Ovarian Cancer Stage 3C Results.

• By gpawelski
• Posted October 1, 2009 at 11:22 am
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edna

Some ovarian cancer patients do have tumors which are equisitely sensitive to platinum (carboplatin). These patients should be treated with aggressive platinum dosing, because you have a good shot at getting a very long term survival.

Was you mother's cancer cells sensitive to carboplatin therapy? Giving high dose platinum to patients with intrinsically resistant disease doubtless causes more hurt than help.

You may want to reserve aggressive therapy for those patients who will derive more benefit than harm, while identifying the most promising treatment regimens. In patients with tumors very resistant to cytotoxic chemotherapy, the most promising treatments may be angiogenesis inhibitors, growth factor inhibitors, or more integrative medicine approaches.

It may be better not to give more aggressive and toxic, mutagenic and immunosuppressive combinations, but to give "targeted" single agents, or give least toxic mutagenic synergistic combinations. Although something may be an above-average regimen in some patients, it may not be a highly active regimen in others.

More emphasis could be put on matching treatment to the patient, through the use of individualized pre-testing, having more respect for minimal partial response or stable disease, when it can be achieved through use of the least toxic and mutagenic drug regimens, and reserve the use of higher dose therapy or aggressive combination chemotherapy to those patients with tumor biologies most amenable to attack and destroy by these treatments.

Trying to mate a notoriously heterogeneous disease into one-size-fits-all treatments is disingenuous to all who are inflicted with it. Knowing which chemotherapy agents the patient's cancer cells are resistant to is important. These options can be eliminated. Knowing which chemotherapy agents are most effective is important too. Chossing the most effective agent can help patients to avoid the physical, emotional and financial costs of failed therapy and experience an increased quality of life.

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• By edna72375
• Posted October 6, 2009 at 10:31 am
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Thank You so much for your informational reply. I do appreciate it. Your right I think we really should now which chemotherapy drugs is working.

Edna

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• By edna72375
• Posted October 7, 2009 at 4:14 pm
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Dear Sir,

You impress me with your suggestion is there a way I can call you or feel free to call me to discuss the treatment further. My number is 916 519 2754. I really want to connect with you for I feel you gave me the best suggestion.

Allow me to give brief information regarding my Mom's history. My Mom was diagnosed with Papillary Seous Carcinoma back in 2006. She is 71 yrs old. She has ovarian cancer stage 3 C, and she carries BRCA 1 or BRCA 2 genes.

In 2006, she did 2 surgery. The first surgery, they just opened and checked everything and closed it. Then she had 4 times chemo therapy by using carboplatin and taxol. After that the Doctor reopened it and did cytoreductive surgery. Then, she received 7 times chemo.

In May of 2008, the cancer recured. She's been on chemo therapy for 11 times, that includes doxil 5 times, mixture of avastin and cytoxan 6 times. Her CA 125 is around 354, and gradually goes up. I looked for the best solution to get her CA 125 controlled. I moved her to different Doctor and they put her back on carboplatin. The Doctor said this is the best medicine for BRCA 1 and 2 genes mutation. Her CA 125 jumps from 1,017 to 1,600 in 3 weeks time even after receiving the 1st cycle. She just finished her 2nd cycle. I ask the Doctor for an increase in dosage and she agreed. They will probably increase the carboplatin on the 3rd cycle. Did I do the right thing? Yes, the Doctor said she is platinum sensitive.

The original plan is to put her on clinical trial for Olaparib (PARP Inhibitor). The requirement is to be able to recieved 4 cycles of carboplatin and be stable enough to participate on the trial.

Do you think carboplatin is the best medicine for her? What do you thing about Olaparib?

If carboplatin is the best medicine according to the Doctor so did she get any worst when they put her on doxil, avastin and cytoxan.

What do you think about Gemzar? The other Doctor introduces carboplatin and Gemzar.

If you need more info let me know.

Thank you,

Edna

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• By gpawelski
• Posted October 7, 2009 at 8:49 pm
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Edna

In regards to your doctor saying that she is platinum sensitive, patients would certainly have a better chance of success had their cancer been chemo-sensitive rather than chemo-resistant, where it is more apparent that chemotherapy improves the survival of patients, and where identifying the most effective chemotherapy would be more likely to improve survival.

Chemotherapy is chosen on the basis of clinical evidence (clinical trials). However, clinical trials are highly empirical, they test drugs on general populations and then look for a clincial response and a treatment effect that is not likely to be a chance result. However, the side effect of this is inflexibility, some individual patients may unnecessa rily be exposed to inferior experimental therapies.

A problem with the empirical approach is it yields information about how large "populations" are likely to respond to a treatment. Doctors don't treat populations, they treat "individual" patients. Because of this, doctors give treatments knowing full well that only a certain percentage of patients will receive a benefit from any given medicine. The empirical approach doesn't tell doctors how to personalize their care to individual patients.

A good benchmark assessment of the "efficacy" of drugs that come out of clinical trials, could be "Cell Function Analysis." Cell Function Analysis, using a cell-death endpoint, can help see what treatments would not have the best opportunity of being successful (resistant) and identify drugs that have the best opportunity of being successful (sensitive).

Patient tumors with the same histology do not necessarily respond identically to the same agent or dose schedule of multiple agents. Laboratory screening of "live" samples from a patient's tumor can help select the appropriate treatment to administer, avoiding ineffective drugs and sparing patients the side effects normally associated with these agents.

It can provide predictive information to help physicians choose between chemotherapy drugs, eliminate potentially ineffective drugs from treatment regimens and assist in the formulation of an optimal t herapy choice for each patient. This can spare the patient from unnecessary toxicity associated with ineffective treatment and offers a better chance of tumor response resulting in progression-free survival.

Identifying patients with resistant neoplasms may not only spare them toxicity but may prolong their lives, by sparing them from the life shortening effects of ineffective chemotherapy.

Again, patients would certainly have a better chance of success had their cancer been chemo-sensitive rather than chemo-resistant, where it is more apparent that chemotherapy improves the survival of patients, and where identifying the most effective chemotherapy would be more likely to improve survival above that achieved with empiric chemotherapy.

With the absence of effective laboratory tests to guide physicians, many patients do not even get a second chance at treatment when their disease progresses. Spending six to eight weeks to diagnose treatment failure often consumes a substantial portion of a patient's remaining survival, not to mention toxicities and mutagenic effects. In cases where there are several equivalent treatments available, patients can benefit from these assay-testing results as a supplement to other clinical data when deciding on a treatment option.

It's always going to be a case of what works best for you, after you perform extensive research and study. Your life depends on all the information you can muster. This is called informed consent. You must be aware of all possible "problems" as well as the "benefits." In addition, the physician "informing" a patient needs to spend enough time to make sure that the patient understands well enough that the "consent" is truly "informed."

That said, I would not venture a recommendation of treatment for anyone, except (again) that patients would certainly have a better chance of success had their cancer been chemo-sensitive rather than chemo-resistant, where it is more apparent that chemotherapy improves the survival of patients, and where identifying the most effective chemotherapy would be more likely to improve survival.

Empiric, physician's choice chemotherapy for patients who have undergone surgical resection is recommended without knowledge of the tumor's specific biologic characteristics and many patients my not benefit. Multi-drug resistance is common in many solid tumor cancers. As a result, a majority of patients endure a predictable toxicity from empiric-based chemotherapy without a survival advantage.

Many patients are treated not only with targeted therapy, but with a combination of chemotherapy drugs. The oncologist might need to administer several chemotherapy drugs at varying doses because tumor cells express survival factors with a wide degree of individual cell variability.

To beat down your individual cancer mortality, an oncologist needs to target all the many cancers that make up your individual cancer, the dozens of different pathways that cells use to proliferate and spread. That is the leading edge of research and treatment today, determining how an individual's tumor cells work and hitting those pathways with multiple drugs, simultaneously or sequentially, each chosen because it targets one of those growth, replication and angiogenesis pathways.

Over the last fifteen years, advances in cell culture technology, test availability, reliability and reproducibility of measurable "cell-death" endpoints have contributed to the accuracy of cell culture assays. These advances have prompted Medicare coverage for the tests as Oncologic in Vitro Chemoresponse Assays. The decision had been made that the assay is a perfectly appropriate medical service, worthy of coverage on a non-investigational basis.

The hope is to match tumor type to drug. You need to make the next leap, getting the right drug to the patient.

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