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Pheochromocytoma
A Move from California and a Second Chance
Patient Diagnoses
A 67 year-old Caucasian female with a history of: pheochromocytoma (cancer of the adrenal gland), breast cancer and diagnosed with stage IV ovarian cancer after presenting with a pleural effusion (fluid build up in the tissues between the lung and chest cavity) in August 2008.
Patient Treatment History
- Patient received dose dense AC in 2006 followed by 6 cycles of Taxol for her breast cancer.
- In August 2008 the patient noticed increased shortness of breath and a further workup showed a large right pleural effusion with abdominal ascites and peritoneal carcinomatosis. She was also found to have a CEA 125 at 1300 but no ovarian mass was detected. Special stains performed on a cytology specimen from the ascites were most consistent with ovarian cancer. The patient then underwent a pleuracentesis of a right-sided pleural effusion, which relieved her symptoms. The patient was then started on standard chemotherapy.
- Following subsequently noted rising tumor marker and development of a recurrent pleural effusion and a CEA 125 of 900 in July 2009, the patient ultimately required a right pleurodesis and required continuous supplemental oxygen.
- A left pleural effusion requiring chest tube placement was identified approximately one month later and the patient received salvage chemotherapy with Doxil and then went onto receive cyclophosphamide and Avastin.
As a result of having tried all available options, she was referred to Dr. Hirschfeld by her oncologist in California.
Patient Challenge
This patient posed a number of challenges as outlined below:
- Poor performance status requiring continuous supplemental O2 because of her current history of bilateral pleural effusions and diffuse ascites.
- Treatment incorporating 3 lines of therapy.
- Questionable diagnoses (was this possibly a recurrence of breast cancer).
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Clinical Treatment Plan
The patient was started on low-dose multidrug chemotherapy which included drugs which she had failed in the past combined at low doses with other chemotherapeutic drugs to optimize synergistic interactions.
The rationale behind this plan is that it has been well documented through literature and experience at Bruckner Oncology that by adding a drug or drugs to a failed regimen, the “failed” regimen can actually salvaged thus giving failed drugs a second chance to work. Also, by utilizing low doses from one half to one third of standard dose, we can minimize the toxicity of a regimen and treat patients, such as the woman in this case study, who would not tolerate a standard high dose regimen.
Outcomes/Results
The patient tolerated the therapy remarkably well. Her tumor marker CA -125 decreased from a high of 1400 to low of 77 and she has continued on this regimen for over a year and 3 months. Her CT scan showed interval improvement with residual peritoneal tumor implants. A small quantity of residual ascites is present and residual bilateral small complex pleural effusions with findings suggesting interval pleurodesis.
The patient was considering hospice over a year and a half ago and has since had an excellent response to our innovative regimen, which took into account her previous treatments, her age, and her comorbidities. A regimen was specifically designed for her and her cancer. Despite the fact that she received multiple chemotherapy drugs simultaneously, her quality of life has dramatically improved.
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