The single use of carboplatin has been a standard regimen for the patients with platinum sensitive disease. A Spanish trial was conducted by more stringent design. Those who were treated with paclitaxel and carboplatin had a significantly higher response rate Furthermore, the platinum and paclitaxel combination did not increase toxicity except moderate neurotoxicity.
These results suggested the benefits of a paclitaxel and platinum combination and it became the standard treatment of choice for the patients with platinum sensitive disease Table 3. A phase I, II study of gemcitabine and carboplatin combination showed In total, patients were recruited and higher response rates were shown in the gemcitabine plus carboplatin combination including a higher CR rate There was no difference in nonhematologic toxicities, but grades 3 and 4 hematologic toxicities were greater with the combination [ 8 ] Table 2.
Pegylated liposomal doxorubicin PLD is one of the alternatives for platinum resistant ovarian cancer. The lack of incidence of carboplatin-related allergic reaction in the PLD-treated patients may be an additional benefit of this combination [ 9 ].
The number of patients was in CD and in CP. These two regimens had different toxicity profiles. CD had more incidences of thrombocytopenia and palmar-plantar erythrodysesthesia PPE. Nevertheless, CD had extremely less incidence of Grade 4 neutropenia, Grade 2 alopecia, Grade 2—4 neurotoxicity, and carboplatin hypersensitivity reaction, which resulted in significantly less incidence of discontinuation of treatment by toxicity than CP.
This combination may be a good option for platinum or taxane sensitive relapse [ 10 ]. Docetaxel showed similar response to paclitaxel and a different toxicity profile in first line chemotherapy [ 28 ]. We can expect a similar response to bolus DC treatment with less hematologic toxicity. In summary, a carboplatin-based combination is strongly recommended for patients with platinum sensitive disease rather than carboplatin monotherapy.
Paclitaxel with carboplatin is the most frequently used combination and showed favorable result for these patients. Nevertheless, alternative combinations of gemcitabine or PLD with carboplatin have responses and prolonged survival rates similar to paclitaxel and carboplatin with different toxicity profiles. Gemcitabine combination showed similar bone marrow toxicity but less neuropathy or alopecia.
Therefore, duration of disease control and low incidence of toxicity should be an important factor in choosing the proper drugs [ 29 ]. PLD demonstrated a response in the treatment of recurrent ovarian cancer in some phase II studies [ 30 , 31 ]. PLD is recognized as the first choice nonplatinum agent for patients with relapse, who have failed first-line therapy, or who cannot tolerate platinum retreatment due to toxicity [ 33 ].
Gemcitabine has less toxicity except for manageable neutropenia. Fatigue grade2 is frequently the worst toxicity, nausea grade3 and neutropenia grade3 and 4 are also statistically frequent in gemcitabine, and PPE is more frequent in PLD [ 14 ] Table 4. The different mechanisms and noncross-resistance of gemcitabine can be expected to overcome drug resistance in combination with other nonplatinum drugs [ 34 ].
Topoisomerase inhibitors, topotecan, irinotecan, and oral etoposide can also be used for platinum resistant disease. The standard treatment of topotecan is 1. Recently, a lower dose 1. The PFS rates were similar between two arms. In patients with platinum sensitive disease, PLD was demonstrated to be significantly superior to topotecan in overall survival.
On the other hand, in the platinum-refractory subgroup there was no statistically significant survival trend in favor of either liposomal doxorubicin or topotecan Table 4 [ 38 ]. Complete response by chemotherapy for recurrent ovarian cancer is rare, and shrinkage of the tumor does not always ensure prolongation of survival.
A surgical approach may bring clinical benefit to some patients. Surgery for clinical recurrence is defined as secondary cytoreductive surgery, similar to surgery for persistent disease at the completion of chemotherapy.
In multivariate analysis, disease free interval, the number of sites of recurrence, and residual disease after secondary cytoreduction were factors found to influence prognosis.
A longer period of PFS and complete resection at secondary cytoreductive surgery are common favorable prognostic factors [ 39 — 41 ]. Nevertheless, the surgical result is dependent on the number of sites and the skill of the surgeon. Onda et al. Patients with three or all four of these factors who received complete surgical resection at secondary cytoreduction showed a favorable prognosis [ 42 ].
Recommendation for secondary cytoreduction based on disease free interval and number of recurrence site. DFI: disease free interval. SC: secondary cytoreduction. Chi et al. At secondary reduction, bowel or other organ resections are often also performed. On the other hand, patients with longer PFS are also expected high response to second-line chemotherapy.
Therefore, careful consideration must be made when deciding which strategy, surgery, or chemotherapy to use to most benefit each patient. Recurrence of ovarian cancer is a lethal and chronic disease. Nevertheless, patients with recurrent platinum-sensitive ovarian cancer may have increased response rates and longer PFS when treated with combination platinum-based chemotherapy compared to carboplatin alone.
Many women are treated with a course of chemotherapy that may or may not be accompanied by surgery. While the presence of symptoms does not necessarily indicate an ovarian cancer recurrence, it is always best for an ovarian cancer survivor to consult with a physician whenever she has a question or concern. Any woman is welcome to consult with the multispecialty ovarian cancer team at Moffitt Cancer Center, with or without a referral.
If you would like to schedule an appointment to discuss ovarian cancer recurrence with a physician at Moffitt, please contact us at or access our convenient new patient registration form.
Please call for support from a Moffitt representative. New Patients and Healthcare Professionals can submit an online form by selecting the appropriate buttonbelow. Existing patients can call When cancer returns after a period of remission, it is considered a recurrence. Around 70 percent of patients diagnosed with ovarian cancer will have a recurrence.
For all their importance, statistics are just that—representations of a wide range of individuals and outcomes. Data has shown that statistically speaking, recurrent ovarian cancer is treatable, but is rarely completely curable. Your approach to a recurrence will depend on a number of factors, all of which should be discussed with your gynecologic oncologist.
Researchers have made significant advances in maintenance therapies in recent years, which means more people are managing ovarian cancer as a chronic disease for longer periods of time, and there are women who have had a recurrence, who then go on to be NED No Evidence of Disease. Understanding Cancer. What Is Cancer? Cancer Statistics. Cancer Disparities. Cancer Causes and Prevention. Risk Factors. Cancer Prevention Overview. Cancer Screening Overview.
Screening Tests. Diagnosis and Staging. Questions to Ask about Your Diagnosis. Types of Cancer Treatment. Side Effects of Cancer Treatment. Clinical Trials Information. A to Z List of Cancer Drugs. Questions to Ask about Your Treatment. Feelings and Cancer. Adjusting to Cancer. Day-to-Day Life. Support for Caregivers. Questions to Ask About Cancer. Choices for Care. Talking about Your Advanced Cancer. Planning for Advanced Cancer.
Advanced Cancer and Caregivers. Questions to Ask about Advanced Cancer. Managing Cancer Care. Finding Health Care Services. Advance Directives. Using Trusted Resources. Coronavirus Information for Patients.
Clinical Trials during Coronavirus. Adolescents and Young Adults with Cancer. Emotional Support for Young People with Cancer. Cancers by Body Location. Late Effects of Childhood Cancer Treatment.
Pediatric Supportive Care. Rare Cancers of Childhood Treatment.
0コメント