Therapy For Ovarian Cancer Patients Research Articles

CA-125 Levels after Surgical Exploration and Radioactive Chromic Phosphate in Ovarian Cancer Patients

Trends in CA-125 levels after completion of therapy in ovarian cancer patients who received intraperitoneal radioactive chromic phosphate therapy (32P) after primary surgical resection or second-look surgery were evaluated. Ninety patients who underwent surgical exploration and32P were reviewed. Twenty-nine patients were excluded due to insufficient number of CA-125 levels or recurrence within 12 months, with 61 patients with serial CA-125 levels and no evidence of disease for 12 months available for analysis.32P followed initial resection in 24 patients (16 Stage I, 3 Stage II, 5 Stage III).32P followed chemotherapy and second-look procedures in 37 patients (4 Stage I, 3 Stage II, 27 Stage III, 3 Stage IV). Elevated CA-125 levels were present in 25 (41%) patients within 12 months of32P (46% after primary exploration, 38% after second-look). The degree of CA-125 elevation (U/ml) was 30–100 (23%), 100–200 (11%), and >200 (7%). Of the 25 patients with an elevated CA-125, the elevation persisted more than 4 months in 11 (44%). All but two patients had normal CA-125 levels by 12 months. An abnormal elevation in CA-125 was seen in 33% of patients 4 months after receiving32P and abdominal surgery, with values ranging as high as 500 U/ml. Although elevations in CA-125 are reported following surgery alone, the duration of elevation appears to be longer with32P. Therefore, persistent elevations of CA-125 following32P between 4 and 12 months should be judged with caution as they may not reflect recurrent disease.

A preliminary risk-benefit assessment of paclitaxel.

Paclitaxel is an antineoplastic agent, first isolated and described in 1971. Despite its novel structure and apparent activity in vitro, little interest was shown in developing the compound because of its scarcity, problems with its formulation and the mistaken assumption that its mechanism of action was similar to that of the vinca alkaloids. Approximately 10 years later, the unique mechanism of action of paclitaxel, its ability to stabilise microtubules, was discovered, and its activity against human tumour xenografts was demonstrated. Interest in the drug was reignited and clinical testing began. Severe hypersensitivity reactions were controlled in the phase II programme with a premedication regimen consisting of dexamethasone, histamine H1-antagonists and H2-antagonists. Neutropenia was dose limiting in all studies conducted in patients with solid tumours. This toxicity was schedule-dependent, and less severe when paclitaxel was administered as a 3-hour infusion regimen. Peripheral neuropathy was mild to moderate in the initial experience, and dose-dependent. However, when bone marrow support with haemopoietic growth factors was used to allow paclitaxel dose intensification, neurotoxicity became dose limiting. To date, substantial clinical efficacy has been demonstrated in ovarian, breast, non-small-cell lung, and head and neck cancers. Response rates were low in initial studies in melanoma, prostate, colon, cervix and renal cancer. In December 1992, US Food and Drug Administration approval was granted for the use of paclitaxel as second-line therapy in ovarian cancer patients. More recently, similar approval was granted for use in recurrent breast cancer. Nevertheless, important questions remain.(ABSTRACT TRUNCATED AT 250 WORDS)

Etoposide and carboplatin as salvage and first-line therapy in ovarian cancer patients

The agents etoposide and carboplatin are active against ovarian cancer and display synergistic anti-tumor activity in animal tumor models. The objective of these two phase II trials was to determine the efficacy and toxicity of the combination of etoposide with carboplatin in previously treated and untreated patients with ovarian cancer. Etoposide (100 mg/m2) was administered as a one-hour infusion on three consecutive days and carboplatin (400 mg/m2) as a 30-minute infusion on day 2 of each monthly scheduled cycle. In 20 patients, previously treated with cisplatin-containing regimens, a total of 102 cycles was applied as salvage therapy (ST) and in 27 patients, a total of 168 cycles as first-line therapy (FLT). ST yielded 2 complete remissions (CR) and one partial remission (PR); in 7 patients, no evidence of disease (NED) and in 6 patients, no change (NC) were observed. The progression-free intervals (PFI) lasted a median 7.0 months (range < 2-14 months). FLT resulted in 7 CR (4 of them pathologically (p) verified), 11 NED (1 pNED), 3 PR (1 pPR) and 6 NC. The objective response rate was 63% (95% confidence interval: 36-89%). PFI lasted a median 8.0 months (range 3-25+ months); median survival had not been reached at the time of evaluation. Thrombocytopenia (WHO grade 4) was the limiting toxicity. Although not fulfilling the expectations of synergistic activity as shown in preclinical models, the combination of etoposide with carboplatin is an active and feasible therapy regimen in the out-patient management of ovarian cancer.

Carboplatin and cyclophosphamide salvage therapy for ovarian cancer patients relapsing after cisplatin combination chemotherapy

30 ovarian cancer patients with a relapse after prior cisplatin combination chemotherapy were treated in a phase II study with cyclophosphamide 100 mg/m 2 orally on days 1–7 and carboplatin 300 mg/m 2 intravenously on day 8. Treatment was well tolerated. The major side-effect was thrombocytopenia. 28 patients were evaluable for response. The response was 5 CRs (18%), 4 PRs (14%) 15 SDs (53%) and 4 PDs (14%), for an overall response rate of 32%. The overall progression-free survival lasted from 2 to 23 months, median 8 months. Overall survival ranged from 2 to 35+ months, median 12 months. Patients with a therapy-free interval of more than 1 year showed a higher response rate (46%) than patients with a shorter therapy-free interval (20%). It is concluded that platinum containing second-line chemotherapy, after treatment that already contained cisplatin, is only warranted to palliate symptoms.

A Comparison of Postoperative Radiotherapy with Postoperative Chemotherapy in Stage II—IV Ovarian Cancer Patients

Abstract A retrospective comparison between 28 stage II–IV ovarian cancer patients who received postoperative abdominopelvic irradiation and 15 such patients who received postoperative cis -platinum, Adriamicin, and Cytoxan chemotherapy was made. In both treatment groups there was a trend for a longer progression-free interval and 3-year survival in patients with residual tumor masses of less than 2 cm in diameter. In these patients there was also a trend favoring radiotherapy. However, all differences were not significant. Criteria for the choice of either modality of postoperative therapy of ovarian cancer patients remain to be determined. Nevertheless, the efficacy of both modes of treatment does not differ greatly.

A comparison of postoperative radiotherapy with postoperative chemotherapy in stage II–IV ovarian cancer patients

A retrospective comparison between 28 stage II–IV ovarian cancer patients who received postoperative abdominopelvic irradiation and 15 such patients who received postoperative cis-platinum, Adriamicin, and Cytoxan chemotherapy was made. In both treatment groups there was a trend for a longer progression-free interval and 3-year survival in patients with residual tumor masses of less than 2 cm in diameter. In these patients there was also a trend favoring radiotherapy. However, all differences were not significant. Criteria for the choice of either modality of postoperative therapy of ovarian cancer patients remain to be determined. Nevertheless, the efficacy of both modes of treatment does not differ greatly.