Advanced ovarian cancer
Tóm tắt
State-of-the-art treatment for advanced ovarian cancer requires a multimodality approach. Aggressive surgical debulking with the goal of optimal cytoreduction is the initial step. After primary cytoreductive surgery, standard treatment for patients with stage III and IV disease is systemic combination chemotherapy consisting of six cycles of paclitaxel and carboplatin. Approximately 70% of patients enter a clinical remission with this approach, yet less than 30% remain disease free. Options following primary therapy include observation or second surgical assessment if no clinical evidence of disease is present. Novel strategies for consolidation are needed. Second-look surgery can be performed safely and effectively laparoscopically, and this is the most accurate means of identifying patients who appear to be clinically free of disease but actually harbor persistent cancer. Although this procedure is an extremely accurate means of identifying these patients, women who have pathologically negative second-look surgery are still at risk for relapse. Patients can receive additional treatment following second-look surgical assessment via the intraperitoneal route if they are pathologically negative or if they have microscopic or small volume disease. Alternatively, additional systemic chemotherapy can be given with non-cross-resistant systemic agents, but no current standard approach for consolidation therapy exists for patients following the completion of primary treatment. Unfortunately, most patients relapse. Multiple agents with similar activity in phase II trials are available to treat patients with advanced recurrent disease. Combination therapy in this setting has not been shown to have significantly superior progressionfree or overall survival compared with single agents. The selection of treatment for patients with recurrent disease is currently based on a determination of the treatmentfree interval since last treatment, as well as the route, schedule, and expected side effects of the agent.
Tài liệu tham khảo
Landis S, Murray T, Bolden S, et al.: Cancer Statistics 1999. CA Cancer J Clin 1999, 49:8–31.
Pecorelli S, Odicino F, Maisonneuve P: Carcinoma of the Ovary. In FIGO Annual Report on the Results of Treatment in Gynecological Cancer, Vol 23. Edited by Pecorelli S, Creasman WT. Oxford: Isis Medical Media Limited; 1998.
Chi D, Hoskins WJ: Primary surgical management of advanced epithelial ovarian cancer. In Ovarian Cancer, edn 2. Edited by Rubin SC, Sutton GP. Philadelphia: Lippincott, Williams & Wilkins, in press.
McGuire WP, Hoskins WJ, Brady MF, et al.: Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. N Engl J Med 1996, 334:1–6. Pivotal trial showing the survival advantage for the addition of paclitaxel to the primary treatment regimen.
DuBois A, Lueck HJ, Meier W, et al.: Cisplatin/paclitaxel vs carboplatin/paclitaxel in ovarian cancer: an update of an Arbeitsgemeinschaft Gynaekologische Oncologie (AGO) Study Group Trial. Proc ASCO 1999, 18:356(a). Study suggesting the equivalence of carboplatin and cisplatin with less toxicity in the former.
Ozols RF, Bundy BN, Fowler J, et al.: Randomized phase III study of cisplatin (CIS)/paclitaxel (PAC) versus carboplatin (CARBO)/PAC in optimal stage III epithelial ovarian cancer (OC). Proc ASCO 1999, 18:356a. Study suggesting the equivalence of carboplatin and cisplatin, with less toxicity in the former.
Abu-Rustum NR, Barakat R, Siegel PL, et al.: Second look operation for epithelial ovarian cancer. Obstet Gynecol 1996, 88:549–553.
Barakat R, Almadrones L, Venkatraman E, et al.: A phase II trial of IP cisplatin and etoposide as consolidation therapy in patients with stage II-IV epithelial ovarian cancer following negative surgical assessment. Gynecol Oncol 1998, 69:17–22.
Hoskins WJ, Rubin SC, Dulaney E: Influence of secondary cytoreduction at the time of second look laparotomy on the survival of patients with epithelial ovarian carcinoma. Gynecol Oncol 1989, 34:365–371.
Jakobsen A, Bertelsen K, Andersen J, et al.: Dose-effect study of carboplatin in ovarian cancer: a Danish Ovarian Cancer Group Study. J Clin Oncol 1997, 15:193–198.
Lambert HE, Rustin GJ, Gregory WM, et al.: A randomized trial of five versus eight courses of cisplatin or carboplatin in advanced epithelial ovarian carcinoma. A North Thames Ovary Group Study. Ann Oncol 1997, 8:327–333.
Abu-Rustum NR, Aghajanian C, Barakat R, et al.: Salvage weekly paclitaxel in recurrent ovarian cancer. Semin Oncol 1997, 24:S62-S67.
Markman M, Kennedy A, Webster K, et al.: Clinical features of hypersensitivity reactions to carboplatin. J Clin Oncol 1999, 17:1141. Describes the entity of required hypersensitivity, which can occur with repeated platinum administration. Patients require careful observation in this setting.
Rose PG, Blessing J, Mayer AR, et al.: Prolonged oral etoposide as second line therapy for platinum resistant and platinum sensitive ovarian carcinoma: a gynecologic group study. J Clin Oncol 1998, 16:405–410.
Shapiro JD, Millward MJ, 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.
Muggia FM, Hainsworth JD, Jeffers S, et al.: Phase II study of liposomal doxorubicin in refractory ovarian cancer: antitumor activity and toxicity modification by liposomal encapsulation. J Clin Oncol 1997, 15:987–993.
Ahlgren JD, Ellison NM, Gottlieb RJ, et al.: Hormonal palliation of chemoresistant ovarian cancer: three consecutive Phase II trials of the Mid-Atlantic Oncology Program. J Clin Oncol 1993, 11:1957–1968.
Kudelka AP, Tresukosol D, Edwards CL, et al.: Phase II study of intravenous topotecan as a 5 day infusion for refractory epithelial ovarian carcinoma. J Clin Oncol 1996, 14:1552–1557.
Bajetta E, Di Leo A, Biganzoli L, et al.: Phase II study of vinorelbine in patients with pretreated advanced ovarian cancer: activity in platinum resistant disease. J Clin Oncol 1996, 14:2546–2551.
van der Burg MEL, van Lent M, Byyse M, et al.: The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. N Engl J Med 1995, 332:629–634.
Vergote I, De Wever I, Tjalma W, et al.: Neoadjuvant chemotherapy or primary debulking surgery in advanced ovarian carcinoma: a retrospective analysis of 285 patients. Gynecol Oncol 1998, 71:431–436.
Schwartz PE, Rutherford TJ, Chambers JT, et al.: Neoadjuvant chemotherapy for advanced ovarian cancer: long term survival. Gynecol Oncol 1999, 72:93–99.