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I have recurrent high grade serous ovarian cancer and have had two lots of chemotherapy. Unfortunately I am platinum resistant so chemo options are very limited. My oncologist has advised me that the cancer is incurable so they will not operate again. However, over the last 3/4 weeks my bowel habits changed so I went to see my gp and phoned the CNS nurse to advise. My bloods came back with markers of 3600 and I’m due a ct scan this Friday. I’m currently taking Letrozole as the cancer is oestrogen receptive but it would appear this has not managed to contain it. Is there other options available, is immunotherapy available for ovarian cancer patients? I’m aware that trials have been on hold due to Covid 19 but are there ones that I should be making my oncologist aware of. I do feel that I am not considered for other treatments because it’s incurable and that the oncologist has written me off. I’d really appreciate your advice. Thank you
Thanks for getting in touch. My name is Deborah and I’m one of the Cancer Information Nurses on the Macmillan Support Line. I’m sorry to hear that you’ve had a recurrence of ovarian cancer. I understand that you’ve already had a hysterectomy, two lots of chemotherapy and hormone therapy and your oncologist has advised that further surgery is not recommended. I appreciate that due to limited chemotherapy options and a question over whether the hormone therapy is still effective, you’re looking into other treatment options and whether these might be suitable for you.
According to the NICE Guidelines for the management of advanced ovarian cancer, there are some treatment options which might be available. However, these are general guidelines and your own hospital team are best placed to decide which treatments would work better for you.
If your consultant feels that you might benefit from further chemotherapy, they might consider one or more of the following treatments: paclitaxel alone, usually as a weekly treatment; liposomal doxorubicin; gemcitabine; cisplatin; etoposide; cyclophosphamide. These are usually given to people whose cancer cells have become resistant to platinum based chemotherapy regimes. Your suitability for further chemotherapy will also depend on which chemo drugs you have already had and other factors such as your general health.
You asked whether immunotherapy might be an option for you. There are some targeted cancer drugs that can help the body to control the growth of some types of cancer cells. These can be given alone or alongside chemotherapy, or after chemotherapy. Types of targeted cancer drugs for ovarian cancer include: bevacizumab (Avastin); olaparib (Lynparza); niraparib (Zejula). Although these drugs can be beneficial in some cases, they are currently only recommended for the maintenance treatment of relapsed, platinum-sensitive, ovarian cancer which has responded to platinum-based chemotherapy. As your cancer cells have now become resistant to platinum-based drugs, targeted therapy might not be a suitable option for you. Also, access to these drugs varies, depending on where you live in the UK.
You can ask your consultant about clinical trials and whether there are any for which you meet the criteria. They will be able to advise if there are any which might be beneficial to you. Despite COVID-19, many research teams continue to recruit participants for trials. You can read more information about clinical trials on the Cancer Research website.
I know it can be disheartening to be told that your treatment options are limited. I assure you that every possible treatment will be considered by your hospital team and they will be only too happy to talk about what your options are. It may be the case that they feel none of the above treatments are suitable for you, either because they don’t think the drugs will have the desired effect on the cancer cells or maybe due to severe side effects having a negative impact on your quality of life. Whatever the reasons, there should be a discussion between you and your team to decide what’s best for you. Perhaps once your CT scan results come back, you can ask to speak to your consultant about what will happen next?
Even if none of the above treatments are suitable, your team will do everything they can to manage your symptoms and keep you as well as possible for as long as possible. You will never be abandoned. There are specialist palliative care teams who can offer practical and emotional support to make sure you are well cared for. Your own GP and local District Nurses will also be on hand should you need any further support.
I see you previously posted to our ovarian cancer group but you haven’t been active for a while. You might find it helpful to re-join this group to chat to other women who may be in a similar situation.
I hope this has been helpful, Kempy58. I know you’ve got a lot to think about. If you would like to chat to one of our nurses or advisors, you’re welcome to call the support line on 0808 808 0000. We’re open every day, 8am-8pm.
Take care of yourself.
Deborah, Macmillan Information Nurse Specialist
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