MMMT Chemo / Radiation Regimen

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.

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.

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 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 with us to share the good news that your mother has finished chemo. Hope she has smooth sailing ahead.