance (P=0.056 versus P=0.05)…

"Paclitaxel plus carboplatin and bevacizumab extended overall survival in patients with platinum-sensitive recurrent ovarian cancer, but the difference did not reach statistical significance," said Robert L. Coleman, MD, of the MD Anderson Cancer Center in Houston. "The combination was associated with a significant improvement in progression-free survival."

Adverse events occurred more frequently with bevacizumab, including grade 3-plus thromboembolism (4% versus 1%),

Infection (13% versus 6%),

Hypertension (12% versus 1%),

And proteinuria (8% versus 0%).

Gastrointestinal perforation, fistula, or abscess (all grades) also occurred more often in the bevacizumab arm (15% versus 4%).

In general, a quality-of-life assessment showed no deterioration of life quality in patients randomized to bevacizumab.

Adverse events of special interest occurred with similar frequency in the two arms: allergy/hypersensitivity reaction (27% with bevacizumab, 25% without),

all-cause mortality (2.4% versus 0.6%), and deaths possibly related to study treatment (2% overall)… The GOG213 trial was supported by the National Cancer Institute.”

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8.      http://www.medpagetoday.com/clinical-context/GynecologicCancers/56872

cme/ce Clinical Context 03.22.2016

“SGO: Optimal Chemo for Ovarian Cancer Fails to Emerge

No PFS difference among three regimens evaluated in key trial

• by Charles Bankhead - Staff Writer, MedPage Today

Action Points

• Note that these studies were published as abstracts and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• Results of a long-awaited ovarian cancer trial failed to show an advantage for any of three chemotherapy regimens.
• Note that the regimens -- involving combinations of intraperitoneal (IP) and intravenous (IV) chemotherapy plus bevacizumab (Avastin) -- led to a median progression-free survival of 27 to 29 months in patients with optimally debulked stage II-III disease.

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.

The results were a far cry from the 60-month median PFS in optimally debulked patients achieved with a higher dose of IP cisplatin in the Gynecologic Oncology Group (GOG) 172 trial reported more than a decade ago, and the three regimens' median PFS values remained similar to the 24-month median for all patients in GOG 172.

Moreover, toxicity remained a problem, although not nearly as severe as what was observed in GOG 172, reported Joan L. Walker, MD, of Oklahoma University's Stephenson Cancer Center in Oklahoma City, here at the Society of Gynecologic Oncology meeting…”

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doxil literally burned my upper body and now starting Avastin today for Uterinr cancer. MDA doctor told me Doxil fir rest of my life. local doctor putting me on Avastin. I plan to return to MDA show them pictures and get even more opinions. Feels they don’t know what to do with me.