Chemotherapy, ovarian cancer

Recommend the appropriate surgical and chemotherapy treatment options for newly diagnosed and relapsed ovarian cancer patients. 

Single-agent chemotherapy is standard practice for recurrent platinum-resistant ovarian cancer. 

A 36-year-old woman who has been in good health presents to your clinic complaining of constipation and abdominal pain. She explains to you that she has been feeling stressed lately because her 40-year-old sister is undergoing chemotherapy for breast cancer, and they just lost there mother to ovarian cancer a few years ago. 

Health care providers use a multimodality approach including surgery and chemotherapy in the initial treatment of ovarian cancer with a curative intent. Although most patients will achieve a complete response initially, more than 50% of cancers will recur within the first 2 years,2,35 Complete response to treatment is defined as no evidence of disease can be detected by physical examination or diagnostic tests, and patient has a normalized CA-125 value. 

FIGURE 91-3. Summary of chemotherapy treatment algorithm for epithelial ovarian cancer. CR, complete response PR, partial response PD, progressive disease. 

TABLE 91-1. Summary of First-Line Chemotherapy Regimens for Advanced Ovarian Cancer... 

Gold standard first-line chemotherapy after initial surgery for treatment of ovarian cancer. 

TABLE 91-2. Summary of Chemotherapy Agents Used for First-Line Treatment of Advanced Ovarian Cancer Mechanism of action of first-line agents ... 

TABLE 91-3. Summary of Chemotherapy Agents Used for Second-Line Treatment of Progressive and Recurrent Platinum-Resistant Ovarian Cancer... 

Provide appropriate patient education on respective chemotherapy agents that will be given for treatment of recurrent ovarian cancer. 

Gadducci A, Cosio S, Conte PF, Genazzani AR. Consolidation and maintenance treatments for patients with advanced epithelial ovarian cancer in complete response after first-line chemotherapy a review of the literature. Crit Rev Oncol Hematol 2005 55 153-166. 

CA 125 is a mucin-like glycoprotein antigenic determinant expressed on the surface of coelomic epithelium and human ovarian carcinoma cells however, it does not appear to be specific for ovarian cancer because elevated levels have been reported in breast and colorectal cancers. Studies have shown increased CA 125 levels in patients with ovarian cancer, whereas decreased CA 125 levels in chemotherapy are associated with improved possibility for survival. Some studies have shown failure of CA 125 levels to return to normal after chemotherapy, indicating... 

Topotecan is the second camptothecin derivative it is itself an active drug, and received FDA approval as second line therapy in metastatic ovarian cancer (1996) and in SCLC (1998) [13], In addition, representatives of a second generation of topi inhibitors, the homocamptothecins, are now being developed for chemotherapy, e.g., BN-80915 and BN-809271 [14]. 

Paclitaxel (Taxol, Bristol-Myers Squibb) is a chemotherapy drug for ovarian cancer, breast cancer, and certain lung cancers. It was discovered by the US National Cancer Institute in the 1960s. Originally, it was extracted from the bark of the North American yew tree (Taxus brevifo-lia). Clinical tests had necessitated the harvesting of the bark, and this method damaged the trees irreversibly. 

Reed FP, Yuspa SH, Zwelhng LA, Ozols RF, Poirier MC. Quantitation of cisplatin-DNA intrastrand adducts in testicular and ovarian cancer patients receiving cisplatin chemotherapy. J Clin Invest 1986 77 545-550. 

Reed E, Ozols RF, Tarone R, Yuspa SH, Poirier MC. Platinum-DNA adducts in leukocyte DNA correlate with disease response in ovarian cancer patients receiving platinum-based chemotherapy. Proc Natl Acad Sci USA 1987 84 5024-5028. 

Although there have been some efforts to combine chemotherapy and radiation for patients with ovarian cancer, these cancers are usually advanced at presentation, limiting the role of local treatment. For patients with endometrial cancer, the possible role of combined adjuvant treatment is just beginning to be explored by the multi-institutional clinical trials groups. 

A systematic review in the Cochrane database of forty-nine trials of chemotherapy for advanced ovarian cancer involving 8763 women concluded The available evidence, although not conclusive, suggests that platinum-based chemotherapy is better than non-platinum therapy. There is some evidence that combination therapy improves survival compared with platinum alone. No difference in effect has been shown between cisplatin and carboplatin (see Advanced Ovarian Cancer Trialists Group, 1999). 

Aabo K, Adams K, Adnitt P, Alberts DS, Athanazziou A, Barley V et al. Chemotherapy in advanced ovarian cancer four systematic meta-analyses of individual patient data from 37 randomized trials. Advanced Ovarian Tri-alists Group. Br J Cancer 1998 78 1479-87. 

Advanced Ovarian Cancer Trialists Group. Chemotherapy for advanced ovarian cancer. Cochrane Database Syst Rev 1999. Issue 4. 

Avril et al. [99] evaluated sequential [ F]-FDG-PET to predict patient outcome after the first and the third cycle of neoadjuvant chemotherapy in 33 patients with advanced-stage ovarian cancer. A significant correlation was observed between [ F]-FDG-PET metabolic response after the first (p = 0.008) and the third (p = 0.005) cycle of chemotherapy and overall survival. After the first cycle, a threshold of 20% SUV decrease for differentiation of metabolic responders and nonresponders revealed the following median overall survival 38.3 months for metabolic responders compared to 23.1 months for metabolic nonresponders. 

Therefore, [ F]-FDG-PET also appears to be a promising tool for early prediction of response to neoadjuvant chemotherapy in patients with ovarian cancer. 

N. Avril, S. Sassen, B. Schmalfeldt, J. Naehrig, S. Rutke, W.A. Weber, M. Werner, H. Graeff, M. Schwaiger, W. Kuhn, Prediction of response to neoadjuvant chemotherapy by sequential F-18-fluorodeoxyglucose positron emission tomography in patients with advanced-stage ovarian cancer, J. Clin. Oncol. 23(30) (2005) 7445-7453. 

G. Other applications Herceptin has been combined with cisplatin in the treatment of heavily pretreated metastatic breast cancer. Treatment of patients with ovarian cancer is under investigation. A recent study demonstrated that Herceptin increased the clinical benefits of first-line chemotherapy—doxorubicin (or epiru-bicin) and cyclophosphamide or pacli-taxel—in metastatic breast cancer that overexpressed HER2. 

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