Question asked by: 
Date asked: 
Sep 2015

My wife has 3c ovarian cancer since 2011, she has had de-bulking surgery and four full courses of chemotherapy. The disease has remained stable but the CA125 has increased, although not massively, since an emergency operation delayed her appointment to see her specialist this year.

Firstly, how do I go about finding out if better drugs are available for treating my wife's ovarian cancer in Scotland or Wales compared to England? Do I need to move abroad to Europe or America to get the best treatment? 

Secondly, is inter-peritoneal chemotherapy which now has practising centres in the UK an option to consider? 

Finally, my wife's magnesium levels always drop during chemotherapy, so she takes magnesium prescribed tablets to correct this, can the magnesium work against the action of the chemotherapy drug? 

How can I find the best drugs and chemotherapy for my wife?
Speak to your clinician about your wife’s options and remember you can always seek a second opinion
Response by Professor Iain McNeish, Professor of Gynaecological Oncology

With regard to your first question on access to drugs - unfortunately there are few drugs available for treating ovarian cancer currently, so it's unlikely your wife is being denied anything that is available in other places. Have you had this discussion with your clinician? Is there a particular drug you've heard of that you'd like to know more about? 

We'd recommend speaking to your clinician about options now and later, and also asking about what clinical trials are available for your wife to access.  Remember you can always seek a second opinion if you do not feel you're getting answers from your clinician - you can ask your wife's GP or clinical nurse specialist to arrange this for you. 

With regard to your second question about intraperitoneal chemotherapy, 

NICE guidance does not recommend intra peritoneal therapy (IP therapy) outside of a trial.  A recent UK/Canadian Phase II trial called PETROC has just closed which was addressing whether IP was more/as effective as standard IV therapy. Additionally, the trial was assessing the safety profile and practicality of IP therapy. This data is not yet available so we do not yet recommend it as an option to consider.  All the evidence for intra-peritoneal chemotherapy has come from women having their first line treatment (ie at the time of diagnosis).  There are no reliable data on use of intraperitoneal chemotherapy in women whose disease has relapsed, so this is not something that we could recommend in this case.  

As for magnesium, we know that carboplatin chemotherapy can make the kidneys slightly leaky, so that women lose magnesium in the urine.  Low magnesium levels can make people feel weak and tired, and can also cause low levels of other salts such as calcium.  However, there is no evidence that low magnesium has any effect on how well chemotherapy works. The magnesium tablets won’t interfere with the chemo either positively or negatively.