Management of Treatment-Related Toxicity in Advanced Ovarian Cancer

Abstract

Recognition of recurrent ovarian cancer as a disease with significant secondary responses and remissions has led to an increase in the need for oncologists to plan for the long-term therapy of patients. However, many of the currently available front-line and salvage agents used in advanced ovarian cancer are associated with cumulative and/or irreversible toxicities that pose challenges in longterm planning. The irreversible effects associated with some of these therapies may render patients less tolerant to subsequent treatments and lead to a cycle of diminishing treatment options with each remission and disease relapse. Additionally, the potential for patients to experience cumulative toxicity must be carefully weighed against the goals of prolonging the disease-free interval and improving patient quality of life. A number of agents are available in the treatment armamentarium (platinum, paclitaxel, gemcitabine, etoposide, liposomal doxorubicin, and topotecan), many, but not all of which are associated with cumulative toxicity. For instance, cumulative neurotoxicity associated with cisplatin as first-line therapy may diminish the option for retreatment with platinum at first relapse. In contrast, the main toxicity associated with topotecan is noncumulative, manageable myelosuppression. In this review, the major toxicities associated with the predominant chemotherapy agents used in advanced ovarian cancer are discussed along with selected management approaches in the context of long-term treatment planning and sequencing.

Efficacy and safety of erlotinib HCl, an epidermal growth factor receptor (HER1/EGFR) tyrosine kinase inhibitor, in patients with advanced ovarian carcinoma: results from a phase II multicenter study

“…Erlotinib may also be a better maintenance option after successful first-line chemotherapy, potentially prolonging the platinum-free and/or chemotherapyfree interval and minimizing the possibility of cumulative toxicities and resistance development. These are well-recognized and desirable goals in managing patients with advanced ovarian cancer (9,18) . As erlotinib has a good safety profile so far and some activity in the less than optimal setting of late-stage ovarian cancer, several trials will evaluate it further in this and earlier disease.…”

The potentials of nanotechnology-based drug delivery system for treatment of ovarian cancer

“…Also, a number of randomized trials using combination of hexamethyl melamine, cyclophosphamide (CPP), methotrexate (MTX), and fl uorouracil have achieved higher survival rates compared to single therapeutic agent (Carmo-Pereira et al 1981). (Dunton 2002).…”

Contemporary Quality of Life Issues Affecting Gynecologic Cancer Survivors

“…172,186 Neurotoxicity, anemia, and nausea and vomiting all have well-known adverse effects on HRQOL. Paclitaxel in combination with a platinum compound is now considered the standard of care as first-line chemotherapy for advanced ovarian cancer.…”