Tamoxifen in relapsed ovarian cancer: A systematic review

Abstract

Williams C. Tamoxifen in related ovarian cancer: A systematic review. Int J Gynecol Cancer 1998; 8: 89–94. This review examines the evidence for useful clinical activity of tamoxifen in women with ovarian carcinoma who have failed conventional cytotoxic chemotherapy. The optimized search strategy of the Cochrane Gynaecological Cancer Collaborative Review Group, together with citations provided by Zeneca (the manufacturer of tamoxifen), and authors of trials identified in this area were used. Selection criteria consisted of phase 2 trials, randomized or unrandomized, of tamoxifen in women with ovarian carcinoma, previously treated with cytotoxic chemotherapy. Phase 3 trials in similar patients were also sought. Trials were then assessed for inclusion in the study and data extracted by the author. There are no randomized controlled trials of tamoxifen alone vs best supportive care in patients with refractory or recurrent ovarian cancer. There is a series of phase 2 trials that report objective response rates and (in some) stable disease rates. Fifty-five of 503 patients (10.9%) were reported to have achieved an objective response and 59 of 291 patients (24%) achieved stable disease (for variable periods). Since only a subset of trials reported rates of stable disease, these may form a biased group favoring a high rate of disease stabilization. There were no analyzable data on duration of response or overall survival. There were no useful data presented on the palliative effects of tamoxifen, in terms of symptom control or quality of life. Tamoxifen demonstrates a modest degree of effectiveness in ovarian cancer refractory to cytotoxic chemotherapy. The overall objective response rate in all trials (503 patients) was about 11%. There is, however, a wide variation in the objective response rates in the different trials (0% to 56%). This may, in part, reflect varying criteria for selection of patients for inclusion in individual studies and different methods for recording responses and application of these methods. Some trials reported on rates of stabilization of disease, but these data may be biased as such information was only presented in selected studies. There is no useful analyzable data on the duration of responses or survival. There is also, importantly, virtually no data on the palliative effects of tamoxifen given in this situation, even though the intent of treatment was entirely palliative. Those studies that collected data on hormone receptors found no consistent correlation between the presence of receptors and an increased chance of response to tamoxifen.