Treatment of recurrent or persistent platinum-refractory ovarian, fallopian tube or primary peritoneal cancer with gemcitabine and topotecan

Overcoming platinum resistance in ovarian carcinoma

“…The combination of these two agents was chosen because of differing mechanisms of action, possible synergistic effects, and minimally overlapping toxicity profiles 14. Although topotecan was commonly used in recent clinical trials, only one study evaluated the efficacy of gemcitabine combined with topotecan 21. The response rate of this trial was below the average of other clinical trials utilizing combination therapies (17.4 vs. 21.7%, Figure 1), and no statistical difference was seen in the response rate between gemcitabine alone and gemcitabine with topotecan (Figure 2).…”

“…While modest improvements in response rates with combination chemotherapy may be attractive, the decision to use such regimens must carefully balance the potential for increased toxicity in a setting where cure is unattainable. Indeed, gemcitabine-based therapy was associated with considerable incidence of grade 3 or 4 neutropenia, and 62.5% of clinical trials with gemcitabine-based therapy reported a 50% or higher incidence of grade 3 or 4 neutropenia (range 26% to 80%) 12–21. Furthermore, more toxicity was associated with gemcitabine-based therapy compared to non gemcitabine-based therapy.…”

Quality Of Life Of The Patients With Ovarian Cancer

“…The FACT system was more widely used because the FACT-O was developed earlier than the EORTC QLQ-OV28. The FACT-O has been applied in studies assessing palliative chemotherapy for advanced ovarian cancer (using EORTC QLQ-C30 and FACT-O) (Doyle et al, 2001), general chemotherapy ( Le et al, 2004), adjuvant and salvage chemotherapy for advanced ovarian cancer (Le et al, 2005), interval cytoreduction in advanced ovarian cancer (Wenzel et al, 2005), active coping (Canada et al, 2006), Thallidomide therapy (Gordinier et al, 2007), phase I/II gemcitabine and doxirubicine (Goff et al, 2003)] and phase II gemicitabine and topotecan trials for platinum-refractory ovarian cancers (Goff et al, 2008), and factors for decreased QoL (von Gruenigen et al, 2009). In summary, the FACT-O and FACT-G scores became better when there was response to treatment, active coping can improve HRQoL, and factors causing decreased HRQoL can be detected and managed in advance.…”