Carboplatin/Taxol/Avastin Combo - 1256230

Hello lynnrich,

The side effects of chemotherapy can be cumulative and grow worse over time, although it depends which agents are used. That is why a regimen such as Carbo/Taxol/Avastin is usually not used beyond 4-6 cycles. Here is a previous post from Dr. West discussing this issue:

"You're right to question the cumulative effects of chemotherapy. There have been several studies that have demonstrated that there isn't any significant added value to continuing a full combination of first line chemo (typically a platinum doublet -- cisplatin or carboplatin with a partner drug like Taxol (paclitaxel) or one of various others -- sometimes combined with Avastin (bevacizumab), an anti-angiogenic targeted therapy that blocks tumor blood supply) beyond 4-6 cycles. Though some people continue multi-agent chemo beyond 4-6 cycles, that's definitely not the norm, in large part because cumulative side effects increase faster than any incremental benefit from the 7th, 10th, or 14th cycle. And the platinum drugs, especially carboplatin, are very well known to be associated with a hypersensitivity reaction with prolonged administration. And Taxol in particular is notorious for producing problematic neuropathy that only gets worse with ongoing treatment. Consequently, these agents are not ones that are recommended for maintenance therapy."

[continued in the next post]

[continuation of previous post]

"Breaks from treatment are very reasonable, but some other agents are more amenable to use over a more prolonged basis as a maintenance therapy. Avastin alone can often be given for a long time without many side effects, and it is sometimes paired with the chemo agent Alimta (pemetrexed) in patients with a nonsquamous NSCLC -- or Alimta on its own is often given and has evidence to support giving it as a maintenance therapy, where it is often very well tolerated. Another agent that is studied and shown to have some benefit while also being very feasible to give over a prolonged interval is Tarceva (erlotinib), which isn't chemotherapy but is an oral targeted therapy against the molecule EGFR -- the epidermal growth factor receptor. The chemo agent gemcitabine has been studied less but could also be a maintenance therapy, in that it has also been studied in a limited capacity as a maintenance therapy and is often well tolerated. But a cornerstone of all of these options is that they don't often have cumulative adverse effects."
- http://cancergrace.org/forums/index.php?topic=8916.msg69006#msg69006

On the other hand, side effects tend to be much more controllable now than in years past. There may be interventions that could help control some or all of these side effects, so I'm hoping your diligent follow-up with your husband's doctor will provide some relief.

JimC
Forum moderator

I'm sorry for the challenges your husband (and you) are now facing.

Jim provided his own good explanation already, along with some extensive comments I already made on this subject, so I have little to add. I'd say that cumulative side effects are more likely than any kind of desensitization in which the body "gets used to" the chemotherapy. It's very possible that if the nosebleeds or some other side effect of Avastin (bevacizumab) such as headache or bleeding from elsewhere (such as hemorrhoids) emerges as an escalating problem, stopping the Avastin may be very sensible.

Anti-cancer treatment always entails working on a balance between efficacy of treatment and its tolerability. This is often a moving target and may well require changes in the plan as time goes by.

Good luck.

-Dr. West