1
|
Roncolato F, O'Connell R, Joly F, Lanceley A, Hilpert F, Buizen L, Okamoto A, Aotani E, Salutari V, Donnellan P, Oza A, Avall-Lundqvist E, Berek J, Fehm T, Ledermann J, Roemer-Becuwe C, Stockler M, King M, Friedlander M. Predictors of progression free survival, overall survival and early cessation of chemotherapy in women with potentially platinum sensitive (PPS) recurrent ovarian cancer (ROC) starting third or subsequent line(≥3) chemotherapy – The GCIG symptom benefit study (SBS). Gynecol Oncol 2020; 156:45-53. [DOI: 10.1016/j.ygyno.2019.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 09/27/2019] [Accepted: 10/03/2019] [Indexed: 11/24/2022]
|
2
|
Lee CK, Asher R, Friedlander M, Gebski V, Gonzalez-Martin A, Lortholary A, Lesoin A, Kurzeder C, Largillier R, Hilpert F, Hardy-Bessard AC, Kaminsky MC, Poveda A, Pujade-Lauraine E. Development and validation of a prognostic nomogram for overall survival in patients with platinum-resistant ovarian cancer treated with chemotherapy. Eur J Cancer 2019; 117:99-106. [PMID: 31279306 DOI: 10.1016/j.ejca.2019.05.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Platinum-resistant ovarian cancer (PROC) is associated with a variable prognosis and unpredictable survival times. We have developed and validated a prognostic nomogram with the objective of improving the prediction of overall survival (OS) in patients treated with chemotherapy. METHODS The nomogram was developed using data from a training cohort of patients from two trials, including the chemotherapy-only arm in AURELIA and all randomised patients in CARTAXHY. Multivariable proportional hazards models were generated based on pretreatment characteristics to develop a nomogram that classifies patients based on OS. We subsequently assessed the performance of the nomogram in terms of discrimination and calibration in independent validation patient cohorts: PENELOPE and the bevacizumab-chemotherapy arm of AURELIA. RESULTS The nomogram included six significant OS predictors, in order of importance: performance status, ascites, size of the largest tumour, CA-125, platinum-free interval and primary platinum resistance (C-statistic 0.69). In the training cohort, the median OS in the good, intermediate and poor prognosis groups was 25.3, 15.2 and 7.4 months, respectively. In the PENELOPE validation cohort (C-statistic 0.59), the median OS in the good, intermediate and poor prognosis groups was 18.5, 10.3 and 5.8 months, respectively. In the AURELIA bevacizumab-chemotherapy validation cohort (C-statistic 0.67), the median OS in good, intermediate and poor prognosis groups was 26.7, 13.8 and 10.0 months, respectively. CONCLUSIONS This nomogram with six pretreatment characteristics allows prediction of OS in PROC and could be used for stratification of patients in clinical trials as well as for counselling patients about prognosis.
Collapse
Affiliation(s)
- Chee Khoon Lee
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia.
| | - Rebecca Asher
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | - Val Gebski
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Antonio Gonzalez-Martin
- Grupo Español de Investigación en Cáncer de Ovario (GEICO) and MD Anderson Cancer Center Spain, Madrid, Spain; Clínica Universidad de Navarra, Madrid, Spain
| | - Alain Lortholary
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) and Medical Oncology, Hôpital Privé du Confluent S.A.S., Nantes, France
| | - Anne Lesoin
- GINECO and Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Christian Kurzeder
- Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Dept. of Gynecology & Gynecologic Oncology, Klinikum Essen Mitte, Essen, Germany
| | | | - Felix Hilpert
- AGO and Dept. of Gynecology and Obstetrics, University Hospital Kiel, Kiel, Germany; Mammazentrum am Krankenhaus Jerusalem, Hamburg, Germany
| | | | | | - Andres Poveda
- GEICO and Instituto Valenciano de Oncología, Valencia, Spain
| | | |
Collapse
|
3
|
Cymbaluk-Płoska A, Chudecka-Głaz A, Pius-Sadowska E, Machaliński B, Menkiszak J, Sompolska-Rzechuła A. Suitability assessment of baseline concentration of MMP3, TIMP3, HE4 and CA125 in the serum of patients with ovarian cancer. J Ovarian Res 2018; 11:1. [PMID: 29304854 PMCID: PMC5755423 DOI: 10.1186/s13048-017-0373-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/21/2017] [Indexed: 01/01/2023] Open
Abstract
Background MMP and TIMP play an important role in the degradation of extracellular matrix components which are essential for tumor growth, invasion and metastasis. Aim of this research was to assess MMP3 and TIMP3 as prognostic factors among patients with ovarian cancer. Results It was found that high levels of output MMP3 correlated with shortened overall survival time of patients by 9.7 months. In addition, it has been shown that high concentrations of output MMP3 were significantly associated with a shorter disease free time in median concentrations implemented p = 0.0059. Statistically significant dependence has been shown between an average concentration of TIMP3 protein to the overall survival of patients. The higher output concentration of TIMP3, the longer patients’ survival by 8.9 month. In addition, it was found that high TIMP3 concentrations output were associated with a significantly longer disease free duration at a median concentrations p = 0.007. Conclusion Preliminary research shows that output levels of MMP3 and TIMP3 proteins correlate with overall survival of patients. In some cases also time free of illness.
Collapse
Affiliation(s)
- Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland.
| | - Anita Chudecka-Głaz
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland
| | - Ewa Pius-Sadowska
- General Pathology Department, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland
| | - Bogusław Machaliński
- General Pathology Department, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland
| | - Janusz Menkiszak
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland
| | - Agnieszka Sompolska-Rzechuła
- Department of Mathematics Applications in Economy, West Pomeranian University of Technology, al. Piastów 17, 70-310, Szczecin, Poland
| |
Collapse
|
4
|
Roncolato FT, Joly F, O'Connell R, Lanceley A, Hilpert F, Buizen L, Okamoto A, Aotani E, Pignata S, Donnellan P, Oza A, Avall-Lundqvist E, Berek JS, Heitz F, Feeney A, Berton-Rigaud D, Stockler MR, King M, Friedlander M. Reducing Uncertainty: Predictors of Stopping Chemotherapy Early and Shortened Survival Time in Platinum Resistant/Refractory Ovarian Cancer-The GCIG Symptom Benefit Study. Oncologist 2017; 22:1117-1124. [PMID: 28596446 DOI: 10.1634/theoncologist.2017-0047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/23/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Clinicians and patients often overestimate the benefits of chemotherapy, and overall survival (OS), in platinum resistant/refractory ovarian cancer (PRROC). This study sought to determine aspects of health-related quality of life and clinicopathological characteristics before starting chemotherapy that were associated with stopping chemotherapy early, shortened survival, and death within 30 days of chemotherapy. MATERIALS AND METHODS This study enrolled women with PRROC before starting palliative chemotherapy. Health-related quality of life was measured with EORTC QLQ-C30/QLQ-OV28. Chemotherapy stopped within 8 weeks of starting was defined as stopping early. Logistic regression was used to assess univariable and multivariable associations with stopping chemotherapy early and death within 30 days of chemotherapy; Cox proportional hazards regression was used to assess associations with progression-free and OS. RESULTS Low baseline global health status (GHS), role function (RF), physical function (PF), and high abdominal/gastrointestinal symptom (AGIS) were associated with stopping chemotherapy early (all p < .007); low PF and RF remained significant after adjusting for clinicopathological factors (both p < .0401). Most who stopped chemotherapy early had Eastern Cooperative Oncology Group Performance Score 0-1 at baseline (79%); PF, RF, and GHS remained independently significant predictors of stopping chemotherapy early in this subgroup. Death within 30 days of chemotherapy occurred in 14%. Low GHS, RF, and PF remained significantly associated with death within 30 days of chemotherapy after adjusting for clinicopathological factors (all p < .012). CONCLUSION Women with low GHS, RF, or PF before starting chemotherapy were more likely to stop chemotherapy early, with short OS. Self-ratings of GHS, RF, and PF could improve patient-clinician communication regarding prognosis and help decision-making in women considering chemotherapy for PRROC. IMPLICATIONS FOR PRACTICE Measuring aspects of health-related quality of life when considering further chemotherapy in platinum resistant/refractory ovarian cancer (PRROC) could help identify women with a particularly poor prognosis who are unlikely to benefit from chemotherapy and could therefore be spared unnecessary treatment and toxicity in their last months of life. Self-ratings of global health status, role function, and physical function could improve patient-clinician communication regarding prognosis and help decision-making in women considering chemotherapy for PRROC.
Collapse
Affiliation(s)
- Felicia T Roncolato
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), New South Wales, Australia
- Macarthur Cancer Therapy Centre, New South Wales, Australia
| | | | - Rachel O'Connell
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | - Felix Hilpert
- Klinik fur Gynakologie und Geburtshilfe, UKSH, Kiel, Germany
| | - Luke Buizen
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Aikou Okamoto
- The Jikei University School of Medicine, Tokyo, Japan
| | - Eriko Aotani
- Kitasato Academic Research Organization, Tokyo, Japan
| | - Sandro Pignata
- Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione G. Pascale, IRCCS, Napoli (MITO), Italy
| | - Paul Donnellan
- Cancer Trials Ireland, Galway University Hospital, Galway, Ireland
| | - Amit Oza
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Elisabeth Avall-Lundqvist
- Department of Oncology, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Karolinska Institutet, Stockholm, Sweden
| | - Jonathan S Berek
- Stanford Comprehensive Cancer Institute, Stanford, California, USA
| | - Florian Heitz
- AGO Study group and Department of Gynecology & Gynecologic Oncology, Kliniken Essen Mitte (KEM), Essen, Germany
| | - Amanda Feeney
- Cancer Research UK & UCL Cancer Trials Centre, London, England
| | | | - Martin R Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), New South Wales, Australia
| | - Madeleine King
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), New South Wales, Australia
- Psycho-oncology Research Group (PoCoG), School of Psychology and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Michael Friedlander
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), New South Wales, Australia
- Prince of Wales Hospital, Sydney, Australia
| |
Collapse
|
5
|
Huang KC, Yang J, Ng MC, Ng SK, Welch WR, Muto MG, Berkowitz RS, Ng SW. Cyclin A1 expression and paclitaxel resistance in human ovarian cancer cells. Eur J Cancer 2016; 67:152-163. [PMID: 27669502 PMCID: PMC5080661 DOI: 10.1016/j.ejca.2016.08.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/30/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The development of intrinsic and acquired resistance to antineoplastic agents is a major obstacle to successful chemotherapy in ovarian cancers. Identification and characterisation of chemoresponse-associated biomarkers are of paramount importance for novel therapeutic development. METHODS Global RNA expression profiles were obtained by high-throughput microarray analysis. Cell cycle, proliferation rate, and paclitaxel sensitivity of ovarian cancer cells harbouring cyclin A1-inducible expression construct were compared with and without tetracycline induction, as well as when the cyclin A1 expression was suppressed by short inhibiting RNA (siRNA). Cellular senescence was evaluated by β-galactosidase activity staining. RESULTS Global RNA expression profiling and subsequent correlation studies of gene expression level and drug response has identified that elevated expression of cyclin A1 (CCNA1) was significantly associated with cellular resistance to paclitaxel, doxorubicin and 5-fluorouracil. The role of cyclin A1 in paclitaxel resistance was confirmed in ovarian cancer cells that harbour an inducible cyclin A1 expression construct, which showed reduced paclitaxel-mediated growth inhibition and apoptosis when cyclin A1 expression was induced, whereas downregulation of cyclin A1 expression in the same cell lines using cyclin A1-specific siRNAs sensitised the cells to paclitaxel toxicity. However, ovarian cancer cells with ectopic expression of cyclin A1 demonstrated slowdown of proliferation and senescence-associated β-galactosidase activity. CONCLUSIONS Our profiling and correlation studies have identified cyclin A1 as one chemoresistance-associated biomarker in ovarian cancer. The results of the characterisation studies suggest that cyclin A1 functions as an oncogene that controls proliferative and survival activities in tumourigenesis and chemoresistance of ovarian cancer.
Collapse
Affiliation(s)
- Kuan-Chun Huang
- Laboratory of Gynecologic Oncology, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Boston, MA 02115, USA
| | - Junzheng Yang
- Laboratory of Gynecologic Oncology, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Boston, MA 02115, USA
| | - Michelle C Ng
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Shu-Kay Ng
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Meadowbrook, Australia
| | - William R Welch
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Michael G Muto
- Laboratory of Gynecologic Oncology, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Boston, MA 02115, USA
| | - Ross S Berkowitz
- Laboratory of Gynecologic Oncology, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Boston, MA 02115, USA
| | - Shu-Wing Ng
- Laboratory of Gynecologic Oncology, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Boston, MA 02115, USA.
| |
Collapse
|
6
|
Suh DH, Kim HS, Chang SJ, Bristow RE. Surgical management of recurrent ovarian cancer. Gynecol Oncol 2016; 142:357-67. [PMID: 27130407 DOI: 10.1016/j.ygyno.2016.04.537] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/06/2016] [Accepted: 04/22/2016] [Indexed: 01/21/2023]
Abstract
Most patients with advanced-stage epithelial ovarian cancer will experience a relapse of disease despite a complete response after surgical cytoreduction and platinum-based chemotherapy. Treatment of recurrent ovarian cancer mainly comprises various combinations of systemic chemotherapy with or without targeted agents. The role of cytoreductive surgery for recurrent ovarian cancer is not well established. Although the literature on survival benefit of cytoreductive surgery for recurrent disease has expanded steadily over the past decade, most studies were retrospective, single-institution series with small numbers of patients. Given the balance between survival benefit and surgery-related morbidity during maximum cytoreductive surgical effort, it is essential to establish the optimal selection criteria for identifying appropriate candidates who will benefit from surgery without worsening quality of life. Three phase III randomized trials for this issue are currently underway. Herein, we present contemporary evidence supporting the positive role of cytoreductive surgery and offer selection criteria for optimal candidates for surgery in the treatment of recurrent ovarian cancer.
Collapse
Affiliation(s)
- Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Suk-Joon Chang
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
| | - Robert E Bristow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Orange, CA, USA
| |
Collapse
|
7
|
Zhang M, Zhuang G, Sun X, Shen Y, Zhao A, Di W. Risk prediction model for epithelial ovarian cancer using molecular markers and clinical characteristics. J Ovarian Res 2015; 8:67. [PMID: 26490766 PMCID: PMC4618052 DOI: 10.1186/s13048-015-0195-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/12/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A high-quality risk prediction model is urgently needed for the clinical management of ovarian cancer. However most existing models are solely based on clinical parameters, and molecular classifications in recent reports are still being debated. This study aimed to establish a risk prediction model by using both clinicopathological and molecular factors (the synthetic model) for epithelial ovarian cancer. METHODS A retrospective cohort study was conducted in epithelial ovarian cancer patients (n = 161) treated with primary debulking surgery and adjuvant chemotherapy. The expression level of 15 selected molecular markers were measured using immunohistochemistry. A risk model was developed using COX regression analysis with overall survival as the primary outcome. A simplified scoring system for each prognostic factor was based on its coefficient. Independent validation (n = 40) was conducted to evaluate the performance of the model. RESULTS A total of 10 out of 15 molecular markers were significantly associated with clinical characteristics and overall survival. The synthetic model performed better than the clinicopathological risk model or the molecular risk model alone, as assessed by analysis of the receiver-operating characteristics curve area and the Youden index. The synthetic model included parity (>3), peritoneal metastasis, stage, tumor type, residual disease, and expression of human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR), breast cancer 1 (BRCA1), murine sarcoma viral oncogene homolog B (BRAF) and Kirsten rat sarcoma viral oncogene homolog (KRAS). CONCLUSIONS Our synthetic risk model may more accurately predict survival of epithelial ovarian cancer patients than current models.
Collapse
Affiliation(s)
- Meiying Zhang
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China. .,Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
| | - Guanglei Zhuang
- State Key Laboratory of Oncogenes and Related Genes, Renji-Med X Clinical Stem Cell Research Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
| | - Xiangjun Sun
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China. .,Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
| | - Yanying Shen
- Department of Pathology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
| | - Aimin Zhao
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China. .,Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
| | - Wen Di
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China. .,Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
| |
Collapse
|
8
|
Clinical outcomes of women with recurrent or persistent uterine leiomyosarcoma. Int J Gynecol Cancer 2015; 24:1434-40. [PMID: 25248114 DOI: 10.1097/igc.0000000000000221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study aimed to identify prognostic factors influencing the outcome of recurrent or persistent uterine leiomyosarcoma (ULMS). METHODS All patients with recurrent or persistent ULMS who underwent treatment at the participating institutions between January 2000 and December 2010 were identified from the tumor registry. The Kaplan-Meier method was used to generate overall survival data. Factors predictive of outcome were compared using the log-rank test and Cox proportional hazards model. RESULTS One hundred fifteen (68.8%) patients who had recurrent/persistent disease were identified, 40 (34.8%) had persistent disease, and 75 (65.2%) had a recurrence. Median follow-up time was 24.9 months. The 5-year postrelapse survival rate was 15% and was not significantly different between women with recurrent or persistent disease (16% vs 13%; P = 0.1). Variables identified affecting the 5-year postrelapse survival rate included low number of mitosis at the time of diagnosis (<25, 25% vs 5%; P = 0.002), time to relapse from original diagnosis (≤6 vs >6 months, 8% vs 22%; P = 0.003)), and surgical treatment (17% vs 12%; P = 0.01). Age, stage, chemotherapy at time of original diagnosis or at the time of relapse, site of recurrence, and single versus multiple sites of recurrence were not associated with survival. In a multivariate Cox regression model, only low number of mitosis (hazard ratio, 0.5; 95% confidence interval, 0.3-0.8, P = 0.02) was identified as a predictor of overall survival. CONCLUSIONS The prognosis of patients with recurrent/persistent ULMS is, in general, poor. Women who have low number of mitosis at the time of diagnosis seemed to have better postrelapse survival.
Collapse
|
9
|
Hanker LC, Loibl S, Burchardi N, Pfisterer J, Meier W, Pujade-Lauraine E, Ray-Coquard I, Sehouli J, Harter P, du Bois A. The impact of second to sixth line therapy on survival of relapsed ovarian cancer after primary taxane/platinum-based therapy. Ann Oncol 2012; 23:2605-2612. [PMID: 22910840 DOI: 10.1093/annonc/mds203] [Citation(s) in RCA: 230] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite recent progress in the treatment of ovarian cancer, the majority of patients eventually relapse. There is little information on the effectiveness of chemotherapy in higher treatment lines. PATIENTS AND METHODS Characterization of the second to sixth line therapy and its effects on survival was carried out, based on data of n = 1620 patients from three large randomized phase III trials investigating primary therapy. RESULTS Median progression-free survival (PFS) after the first, second, third, fourth and fifth relapse was 10.2 [95% confidence interval (CI) 9.6-10.7], 6.4 (5.9-7.0), 5.6 (4.8-6.2), 4.4 (3.7-4.9) and 4.1 (3.0-5.1) months, respectively. Median overall survival (OS) after the first, second, third, fourth and fifth relapse was 17.6 (95% CI 16.4-18.6), 11.3 (10.4-12.9), 8.9 (7.8-9.9), 6.2 (5.1-7.7) and 5.0 (3.8-10.4) months, respectively. The most frequent second and third line chemotherapy was platinum combination (n = 313, 24.5%) and topotecan (n = 118, 23.6%), respectively. Relapse treatment improved PFS and OS at the second to fourth recurrence, although frequently not performed according to the standard of care. In multivariate analysis, platinum sensitivity and optimal primary tumor debulking were revealed as independent prognostic factors for PFS up to third relapse. CONCLUSION A maximum of three lines of subsequent relapse treatment seems to be beneficial for patients with recurrent ovarian cancer. Optimal primary tumor debulking and platinum sensitivity remain independent prognostic factors even after more frequent relapses.
Collapse
Affiliation(s)
- L C Hanker
- Department of Gynecology and Obstetrics, Johann Wolfgang Goethe-University, Frankfurt am Main.
| | - S Loibl
- German Breast Group Forschungs GmbH, Neu Isenburg, Department of Gynecology and Obstetrics Klinikum Offenbach, Offenbach am Main
| | - N Burchardi
- Coordinating Center for Clinical Trials, Philipps-University, Marburg
| | - J Pfisterer
- Department of Gynecology and Obstetrics, Städtisches Klinikum, Solingen
| | - W Meier
- Department of Gynecology and Obstetrics, Evangelical Hospital, Duesseldorf, Germany
| | | | - I Ray-Coquard
- Department of Oncology, Centre Léon Bérard, Lyon, France
| | - J Sehouli
- Department of Gynecology, Charité/Campus Virchow Klinikum Medical University, Berlin
| | - P Harter
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Essen, Germany
| | - A du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Essen, Germany
| | | |
Collapse
|
10
|
Tanner EJ, Chi DS, Eisenhauer EL, Diaz-Montes TP, Santillan A, Bristow RE. Surveillance for the detection of recurrent ovarian cancer: Survival impact or lead-time bias? Gynecol Oncol 2010; 117:336-40. [DOI: 10.1016/j.ygyno.2010.01.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 12/31/2009] [Accepted: 01/07/2010] [Indexed: 01/22/2023]
|
11
|
Treatment for recurrent ovarian cancer-at first relapse. JOURNAL OF ONCOLOGY 2009; 2010:497429. [PMID: 20066162 PMCID: PMC2801501 DOI: 10.1155/2010/497429] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 09/27/2009] [Accepted: 10/15/2009] [Indexed: 11/17/2022]
Abstract
Recurrent ovarian cancer is a lethal disease, and few patients can be cured. Although most patients receive standardized surgery and chemotherapy, the status of recurrent disease is heterogeneous. The site of recurrence and the survival intervals after recurrence are also widely distributed. Among a number of factors, many clinical trials identified time to recurrence was the factor most related to chemosensitivity at first relapse. The current recommendation for platinum sensitive ovarian cancer is a carboplatin containing combination chemotherapy. Generally, a single agent is chosen for platinum resistant ovarian cancer. Patients with single site recurrence and a long disease free interval are candidates for secondary cytoreduction, which may provide longer survival. There are several treatment choices at first relapse, and disease status, chemotherapy-free interval, and the patient's condition play a major role in the decision making process.
Collapse
|
12
|
Harrison ML, Gore ME, Spriggs D, Kaye S, Iasonos A, Hensley M, Aghajanian C, Venkatraman E, Sabbatini P. Duration of second or greater complete clinical remission in ovarian cancer: exploring potential endpoints for clinical trials. Gynecol Oncol 2007; 106:469-75. [PMID: 17614127 PMCID: PMC2694792 DOI: 10.1016/j.ygyno.2007.05.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 05/08/2007] [Accepted: 05/09/2007] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To explore benchmarks for future consolidation strategies, we evaluated a strictly defined (normal CA-125 and normal CT) second-complete-remission (CR) ovarian cancer population for 1) the median progression-free survival (PFS), 2) the frequency with which second remission exceeds first, and 3) the proportion of patients in remission at given time points. METHODS Retrospective sampling was carried out at Memorial Sloan-Kettering (10/1993-12/2000) and the Royal Marsden Hospital (1/1995-4/2003) for the following: histological confirmation and elevated CA-125 at diagnosis; primary surgery; first-and second-line platinum-based chemotherapy with CR; and no maintenance therapy. RESULTS In 35 patients 1) the duration of first PFS was 17.8 months (95% CI, 13.2-24.5 months) and second PFS was 10.8 months (95% CI, 9.6-12.2 months); 2) the number of patients with second response longer than first was 3/35 (9%); 3) the proportion of patients remaining in second complete remission was 100% (3 months), 100% (6 months), 83% (9 months), 34% (12 months), 23% (15 months) and 8.6% (18 months), respectively. CONCLUSION 1) The median PFS from second complete remission is short. 2) A second response is rarely longer than the first even in this second CR population. 3) The number of patients with a second response longer than the first, or the proportion of patients remaining in complete remission at given time points could be evaluated as an outcome measure in future studies.
Collapse
Affiliation(s)
| | - Martin E Gore
- Department of Gynaecology, The Royal Marsden Hospital, London, UK
| | - David Spriggs
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Stan Kaye
- Department of Gynaecology, The Royal Marsden Hospital, London, UK
| | - Alexia Iasonos
- Department of Epidemiology-Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Martee Hensley
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Carol Aghajanian
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Ennapadam Venkatraman
- Department of Epidemiology-Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Paul Sabbatini
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA
| |
Collapse
|
13
|
Blanchard P, Plantade A, Pagès C, Afchain P, Louvet C, Tournigand C, de Gramont A. Isolated lymph node relapse of epithelial ovarian carcinoma: outcomes and prognostic factors. Gynecol Oncol 2006; 104:41-5. [PMID: 16952391 DOI: 10.1016/j.ygyno.2006.06.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Revised: 06/19/2006] [Accepted: 06/21/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Relapses of epithelial ovarian carcinoma (EOC) have a poor prognosis. Isolated lymph node relapses (ILNR) are considered of relatively good prognosis with intensive therapy. METHODS This retrospective study aimed to describe incidence, characteristics, outcomes and prognostic factors of ILNR treated over 15 years. RESULTS Twenty-seven patients (4.2%) experienced an ILNR among 640 patients. Median age was 59 years, tumour stages included stage I (n=4), II (n=5), III (n=15) and IV (n=3). After initial optimal treatment, median progression-free survival (PFS) was 26 months. Sites of relapse were retroperitoneum (n=15), left supraclavicular (n=7), mediastinum (n=4), iliac (n=4) and inguinal (n=3). ILNR locations were unique in 63% of patients (n=17) and multiple in 37% (n=10). Treatment modalities were surgery in eight patients (30%), chemotherapy in 15 (55%) and radiotherapy in 5 patients (18%), alone or in combination. Seven patients without tumour-related symptoms (26%) were not treated. Median overall survival (OS) after ILNR was 26 months. Median OS from initial diagnosis was 68 months. 25% of patients had a very long survival (>100 months), independent of their initial staging or PFS. There was no difference in 2-year survival after ILNR between the groups of early relapse (before 24 months) and late relapse (after 24 months). In the seven non-treated patients, median OS was 91 months. CONCLUSION ILNR is a rare event in EOC. Time to relapse may not have its usual prognostic value. Immediate or delayed therapy should be discussed in case of asymptomatic ILNR.
Collapse
Affiliation(s)
- Pierre Blanchard
- Service d'Oncologie Médicale, Hôpital Saint Antoine, 184 rue du Faubourg Saint Antoine, 75012, Paris, France.
| | | | | | | | | | | | | |
Collapse
|
14
|
Gronlund B, Christensen IJ, Bülow-Lehnsby AL, Engelholm SA, Hansen HH, Høgdall C. Recurrent epithelial ovarian cancer: validation and improvement of an established prognostic index. Eur J Obstet Gynecol Reprod Biol 2006; 123:98-106. [PMID: 15896897 DOI: 10.1016/j.ejogrb.2005.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Accepted: 03/22/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To validate and improve an established prognostic index in patients with recurrent ovarian cancer. METHODS A Canadian three-covariate prognostic index (tumour grade at diagnosis, initial performance status, and time to relapse/primary progression (TRP)) was validated in a well-defined cohort of comparable Danish patients. Potential parameters to be included in an improved prognostic index were revealed by univariate and multivariate analyses in the Danish validation group. RESULTS The Canadian index validated in the Danish patient population (n=189) found a statistical significant difference in survival between the prognostic groups good and intermediate (P<0.0001), whereas there was no significant difference in survival between the prognostic groups intermediate and poor (P=0.51). In order to improve the accuracy of the index, the candidate parameters, treatment free interval (TFI), CA125 level and performance status, at time of relapse/primary progression, were added, whereas the parameters, tumour grade, and initial performance status, from the Canadian index were excluded. As the correlation coefficient between TRP and TFI was very high (r=0.91), TRP was substituted with TFI in the improved prognostic model. The final model was: 0.8 (performance status)+0.33 log (CA125)-1.31 log (TFI). The improved model was a good predictor of one-year survival (AUC 0.85; logistic regression; P<0.0001). The median survival (with 95% CI) of the four prognostic groups (A-D) was 50.6 (34.0-not available), 25.0 (22.1-33.6), 11.3 (8.5-12.9), and 5.2 (3.5-6.3) months, respectively. CONCLUSIONS A novel prognostic model (the Copenhagen index) for patients with recurrent ovarian cancer is presented.
Collapse
Affiliation(s)
- Bo Gronlund
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark.
| | | | | | | | | | | |
Collapse
|
15
|
Gronlund B, Dehn H, Høgdall CK, Engelholm SA, Jørgensen M, Nørgaard-Pedersen B, Høgdall EVS. Cancer-associated serum antigen level: a novel prognostic indicator for survival in patients with recurrent ovarian carcinoma. Int J Gynecol Cancer 2006; 15:836-43. [PMID: 16174233 DOI: 10.1111/j.1525-1438.2005.00145.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim was to examine the value of the pretherapeutic serum cancer-associated serum antigen (CASA) level as a prognostic factor for survival in patients with recurrent epithelial ovarian carcinoma. Serum levels of CASA and cancer antigen (CA)125 were prospectively determined in 70 consecutive patients with recurrent ovarian cancer before the start of second-line chemotherapy. Univariate and multivariate analyses of survival were performed. The median level of serum CASA was 6.5 U/mL (range: 0.2-1437 U/mL). Univariate analysis showed that patients with a CASA level >10.0 U/mL had significantly shorter survival than patients with CASA level < or =10.0 U/mL (P= 0.002). Using different CASA cutoff levels (6.0, 6.5, and 10.0 U/mL), multivariate Cox analyses identified CASA as an independent prognostic factor for survival at every cutoff level. The strongest prognostic function for CASA was found at a cutoff level of 10.0 U/mL (>10 vs < or =10 U/mL; hazard ratio, 2.7; 95% confidence interval, 1.6-4.7; P < 0.001). The pretreatment CA125 level was not found to be significantly associated with survival by any of the cutoffs (35, 65, 132, and 339 U/mL). A pretreatment elevated level of the tumor marker CASA is an adverse prognostic factor for survival in patients with ovarian cancer relapse.
Collapse
Affiliation(s)
- B Gronlund
- Departments of Oncology and Gynecology, Rigshospitalet, National University Hospital, Copenhagen, Denmark.
| | | | | | | | | | | | | |
Collapse
|
16
|
Hoskins PJ, Le N. Identifying patients unlikely to benefit from further chemotherapy: A descriptive study of outcome at each relapse in ovarian cancer. Gynecol Oncol 2005; 97:862-9. [PMID: 15894355 DOI: 10.1016/j.ygyno.2005.03.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 03/09/2005] [Accepted: 03/14/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Not all patients with relapsed ovarian cancer (EOC) benefit from further treatment and thus treatment should be selectively applied. METHODS/PATIENTS A retrospective review of survival and response outcomes in 120 women with relapsed EOC, all treated at original diagnosis with surgery and platin plus paclitaxel, who had all their initial and subsequent relapse therapy carried out at the BCCA. RESULTS In those patients selected for re-treatment upon relapse, lack of progression rates were 63%, 50%, 45%, 44%, 29%, and 20% respectively for first through sixth relapse. The corresponding median survivals from that relapse were 14, 10, 6, 7, 8, and 5 months. A predictive model based upon the length of the interval between the two preceding relapses (or diagnosis to 2nd relapse) predicted which patients would survive less than 6 months (patient defined "lack of benefit" to chemotherapy criterion): diagnosis to second relapse <12 months; first to third relapse <6 months; second to fourth <6 months; third to fourth <6 months, and fifth to sixth <6 months. CONCLUSION In selected patients, multiple episodes of re-treatment are of value. A time-based statistic identifies those who will not benefit, defined as survival less than 6 months.
Collapse
Affiliation(s)
- Paul J Hoskins
- Division of Medical Oncology, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6.
| | | |
Collapse
|
17
|
Abstract
Advances in the treatment and early detection of ovarian cancer have led to gains in 5-year survival rates, with 52% of women diagnosed between 1992 and 1997 surviving 5 years or longer, compared with 41% of women diagnosed between 1983 and 1985. Although approximately 10%-15% of patients achieve and maintain complete responses to therapy, the remaining patients have persistent disease or eventually relapse. These patients will generally undergo a series of treatments, each associated with progressively shorter treatment-free intervals. Nevertheless, median survival of patients with recurrent ovarian cancer ranges from 12-24 months, demonstrating the chronic natural history of the disease. Advances in the treatment of ovarian cancer over the past decade have led to these improvements and have prompted oncologists to now view the management of patients with ovarian cancer as an ongoing, long-term challenge. This shift in approach has raised important new questions regarding patient management, including the need to define trigger points for initiating or changing treatment (e.g., sequential increases in serum cancer antigen 125 levels, appearance of symptoms, or cumulative toxicities), anticipation of impending treatment decision points, recognition that the overtreatment of patients early in the disease process may adversely affect future treatment opportunities, and a renewed emphasis on patient education and participation in decision-making. This review will discuss these important patient management issues and will conclude with case studies illustrating two distinct treatment strategies (planning and sequencing) for the long-term management of patients with ovarian cancer.
Collapse
Affiliation(s)
- Deborah K Armstrong
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Bunting Blaustein Cancer Research Building, Room 190, 1650 Orleans Street, Baltimore, MD 21231-1000, USA.
| |
Collapse
|
18
|
Gronlund B, Høgdall C, Hansen HH, Engelholm SA. Performance status rather than age is the key prognostic factor in second-line treatment of elderly patients with epithelial ovarian carcinoma. Cancer 2002; 94:1961-7. [PMID: 11932898 DOI: 10.1002/cncr.10385] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intravenous cytostatic agents as second-line treatment of epithelial ovarian carcinoma have been withheld from many elderly patients because of fear of toxicity. The purpose of the study is to compare the toxicity and efficacy between elderly (older than 65 years of age) and younger (younger than 65 years of age) patients receiving intravenous second-line treatment of epithelial ovarian carcinoma. METHODS This study was a retrospective analysis of 286 consecutive patients with primary epithelial ovarian carcinoma. Inclusion criteria included histopathologically documented International Federation of Gynecology and Obstetrics (FIGO) Stage IC-IV epithelial ovarian carcinoma; first-line treatment with paclitaxel and a platinum analog; intravenous second-line treatment with topotecan 1.0 mg/m(2)/day for 5 days, every 3 weeks or paclitaxel (175 mg/m(2)) and carboplatin (AUC 5), every 3 weeks. RESULTS One hundred two patients fulfilled the inclusion criteria receiving topotecan (n = 57) or paclitaxel-carboplatin (n = 45) because of refractory or recurrent disease. The patients' age at start of second-line treatment in the younger (n = 68) and the elderly (n = 34) group were median 54.0 years (range, 34.7-64.3) and 69.5 years (range, 65.1-77.2), respectively. In the patient group aged younger than 65 years, initial performance status was more favorable than in patients aged older than 65 years (P = 0.007) whereas the groups were similar in relation to other potential prognostic factors (P > 0.05). For patients aged younger than 65 years, the overall response rate of 50% (95% confidence interval [CI], 37-63%) was similar to the response rate of 44% (95% CI, 27-62%) in patients aged older than 65 years (P = 0.29). The overall survival from the first day of second-line treatment in patients aged younger and older than 65 years were median 13.3+ months (range, 1.2-38.3+) and 11.8+ months (range, 2.0-41.0+), respectively (P = 0.25). In a multivariate Cox analysis, performance status at time of first-line treatment (0 vs.1-2; P = 0.013; hazard ratio [HR], 2.12), performance status at time of second-line treatment (0 vs. 1-2; P = 0.004; HR, 2.47), and response to second-line treatment (CR + PR vs. NC + PD; P < 0.001; HR, 4.38) were found to be independent significant factors for overall survival whereas age (younger than 65 years vs. older than 65 years) yielded no independent information (P = 0.90). No differences in the rate of postponement of treatment, neutropenia Grade 4, thrombocytopenia Grade 3-4, nor hypersensitivity reaction to either cytostatic agent between older and younger patients were noticed (P > 0.05). CONCLUSIONS Modality of second-line treatment of epithelial ovarian carcinoma should be determined more by assessment of performance status than age per se. Second-line treatment with topotecan or paclitaxel-carboplatin can be safely administered in the aged.
Collapse
Affiliation(s)
- Bo Gronlund
- Department of Oncology 5073, Finsen Center, Rigshospitalet, 9 Blegdamsvej, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark.
| | | | | | | |
Collapse
|
19
|
Dickson J, Magee B, Stewart A, West CML. Relationship between residual radiation-induced DNA double-strand breaks in cultured fibroblasts and late radiation reactions: a comparison of training and validation cohorts of breast cancer patients. Radiother Oncol 2002; 62:321-6. [PMID: 12175563 DOI: 10.1016/s0167-8140(01)00432-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND PURPOSE Using pulsed field gel electrophoresis (PFGE) a significant correlation was demonstrated between residual DNA double-strand breaks (dsbs) and the development of late radiation fibrosis in a group of 39 breast cancer patients studied retrospectively. This group formed a training cohort generating a hypothesis that there is a relationship between residual radiation-induced DNA dsbs in cultured fibroblasts and late radiotherapy reactions in breast cancer patients. The aim of this study was to retest and validate the hypothesis. MATERIALS AND METHODS The study was retrospective. Skin biopsies were taken from a validation cohort of 50 breast cancer patients and PFGE was used to examine residual radiation-induced dsbs in cultured fibroblasts. Late morbidity was measured clinically as fibrosis and using the late effects on normal tissues scales that incorporate subjective, objective management and analytic data (LENT SOMA). RESULTS PFGE data were obtained for 49 biopsies. In the 49 patients there was no correlation between residual DNA damage and either fibrosis (r=-0.027, P=0.85) or LENT SOMA (r=-0.10, P=0.48) scores. There was no significant relationship between residual damage and fibrosis for the combined training and validation cohorts of 88 patients (r=0.20, P=0.063). CONCLUSIONS This study did not validate the hypothesis that there is a relationship between fibroblast residual DNA damage and late morbidity in breast cancer patients. The PFGE assay on fibroblasts is not a suitable test of the degree of late radiation-induced fibrosis in the breast.
Collapse
Affiliation(s)
- Jeanette Dickson
- CRC Experimental Radiation Oncology Group, Paterson Institute for Cancer Research, Christie Hospital NHS Trust, Manchester, M20 4BX, UK
| | | | | | | |
Collapse
|
20
|
Abstract
The treatment of ovarian cancer is an evolving area and important clinical questions remain unanswered at all stages from early disease to relapse. This review outlines current practice at each disease stage, some of the current unanswered questions and issues surrounding the design of clinical trials to answer these questions. The gold standard test for new treatments must remain the randomised controlled trial with survival as the major endpoint because other outcome measures such as radiological response do not bear a strong relationship to survival. Patient factors greatly influence the likelihood of response to treatment and subsequent survival, hence failure to control for these in trial design may lead to spurious results. Quality of life is an important endpoint but quality-of-life measures in clinical trials should be interpreted carefully. The introduction of novel, target directed anticancer therapies will require new study designs as the phase I/II/III paradigm may not be relevant. It is current practice to offer adjuvant chemotherapy to women with early stage disease who are considered at high risk of relapse despite conflicting evidence from clinical trials. Current questions include the optimal choice of regimen and the duration of treatment. However, the relative rarity of early stage disease and the likely small difference between treatments makes evaluations difficult. Advanced disease is currently treated using a combination of surgical cytoreduction and platinum-paclitaxel chemotherapy. Women with poor risk disease are unlikely to be cured of their disease and the investigation of strategies to minimise treatment may be appropriate. Conversely, women with good risk disease may be better candidates for experimental treatment to increase cure rate. Strategies that have been tried include dose-intensification, high-dose therapy and intraperitoneal therapy. Whereas there is some evidence to support the latter, there is no current evidence for dose-intensification or high-dose therapy, and these must remain areas of investigation. Most current trials investigate the addition of agents to platinum-paclitaxel. Relapsed disease is an important area. Despite this, only 9 randomised controlled trials have been undertaken. Uncertainties exist in the role of surgery, both surgical cytoreduction and palliative surgery. The mainstay of treatment at disease relapse is chemotherapy and the choice of agent revolves around the concept of platinum sensitivity. Many agents are active in platinum-resistant disease, but uncertainties remain about the relative efficacies of each and the place of combination therapy.
Collapse
Affiliation(s)
- D D Gibbs
- Department of Medicine, The Royal Marsden Hospital, London, England
| | | |
Collapse
|
21
|
Gronlund B, Høgdall C, Hansen HH, Engelholm SA. Results of reinduction therapy with paclitaxel and carboplatin in recurrent epithelial ovarian cancer. Gynecol Oncol 2001; 83:128-34. [PMID: 11585424 DOI: 10.1006/gyno.2001.6364] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of the study was to evaluate the treatment results and toxicity of a retreatment regimen of paclitaxel and carboplatin in patients with ovarian cancer relapse. METHODS A retrospective analysis of 241 consecutive patients with primary epithelial ovarian cancer receiving paclitaxel and a platinum analogue as first-line treatment was performed. Relapse treatment of platinum-sensitive patients consisted of paclitaxel (175 mg/m(2)) over 3 h followed by carboplatin at an area under the concentration-time curve of 5, repeated every 3 weeks. RESULTS Forty-three patients with relapse were treated with paclitaxel and carboplatin after a median progression-free interval from the end of first-line chemotherapy of 15.8 months (range 6.0-41.7 months). In patients with evaluable disease the overall response rate was 84% (95% CI: 68.0-93.8%). The progression-free survival and overall survival from start of relapse treatment were a median of 9.7 months (range 1.4-26.9 months) and 13.1 months (range 4.5-35.5 months), respectively. In a multivariate Cox analysis independent prognostic factors for progression-free survival after first relapse were response to relapse treatment (P = 0.002, hazard ratio = 13.9) and time to first recurrence (P = 0.016, hazard ratio = 0.167). The planned treatment was accomplished by 67% of patients. Grade 4 neutrocytopenia over 1 week was observed in 9.3% of patients. Grade 1-2 peripheral neuropathy was reported in 30% of patients. Only 1 patient had her paclitaxel dose attenuated because of grade 4 neuropathy. CONCLUSION Retreatment with paclitaxel and carboplatin in patients with platinum-sensitive epithelial ovarian cancer relapse yielded a high response rate and encouraging progression-free survival and overall survival. Paclitaxel-carboplatin reinduction therapy is generally well tolerated and the toxicity is manageable.
Collapse
Affiliation(s)
- B Gronlund
- Department of Oncology, Finsen Center, Righospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark.
| | | | | | | |
Collapse
|
22
|
Munkarah A, Levenback C, Wolf JK, Bodurka-Bevers D, Tortolero-Luna G, Morris RT, Gershenson DM. Secondary cytoreductive surgery for localized intra-abdominal recurrences in epithelial ovarian cancer. Gynecol Oncol 2001; 81:237-41. [PMID: 11330956 DOI: 10.1006/gyno.2001.6143] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the role of secondary cytoreductive surgery in patients with recurrent epithelial ovarian cancer with an apparent solitary intra-abdominal focus. METHODS We conducted a retrospective review of patients with epithelial ovarian cancer who underwent secondary cytoreduction for recurrence at the University of Texas M. D. Anderson Cancer Center between 1985 and 1994. Eligible patients included those who had a laparotomy to resect a tumor that was apparently solitary. Cytoreductive surgery was defined as optimal if the diameter of the largest residual tumor was < or =2 cm and suboptimal if >2 cm. RESULTS Twenty-five patients met our eligibility criteria. Their mean age was 55 years (range, 35-73 years). The median time from primary diagnosis to recurrence was 37.6 months. Tumor was found to be confined to a solitary site in 15 patients (60%), to two sites in 6 (24%), and to three or more sites in 4 (16%). Surgical procedures included cytoreduction in 10 patients, intestinal resection in 8, splenectomy in 3, and limited biopsies in 4. Secondary cytoreduction was optimal in 18 of 25 patients (72%). The median postsecondary cytoreduction survival was 25.1 months for patients who had suboptimal secondary cytoreduction compared with 56.9 months for those who had optimal cytoreduction (P = 0.08). CONCLUSIONS Secondary cytoreductive surgery for recurrent ovarian cancer at an apparently solitary intra-abdominal site resulted in optimal residual tumor in a high proportion of patients. Although there was no survival advantage for patients whose tumor was optimally debulked, there was a trend toward improved survival. A large prospective randomized trial of secondary cytoreduction for recurrence is recommended.
Collapse
Affiliation(s)
- A Munkarah
- Division of Gynecologic Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI 48201, USA.
| | | | | | | | | | | | | |
Collapse
|
23
|
Bomalaski JJ. The treatment of recurrent ovarian carcinoma: balancing patient desires, therapeutic benefit, cost containment and quality of life. Curr Opin Obstet Gynecol 1999; 11:11-5. [PMID: 10047957 DOI: 10.1097/00001703-199901000-00003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite an increasing number of studies utilizing various agents and protocols, the disease free interval and survival rates in patients with recurrent ovarian cancer are usually measured in months instead of years. The optimal therapy strategy should be determined using informed decisions based on realistic treatment outcomes, quality of life issues, and cost containment.
Collapse
|
24
|
Women's Health LiteratureWatch. J Womens Health (Larchmt) 1999; 8:129-38. [PMID: 10094091 DOI: 10.1089/jwh.1999.8.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|