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Platinum resistant ovarian cancer. Tested for TLC and platelet count. What are the risk?

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Oncologist, Radiation
Practicing since : 2007
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For a Ovarian Cancer (platinum resistant) patient undergoing 3rd Line Chemo treatment with gemcitabine + carboplatin, what is the consequence of TLC=180 and Platelet Count=10,000. Is it a potentialy life threatening situation? What should be the immediate medication?
Posted Sun, 3 Mar 2013 in Cervical and Ovarian Cancer
Answered by Dr. Dipanjan Majumder 1 hour later
Thanks for seeking help at XXXXXXX forum.

Let me inform a little on this disease. Ovarian cancer is highly platin sensitive so Paclitaxel and Carboplatin selection as a first line chemotherapy was perfect.

But, unfortunately the disease has got a recurrence just within 4 months. This condition is called platinum resistant disease.

Platinum-resistant disease includes patients that have relapsed within six months of prior platinum therapy. As a group, the expected response rate to retreatment with platinum is less than 20%, although some patients may remain platinum-sensitive.

In a univariate and multivariate analysis of five phase II studies, the platinum-free interval was the most significant variable in predicting the response to second-line chemotherapy. Among 92 patients with relapsed ovarian cancer, 26/42 (62%) patients with a treatment-free interval of ≥ seven months responded to second-line chemotherapy, compared with 5/50 (10%) patients with a treatment-free interval of ≤ six months.

Platinum free interval remains to be the significant prognostic factor.

In second line liposomal doxorubicin can be used for 4 cycle then on progression third line can be given. This treatment protocol is selected for your patient.

Now she has developed bone marrow suppression. [ TLC 200, Platelet 0000, hemoglobin - not mentioned]

If she has fever >38.3 degree F , diagnosis of febrile neutropenia can be confirmed.

-Subcutaneous Injection filgrstim 5mcg/kg/day is preferred until absolute neutrophil count 2-3 x 10^9/mcL.
-rHu IL-11 can be used to minimise requirement of platelet transfusion 50 mcg/kg daily for 10-21 days until platelet count exceeds 50,000/mcL

Platelet transfusion is needed.

Blood pressure, pulse rate, respiratory rate, body temperature complete blood count, renal function test and liver function test are to be be monitored closely.

Depending on blood culture report appropriate antibiotic to be started.

Clinical feature will also help to select injectable antifungals.

Do not worry right now. there is a chance of recovery. Consult your doctor and please try to follow his/her advise. Keep me posted for further queries.

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