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Forum Name: Ovarian Cancer

Question: Ovarian Clear cell adenocarcinoma - platinum resistant


 jyotsnam60 - Sun Feb 28, 2010 1:21 pm

My mother (59, F) was diagnosed Ovarian cancer in June 2009 through CT Scan and CA 125 test. She had gone through 1 cycle of Chemotherapy (Pactitaxel-260 + Carboplatin 450) before Surgery (22nd Aug 2009). Her both ovaries (having large tumors), Uterus, Omentum & Appendix were removed. In Biopsy the type was detected as Clear Cell Adeno-carcinoma admixed with Endometroid Carcinoma.
Post-operative, she has gone through 6 cycles of Chemotherapy using Pactitaxel-260 + Carboplatin 450 (till end of December). She responded during initial cycles (confirmed through decreased level of CA 125 results), but assessment after the 6th cycle showed that disease has comeback (confirmed through USG, PET CT and CA 125 results).
It seems that her disease is Platinum resistant, as it has come back / progressed during platinum treatment itself.

As a 2nd line , she has gone through 1 cycle of PLD, which didn’t have any effect as the disease progressed further (symptoms are gross ascites in peritoneal cavity, raised CA 125 levels).

Can you help me with the options ? I heard that some combination chemotherapy is the best option, but no real guidance on what best to use.

Regards
 Dr. Tamer Fouad - Sat May 22, 2010 11:25 am

User avatar Dear jyotsnam60,

First of all please accept my sincere apology for the delayed reply. I am sorry to hear about your mother's suffering as advanced cancer no doubt inflicts a severe physical and psychological suffering both to the patient and her family.

I will attempt to reply to your question because it is an important one, in the hope that others who find themselves in a similar situation may benefit from your question. As you mentioned your mother would be classified as platinum resistant which is a obviously a poor indicator of response to therapy in general. Ovarian tumors that resist platinum are difficult to treat and very aggressive.

The best second line option is again as you mention: PDL (Pegylated liposomal doxorubicin HCL). Whether a patient should receive a 3rd line would depend on her tolerance to chemotherapy. Is she strong enough to undergo a further attempt at controlling disease. If the answer is yes then the next viable option would be Topotecan. Another option is to use Gemcitabine as a single agent with response rates of approximately 20%.

For those that are deemed unable to undergo IV chemotherapy a viable alternative is oral vepside capsules.

Again, I am so sorry if this answer comes too late - I felt obliged to respond to you due to its significance.

With best wishes,
Tamer

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