Just Found These Studies on Ascites

Bestbird

Although I'm not sure about the availability of these drugs, this may be worth looking into.

Drugs that may help alleviate ascites and/or discomfort:

• Avastin (Bevacizumab): In one study, nine patients with refractory malignant ascites were given Avastin.Three patients had breast cancer, three had colon cancer, 2 had uterine cancer and one had ovarian cancer.Prior therapy included systemic chemotherapy and large volume paracentesis. All patients had rapid re-accumulation within 2 weeks of paracentesis before treatment. Patients were given intraperitoneal bevacizumab at 5 mg/kg monthly. Malignant ascites resolved without reaccumulation or repeat paracentesis in all nine patients after a single intraperitoneal dose of bevacizumab over a median observation period of over two months.From: http://meeting.ascopubs.org/cgi/content/short/25/1...

• Catumaxomab (Removab): Although the author was not able to locate studies with breast cancer patients, a study on ovarian cancer patients was reported.Catumaximab was evaluated as part of a Phase I/II dose-escalating study for intraperitoneal (IP) application in 23 patients with ovarian cancer who had ascites with EpCAM-positive tumor cells.The patients were treated with 4–5 intraperitoneal infusions of catumaxomab in doses of 10 to 200 micrograms within 9–13 days with loading doses of 5–10 μg. The maximum tolerated dose was defined at 10, 20, 50, 200, and 200 μg for the first through fifth doses. Treatment with catumaxomab resulted in significant and sustained reduction of ascites flow rate. A total of 22 of 23 patients did not require paracentesis between the last infusion and the end of study one month later, and tumor cell monitoring revealed a reduction of EpCAM-positive malignant cells in the ascites.From: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880345/

A separate study of 26 cancer patients who received at least three of four IP instillations of catumaxomab led to a median interval of 15 days before a patient required an intraperitoneal puncture. Median overall survival was 92.5 days, but five patients remained alive and free of puncture for as long as 876 days. It was concluded that IP catumaxomab can be administered in relatively frail outpatients, achieving good ascites control. A survival benefit was seen in fit patients who received complete IP catumaxomab treatment and were able to undergo subsequent systemic therapy. From: http://www.medpagetoday.com/MeetingCoverage/SGO/44...

• Octreotide (Sandostatin LAR®): Thirty-three patients were enrolled in a two-arm study, with 16 patients assigned to the octreotide arm and 17 to the control arm. The median time to next paracentesis was 28 and 14 days in the octreotide and placebo arm, respectively. After adjustment for extracted ascites volume and abdominal girth change, no statistically significant difference between the groups was observed, although octreotide-treated patients described less of abdominal bloating, abdominal discomfort, and shortness of breath at one month.As prescribed in this trial, octreotide did not seem effective in prolonging the time to next paracentesis, although symptoms had improved.From: http://www.ncbi.nlm.nih.gov/pubmed/22572824

Longtermsurvivor

Thanks, Anne!

I'm familiar with octreotide because it's used in carcinoid and endocrine cancers. It's intriguing that it works for ascites too.

While I'm not inclined to IP chemotherapy, I was intrigued by this study:

ANTICANCER RESEARCH 26: 709-714 (2006)

Reducing Malignant Ascites Accumulation by Repeated Intraperitoneal Administrations of a Viscum album Extract

GIL BAR-SELA1, HADASSAH GOLDBERG1, DAN BECK2, AMNON AMIT2 and ABRAHAM KUTEN1

Departments of 1Oncology and 2Gynecology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Abstract. Background: Malignant ascites is a major problem in the management of advanced stages of certain malignancies. The possibility of reducing the accumulation of ascites by intraperitoneal injections of a Viscum album extract (Iscador M®) was evaluated.

Patients and Methods: Twenty-three patients, with end-stage malignancies of varying histology, requiring repeated peritoneal punctures, were eligible for analysis. The time-interval between the first two punctures was measured and defined as the baseline. Following each subsequent puncture, Iscador M® 10 mg was injected intraperitoneally. The intervals between later punctures were compared to previous intervals.

Results: Following the first injection, the median time-interval between injections increased from 7 to 12 days, reaching 13 days after the second injection. No toxicity was observed.

Conclusion: This phase II study suggests that installation of Iscador M® into the peritoneal cavity may reduce the need for repeated punctures. A randomized trial is needed to confirm these promising preliminary results.

Free full text at:

http://ar.iiarjournals.org/content/26/1B/709.full.pdf

Bestbird, as you know, I've been engaged with Iscador since 1996 when chemotherapy failed me. It's changed and saved my life many times over. Still, I haven't sought IP injections of it.

The survival curves of those with ascites who don't respond to conventional treatments are very short. I feel very grateful to have had ascites for over a year and an implanted drain for nearly 7 months. Very grateful to be alive and for the relief of that very uncomfortable symptom of advanced cancer.

All love & gratitude for you too, Stephanie

Bestbird

Dearest Stephanie, Thank you so much for sharing your thoughts. The study about intraperitoneal injections of Iscador is particularly intriguing, especially as I am currently hunting for scientific studies regarding alternative treatments that may alleviate symptoms and potentially improve OS.

I too am a believer in Iscador, and it is a pivotal part of your therapeutic regimen. I truly wish more studies of this nature were available.

It is good to hear that the daily draining has made you more comfortable, and I hope that each day brings you fulfillment and something special to enjoy, just as your beautiful posts do for us.

Love.

Rosevalley

You know I read this and wonder why my oncologist didn't suggest any of it but opted for the pleurx cath and self draining. I meet with her on the 6th and I will ask. It would be great to be drain free... if the ascites could be beaten back. I am not sure that's even possible. thank you for sharing the information!!

Bestbird

Rosevalley, the information that Stephanie kindly provided seemed especially intriguing! I wish there were more studies relative to therapies that alleviate ascites and promote QOL. Hoping that each and every helpful therapy will be at hand for you!

Rosevalley

I will be asking when I see her and I will post what information I find out. I have also had my pleurx since September 2015 for 7 months, same as Stephanie. Most folks with malignant ascites have a life expectancy of between 2-5 months. I have clearly beaten that. The longest I have read someone lived with a drain was 18 months. That was an ovarian cancer patient not a BC patient. If anyone knows of other stories please share them.

Hummingbird4

Hi ladies,

I am finding the information here very helpful and, as usual with belly mets treatments - confusing. I agree, Rosevalley, why are we not told of anything except the drain? I just saw a gastroenterologist last Wednesday at my cancer center, which is a top major cancer center - and she never mentioned possible drugs. My onc also has only talked about draining. Very interesting!

I have had malignant ascites for over a year now. Last March, I had my ovaries removed because my scans showed progression there and my onc was concerned it could be ovarian cancer. So she wanted a biopsy. Well, at the same time, my ascites were also biopsied. The results were that it wasn't ovarian cancer, but bc. The fluid was malignant also - bc. Luckily for me though, my ascites have stayed mild to mild/moderate and I am not having symptoms from this. As you know already, my problem is with the mets to my bowels. But even so, when the ascites are discussed, nothing is ever mentioned except draining.

Thank you all for sharing this.

Longtermsurvivor

Some bad news on intraperitoneal chemotherapy for peritoneal cancer.

This is about a recent study on its use in ovarian cancer. Those women have led the way in developing this treatment by participating in trials like this one that found no survival benefit from the treatment.

Sad and discouraging news for those interested in this aggressive treatment option:

Excerpt:

A punishing treatment

IP chemotherapy can be miserable for patients.

It delivers the drugs not through an IV but through a port in the abdomen that leads directly to the cancerous tissue.

That means pumping a liter of fluid through the port, distending the abdomen. Patients describe this as feeling like a beached whale; it can take hours for the fluid to be absorbed.

Patients are then rocked side to side on their beds to swish their insides with medicine, a technique also used with some other abdominal cancers. The treatment can cause nausea and vomiting so severe that patients dehydrate. Nerve damage from the treatment can also cause disabling pain and weakness in the hands and feet.

A smaller study of IP chemo back in 2006 showed it might be worth the pain: Among 429 patients randomly assigned to different therapies, IP increased overall survival from 50 to 65 months, compared to IV chemo. That landmark clinical trial spurred the National Cancer Institute to take the rare step of issuing a clinical announcement stating IP chemo should become standard care for ovarian cancer.

But the therapy wasn't embraced. A 2015 study showed less than half of patients who might benefit were receiving it.

Many attending the oncology conference thought the new data, based on a study of 1,560 patients, would reinforce the use of IP chemo and make it the standard of care across the nation.

Instead, Rimel and other physicians now say it probably shouldn't be used at all — especially since another study presented at the meeting reported that patients in the trial felt horrible after the treatment. The news is startling to advocacy groups that have spent years fighting for patients to receive IP chemo.

"These results are so jarring — to physicians and everyone else," said Sarah DeFeo, who oversees scientific affairs for the New York-based Ovarian Cancer Research Fund Alliance.

Ovarian cancer, which is hard to detect because there aren't many symptoms, kills 14,000 American women each year.

"There just aren't a lot of options," DeFeo said.

Read the whole article here:

'We thought we were curing people': Hope dims as ovarian cancer therapy fails test

Bestbird

Stephanie, your helpful article highlights the need to take toxicities and side effects into account when assessing a potential treatment. On the surface, the survival benefit is encouraging, but it must be weighed together with the adversity faced by these patients.

For those who may not be familiar, the treatment described above is very different from Stephanie's March 19 post about injecting Iscador (mistletoe extract) into the peritoneal area. This is very simple to do and outside from the initial "ouch" has no toxicity and little side effect (sometimes discomfort around the injection site and/or mild flu-like symptoms which are not uncommon for immunotherapy).

Hummingbird4

Stephanie, very interesting article. Thank you again for posting important information. I know things have been difficult for you, especially lately. I think of you frequently and hope you are comfortable. I appreciate that you continue to share here. Thank you.

Bestbird, thank you too for the additional info. I will see my onc on April 5 and I will ask her about any other possible treatments besides traditional chemo.