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| The Johns Hopkins Ovarian Cancer Center of Excellence acknowledges and thanks Aventis, Genzyme, GlaxoSmithKline, Oncotech, Ortho Biotech, and The Pam McDonald Fund for their support of this website through provision of unrestricted educational grants. |
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Below are answers to previously submitted questions in the Ask the Expert Forum. Please note that the information is not indended to be used as medical advice -- please consult your physician with any medical concerns. |
| Category: Ovarian Cancer Chemotherapy and Other Non-Surgical Approaches |
Q: What information is available regarding the protocols, effectiveness, and side effects of continuing treatment (following successful first line treatment for Stage IIIC) and is treatment superior to "watch and wait" after successful first line treatment?
A: This topic has been, and continues to be, widely debated, primarily because the risk of disease recurrence after successful front-line treatment of Stage IIIC ovarian cancer may be as high as 40% to 50%. Many different investigators have tried to reduce this risk even further by administering additional (consolidation) treatment to complete responders (no evidence of disease after completing the initial six cycles of platinum and paclitaxel based chemotherapy). Different consolidation or maintenance treatments have been attempted, such as whole abdomen radiotherapy, intraperitoneal chromic phosphate, radioimmunotherapy, intraperitoneal chemotherapy, high-dose chemotherapy with haematopoietic support, prolonged administration of the first-line regimen, second-line single-agent chemotherapy, and biological agents. Clinical studies have given conflicting and often inconclusive results. Recently, Markman et al. reporting for the Gynecologic Oncology Group published results of a randomized trial comparing 3 or 12 cycles of single-agent paclitaxel following standard front-line therapy for advanced-stage ovarian cancer (J Clin Oncol. 2003 Jul 1;21(13):2460-5). Patients who received 12 cycles had a median progression-free survival time of 28 months, compared to 21 months for patients in the 3 cycle treatment arm. There was no difference in overall survival time, however, between the two groups, indicating this program of consolidation therapy can delay the timing of recurrence but does not appear to impact long-term survival outcome. Other investigators have delivered additional chemotherapy treatments (after front-line therapy) via the intraperitoneal route. In 1998, Barakat et al. (Gynecol Oncol. 1998 Apr;69(1):17-22) reported that 3 cycles of consolidation intraperitoneal chemotherapy with cisplatin and etoposide resulted in a significant extension in median disease-free survival time. These and other studies of consolidation treatment have yet to conclusively demonstrate a significant advantage in overall survival time. Ultimately, the decision to administer consolidation therapy should be based on the initial response to treatment, the patient’s willingness to undergo further treatment and experience side effects, and the patient’s long-term goals and objectives and only after a thorough discussion of these issues with her treating oncologist. For a comprehensive review of this topic see the article by Gadducci et al (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 Aug;55(2):153-66).
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