scholarly journals Point: Chemosensitivity Assays Have a Role in the Management of Recurrent Ovarian Cancer

2011 ◽  
Vol 9 (1) ◽  
pp. 115-120 ◽  
Author(s):  
Julian C. Schink ◽  
Larry J. Copeland
Keyword(s):  
Ovarian Cancer ◽  
Response Rate ◽  
Clinical Information ◽  
Recurrent Ovarian Cancer ◽  
Retrospective Data ◽  
Cooperative Group ◽  
Chemosensitivity Assay ◽  
The Past ◽  
Chemosensitivity Assays ◽  
Better Than

In this era of personalized medicine, patients with recurrent ovarian cancer deserve better than the 25% response rate that is associated with drugs selected based on clinical information alone. In the past decade, marked laboratory improvements have enabled chemosensitivity assay testing to yield a 0.70 correlation with response, and to accurately predict progression-free and overall survival. Compelling retrospective data supporting the use of this technology cannot be ignored while waiting for a cooperative group to test whether chemosensitivity assay should be used to direct salvage therapy.

Counterpoint: Chemosensitivity Assays for Recurrent Ovarian Cancer

2011 ◽  
Vol 9 (1) ◽  
pp. 121-124 ◽  
Author(s):  
Maurie Markman
Keyword(s):  
Ovarian Cancer ◽  
Clinical Trials ◽  
Recurrent Ovarian Cancer ◽  
Evidence Based ◽  
Chemosensitivity Assay ◽  
Reliable Evidence ◽  
In Vitro Chemosensitivity ◽  
Frequent Use ◽  
Chemosensitivity Assays

Unfortunately, no reliable evidence-based data have shown any in vitro chemosensitivity assay strategy to be clinically useful in the management of recurrent ovarian cancer, despite frequent use. Several clinical trials have been proposed with the potential to support or refute the relevance of these approaches.

Chemotherapy of drug-resistant ovarian cancer: a Southwest Oncology Group Study.

1986 ◽  
Vol 4 (9) ◽  
pp. 1374-1379 ◽  
Author(s):  
L R Laufman ◽  
J B Green ◽  
D S Alberts ◽  
R O'Toole ◽  
R D Hilgers ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Response Rate ◽  
Final Analysis ◽  
Drug Resistant ◽  
Eligibility Criteria ◽  
Interim Analyses ◽  
Southwest Oncology Group Study ◽  
Pathology Review ◽  
Insight Into ◽  
Better Than

We present a final analysis, including pathology review, of a cooperative group study of drug-resistant ovarian cancer. Of 200 patients registered, 112 were eligible and evaluable, with a response rate of 26% and median survival of 7 months. Because these results are poorer than those reported in the preliminary and interim analyses of this study, we scrutinized the 88 excluded patients, most of whom failed to meet our strict pathologic criteria for a diagnosis of ovarian cancer of epithelial type, and who, as a heterogeneous group, fared better than patients who did meet the eligibility criteria. We believe this analysis provides insight into the spectrum of diseases that are frequently called ovarian cancer, but might be more properly labeled abdominal carcinomatosis.

A multi-institutional evaluation of factors predictive of toxicity and efficacy of bevacizumab for recurrent ovarian cancer

2008 ◽  
Vol 18 (3) ◽  
pp. 400-406 ◽  
Author(s):  
J. D. Wright ◽  
A. A. Secord ◽  
T. M. Numnum ◽  
R. P. Rocconi ◽  
M. A. Powell ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Tumor Response ◽  
Response Rate ◽  
Single Agent ◽  
Chylous Ascites ◽  
Recurrent Ovarian Cancer ◽  
Cytotoxic Agent ◽  
Combination Group ◽  
Factors Associated ◽  
Grade 3

While bevacizumab has shown activity in recurrent ovarian cancer, a higher than expected incidence of bowel perforations has been reported in recent trials. We sought to determine factors associated with toxicity and tumor response in patients with relapsed ovarian cancer treated with bevacizumab. A retrospective review of patients with recurrent ovarian cancer treated with bevacizumab was undertaken. Response was determined radiographically and through CA125 measurements. Statistical analysis to determine factors associated with toxicity and response was performed. Sixty-two eligible patients were identified. The cohort had received a median of 5 prior chemotherapy regimens. Single-agent bevacizumab was administered to 12 (19%), while 50 (81%) received the drug in combination with a cytotoxic agent. Grade 3–5 toxicities occurred in 15 (24%) patients, including grade 3–4 hypertension in 4 (7%), gastrointestinal perforations in 7%, and chylous ascites in 5%. Development of chylous ascites and gastrointestinal perforations appeared to correlate with tumor response. The overall response rate was 36% (4 complete response, 17 partial response), with stable disease in 40%. A higher objective response rate was seen in the bevacizumab combination group compared to single-agent treatment (43% vs 10%) (P = 0.07). However, 29 grade 3–5 toxic episodes were seen in the combination group vs only 1 in the single-agent bevacizumab cohort (P = 0.071). We conclude that bevacizumab demonstrates promising activity in recurrent ovarian cancer. The addition of a cytotoxic agent to bevacizumab improved response rates at the cost of increased toxicity. Gastrointestinal perforations occurred in 7%. The perforations occurred in heavily pretreated patients who were responding to therapy

Topotecan Has Substantial Antitumor Activity as First-Line Salvage Therapy in Platinum-Sensitive Epithelial Ovarian Carcinoma: A Gynecologic Oncology Group Study

2000 ◽  
Vol 18 (5) ◽  
pp. 1062-1062 ◽  
Author(s):  
William P. McGuire ◽  
John A. Blessing ◽  
Michael A. Bookman ◽  
Samuel S. Lentz ◽  
Charles J. Dunton
Keyword(s):  
Ovarian Cancer ◽  
Active Drug ◽  
Response Rate ◽  
Gynecologic Oncology ◽  
Response Duration ◽  
Recurrent Ovarian Cancer ◽  
Hematologic Toxicity ◽  
Gynecologic Oncology Group ◽  
Median Response ◽  
Platinum Sensitive

PURPOSE: Topotecan is known to be active in recurrent ovarian cancer, but most prior studies have focused on platinum-resistant or refractory populations. This study was undertaken to define the response rate and progression-free interval in platinum-sensitive patients. PATIENTS AND METHODS: Patients with recurrent ovarian cancer after one or two prior chemotherapy regimens and in whom the interval between prior platinum therapy and the initiation of protocol therapy was greater than 6 months were treated with topotecan 1.5 mg/m2 intravenously over 30 minutes daily for 5 days, with this cycle repeated every 21 days. RESULTS: Forty-eight patients were entered onto the study; 47 were assessable for toxicity and 46 for response. The response rate was 33% (two complete responses and 13 partial responses), with a median response duration of 11.2 months. Hematologic toxicity predominated but was manageable in most patients with frequent incorporation of cytokines and RBC and platelet transfusions. Fatigue was reported in 15 patients and resulted in the discontinuation of therapy in five responding patients. CONCLUSION: Topotecan is an active drug in platinum-sensitive ovarian cancer, with significant but manageable hematologic toxicity. Fatigue is also a common problem that may be dose-limiting in some patients.

Weekly association of gemcitabine and topotecan in early recurrent ovarian cancer patients: A French multicenter phase II study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16016-16016
Author(s):  
F. Joly ◽  
T. Petit ◽  
P. Pautier ◽  
E. Guardiola ◽  
F. Mayer ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Survival Time ◽  
Phase Ii ◽  
Stable Disease ◽  
Response Rate ◽  
Phase Ii Study ◽  
Objective Response ◽  
Recurrent Ovarian Cancer ◽  
First Line ◽  
Multicenter Phase

16016 Background: A weekly association of gemcitabine and topotecan was tested with the aim of evaluating its efficacy and tolerance in patients recurring after first line platinum and taxane-based chemotherapy. Methods: From December 2004 to April 2006, 77 patients whose disease has progressed within 12 months (time-free interval, TFI) after first line chemotherapy were enrolled in a multicenter phase II study. Primary endpoint was overall response rate (ORR). Gemcitabine (1000 mg/m2) and topotecan (2.5 mg/m2) were given day 1, 8 and 15 (q 28 d) for 6 to 9 cycles. Tumor response was assessed according to RECIST or Rustin criteria. Clinical response was assessed using symptoms improvement in responders and patients with stable disease. Follow-up was updated December 2006. Results: Initial characteristics were: median age 63 years (38 to 80), WHO PS 0–1 93%, serous histology 85%, TFI < 6 months 45%, measurable disease 71%. Four cycles (1 to 8) were administered in average. The only major toxicity was neutropenia (Grade 3 and 4 in 17% and 6% of patients) with one febrile neutropenia; one toxic death (pneumopathy) was observed. 34% of cycles were incomplete (d8 and/or d15 not administered) because of grade 1–2 thrombopenia or grade 1–4 neutropenia. Lenograstim and erythropoietin were administered in 14% and 34% of patients, respectively. Sixty-six (86%) patients were evaluable for response (2 cycles administered). The ORR was 14% (CR=3%, PR=11%); there were 53% of stable disease. ORR was 7% and 20% in patients with TFI < 6 months and = 6 months, respectively. Symptoms were improved in 18 (64%) of 28 patients and pain in 11 (39%) of 28 patients. Median event-free survival time was 3.7 months. Median overall survival time was 12.3 months (7.5 and 15.6 months in patients with TFI < 6 months and = 6 months, respectively; p=0.0244). Conclusions: In resistant/refractory ovarian cancer, weekly gemcitabine and topotecan is associated with low objective response rate but with a high proportion of stable disease and symptoms control leading to acceptable quality of life. No significant financial relationships to disclose.

The Response Rate of Carboplatin/Paclitaxel for the Platinum Sensitive Recurrent Ovarian Cancer Patients

2003 ◽  
Vol 14 (4) ◽  
pp. 275
Author(s):  
Hye Jin Chang ◽  
Hee Sug Ryu ◽  
Yun Kyoung Lim ◽  
Se Hee Moon ◽  
Ki Hong Chang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Response Rate ◽  
Recurrent Ovarian Cancer ◽  
Platinum Sensitive

Use of an ATP-based chemosensitivity assay to design new combinations of high-concentration doxorubicin with other drugs for recurrent ovarian cancer

2002 ◽  
Vol 13 (6) ◽  
pp. 625-630 ◽  
Author(s):  
Federica Di Nicolantonio ◽  
Michael H Neale ◽  
Louise A Knight ◽  
Alan Lamont ◽  
Geraldine E Skailes ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Recurrent Ovarian Cancer ◽  
New Combinations ◽  
High Concentration ◽  
Chemosensitivity Assay

Randomized phase II study of two schedules of topotecan in previously treated patients with ovarian cancer: a National Cancer Institute of Canada Clinical Trials Group study.

1998 ◽  
Vol 16 (6) ◽  
pp. 2233-2237 ◽  
Author(s):  
P Hoskins ◽  
E Eisenhauer ◽  
S Beare ◽  
M Roy ◽  
P Drouin ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Response Rate ◽  
Phase Ii Study ◽  
Randomized Study ◽  
Recurrent Ovarian Cancer ◽  
S Phase ◽  
Randomized Phase Ii ◽  
Previously Treated Patients ◽  
Previously Treated ◽  
Grade 3

PURPOSE As topotecan is S-phase-specific, its efficacy is likely schedule-dependent. Therefore, a randomized study using a "pick the winner" design was undertaken to compare two schedules in patients with recurrent ovarian cancer. PATIENTS AND METHODS Patients with recurrent epithelial ovarian cancer previously treated with no more than two separate regimens of chemotherapy, one of which had to be platinum-containing, were randomized to either topotecan 1.5 mg/m2 intravenously (i.v.) over 30 minutes daily for 5 days repeated every 21 days (arm A, the standard arm), or topotecan 1.75 mg/m2 as a 24-hour infusion once a week for 4 weeks repeated every 6 weeks (arm B, the experimental arm). RESULTS Sixty-six patients were eligible and 63 were assessable for response. The response rate in arm A was 22.6% (95% confidence interval [CI], 9.6% to 41.2%), which was significantly superior to that in arm B, 3.1% (95% CI, 0.1% to 16%) (P = .026). The regimens were not equitoxic, with 94% of patients on arm A experiencing grade 3 or 4 granulocytopenia as opposed to 52% on arm B. CONCLUSION The weekly 24 hour infusion of topotecan at 1.75 mg/m2 was ineffective in relapsed ovarian cancer. The daily-times-five schedule remains the schedule of choice. As the regimens were not equitoxic, one cannot differentiate between an ineffective schedule and an ineffective dose as the reason for the differing response rates. However, the degree of myelotoxicity that already occurs will preclude any substantially higher dosing with the weekly regimen.

Gemcitabine and Vinorelbine Combination in Platinum-Sensitive Recurrent Ovarian Cancer

2009 ◽  
Vol 19 (9) ◽  
pp. 1529-1534 ◽  
Author(s):  
Annamaria Ferrero ◽  
Vilma Logrippo ◽  
Pier Giorgio Spanu ◽  
Luca Fuso ◽  
Stefania Perotto ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Response Rate ◽  
Response Duration ◽  
Recurrent Ovarian Cancer ◽  
Ca 125 ◽  
Cancer Antigen 125 ◽  
Median Response ◽  
Platinum Sensitive ◽  
Free Interval ◽  
Platinum Based Chemotherapy

Objectives:Most patients with ovarian cancer are candidates for second-line or salvage treatments often for prolonged periods. Patients with platinum-sensitive disease can benefit from a platinum retreatment with a likelihood of response dependents on the treatment-free interval. Alternative agents and combination chemotherapy are potential therapeutic approaches. At our institution, we carried out a phase II trial to evaluate feasibility, efficacy, and toxicity of gemcitabine and vinorelbine combination in recurrent ovarian carcinoma. The aim of the present study was to evaluate the role of this combination in patients with platinum-sensitive disease.Patients and Methods:Patients with platinum-sensitive disease recurring after 1 or more lines of platinum-based chemotherapy were included. Vinorelbine at 25 mg/m2followed by gemcitabine at 1000 mg/m2was administered intravenously on days 1 and 8 every 3 weeks. Response Evaluation Criteria in Solid Tumors and cancer antigen 125 test (CA-125 Kinetics [Rustin criteria]) were adopted to classify responses. Toxicity was assessed according to the National Cancer Institute Common Toxicity Criteria.Results:Thirty-nine patients were eligible. Platinum-free interval (PFI) was 6 to 12 months in 13 patients (33.3%; PFI 6-12) and more than 12 months in 26 patients (66.7%; PFI > 12). The overall response rate was 48.7%, with 6 complete responses. Median response duration was 38 weeks. The response rate was 23% in PFI 6-12 and 62% in PFI >12. The most frequently observed toxicity was hematological, with 23% of the patients having grade 3 or 4 neutropenia.Conclusions:Gemcitabine and vinorelbine combination is effective and well tolerated in recurrent platinum-sensitive ovarian cancer. It may represent an option in the management of these patients because the chronic nature of the disease.

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