Chemotherapy for ovarian cancer - a consensus statement on standard practice

Adams, Malcolm; Calvert, A. H.; Carmichael, J.; Clark, Peter; Coleman, Robert E.; Earl, Helena; Gallagher, Chris; Ganesan, Trivadi S.; Gore, M.; Graham, John D.; Harper, P.; Jayson, Gordon C; Kaye, Stan B.; Ledermann, Jonathan A.; Osborne, Richard; Perren, Timothy J.; Poole, C.; Radford, John; Rustin, G. J. S.; Slevin, M. L.; Smyth, John F.; Thomas, Hilary; Wilkinson, Peter M

doi:10.1038/bjc.1998.699

Cited by 59 publications

(24 citation statements)

References 15 publications

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“…In relation to this last point, it was reported that around half of the patients on each of the three arms of the trial had gone on to receive some form of additional treatment after protocol chemotherapy but before progression of disease, with a proportion of those on the single agent cisplatin control arm receiving paclitaxel at this time. This early crossover has been widely assumed to account for the failure to detect any benefit for paclitaxel/cisplatin in the trial (Gore et al, 1997;Adams et al, 1998;National Cancer Guidance Steering Group, 1999). However, a number of individuals, including the GOG-132 investigators (Muggia et al, 2000;Torri et al, 2000), have been reluctant to accept that this explanation is necessarily sufficient to explain the difference in the results.…”

Section: The Explanations For the Results Of Gog-132mentioning

confidence: 99%

First-line treatment for advanced ovarian cancer: paclitaxel, platinum and the evidence

et al. 2002

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Four large randomised trials of paclitaxel in combination with platinum against a platinum-based control treatment have now been published in full, representing around 88% (3588 out of 4057) of patients randomised into the eight known trials of this question. There is substantial heterogeneity in the results of these four trials. Four main explanations for this heterogeneity have been proposed: differences in the extent and timing of 'crossover' to taxanes in the control groups; differences in the types of patient included; differences in the effectiveness of the research regimens used; differences in the effectiveness of the control regimens used. In this study we examine whether any of these explanations is consistent with the pattern of results seen in these trials. Each explanation suggests that a particular characteristic of each trial was responsible for the results observed. For each explanation the trials were split into groups according to that characteristic, in order to partition the total heterogeneity into that seen 'within' and 'between' groups of trials. If a particular explanation was consistent with the pattern of results, we would expect to see relatively little heterogeneity within each group of trial results viewed in this way, with most of the heterogeneity being between groups which are dissimilar with respect to the key characteristic. Heterogeneity 'within' and 'between' groups was formally compared using the F-ratio. If any explanation appeared to be consistent with the results of the trials, it was considered whether the explanation was also consistent with other evidence available about these regimens. Only one explanation appeared to be consistent with the pattern of results seen in these trials, and that was differences in effectiveness of the control arms used in these trials. This suggests that the very positive results in favour of paclitaxel/cisplatin seen in two of the trials may have been due to the use of a suboptimal control arm. There is no direct evidence about the relative effectiveness of the control arms used in these trials, but indirect evidence is consistent with the conclusion that the cyclophosphamide/cisplatin regimen used in two of the trials may be less effective than the control regimens used in the other trials. Specific concerns about the choice of a cyclophosphamide/cisplatin control arm in the first of these trials to report were raised before the results of the other trials were known, i.e. before any heterogeneity had been observed. Further investigation of this question would be useful. In the meantime, given all of the randomised evidence on the efficacy and toxicity associated with the regimens used in these trials, we conclude that single agent carboplatin is a safe and effective first-line treatment for women with advanced ovarian cancer.

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Section: The Explanations For the Results Of Gog-132mentioning

confidence: 99%

First-line treatment for advanced ovarian cancer: paclitaxel, platinum and the evidence

et al. 2002

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“…Participants were recruited into the study before commencing a first-line platinum-based chemotherapy regimen, conventionally administered every 3 weeks for six cycles (Adams et al, 1998). Routine computed tomography scans were performed at the start and at the end of treatment.…”

Section: Participantsmentioning

confidence: 99%

A longitudinal investigation of psychological morbidity in patients with ovarian cancer

2008

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Ovarian cancer patients may experience psychological disorders due to the aggressive nature of the illness and treatment. We investigated the presence of psychological disorders longitudinally in women with a new diagnosis of ovarian cancer and the factors that predicted development and maintenance of these disorders. Patients were assessed in a prospective longitudinal study at the beginning of chemotherapy treatment, mid-treatment, end of treatment and 3 months follow-up for depression, anxiety, perceived social support, neuroticism and cognitive strategies to control unwanted thoughts. A total of 121 patients were recruited and 85 patients were assessed at all four time points. Three different longitudinal profiles of anxiety and depression caseness were found: non-cases (never cases), occasional cases (cases on at least one but not all four occasions) and stable cases (cases on all four occasions). Most of the women were occasional cases of anxiety (52%, 44), whereas for depression, the majority of women were non-cases (55%, 47). A subset of patients were stable cases of anxiety (22%, 19). Neuroticism and marital status were significant independent predictors of anxiety caseness profile. Neuroticism and use of anti-depressants were independent predictors of depression caseness profile. Social support was not related to psychological morbidity.

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“…The state of the art in clinical routine treatment of cancer patients is a standard combination of different cytostatic drugs based on consensus guidelines for the various tumor entities [3,4]. Bearing in mind the heterogeneity of tumors, the optimal benefit to the patient is not guaranteed, and these treatments are often accompanied by strong side effects.…”

Section: State Of the Art In Chemotherapymentioning

confidence: 99%

Diagnostic Platform for Personalized Chemosensitivity Assays - Robust Results via Process Automation

Reis

Steiner²,

Siegert

et al. 2012

Biomedical Engineering / Biomedizinische Technik

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Individualized cancer therapy, as part of personalized medicine, aims for an optimal treatment with minimal side effects. In chemotherapy, one approach is to screen for the most potent combination of chemotherapeutics (chemotherapeutic scheme) to improve quality of life and achieve a high therapy efficacy. Due to high personnel costs associated with the first generation of manual chemosensitivity assays most health insurance providers do not cover this type of therapy. Also, the outcome of such personalized assays has to be proven first. The fully automated DiagnoSYS platform technology is a system effectively using the potential of chemosensitivity assays. It was shown that with an adequate degree of automation, higher reproducibility was achieved. An ATP/TCA assay was used as the first demonstrator assay. Integrated tissue preparation, based on precise regulation of a Miltenyi Biotec M-or C-Tube, combined with magnetic cell enrichment and depletion via EpCAM and CD90 labeling and luminescence based cell vitality measurements, made it possible to enhance the signal to noise ratio of luminescence readings. The platform technology is based on the internationally accepted SBS-format. Therefore, all processing steps, from tissue preparation to luminescence or fluorescence readings, could rapidly and easily be exchanged, and allows for processing different assay approaches, such as ATP/TCA or prognostic biomarkers as uPA/PAI-1, on the same platform. As a result of modular programming, further processing steps could also be implemented without difficulty. Besides the optimization and standardization of personalized assays, cost reduction, which goes hand in hand with automation, will make the platform affordable for research groups and clinical personnel, amplifying the acceptance of personalized medicine approaches in the future.

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Chemotherapy for ovarian cancer - a consensus statement on standard practice

Cited by 59 publications

References 15 publications

First-line treatment for advanced ovarian cancer: paclitaxel, platinum and the evidence

First-line treatment for advanced ovarian cancer: paclitaxel, platinum and the evidence

A longitudinal investigation of psychological morbidity in patients with ovarian cancer

Diagnostic Platform for Personalized Chemosensitivity Assays - Robust Results via Process Automation

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