Answers from a Doctor

To all who responded to my "4th chemo postponed" thread, thank you. I drafted up some questions and actually got a lengthy response from a gyn/onc (not my doctor, but someone who was recommended to me) this morning and thought I'd share a paraphrase of the exchange.

1. Blood counts are expected to drop dramatically after Neupogen shots -- usually by 50% on the day after the shots stop. Some patients experience their white count drop 10-15 days after treatment, but some (like me) experience those drops much later. Carboplatin in particular can cause counts to drop significantly.

2. This doctor has not seen any definite proof that 8 treatments are better than 6. Some doctors just prefer to give 8, hoping it will be more effective. The doctor said that this is reasonable, although not proven.

3. There are two approaches to keep chemo on schedule: 1) lowering the dose and 2) starting Neupogen or Neulasta before the counts drop. There is no proof that one approach is better than the other. If I am getting a higher dose of Carboplatin, reducing the dose seems logical. If I am getting a normal dose, then the Neupogen/Neulasta strategy might work.

4. I asked him about maitake mushroom, Essiac tea and marijuana affecting my counts, and he said that nothing I was doing would have affected my counts in any way. He said some patients are just more sensitive. "Remember, the doses we use of chemo are average, meaning that we start every patient at around the same dose. Some need more, some need less." I do know that I'm getting 321 mgs of Taxol. Not sure on the Carboplatin yet; the nurse gave me the wrong info (1000 mgs of Carbo, which can't be right).

5. In general, he agreed with the stats provided to me by my doctor (69% of patients respond to chemo and of those, 50% recur). In terms of preventing recurrence, he has seen two things be somewhat effective:
-- 6 months of an oral chemo agent called Hexalen (after ending 6 cycles of Taxo/Carboplatin). A study suggested that this does decrease recurrence.
-- 12 additional doses of Taxol (no more Carboplatin) also appears (via study) to decrease recurrence.

He mentioned a clinical trial involving intraperitoneal doses of Taxotere. Half the participants get the drug, half get a placebo, so that complicates things a bit. There is also another trial using a "vaccine" (antibody) to delay recurrence.

I thought all of this was of interest, so just wanted to pass it along. I am always grateful when I can get specifics from a doctor.

s!

Although I am not a OVCA person, I liked your info. I can tell that you were brought up in a "medical" enviroment. Dad = doc & Mom = nurse (right???) You were so informative. I do hope that you are able to get back on schedule one way or the other.

I wish you the best of luck.

God Bless & Take care

s SirenSong

Quite a good bit of info there!!! I'd definitely stay in touch with this doc.
I have heard alot about the vaccine. It is being trialed at the Natl Cancer Institute but soon to open wider. And it apparently has minimal side effects. It is currently being used on people in that first remission.

karenann

Karenann --

I will stay in touch with him, and the trial sounds great! But I go to an HMO that is self-encapsulated (e.g., it's a major hospital and everything is provided through its own chain of hospitals). I thus don't think I could go elsewhere without paying. If they're looking for people to participate, though, I would certainly be game. I will inquire about it. Good to know you've heard good things. :-)

Known2B --

How did you remember that about my parents? :-) Thanks for your support. I hope the info was helpful. And thanks for your kind wishes about me getting back on schedule! :-)

Siren:

That's very interesting about the short-term effect of the Neupogen/Neulasta. I guess I'd always thought that the counts stayed higher longer than that .

The vaccines are looking more and more promising all the time. My understanding is that they're doing these for a number of different sorts of neoplasms that might be resistant to chemo (and/or that require such huge chemo doses). You're Kaiser, right? They do participate in clinical trials all the time; my DD has been involved in two. They're big enough to have a significant cohort for trials, and I'd bet they would have something worked out for a specific protocol at another institution. You might be able to find out which trials are available locally (Cedars-Sinai has done vaccine trials in brain cancers, don't know about GYN). And UCLA may also be working on it. A friend of mine has a cousin who has ovca, same stage, who is an RN at UCLA and participating in some protocol there; don't know which one, though.

I'm glad you got some answers. Are your counts improving? ing that you're able to get back to your schedule soon, albeit with a differing dose of carbo perhaps...

Take care; I've been thinking of you often and wondering how it's all going!



Audrey

My computer was down for about a week and I couldn't log on. So sorry to hear about your delay! The information you provided is very helpful. I wish you all the best and that you get back on track very soon. You are in my prayers!