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everyone here seems to have carbo/taxol for first time chemo, why can't we go for drugs like avastin or the platinum based drugs directly for first time chemo?
why wait for recurrence before trying out avastin/platinum based drugs?
Cancer Taxol Surgery Colorectal cancer Avastin Ovarian cancer Taxotere Hernia Cytoxan Pain Carboplatin
Protocol Protocol Protocol.Most women do get the carboplatinum and another drug first line.The Avastin is still in clinical trials so It is not redily available for ovca, unless you sign up for a trial using the Avastin.I signed up when I was diagnosed last year for the clinical trial GOG 218 for carboplatinum/taxol/Avastin.I got the Avasin cycles 2-6, but not after.Needless to say I went into remission for a few months and my Ca slowly rised.I belive the avastin was great for killing the cancer.You can still get the avstin if you get your dr.to send your ins.co.a letter stating you need it, or you can contact the manufacturer directly and ask to get the drug at no cost.Only thing is with clinical trials, its a crap shoot if you are getting the drug of choice or a placebo.I know how you feel about the drug choices the drs.use, yet as I stated above its about the protocol they are under.SOme drs. dont go by that, and do their own thing.Keep Positive.
What works for some doesn't always work for others. I was given taxol/carbo which is first line treatment. That was in 2004, stage 3c. I just passed the 5 yr mark having had no recurrence. So for me, this was the best. Maybe on down the road if I should get it again, it might be a different story.
Platin-drugs with Taxol- drugs are longtime established drugs proven to work. Avastin is fairly new, hugely expensive and the benefit proof is debated. Recently there was a letter in the journal "Nature" , that put up a theory, that Avastin causes regression of tumors at first and then might stimulate faster metastasis. I think it is prudent not to jump on the bandwagon quite yet. The proof is in the pudding; it takes time. Edith
I don't know if there ae any long-term statistics on avastin. Since I had clear-cell, I read a great deal about the various treatments over a year ago. I don't remember whether avastin was on the scene yet. I do remember that effectiveness of other chemos for my type of tumor was either 33% or 25%, and that was the
best-case scenario, not the norm. (It wasn't quite as dire for other types of tumors.)
I had six rounds of carboplatin/taxol and at 20 months past chemo I have NED.
I've also had three drugs for various conditions that did a fantastic job for those conditions but were pulled from the market because they caused heart attacks, strokes, etc. The research on humans had not covered a long-enough time frame for these side effects to show up when the drugs were approved.
It is so frustrating!
Carboplatin is a platinum-based drug. I do want to research any studies done without the accompanying taxol, since I still have neuropathy in my feet (and a little in my fingers--doesn't interfere with teaching, but has played havoc with the crafting).
It is still a big unknown, costly, amd some insurances won't let docs use it. I just had this discussion yesterday with my Onc becuase I am in recurrence. He said here in CA that BS Anthem wiil NOT approve it but most others have.
He likes it, but likes Doxil more.
Jeanie
Right now, the only way to get Avastin as part of front line treatment is to be part of a clinical trial. Three years ago I was in a Phase II clinical trial which did exactly what you suggest. Only 65 or such women were on that trial. There are more extensive phase III trials ongoing now, which are randomizing to different trial arms to determine whether Avastin should only be combined with the chemo cycles or be used for another full year of consolidation therapy. It takes a long time for these trials to close out and show a statistical improvement in time-to-disease-progression, over the standard front-line protocol. I believe that early results will be ready for publication in the next year or so.
Seems as if I have met quite a few women on maintenance Avastin. Medicare has approved it.
I have wondered if soon it will be part of the carbo/taxol initial treatment.
Doxil does seem to be liked especially for liver mets. ANd the parps are going to be huge and soon I think. There is a rush to get them to market and they seem pretty easy to take.
I respectfully disagree with those who say it is only available in a clinical trial. My doc told me yesterday that I can get it as long as insurance pays for it. It is available without clinical trial. I started a discussion about this a few weeks ago and several women responded who are using Avastin and not on clinical trials.
Jeanie
I went back and read the discussion from June 4.
Although It is not FDA approved for OC, it is available for use, if insurance will pay for it. Medicare, among others, will pay for it for OC. This is according to Cara Tenenbaum, at OCNA, and other responders.
Jeanie
More update--Avastin was approved for Ovca by FDA in April or May, at which point it was added to my Taxol/Carbo treatment.
As my CA125 is normal I have just started on Carbo and Avastin only. It was going to be Taxol and Avastin but my feet were getting more and more pain. Without the Taxol they are definitely better, although still have a long way to go.
I believe the plan is to keep taking Avastin as a maintenance drug. Interesting that there is a suggestion that it may not be effective in the long run, altho my doc has people who have been on it for several years (not for Ovca).
A lot of doctors feel that carbo and taxol are the first drugs to use because they are heavy hitters. When there is recurrence, they like to try something else. They are all testing. Right now, no one knows the correct ones to use to have NED.
I'm so happy that more women can get this drug without being in a trial. I guess my info is outdated!
Carbo/Taxol is the first line treatment because it usually works for most people. I know it gave me a 6 yr. remission the first time.
For recurrences, the chemo is usually tailored to fit the case and type of recurrence and that's when all the other drugs come in, including a possible repeat of Carbo/Taxol.
well, according to the clinical trial of carbo/taxol and avastin, by 2012, that will be the standard first line treatment for ov ca. my doc doesn't seem impressed with avastin, but he has it in our arsenol of drugs. he feels even thought the bowel perforation is only 4 or 5% chance, that is a great risk, since it can lead to mortality in 50% of the cases, if it does occur. anyway, if they could use it before tumors or weakenings develop on the intestines, that would eliminate the risk! additionally, it was developed, as i understand for the treatment of colorectal cancer anyway, yet it is highly effective in treating it, and i have read about people being on avastin for almost 2 years. it just seems that they do not get very far with ovarian cancer, because we are in the group of people that are a small percentage when it comes to cancer statistics. they go for curing or helping those masses instead of all of us. we just need to pray GOD will help us, and i know he walks with me, i pray he will undeniably show all he is in control and give us healing that only an be of him! god bless....
Hi Mathwiz, I was just reading your other post about your mother having to have chemo to reduce tumors prior to surgery. I don't know if your question in this post is related. If they are, there is a good reason for the doctors to be cautious about using Avastin. Avastin will weaken all of the blood vessels, and makes healing very difficult. Some of the slow healing effects linger for awhile. There is a waiting period of at least four weeks after finishing treatment, before surgery will be done.
I hope this info helps.
Sheara
There is good reason to be cautious with Avastin but I expect in the next 2-3 years there will be alot more data that will guide its use. for some of us it is gift. I have been on it twice a month for 8 months, first with cytoxan and then taxotere in early June 2009. ( I have never gone into remission since diagnosed in April 2004 with 3C ovca, epithileal and have had all kinds of cocktails since.) I developed a small bowel obstruction related to an incisional hernia in mid June and there was grave concern on the part of the doctors because I had had avastin only 2 weeks earlier. They warned me there could be very minimal wound healing and the surgery might not even work but I was not in a position to put off the surgery any longer.
Fortunately I am now two weeks past surgery and so far the wound is holding and no complications so far. I count it due to God's healing and alot of love and prayer energy!! The surgeon told me after surgery that he would leave the staples in for a year and half or until they rusted out, which ever came first! I love his sense of humor! I am also fortunate that I have never had a surgery as such on the intestines, though I have had multiple hernia repairs that were incarcerated.
So I guess what I am saying is that there are risks to every chemo, some greater than others. And our decision is make the best choice for ourselves with the guidance of the oncologist. I wish you all the best in the decision you make along with the oncologist.
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