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Post-Chemo Treatment Options Post-Chemo Treatment Options

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Unread 07-14-2003, 10:29 PM
Post-Chemo Treatment Options

I've spoken with three different doctors and have gotten three different suggestions for post-chemo options. I will have 4-6 weeks after my last chemo during which to make a decision. As such, I'm interested in any thoughts that you have to share on any of these potential post-chemo therapy options:

1. Twelve months of weekly Taxol (most people's hair grows back, and since the dose is low, side effects are minimal to non-existent). My surgeon said this is proving to be very helpful in preventing recurrence. But I assume it takes a toll on your body.

2. Intraperitoneal Taxotere (injected straight into the abdomen). The doctor who oversees this is at another hospital, and has great success with it. I need to do more research.

3. Second-look surgery, and then treating until there is no evidence of disease (NED). While my surgeon is for second-look surgeries, he says that they by no means reduce the risk of recurrence. He also says that they cannot guarantee "no disease" after this type of surgery, which, he said, is fairly major and complicated. Despite all the biopsies that can be performed, there can always be something hiding. So it may not be worth it. This approach was, however, suggested by one of the top ovaca doctors in the country.

4. OvaRex Trial (though I am leaning away from this as my CA125 would get permanently messed up and would not be reported to my doctor, even if it rises -- there is also a chance I would get a placebo)

5. Just watch my CA125 and continue down a path of healthy eating and exercise

As I mentioned in another post, two of the senior physicians I've spoken to at Kaiser and USC Norris Cancer Center have said basically the same thing: Once you get through chemo for this type of cancer, it's kind of difficult to determine what to do, and no one really knows the answer. I appreciate this type of honesty.

Your thoughts on any of the above are appreciated. It takes me a long time to make decisions about stuff like this, so I have to start now. If 50% of people who respond to chemo ultimately recur, there is no reason to believe that I wouldn't be in the "non-recurrence" group. However, there is a small window during which I can opt for other traditional approaches . . . so I have to consider everything.

Thanks for any thoughts you might be able to share!

Funny aside: My white count today was 43! (Of course, that was also "critical," but on the high side. My random glucose was also way high, but they think that's because of the steroids. I'll get it checked again on Friday. Neupogen will start up again on Wednesday.)
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Unread 07-14-2003, 10:47 PM
Post-Chemo Treatment Options

Wow, lot's of choices. I wasn't given tne option of more chemo to prevent recurrence. They just monitir me with PET scans. When my Dr reversed the colostomy he did a second look, while he was in there, but wouldn't have done this if I weren't hvaing surgery. I would not choose the 2nd look surgery, because of all the adhesions and as you said something can be hiding. I wouldn't go with the Ovarax either., so that just leaves the 12 month Taxol and the intraperitoneal Taxotere. Did the Doctor tell you how much these treatments increae your chances of not having a recurrence?
I would probably just go with the healthy eating, watch the CA 125, have regular scans and treat a recurrence if it arises. Cancer, and all the different treatment options we face, possible outcomes make me feel like I'm in a Dirty Harry movie " Do you feel lucky?" I am not much help am I?
I guess if it were me I'd get the opinion of the Dr I trust most and I'd pray, hope God would guide my choice.
Unread 07-15-2003, 07:10 AM
Quite a list of choices

Is that 12 months of weekly taxol or 12 months of low dose taxol once a month? I haven't heard of a year of weekly low dose taxol but I have heard of a year of low dose monthly. Some Drs. feel that it's helpful and others say there's no protocol for it. I know a woman who did this, stopped, and recurred shortly thereafter. There's no consensus on what I can see.

IP taxotere--it does make sense to hit the cancer right where it would be lurking--in the abdominal area. I'd definitely want a consult with that Dr. before deciding yes or no.

Ovarex--seems to work very well in trials but like you say it fouls up CA125. Remember though CA125 is not perfect--on a big ovarian board, a woman whose CA125 was steady at 8 went to 9. She insisted on a CT scan and was right--she had a widespread recurrence. Another friend was at 4 when they saw something they ignored on her CT scan--by the time she was at 6 she had ascities and a tumor full of cancer. So fouling up CA125 shouldn't necessarily be the sole reason to say no to Ovarex.

Second Look Surgery--I wasn't offered that and know it's not done much these days--it could spot tiny cancers but personally I have no desire to be opened again except in an emergency.

Lots of choices and decisions. All have pluses and minuses. You may want a second consult and definitely find out if it's 52 weekly taxol or 12 monthly taxol.

As for me--at my recurrence I had the choice of continuing on with Carboplatin at a lowered dose monthly or standard dose every other month until it failed and then going to another drug. I had the choice of stopping after 8. There is no protocol that either one would produce a better result. I chose to stop the carboplatin and wait. My body was not in good shape, as carboplatin took a major toll on my digestive system and my blood counts/bone marrow. My emotional state was tired as well. I looked at this and decided that if I stopped and the cancer returned, I would have another chance at carboplatin; if I went on until it failed, I would be looking again at drugs I do not want. I chose to stop.

Think it through carefully. These were my choices and my opinions personally, and should not be considered as offering any medical advice.
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Unread 07-15-2003, 08:26 AM
Post-Chemo Treatment Options

s SirenSong

It is tough to make a decision like this. And it truly is about what you will regret the least in the future.
Just some thoughts to consider:
Intraperitoneal chemo does have so many potential side effects.
The biggest being infection. There would be an open wound in your abdomen where the cathetar through.
Consolidation with taxol has not yet shown to increase survival time. So you could conceivably be sacrificing good healthy remission time while you continue to be immunosuppressed.
At the SGO conference in February, none of the gyn onc who were on the panel, agreed with taxol consolidation. Although it certainly is done quite often.
Consolidation is an area of huge research. Drugs with different mechanisms of attacking the tumor are constantly being researched.
It will be interesting to see what you decide SirenSong.
Best wishes in this process.

Unread 07-15-2003, 01:29 PM

Siren Song,

You have a number of post chemo options to consider and then to chose from. They seem to range from clinical trials - the OvaRex - to 12 months of Taxol. I would agree with your concerns on the former - you might be in the placebo group, and with your concerns on the latter "takes a toll on your body". BUT! they both are valid.

And Intraperitoneal Taxotere has had success as you mention. How long would that particular post chemo option last for? 12 months like low dose Taxol?

Second look surgery has also been mentioned to me, and additional chemo - up to 9, if necessary this go round, BUT, having 'passed' the 3rd chemo which I consider a watershed, I can just focus on going through the program now. But, I know how important it is in life to have options. The key is what you are doing - research the best one for you.
Unread 07-15-2003, 03:20 PM
Post-Chemo Treatment Options

Siren Song
You have been given some interesting options. My advice is to research them & perhaps seek a second opinion. My CA 125 is not a good marker for me so that wouldnt' factor into my deliberations. But I know that marker is important to many people.

Good Luck in your decision. I think it is great that patients are now given options regarding their healthcare.

Ruth S
Unread 07-18-2003, 07:09 PM
Post-Chemo Treatment Options

Hi Siren....

Gee Wizz.....They are really giving you lots of choices.

My oncologist specializes in ovarian cancers and I was not given choices.. She and my oncologist/gynocologist said that they do not do second look surgery anymore so that was not even an option for me.

She goes with healthy eating, seeing her every 3 months for the first two years and every 6 months after that for 5 years. She also watches, very closely, my ca125 number and abdominal cat scans periodically.

she did mention to me that she has been watching the overex trials and liked what she saw. I will check again with her at my next appointment.

Unread 07-19-2003, 11:46 AM
Post-Chemo Treatment Options

Sigh. I wanted to get a second opinion about post-chemo treatment options from a respected doctor at another hospital that my insurance won't cover. The price? $700-1000, depending on whether you want a path review.

Isn't that amazing? I've been so spoiled by my HMO that I had no idea how much it would cost to go somewhere else. (Luckily, the doctor in question trained my surgeon, so I suspect I might be fine not speaking with him. We've traded e-mails, and I've learned a lot from those.)

The OvaRex trial seems interesting, but I don't like the "messing up the CA125" aspect of it. I have to secure and read the disclosure document before I make a decision on that.

Meanwhile, Chemo No. 5 went fine. Tired and achey, but that's to be expected. This heat hasn't been helping. Tomorrow's plan: To get an air conditioner. :-)
Unread 07-21-2003, 09:12 AM
Post-Chemo Treatment Options

You have accomplished Chemo #5. Almost over, and it must be a feeling of relief, I would hope. And hope that you get lovely breezes today - I know only too well about heat - "sultry and hot showers" (??) here today, and, no, no air conditioning!

Big to you
Unread 07-21-2003, 11:35 AM
Post-Chemo Treatment Options

s Dina

Congrats on getting number five done!!!! You are almost there.
I have been looking further into the ovarian cancer vaccine.
My docs at Fox Chase. who are not easily impressed with many trials, feel this is worth checking out further.
If anyone is interested, just type ovarian cancer vaccine into a google search, and the Natl Cancer Institute site regarding this will come up.
Also, Catherine Maruffi is the research nurse on this trial.
She can be reached at 301 435 5392.


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