Finally a Treatment Plan

Dr. Shah has finally written order for me to start Topetecan (cytotoxic chemotherapy) on Wednesday, December 20th. Topetecan will be administered weekly for three weeks, then I will take a one week break. This will be scheduled for 6 cyles (so that means at least 6 months of chemo). I will also be given Avastin concurrently. The Avastin will begin after four weeks (I believe this is because I have to have a port put in and Avastin cannot be administered within 4 weeks of any surgery).

Dr. Ramirez from MDA Houston finally called to give me the opinion of their Review Board. Believe it or not, the Radiologist still has not read my PET films. Interestingly, one of my radiologists here in Orlando felt that the PET was not definitive as to the metastasis and he suspected that MDA would want me to redo the scans, but here I am beginning treatment and the Radiologists out in MDA Houston have no had the decency to read my films and offer their opinion. I am disgusted with them.

At any rate, Dr. Ramirez claims that the board suggests the standard treatment of Topetecan weekly for three weeks and off one week, as Dr. Shah suggests, but to recheck after three months. Whereas Dr. Shah is suggesting to go for 6 months of treatment. Dr. Ramirez does not support adding Avastin. He claims that he can see how Dr. Shah, being a medical oncologist, would find that Avastin has credence, but they (in the field of Gynecological Oncology) have not seen any supporting evidence of Avastin working for cervical cancer. I mentioned that there is a GOG Phase I clinical trail going on right now all over the country for Avastin for recurrent cervical cancer. His response is that only 1% of Phase I trials result in successful findings.

He was stern in his recommendation. I am more excited about Avastin than Topetecan for that matter. In fact, I wish I did not have to take the Topetecan. I wonder if there is some improvement after 6 cycles, if they will discontinue Topetecan but continue Avastin?

Another disappointment is that I had a trip planned to drive up to North Carolina to take my kids to see snow (the little ones have never seen snow). I had plans with two other families. However, now that my chemo will start on the 20th (I was planning to go from the 18th to the 23rd), I have to cancel the trip. Dr. Shah said that it would be ok to push everything out a week and start on the 27th, but my husband and I feel that it would be irresponsible of us to push off the treatment. The CT/PET that showed my recurrence was 11/1/06. At that time, I had no symptoms. Now I am in constant chronic pain requiring pain meds around the clock (it gets a little worse each day). So really.. I think I need to get started. Of course, they are allowed to be irresponsible in taking so long to find me a treatment plan, but it's my life after all. Hopefully I will have other opportunities to take the children to see snow.