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Alternate Chemo treatment Serous cell

David_01
Posts: 13
Joined: Feb 2020

Hi Guys,

My wife has just had an MRI and it looks like the Paclitaxel/Carboplatin treatment is not being effective at fighting a reacurrence.

My wife was originally diagnosed with Stage 1 high grade and had a full hystorectomy in June of last year. They staged the cancer as Stage 1A, but as 15% of cells were Serous they upgraded from grade 3 to Serous cell.

Post treatment was recommended as just Chemo, but after her first treatment of chemo, she has had a reoccurence (3 months after surgery). So then after 5 weeks of radiation she returned to Chemo treatment and has now had 4 infusions of the Carbo/Taxel. Just as an asside she was not able to have the treatment every 3 weeks as renal failure side affect and positive covid delayed regular treatment.

So my question is does anyone know of any other recommended treatment as we go back to the oncologist in a few days.

Thanks you all in advance for any assistance.

David

ConnieSW
Posts: 1546
Joined: Jun 2012

leave a response to this to the ladies here with personal experience to answer you.  I am sure someone will be along soon but couldn't bear you seeing all the reads without an acknowledgment.  I am glad you found your way here.

David_01
Posts: 13
Joined: Feb 2020

Thanks Connie --- I am a regular reader myself. I only post when I need to pick the brains of the experts and obviously as a man it is hard for me to comment other that about how to support.

LisaPizza's picture
LisaPizza
Posts: 340
Joined: Feb 2018

I'll cut and paste below the list of alternate therapies from the NCCN guidelines. Not all of them are used commonly. The hormonal therapies are not generally first choice after frontline chemo fails, but might be tried in some circumstances or after finishing chemo. It's probably an overwhelming list, but oncology is like that :( Decisions depend in a lot of factors. Some are even pills.

 

One thing I would recommend is asking about molecular testing. Some therapies, not listed below, are specific to certain mutations, like trastuzumab for HER-2, pembrolizumanb or nivolumab for mismatch repair-deficient (dMMR), and another one I've never heard of and I guess must be rare (Larotrectinib or entrectinib for NTRK gene fusion-positive tumors). I get the impression not all oncologists check for some of these until asked.

 

 

 

 

Systemic therapies

 

• 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)

• Ifosfamide (for carcinosarcoma)

• Ifosfamide/paclitaxel (for carcinosarcoma)

• Cisplatin/ifosfamide (for carcinosarcoma

 

Biomarker-directed systemic  therapy for second-line treatment

 

• Lenvatinib/pembrolizumab

 

Hormone therapy

 

• Medroxyprogesterone acetate/tamoxifen 

(alternating)

• Megestrol acetate/tamoxifen (alternating)

• Progestational agents

Medroxyprogesterone acetate

Megestrol acetate

• Aromatase inhibitors

• Tamoxifen

• Fulvestrant

 

• Everolimus/letrozole

 

 

 

alicia2020
Posts: 114
Joined: Sep 2020

I can't really offer any answers, but I wanted to respond. As ConnieSW said, others will be along soon.
But, I found your post a little confusing , so maybe you could clarify!
So, post-surgery treatment was just chemotherapy? 6 rounds? So she did 6 rounds & then had recurrence? Time-wise that kind of didn't make sense....with time to recover from surgery and then 6 rounds of chemotherapy normally takes 18 weeks, I was confused as to how she could have a recurrence 3 months after surgery. I wasn't clear as to how she ended up on a radiation schedule.
I have no idea what consequence a delay in a 3 week chemo schedule might cause. I'm so sorry about the COVID interference. I have worried about it for months saying, "I'm not worried about getting COVID, or even dying from it. What I'm worried about is if I get it, it will delay my cancer treatment, and THAT might have dire consequences." I don't have an answer, but maybe your wife's doctor will.

I wish you both well.

Alicia

David_01
Posts: 13
Joined: Feb 2020

Hi Alicia-Sorry I confused you with the timeline. My wife had only one infusion chemo treatment before we discovered she had a reaccurance. that was then followed by 5 weeks of 5 days a week radiation to treat the new tumours. Lagest 2.5 x 2.5 1 inch. The radiation treatment reduced the size of tumour to .7 diameter. 

She then had 2 infusion treatments 3 weeks apart, but then went into renal failure when the 4th (total) infusion was due. So she had to go into hospital for 1 week. The following week I had a cough and we both were tested and positive for covid (wife had no symptoms)- cancer center delayed return for 3 weeks i.e. 7 weeks between 3rd and 4th chemo treatments. -- hope that helps. David

Molly110
Posts: 186
Joined: Oct 2019

Hello, David. I had uterine papillary serous cancer, also stage 1, and finished treatment last January -- 6 rounds of taxol/carboplatin and 5 internal radiation (brachytherapy) sessions. I wish I could be helpful, but I didn't even know it was possible to have a recurrence after surgery and one session of chemo. I had a CT scan before surgery, then surgery, then treatment, but there was no scan or CA-125 test done while I was in treatment, so I don't know what might have been going on internally. Three weeks after I completed chemo, my CA-125 was tested, and had dropped from 25 at diagnosis to 7, so the assumption was that the treatment was effective. I continue to have 3-month check ups and will have a scan yearly. 

There are several women who post regularly who also have/had serous, and they are likely much more knowledgeable than I am about alternatives.

Warm best wishes.

Molly

alicia2020
Posts: 114
Joined: Sep 2020

Like Molly, I had never heard of a recurrence so soon. I started chemotherapy about 7-8 weeks after my second surgery (long wait time for results and then trying to determine “primary“ tumor of origin.) They are checking my CA125 every 3 weeks with bloodwork done a couple of days before next infusion & I will have a CT 3 weeks after last infusion.

I’m so sorry you & your wife are having such a difficult time of it. I thought Lisa’s list was impressive & offered lots of hope for finding one that works!

Best, Alicia

David_01
Posts: 13
Joined: Feb 2020

Yes 3 months was very early. My wife started experiencing vaginal bleeding so we went to the gyn oncologist and he said that the stitching on cervix probably came loose. To be sure they did an MRI as CT was not clear enough. So we were lucky that the stitching came loose, otherwise who know how long it would have gone before we found it. As my wife was not noticing any other symptoms. -- Yes I am a glass half full person. Thanks David

Molly110
Posts: 186
Joined: Oct 2019

Ah, I see. I hope some of the more expereinced women see your post and can share what they know. The discussion board seems quiet lately, perhaps because a cherished longtime particiipant passed away recentlly and another much-loved and admired woman is in hospice and has been saying goodbye. 

Lisa had some great information, and I'm sure others will help also.

Take care,

Molly

els19
Posts: 91
Joined: Jun 2014

David has she had genomic testing? With it they can see if they can find a target for her cancer and put her on immunotherapy. A close fried has stage four colon cancer. Chemotherapy didn't help her at all but immunotherapy is working unbelievably well. I know, a different cancer but it shows that people respond differently to treatment. Good luck!

David_01
Posts: 13
Joined: Feb 2020

Thanks els19 -- no she has not any genomic testing and I will ask about it with our oncologist this afternoon.

Maxster
Posts: 63
Joined: Apr 2020

Hello David,  I am sorry to hear of your wife's situation.  I was diagnosed with Stage 3C Grade 3 uterine papillary serous cancer in September of 2019.  I did get a second opinion on treatment.  One thing I believe is true is that when you have the full hysterectomy (uterus, fallopian tubes, ovaries and cervix), there is no cervix to be stitched.  So I am confused as to what type of surgery your wife had.  It is important to remove everything and also have a pelvic wash which can help detect any cancer in that area.  I advise you to find out exactly what they did.  You can have the whole medical history including slides sent to a second opinion of your choice.  They can do many things via telehealth without having to physically exam your wife.  For me it brough great piece of mind and treatment suggested between the two was similar tho not exact.  I had the complete history and 6 sessions of carbo/taxol therapy and 25 rounds of pelvic radiation due to a suspicious node.  I hope she responds well to the chemo and does not experience renal failure again.  If you click on my name you can find out the full course of my treatment.  For follow-up I have a pelvic exam and CA125 every three months.  I do not get a routine CT scan as all three doctors who saw me said the research did not support their use.  Unless my CA125 goes over 35 I will not have one.  My best advice is have someone else take a look at things.  It can be very helpful.  I recommend Memorial Sloan Kettering who does this remotely.  They also will do the genomic testing.  My best to you and your wife.

Theskinnyscot's picture
Theskinnyscot
Posts: 31
Joined: Dec 2019

I think he means the stitching for the vaginal cuff.

David_01
Posts: 13
Joined: Feb 2020

Yes vaginal cuff -- sorry.

David_01
Posts: 13
Joined: Feb 2020

Hi Maxster - yes we have already gone down the second opinion when the first Gyn Oncologist did not want to perform a hysterectomy because of my wifes existing medical issues (see previous post 10 march 2020). I sort of have already a built in second opinion route as our Gyn Oncologist is not the chemo oncologist and we discuss my wifes treatment with both. They are seperate orginisations so true second opinions. - Although I may still get a third opinion when they come up with the next treatment plan as it was confirmed that the carbo/taxel is not working.

Thanks

David

Dak82's picture
Dak82
Posts: 34
Joined: Dec 2020

David I admire your activity to get answers regarding your wife's treatment. Not all husbands--in this case--can face it that head on. My Hubble is an example of this latter group. He does not want to discuss the particulars of the cancer and specifics as to how the treatments work. I was diagnose mid-Nov 2020 with stage 3C2 grade 3 endometriosis adenocarcinoma. Radical hysterectomy, lymphectomy, partial vaginectomy were major surgical procedures. Following the surgery the doctors were convinced they'd removed all the cancer. That's all my husband wanted to hear. Pathology came back in 4 days showing cancer in 3/6 para-aortic lymph nodes. So the equation changed a bit. Oh and I had metastasis in the vagina. All that turned my treatments a bit. Husband thought he heard I would do radiation after surgery--heard nothing about chemo. So when the docs rushed to get me started on 6 rounds of taxol/carbo he was confused. Then we threw in in 3 sessions of brachytherapy due to lack of margin in vaginal tissue that was removed. I am now in round 3 recovery time and feeling good.

Don't get me wrong--he is intensely involved in making sure I am managing pain and other side effects of treatment. But all he wants to know about the cancer it's gone. He would not ask any questions beyond that. That's why I admire your involvement and interest. I talk with my sister in great detail but she lives across the country. I wish sometimes he did want to talk more but I have accepted that. We have been married 36 years--our last anniversary was my surgery date--and he's never been a talker so I know that won't change!

Keep researching and advocating for your wife and I wish you all the best.

 

Deb

David_01
Posts: 13
Joined: Feb 2020

Thanks Deb. This June will be our 40th aniversery and we are a team. I'm an engineer by trade and studying and problem solving is how I am.

The Test results this week were not good as the Cancer is spreading, but still mostly in the Pelvis area. A couple of tumours are restricting flow between kidneys and bladder so she will be having stents installed next week . We hope this fix he kidney problems. The oncologist is having full genetic testing from the original removed tumour/uterus, so we have an appointment in 2 weeks to lay out the next stage of treatment.

David

Dak82's picture
Dak82
Posts: 34
Joined: Dec 2020

So sorry to hear this. I have been very lucky that my diagnosis and treatment follow a very straight line--nothing has happened to disrupt treatment. I was blessed with a robust immune system and never got sick. I chalked that up to the exercise I love to do and even participating in endurance events events such as triathlons.

I pray you and your wife achieve some stability as you fight this together.

Deb

els19
Posts: 91
Joined: Jun 2014

David, some people are just resistant to chemotherapy. I really thought my friend was going to die when chemo didn't work for her. But she's thriving on immunotherapy. There are many different drugs and there are a lot of research studies out there. Hopefully it's just a matter of finding the right therapy for her. We're all different and I often respond to drugs the opposite of most people. My husband and I are also a team and recently celebrated our 50th anniversary. I can't imagine going through all I have with this cancer without him. Your wife is lucky to have you. I'm praying for both of you. 

David_01
Posts: 13
Joined: Feb 2020

Hi els, Yes that is what the doctor was hoping will be the best option for my wife now.

Thanks David

Flufff's picture
Flufff
Posts: 68
Joined: Apr 2019

I had one just 4 months after treatment ended. Also serous. 

I would ask for immunotherapy. Is your wife's cancer hormone driven? If yes, she can get anti hormones as well..

 

hoping for the best for you and your wife <3

David_01
Posts: 13
Joined: Feb 2020

Hi Fluff, I think that is what they are trying to determine with this round of testing, as the original testing did not give them all the details that they wanted to see. 

Thanks

David

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