Chemo for BRCA1+ ovarian cancer recurrence

Hello ladies,
My mother, who is 55, has a recurrence in her para aortic lymph nodes from high grade epithelial ovarian cancer, first diagnosed 2009. She had her lymph nodes removed a week ago and just came back home from hospital.
She also has the BRCA1 mutation, however, in my country docs seem to know nothing about any specific treatment for people with BRCA1 + OC. They say that BRCA1 is just one of the hundreds genetic mutations and at this point it just has to concern us, her children, regarding a future surveillance.
I searched for clinical trials in my country for BRCA1 related ovarian cancer, but had no luck. What local oncologists are offering mom is the same regime as before-Taxol and Carbo, every 3 weeks. So I tried to do a little research on my own and I read some promising results on a 2011 Japanese survey, saying weekly Taxol and Carbo proved better PFS than when administered every 3 weeks.
On the other hand, there are some articles about Taxol resistance in BRCA+ patients, since a normal BRCA function was required for Taxol to work-http://cancerres.aacrjournals.org/content/64/12/4148.full and others.
At the same time, recent studies imply that a second mutation may occur in BRCA+ recurrent ovarian cancer cells, thus making them resistant to carboplatin.
As you can see, I am completely at a lost, and my questions are to all of you BRCA+ ladies facing a recurrence- what kind of treatment were you offered and did your oncologists have in mind your BRCA1 status when choosing the optimal treatment for you?
Did you participate in any clinical trials on PARP inhibitors and do you know about any trials, that are currently recruiting BRCA+ patients?
I read very promising results about Doxil and Carbo combination, were any of you ladies offered that kind of treatment as one more suitable for your BRCA+ status?
Thank you in a advance for your responses!

Edited May 22, 2012 at 10:19 am

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Jenny: I am BRCA1 had recurrence in para arotic lymph node ...and had Doxil/Carbo. See my profile for the full story! I do believe that my doctor chose the Doxil/Carbo due to my BRCA1 status...as US standard of care is use of Taxol/Carbo for first recurrence. All the Best to You and your Mom! Kathleen

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I am brca1 positive and facing 2nd recurrence. Onc did not take it into consideration. I did standard frontline chemo. For 1st recurrence we did Doxil/carbo which is supposed to be better than re-treating with frontline drugs and that came out of results of a study called Calypso. This combo is not necessarily for Brca positive or negative...also I was NED in 4 rounds and got the same amount of time in remission as the frontline chemo. Now for 2nd recurrence we will do Gemzar/carbo.

Four things:

Parp inhibitors have been shown to be more effective for BRCA2 positive women than BRCA1 positive....this is from my onc.

Secondly, always remember that dual agents (meaning 2 drugs) is better than a single agent if your body can tolerate it.

Thirdly, my onc and I feel that it is not a great idea to repeat the same drugs again although that has been the standard. I mean why would you use something that the cells escaped the first time? You want to keep the cancer confused and off balance and that means using at least one different agent.

Fourth, remember that platinum drugs are the best at controlling the cancer. So for one of your agents you want either carboplatin or cisplatin and then hope that the patient doesn't build up resistance. Some people can be on carbo for years and it still works! Uncommon but it is out there and onc has said he has used it for years with some people.

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I am BRCA1 positive - originally diagnosed in Nov 2009 with tumor intact and no spreading - Stage 1B3. My first recurrence was this January and I am receiving Lipodox/Carbo combo which is making my CA-125 go way down. I started cheo at 580 and after 2 chemo infusions, it is now 31. I have done alot of research on the PARP inhibitors and there are alot of clinical trials with different parp inhibitors with various drugs and dosages, however, i chose not to do it because the cinical trials require CT Scans every 2 month. With that said, the head of genetic cancers at Dana Farber recommended the PARP inhibitor trials for BRCA1 patients and felt it would be my best choice. If the Lipodox/Carbo does not put me into a longer remission, at that point I will look at the PARP inhibitor trial again.

I hope your Mom will find the right drug combo. I know this is very difficult decision to make.

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I don't have any information for you, but I wanted to say that I am very impressed by your thoroughness, your diligence, and not least, your English! I hope your mother finds a chemo that works well for her.

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Hello

I am also BRCA 1 positive and on my third occurence of ovarian cancer. I am on a parp inhibitor trial at the Royal Marsden Hospital in the UK. It is going very well so far. I have had two months treatment (tablets taken daily), have had no real side effects and after one month on the new drug all my tumours had shrunk by at least 30%.

Rabbitgal, I have never seen or heard anyone say that parp inhibitors are more effective for BRCA 2 than BRCA 1 so I would be very interested to know where you found that information.

I am happy to answer any questions you may have about parp inhibitors or about being on a trial.

Best wishes to you.
Sharon

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I will be starting a Parp-inhibitor on June 6. I have Lynch Syndrome where there is little research but are treating it as a genetic mutation like BRAC - one arm of the study gets only the parp and the other Parp plus a new chemo (not the usual carbo/taxol/doxil/gemzar) I'll keep you posted - just waiting for myarm to heal - I broke it running on the Yale study. The trial is with Dana Farber and University of Chicago best of luck to u and ur mom.

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Jenny & all: I found an article on Doxil and BRCA.... http://www.clinicaloncology.com/ViewArticle.aspx?d=Solid%2BTumors&d_id=148& i=April+2012&i_id=836&a_id=20683

and here is one on PARP & BRCA..http://www.onclive.com/publications/Oncology-live/2012/April-2012/PARP-Inhi bitors-Intriguing-Despite-Research-Setbacks

.....and for the record today...I would just like to say Cancer Sucks!

Kathleen

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