Remaining controversies in the upfront management of advanced ovarian cancer

Mano, Max S.; Awada, Ahmad; Minisini, A. M.; Atalay, G.; Lago, Lissandra Dal; Cardoso, Fátima; Piccart, Martine

doi:10.1111/j.1048-891x.2004.014502.x

Cited by 15 publications

(5 citation statements)

References 71 publications

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“…Despite excellent responses to first-line chemotherapy, most patients with advanced ovarian cancers who achieve cCR relapse after a median time of 18-24 months (13-15). Among attempts made to improve the clinical outcome of EOC patients is maintaining the response achieved by first-line chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Hexamethylmelamine as Consolidation Treatment for Patients with Advanced Epithelial Ovarian Cancer in Complete Response after First-Line Chemotherapy

et al. 2009

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The aim of this study was to assess the efficacy of consolidation therapy with hexamethylmelamine (HMM) in patients with advanced epithelial ovarian cancer (EOC). Patients treated at our hospital between January 1997 and November 2006 and in documented clinical complete response from advanced ovarian cancer following front-line platinum-based therapy were retrospectively analyzed. The patients treated with HMM were compared to the patients of matched counterpart without consolidation therapy. Of 102 patients enrolled, 49 were treated with HMM and 53 received no consolidation treatment. For patients with HMM and observed patients, the mean age were 54.6 and 55.6 yr; the distribution of stage was similar (P=0.977); the optimal surgery was performed in 36 (73.5%) and 44 (83%) (P=0.336); the recurrence rate were 27 (55.1%) and 33 (62.3%) (P=0.463); and the median progression-free survival were 38 months and 21 months for patients with HMM and observed patients (P=0.235). No treatment-related adverse events were reported during the follow-up period. Although this study failed to show the significant survival benefit of consolidation therapy with HMM in patients with advanced EOC, we consider that our study can contribute data to investigate the effectiveness of consolidation therapy in epithelial ovarian cancer.

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Section: Discussionmentioning

confidence: 99%

Hexamethylmelamine as Consolidation Treatment for Patients with Advanced Epithelial Ovarian Cancer in Complete Response after First-Line Chemotherapy

et al. 2009

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“…It remained an independant variable in a multivariate analyses of survival [ 39 , 54 ]. However, it has not been described as a marker of platinum chemotherapy sensitivity in every study [ 54 , 55 , 56 ]. The discrepancy is likely due to differences in study design.…”

Section: Protein Biomarkers Associated With Chemoresistance and Sumentioning

confidence: 99%

Predictive and Prognostic Protein Biomarkers in Epithelial Ovarian Cancer: Recommendation for Future Studies

Page

Huntsman

Provencher

et al. 2010

Cancers

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Epithelial ovarian cancer is the most lethal gynecological malignancy. Due to its lack of symptoms, this disease is diagnosed at an advanced stage when the cancer has already spread to secondary sites. While initial rates of response to first treatment is >80%, the overall survival rate of patients is extremely low, mainly due to development of drug resistance. To date, there are no reliable clinical factors that can properly stratify patients for suitable chemotherapy strategies. Clinical parameters such as disease stage, tumor grade and residual disease, although helpful in the management of patients after their initial surgery to establish the first line of treatment, are not efficient enough. Accordingly, reliable markers that are independent and complementary to clinical parameters are needed for a better management of these patients. For several years, efforts to identify prognostic factors have focused on molecular markers, with a large number having been investigated. This review aims to present a summary of the recent advances in the identification of molecular biomarkers in ovarian cancer patient tissues, as well as an overview of the need and importance of molecular markers for personalized medicine in ovarian cancer.

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“…Cytoreductive surgery followed by paclitaxel/platinumbased chemotherapy is the standard treatment for advanced epithelial ovarian cancer, able to achieve a clinical complete response rate of 50% approximately, a pathologic complete response rate of 25%-30%, a median progression-free survival of 15.5-22 months, and a median overall survival of 31-44 months (19)(20)(21)(22)(23)(24)(25)(26) . Almost 75% of the patients who achieve a clinical complete response and 50% of those who obtain a pathologic complete response will relapse after a median time of 18-24 months, with pelvis and abdomen being the most common sites of recurrences (26)(27)(28)(29)(30)(31)(32) (Table 2).…”

Section: Advanced Disease (Stage Iib To Iv)mentioning

confidence: 99%

“…Almost 75% of the patients who achieve a clinical complete response and 50% of those who obtain a pathologic complete response will relapse after a median time of 18-24 months, with pelvis and abdomen being the most common sites of recurrences (26)(27)(28)(29)(30)(31)(32) (Table 2). Poorly differentiated grade and large residual disease after initial surgery are the strongest prognostic poor variables.…”

Section: Advanced Disease (Stage Iib To Iv)mentioning

confidence: 99%

Surveillance procedures for patients treated for epithelial ovarian cancer: a review of the literature

Gadducci

Cosio

Zola

et al. 2007

International Journal of Gynecological Cancer

110

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Epithelial ovarian cancer is the leading cause of death from gynecological cancer in the Western countries. Approximately 20%-30% of patients with early-stage disease and 50%-75% of those with advanced disease who obtain a complete response following first-line chemotherapy will ultimately develop recurrent disease, which more frequently involves the pelvis and abdomen. Few formal guidelines exist regarding the surveillance of these patients, and there is no agreement in the literature about the type and timing of examinations to perform. Moreover, the objective of follow-up is unclear as recurrent epithelial ovarian cancer continues to be a therapeutic dilemma and quite all the relapsed patients will eventually die of their disease. The follow-up of asymptomatic patients generally include complete clinical history, serum cancer antigen (CA)125 assay, physical examination, and often ultrasound examination, whereas additional radiologic imaging techniques are usually performed when symptoms or signs appear. (18)Fluoro-2-deoxy-glucose ((18)FDG)-positron emission tomography (PET) has a sensitivity of 90% and a specificity of 85% approximately for the detection of recurrent disease, and this examination appears to be particularly useful for the diagnosis of recurrence when CA125 levels are rising and conventional imaging is inconclusive or negative. Recently, technologic advances have led to novel combined (18)FDG-PET/computed tomography (CT) devices, which perform contemporaneous acquisition of both (18)FDG-PET and CT images. The role of (18)FDG-PET/CT for the detection of recurrent ovarian cancer is very promising, and this technique may be especially useful for the selection of patients with late recurrent disease who may benefit from secondary cytoreductive surgery.

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Remaining controversies in the upfront management of advanced ovarian cancer

Cited by 15 publications

References 71 publications

Hexamethylmelamine as Consolidation Treatment for Patients with Advanced Epithelial Ovarian Cancer in Complete Response after First-Line Chemotherapy

Hexamethylmelamine as Consolidation Treatment for Patients with Advanced Epithelial Ovarian Cancer in Complete Response after First-Line Chemotherapy

Predictive and Prognostic Protein Biomarkers in Epithelial Ovarian Cancer: Recommendation for Future Studies

Surveillance procedures for patients treated for epithelial ovarian cancer: a review of the literature

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