Skip to main content Accessibility help
×
Home
Hostname: page-component-544b6db54f-5rlvm Total loading time: 0.337 Render date: 2021-10-18T00:21:53.797Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

5 - Medical Treatment of Ovarian Carcinoma

Published online by Cambridge University Press:  11 September 2009

Rebecca L. Bowen
Affiliation:
Department of Medical Oncology, St Bartholomew's Hospital, London, UK
Maurice L. Slevin
Affiliation:
Department of Medical Oncology, St Bartholomew's Hospital, London, UK
Rodney Reznek
Affiliation:
St. Bartholomew's Hospital, London
Get access

Summary

Introduction

Ovarian cancer is a very chemosensitive tumour with a number of classes of drugs showing activity. Major advances in treatment of newly diagnosed ovarian cancer have improved survival but most patients relapse and require further treatment and only a minority of patients with advanced disease achieve long-term survival. Research is directed towards finding new effective agents and regimes with minimum toxicities.

Chemotherapy in Early Stage Disease

Two prospective, randomised trials of patients with stage Ia or Ib disease with well or moderately differentiated cancers demonstrated a 5-year survival of over 90% with surgery alone. 81 patients were randomized after surgery to receive oral melphalan (0.2 mg/kg/day for 5 days) or no further treatment. There were no significant differences between the no chemotherapy and the melphalan arms with respect to either 5-year disease-free survival (91% vs. 98%; p = 0.41) or overall survival (94% vs. 98%; p = 0.43). In the second trial, 141 patients with poorly differentiated stage I or stage II disease received either melphalan (as above) or a single intraperitoneal dose of P32 at the time of surgery. The outcomes for the two treatment groups were similar. 5 year disease-free survival (DFS) was 80% in both groups and overall survival was 81% with melphalan versus 78% with P32; p = 0.48 [1]. An Italian group studied 271 patients with moderate or poorly differentiated stage Ia, b and c disease. Patients were randomised to Cisplatinum (50 mg/m2 with repeated courses every 28 days for 6 cycles) versus observation versus P32.

Type
Chapter
Information
Cancer of the Ovary , pp. 82 - 93
Publisher: Cambridge University Press
Print publication year: 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Young, R. C., Walton, L. A., Ellenberg, S. S., et al. Adjuvant therapy in stage I and stage II epithelial ovarian cancer. Results of two prospective randomised trials. N Engl J Med (1990), 322:1021–7.CrossRefGoogle Scholar
Bolis, G., Colombo, N., Pecorelli, S., et al. Adjuvant treatment for early epithelial ovarian cancer: results of two randomised clinical trials comparing cisplatin to no further treatment or chromic phosphate (32P). G.I.C.O.G.: Gruppo Interregionale Collaborativo in Ginecologia Oncologica. Ann Oncol (1995), 6:887–93.CrossRefGoogle ScholarPubMed
International Collaborative Ovarian Neoplasm 1 (ICON1) and European Organisation for Research and Treatment of Cancer Collaborators-Adjuvant ChemoTherapy in Ovarian Neoplasm (EORTC-ACTION). International Collaborative Ovarian Neoplasm Trial 1 and Adjuvant ChemoTherapy in Ovarian Neoplasm Trial: Two parallel randomized phase III trials of adjuvant chemotherapy in patients with early-stage ovarian carcinoma. J Natl Cancer Inst (2003), 95:105–12.
Gottlieb, J. A. and Drewinko, B.. Review of the current clinical status of platinum coordination complexes in cancer chemotherapy. Cancer Chemother Rep (1975), 59:621–8.Google ScholarPubMed
Advanced Ovarian Cancer Trialists' Group. Chemotherapy in advanced ovarian cancer: an overview of randomised clinical trials. Br Med J (1991), 303:884–93.CrossRef
Aabo, K., Adams, M., Adnitt, P., et al. Chemotherapy in advanced ovarian cancer: four systematic meta-analyses of individual patient data from 37 randomised trials. Advanced Ovarian Cancer Trialists' Group. Br J Cancer (1998), 78:1479–87.CrossRefGoogle Scholar
Wani, M., Taylor, H., Wall, M., et al. Plant antitumor agents. VI. The isolation and structure of taxol, a novel antileukaemic and antitumor agent fromTaxus brevifolia. J Am Chem Soc (1971), 93:2324–7.Google Scholar
Enzig, A. I., Wiernik, P. H., Sasloff, J., et al. Phase II study and long term follow up of patients treated with Taxol of advanced ovarian cancer: high-dose versus low-dose and long versus short infusion. J Clin Oncol (1994), 12:2654–66.Google Scholar
McGuire, W. P., Hoskins, W. J., Brady, M. F., et al. Cyclophosphamide and cisplatin compared with paclitaxel in patients with suboptimal stage III or IV ovarian cancer. N Eng J Med (1996), 334:1–6.CrossRefGoogle ScholarPubMed
Piccart, M. J., Bertelson, K., James, K., et al. Randomised intergroup trial of cisplatin-paclitaxel versus cisplatin-cyclophosphamide in women with advanced epithelial ovarian cancer: three year results. J Natl Cancer Inst (2000), 92:699–708.CrossRefGoogle Scholar
Ozols, R. F., Bundy, R. N., Greer, B. E., et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a gynaecologic oncology group study. J Clin Oncol (2000), 21:3194–200.CrossRefGoogle Scholar
Bois, A. Du, Luck, H. J., Bauknecht, T., et al. First-line chemotherapy with epirubicin, paclitaxel and carboplatin for advanced ovarian cancer; a phase I/II study of the Arbeitsgemeinschaft Gynakologische Onkologie Ovarian Cancer Study Group. J Clin Oncol (1999), 17:46–51.CrossRefGoogle Scholar
Muggia, F. M., Hainsworth, J. D., Jeffers, S., et al. Phase II study of liposomal doxorubicin in refractory ovarian cancer: antitumour activity and toxicity modification by liposomal encapsulation. J Clin Oncol (1997), 15:987–93.CrossRefGoogle Scholar
International Collaborative Ovarian Neoplasm Group. Paclitaxel plus carbolated versus standard chemotherapy with either single-agent carboplatin or cyclophosphamide, doxorubicin, and cisplatin in women with ovarian cancer: the ICON3 randomised trial. Lancet (2002), 360:505–15.CrossRef
Alberts, D. S., Liu, P. Y., Hannigan, E. V., et al. Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. N Engl J Med (1996), 335:1950–5.CrossRefGoogle ScholarPubMed
Markham, M., Bundy, B. N., Alberts, D. S., et al. Phase III trial of standard-dose intravenous cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and intraperitoneal cisplatin in small-volume stage III ovarian carcinoma: an intergroup study of the Gynecologic Oncology Group, South Western Oncology Group, and Eastern Cooperative Oncology Group. J Clin Oncol (2001), 19:1001–7.Google Scholar
Armstrong, D. K., Bundy, B., Wenzel, L., et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med (2006), 354:34–43.CrossRefGoogle ScholarPubMed
Thigpen, J. T., Blessing, J. A., Ball, H., et al. Phase II trial of paclitaxel in patients with progressive ovarian carcinoma after platinum-based chemotherapy: a Gynecologic Oncology Group study. J Clin Oncol (1994), 12:1748–53.CrossRefGoogle ScholarPubMed
Trimble, E. L., Adams, J. D., Vena, D., et al. Paclitaxel for platinum-refractory ovarian cancer: results from the first 1000 patients registered to the National Cancer Institute Treatment Referral Centre 9103. J Clin Oncol (1993), 11:2405–10.CrossRefGoogle Scholar
Ledermann, J. A., ICON, on behalf of and AGO Collaborators; and Medical Research Council (MRC) Clinical Trials Unit, London, UK. Randomised trial of paclitaxel in combination with platinum chemotherapy versus platinum-based chemotherapy in the treatment of relapsed ovarian cancer (ICON4/OVAR2.2). Proc Amer Soc Clin Oncol (2003), 22:abstr 1794.Google Scholar
Kohn, E. C., Sarosy, G., Bicher, A., et al. Dose-intense taxol: high response rate in patients with platinum-resistant recurrent ovarian cancer. J Natl Cancer Inst (1994), 86:18–24.CrossRefGoogle ScholarPubMed
Seymour, M. T., Mansi, J. L., Gallagher, C. J., et al. Protracted oral etoposide in epithelial ovarian cancer: a phase II study in patients with relapsed or platinum-resistant disease. Br J Cancer (1994), 69:191–5.CrossRefGoogle ScholarPubMed
Rose, P. G., Blessing, J. A., Mayer, A. R., et al. Prolonged oral etoposide as second-line therapy for platinum-resistant and platinum-sensitive ovarian carcinoma: a Gynecologic Oncology Group study. J Clin Oncol (1998), 16:405–10.CrossRefGoogle ScholarPubMed
Bookman, M. A., Malstrom, H., Bolis, G., et al. Topotecan for the treatment of advanced epithelial ovarian cancer: an open-label phase II study in patients treated after prior chemotherapy that contained cisplatin or carboplatin and paclitaxel. J Clin Oncol (1998), 16:3345–52.CrossRefGoogle ScholarPubMed
Creemers, G. J., Bolis, G., Gore, M., et al. Topotecan, an active drug in the second-line treatment of epithelial ovarian cancer: results of a large European phase II study. J Clin Oncol (1996), 14:3056–61.CrossRefGoogle ScholarPubMed
McGuire, W. P., Blessing, J. A., Bookman, M. A., et al. Topotecan has substantial antitumor activity as first-line salvage therapy in platinum-sensitive epithelial ovarian carcinoma: A Gynecologic Oncology Group Study. J Clin Oncol (2000), 18:1062–7.CrossRefGoogle ScholarPubMed
Huinink, W. ten Bokkel, Gore, M., Carmichael, J., et al. Topotecan versus paclitaxel for the treatment of recurrent epithelial ovarian cancer. J Clin Oncol (1997), 15:2183–93.CrossRefGoogle Scholar
Gore, M., Huinink, W. ten Bokkel, Carmichael, J., et al. Clinical evidence for topotecan-paclitaxel non-cross-resistance in ovarian cancer. J Clin Oncol (2001), 19:1893–1900.CrossRefGoogle ScholarPubMed
Gore, M., Oza, A., Rustin, G., et al. A randomised trial of oral versus intravenous topotecan in patients with relapsed epithelial ovarian cancer. Eur J Cancer (2002), 38:57–63.CrossRefGoogle ScholarPubMed
Lund, B., Hansen, O. P., Theilade, K., et al. Phase II study of gemcitabine (2′,2′-difluorodeoxycytidine) in previously treated ovarian cancer patients. J Natl Cancer Inst (1994), 86:1530–3.CrossRefGoogle ScholarPubMed
Friedlander, M., Millward, M. J., Bell, D., et al. A phase II study of gemcitabine in platinum pre-treated patients with advanced epithelial ovarian cancer. Ann Oncol (1998), 9:1343–5.CrossRefGoogle ScholarPubMed
Shapiro, J. D., Millward, M. J., Rischin, D., et al. Activity of gemcitabine in patients with advanced ovarian cancer: responses seen following platinum and paclitaxel. Gynecol Oncol (1996), 63:89–93.CrossRefGoogle ScholarPubMed
Gabizon, A., Catane, R., Uziely, B., et al. Prolonged circulation time and enhanced accumulation in malignant exudates of doxorubicin encapsulated in polyethylene-glycol coated liposomes. Cancer Res (1994), 54:987–92.Google ScholarPubMed
Janknegt, R.. Liposomal formulations of cytotoxic drugs. Support Care Cancer (1996), 4:298–304.CrossRefGoogle ScholarPubMed
Muggia, F. M., Braly, P. S., Sutton, G., et al. Phase III randomised study of cisplatin versus paclitaxel versus cisplatin and paclitaxel in patients with suboptimal stage III or IV ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol (2000), 18:106–15.CrossRefGoogle ScholarPubMed
Gordon, A. N., Granai, C. O., Rose, P. G., et al. Phase II study of liposomal doxorubicin in platinum- and paclitaxel-refractory epithelial ovarian cancer. J Clin Oncol (2000), 18:3093–100.CrossRefGoogle ScholarPubMed
Gordon, A. N., Fleagle, J. T., Guthrie, D., et al. Recurrent epithelial ovarian carcinoma: a randomised phase III study of pegylated liposomal doxorubicin versus topotecan. J Clin Oncol (2001), 19:3312–22.CrossRefGoogle Scholar
O'Byrne, K. J., Bliss, P., Graham, J. D., et al. A Phase II study of Doxil/Caelyx versus paclitaxel in platinum-treated, taxane-naïve relapsed ovarian cancer. Proc Am Soc Clin Oncol (2002), 21a:203a (abstr 808).Google Scholar
Chollet, P., Bensmaine, M. A., Brienza, S., et al. Single-agent activity of oxaliplatin in heavily pre-treated advanced epithelial ovarian cancer. Ann Oncol (1996), 7:1065–70.CrossRefGoogle Scholar
Piccart, M. J., Green, J. A., Lacave, A. J., et al. Oxaliplatin or paclitaxel in patients with platinum-pretreated advanced ovarian cancer: a randomised phase II study of the European Organisation for Research and Treatment of Cancer Gynecology Group. J Clin Oncol (2000), 18:1993–202.CrossRefGoogle ScholarPubMed
Burger, R. A., DiSaia, P. J., Roberts, J. A., et al. Phase II trial of vinorelbine in recurrent and progressive epithelial ovarian cancer. Gynecol Oncol (1999), 72:148–53.CrossRefGoogle ScholarPubMed
Boehmer, Ch. and Jaeger, W.. Capecitabine in treatment of platinum-resistant recurrent ovarian cancer. Anticancer Res (2002), 22:439–43.Google ScholarPubMed
Blackledge, G., Lawton, F., Redman, C., et al. Response of patients in Phase II studies of chemotherapy in ovarian cancer: implications for patient treatment and the design of Phase II trials. Br J Cancer (1989), 59:650–3.CrossRefGoogle ScholarPubMed
Gore, M. E., Fryatt, I., Wiltshaw, E., et al. Treatment of relapsed carcinoma of the ovary with cisplatin or carboplatin following initial treatment with these compounds. Gynecol Oncol (1990), 36:207–11.CrossRefGoogle ScholarPubMed
Markham, M., Rothman, R., Hakes, T., et al. Second line platinum therapy in patients with ovarian cancer previously treated with cisplatin. J Clin Oncol (1991), 9:389–93.Google Scholar
Rustin, G. J., Nelstrop, A. E., Tuxen, M. K., et al. Defining progression of ovarian carcinoma during follow up according to CA 125: a North Thames Ovary Group study. Ann Oncol (1996), 7:361–4.CrossRefGoogle Scholar
Burg, M. E., Lammes, F. B. and Verweij, J.. The role of CA125 in the early diagnosis of progressive disease in ovarian cancer. Ann Oncol (1996), 1:301–2.CrossRefGoogle Scholar
OV05. MRC Trial. ISRCTN 87786644.
Makar, A. P.. Hormone therapy in epithelial ovarian cancer. Endocr Relat Cancer (2000), 7:85–93.CrossRefGoogle ScholarPubMed
Adelson, M. D. and Reece, M. T.. Effects of gonadotropin-releasing hormone analogues on ovarian epithelial tumors. Clin Obstet Gynecol (1993), 36:690–700.CrossRefGoogle ScholarPubMed
Burger, R. A., Sill, M., Monk, B. J., et al. Phase II trial of bevacizumab in persistent or recurrent epithelial ovarian carcinoma or primary peritoneal carcinoma: a Gynecologic Oncology Group (GOG) Study. Proc Am Soc Clin Oncol (2005), abstr #5009.CrossRefGoogle Scholar
Kavanagh, J., Kudelka, A., Gershenson, D., et al. Phase 2 Study of TLK286 (TELCYTATM, A GST P1–1 Activated Glutathione Analog) in patients with platinum and paclitaxel refractory or resistant ovarian cancer. Proc Am Soc Gynecol Oncologists, Feb 2004.

Send book to Kindle

To send this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Send book to Dropbox

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox.

Available formats
×

Send book to Google Drive

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive.

Available formats
×