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Thread: Please help! CA125 slightly elevated during chemo.

  1. #1
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    Please help! CA125 slightly elevated during chemo.

    Hi all, I joined the cancer forum recently. I've been under a lot of pressure recently and wish I could get some help here.

    Thank you all so much!

    My mom was diagnosed with ovarian cancer in August and the doctor suspected my father had prostate cancer in October (for which I also asked questions on the prostate cancer forum).

    My mom just finished her 5th chemo cycle (in total 6 cycles have been scheduled).

    Her CA125 has never skyrocketed, even before the hysterectomy. The full CA125 migration is as follows:

    80 (before hysterectomy) -> 30.5 (before 1st chemo cycle) -> 19.2 (before 2nd chemo cycle) -> 11.7 (before 3rd chemo cycle) -> 14.9 (before 4th chemo cycle) -> 15.22 (before 5th chemo cycle).

    The doctor was saying it's normal fluctuation during chemo and the CA125 values are well within the normal range. But I'm concerned as I would expect the CA125 value to continue to drop during the chemo cycles if the chemo is still effective. My thinking is if the CA125 value remains relatively stable or even slightly elevated during the chemo cycles, it at least means the chemo has not been effective after the 3rd chemo cycle. In this case, the doctor may consider the possibility of chemo resistance and switch to different drugs?

    Did anybody here experience similar pattern of fluctuation during chemo? Could anybody share some insights on this?

    I really appreciate all your help.

  2. #2
    Super Moderator Top User po18guy's Avatar
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    Quote Originally Posted by itsucks View Post
    The doctor was saying it's normal fluctuation during chemo and the CA125 values are well within the normal range. But I'm concerned...
    Sorry to hear of your worries and your mom's situation. If I were you, I would focus on the above excerpt from your post. Doctor is not concerned, but you are. I understand this, but it is not a completely reasonable train of thought.

    Take your mom's blood work. Have the numbers ever been the same? Of course not. Does that indicate a problem? Not at all. They are a snapshot of a small sample of blood at a single point in time - a sample which is not entirely homogenized. There is more of this blood factor over here, and less of it over there, but the blood sample may measure either one.

    What doctors look for is the trend in her numbers. A continuous trend is what needs to be addressed, not the normal rising and falling - again, from a tiny sample of her blood. Take a picture of your mom exhaling, and it might appear from that snapshot that she is expiring. Is she? Certainly not! She inhales once she is done exhaling. Blood is the same - it rises and falls, as does its content.
    05/08-07/08 Tumor appears behind left ear. Followed by serial medical incompetence on the parts of PCP, veteran oncologist and pathologist (misdiagnosis via non-diagnosis). Providential guidance to proper care at an NCI designated comprehensive cancer center.
    07/08 Age 56 DX 1) Peripheral T-Cell Lymphoma-Not Otherwise Specified. Stage IV-B, >50 ("innumerable") tumors, bone marrow involvement.
    08/08-12/08 Four cycles CHOEP14 + four cycles GND (Cyclofosfamide, Doxorubicin, Vincristine, Etoposide, Prednisone & Gemcitabine, Navelbine, Doxil)
    02/09 2) Relapse.
    03/09-06/13 Clinical trial of Romidepsin > long-term study. NED for 64 twenty-eight day cycles, dose tapered.
    07/13 3) Relapse, 4) Suspected Mutation.
    08/13-02/14 Romidepsin increased, stopped for lack of response. Watch & Wait.
    09/14 Relapse/Progression. Visible cervical nodes appear within 4 days of being checked clear.
    10/06/14 One cycle Belinostat. Discontinued to enter second clinical trial.
    10/25/14 Clinical trial of Alisertib/Failed - Progression.
    01/12/15 Belinostat resumed/Failed - Progression. 02/23/15
    02/24/15 Pralatrexate/Failed - Progression. 04/17/15
    04/15 Genomic profiling reveals mutation into PTCL-NOS + AngioImmunoblastic T-Cell Lymphoma. Stage IV-B a second time. Two dozen tumors + small intestine (Ileum) involvement.
    04/22/15 TEC (Bendamustine, Etoposide, Carboplatin). Full response in two cycles. PET/CT both clear. Third cycle followed.
    06/15-07/15 Transplant preparation (X-rays, spinal taps, BMB, blood test, MUGA scan, lung function, CMV screening, C-Diff testing etc. etc. etc.) Intrathecal Methotrexate during spinal tap.
    BMB reveals 5) 26% blast cells of 20q Deletion Myelodysplastic Syndrome MDS), a bone marrow cancer and precursor to Acute Myeloid Leukemia.
    07/11-12/15 Cyclofosfamide + Fludarabine conditioning regimen.
    07/16/15 Total Body Irradiation.
    07/17/15 Moderate intensity Haploidentical Allogeneic Stem Cell Transplant receiving my son's peripheral blood stem cells.
    07/21-22/15 Triple dose Cyclofosfamide + Mesna, followed by immunosuppressants Tacrolimus and Mycophenolate Mofetil.
    07/23-08/03/15 Marrow producing zero blood cells. Fever. Hospitalized two weeks.
    08/04/15 Engraftment occurs, and blood cells are measurable - released from hospital.
    08/13/15 Day 26 - Marrow is 100% donor cells. Platelets climbing steadily, red cells follow.
    09/21/15 Acute skin Graft versus Host Disease arrives.
    DEXA scan reveals Osteoporosis.
    09/26/-11/03/15 Prednisone to control skin GvHD.
    11/2015 Acute GvHD re-classified to Chronic Graft versus Host Disease.
    05/2016 Tacrolimus stopped. Prednisone from 30-90mg daily tried. Sirolimus begun. Narrow-band UV-B therapy started, but discontinued for lack of response. One treatment of P-UVAreceived, but halted due to medication reaction.
    09/16/16 Three skin punch biopsies.
    11/04/16 GvHD clinical trial of Ofatumumab (Arzerra) + Prednisone + Methylprednisolone begun.
    12/16 Type II Diabetes, Hypertension - both treatment-related.
    05/17 Extracorporeal Photopheresis (ECP) begun in attempt to control chronic Graft-versus-Host-Disease (cGvHD. 8 year old Power Port removed and replaced with Vortex (Smart) Port for ECP.
    05/2017 Chronic anemia (low hematocrit). Chronic kidney disease. Cataracts from radiation and steroids.
    06/17 Trying various antibiotics in a search for tolerable prophylaxis.
    08/17 Bone marrow biopsy reveals the presence of 2% cells with 20q Deletion Myelodysplastic Syndrome, considered to be Minimum Residual Disease.
    12/17 Bone marrow biopsy reveals no abnormalities in the marrow - MDS eradicated. The steroid taper continues.
    01/18 Consented for Kadmon clinical trial.
    03/18 Began 400mg daily of KD025, a rho-Associated Coiled-coil Kinase 2 Inhibitor (ROCK2).
    09/18 Due to refractory GvHD, Extracorporeal Photopheresis halted after 15 months ue to lack of additional benefit.
    10/18 I was withdrawn from the Kadmon KD025 clinical trial due to increasing fatigue/lack of benefit.
    11/18 Began therapy with Ruxolitinib (Jakafi), a JAK 1&2 inhibitor class drug. Started at half-dose due to concerns with drug interactions.

    To date: 1 cancer, relapse, second relapse/mutation into 2 cancers, then 3 cancers simultaneously, 20 chemotherapy/GVHD drugs in 11 regimens (4 of them at least twice), 5 salvage regimens, 4 clinical trials, 5 post-transplant immuno-suppressant/modulatory drugs, the equivalent of 1,000 years of background radiation from 40+ CT series scans and about 24 PET scans.
    Both lymphoid and myeloid malignancies lend a certain symmetry to the hematological journey.

    Believing in the redemptive value of suffering makes all the difference.

  3. #3
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    Quote Originally Posted by itsucks View Post
    Hi all, I joined the cancer forum recently. I've been under a lot of pressure recently and wish I could get some help here.

    Thank you all so much!

    My mom was diagnosed with ovarian cancer in August and the doctor suspected my father had prostate cancer in October (for which I also asked questions on the prostate cancer forum).

    My mom just finished her 5th chemo cycle (in total 6 cycles have been scheduled).

    Her CA125 has never skyrocketed, even before the hysterectomy. The full CA125 migration is as follows:

    80 (before hysterectomy) -> 30.5 (before 1st chemo cycle) -> 19.2 (before 2nd chemo cycle) -> 11.7 (before 3rd chemo cycle) -> 14.9 (before 4th chemo cycle) -> 15.22 (before 5th chemo cycle).

    The doctor was saying it's normal fluctuation during chemo and the CA125 values are well within the normal range. But I'm concerned as I would expect the CA125 value to continue to drop during the chemo cycles if the chemo is still effective. My thinking is if the CA125 value remains relatively stable or even slightly elevated during the chemo cycles, it at least means the chemo has not been effective after the 3rd chemo cycle. In this case, the doctor may consider the possibility of chemo resistance and switch to different drugs?

    Did anybody here experience similar pattern of fluctuation during chemo? Could anybody share some insights on this?

    I really appreciate all your help.
    CA125 is not a foolproof gauge of ovarian cancer.

    They need to do a scan once the treatment cycles are finished.

    Regardless, 0-35 is normal range. I know you are going nuts, and you don't want to believe the doctors, so I'll just tell you.

    My girlfriend's CA125 was well over 1000. She has to do many more cycles than your mother and they have to try and get it down to 35. If they do, it will be a very joyous day.

    Perspective...

    Regardless, I would listen to the oncologist. If you don't trust him/her then that's a different question.

  4. #4
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    I haven't started with my GYN oncologist yet, but in the course of treatment for my rectal cancer it was explained to me that the tumor marker number can increase temporarily due to the chemotherapy. My CEA increased at the end of treatment. My oncologist said not to worry about it.

 

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