Abstract
BackgroundPrognosis of advanced ovarian carcinomas (AOC) remains poor with a 5-year survival of 30%. Benefit from high-dose chemotherapy (HDC) in this disease has not been demonstrated to date.MethodsTo evaluate the value of HDC as consolidation treatment after surgery and platinum/taxane-based therapy, we designed a monocentric retrospective comparative study. We used a subset approach to identify parameters associated with HDC efficacy.ResultsOne hundred and three AOC patients treated with conventional chemotherapy alone (CCA) were compared to 60 patients receiving HDC plus hematopoietic stem cell support. After a median follow-up of 47.5 months there was no overall survival (OS) advantage for the HDC group in the whole population (p=0.29). Nevertheless, HDC was associated to a better outcome in young patients (≤50 years), both in term of progression-free survival (p=0.02, log-rank test) and OS (p=0.05, log-rank test). Median OS was 54.6 and 36 months in the HDC and CCA groups, respectively.ConclusionsAlthough randomized trials failed to demonstrate any benefit for HDC in AOC patients, this study suggests that young patients may derive a substantial advantage from receiving it after the standard treatment. Further prospective studies are warranted to confirm this gain and to search for the biological processes associated with this improvement.
Highlights
Prognosis of advanced ovarian carcinomas (AOC) remains poor with a 5-year survival of 30%
Patients and treatment One hundred sixty-three patients with advanced ovarian carcinomas treated at our institution between April 1995 and July 2009 were included in this study
We have shown in this retrospective comparative study including more than 160 women, that, when applied to all patients, high-dose chemotherapy (HDC) does not improve advanced ovarian cancer survival
Summary
Prognosis of advanced ovarian carcinomas (AOC) remains poor with a 5-year survival of 30%. In 2010 in USA, around 22 000 cases were diagnosed and 14 000 deaths were reported [1] Such a poor prognosis is due to late diagnosis and relative lack of efficacy of current treatments. Major chemotherapy dose intensification using alkylating agents with autologous hematopoietic stem cell support (HSCS) has been investigated in this setting, with encouraging results in pilot studies [15,16,17,18]. These promising results have not been confirmed in randomized phase III trials [19,20], and high-dose chemotherapy (HDC) is currently not recommended for advanced ovarian carcinomas (AOC)
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