Ovarian Cancer

Ovarian cancer, a condition that affects a woman's reproductive organs, is the eighth most commonly diagnosed cancer in the United States. It is estimated that one of every 58 women in the United States will have ovarian cancer sometime during her lifetime.

Theexact cause of ovarian canceris not known. Risk factors for ovarian cancer include a family history of ovarian, breast, or colon cancer; a personal history of breast or colon cancer; and increased age (over 50 years old). Other possible risk factors relating to a woman's reproductive system include early age (before 12 years old) at the start of monthly periods; late menopause (after 52 years old); having a first child after the age of 30 years; infertility; and taking hormones after menopause.

Ovarian cancer treatment summaries

Adjuvant

Adjuvant chemotherapy for ovarian carcinoma is recommended for all newly diagnosed patients with Stage IaG3, IbG3 and Ic, II, III and IV. Several randomized trials and meta-analyses have clearly established the role of platinum agents (cisplatin and carboplatin) in the primary chemotherapeutic management of ovarian cancer.

For over 50 years, researchers have been interested in the intraperitoneal delivery of cytotoxic agents in the management of ovarian carcinoma. Recently Phase III trial and NCI-alert of intraperitoneal paclitaxel and cisplatin with IV paclitaxel compared to IV paclitaxel and cisplatin in women with optimally debulked, Stage III was reported. Although this study of 429 women reported an improvement in PFS and OS for the IP arm, the toxicity of the IP therapy resulted in only 42% of patients completing their assigned therapy in academic centers, leading to criticism of results. At present adjuvant therapy with IP Taxol/CDDP remains an option for selected Stage III optimally debulked patients in experienced centers and systemic taxane-platinum regimens continue to represent the majority of adjuvant therapy.

References:

  • Ozols, RF, Bundy BN, Greer BE et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group Study, JCO (2003) 21:3194-3200.
  • International Collaborative Ovarian Neoplasm (ICON1) collaborators. International collaborative ovarian neoplasm trial 1: A randomized trial of adjuvant chemotherapy in women with early stage ovarian cancer. JNCI, (2003) 95.
  • Vasey, PA et al. Docetaxel-Carboplatin as first line chemotherapy for epithelial ovarian cancer. BrJCancer (2001) 84:170-8.
  • Markman, M et al. Combination chemotherapy with carboplatin and docetaxel in the treatment of cancers of the ovary and fallopian tube and primary carcinoma of the peritoneum. JCO (2001) 19:1901-5.
  • Parmar, MK, Ledermann, JA, Colombo, N et al. ICON and AGO Collaborators. Paclitaxel plus platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON 4/AOO-OVAR-2.2 trial. Lancet (2003) 361:2099-2106.
  • Armstrong, DK et al. “Intraperitoneal Cisplatin and Paclitaxel in Ovarian Cancer”. NEJM (2006) 345 (1):34-43.

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