NEW YORK CITYWeekly irinotecan (Camptosar) and cisplatin (Platinol) can
be successfully given as first-line treatment to women with advanced ovarian
cancer. The toxicity is manageable, and some patients with suboptimally
resected disease achieved an extended disease-free survival, David Spriggs, MD,
reported. He is chief of the Developmental Chemotherapy Service at Memorial
Sloan-Kettering Cancer Center in New York City.
Ovarian cancer is often responsive to early treatment, and
platinum/paclitaxel (Taxol) combinations induce a complete clinical response in
50% to 70% of patients who have advanced disease. Dr. Spriggs said that only
about a quarter of patients who have an initial complete response (CR) have a
pathological complete remission at a second-look laparotomy. "And only
about half of patients who do achieve such a pathologic complete response
remain disease-free long-term, so we are always on the lookout for ways to
enhance outcome," he said.
Risk stratification has been used in attempts to preserve the results in the
good outcome patients while improving or intensifying treatment for
poor-prognosis patients. Levels of the tumor marker CA-125 are expected to be a
useful indicator in ovarian cancer patients because CA-125 is increased in
about 80% of ovarian cancer cases, and normalization of CA-125 levels by the
second or third cycle of therapy is a good prognostic factor.
"Since the use of paclitaxel and platinum began at Memorial Hospital,
no patient with a CA-125 greater than 35 U/mL after three cycles of therapy
achieved a pathologic CR in our institution," Dr. Spriggs said.
Biostatisticians at the Gynecologic Oncology Group (GOG) confirmed that less
than 10% of patients with an elevated CA-125 after three cycles went on to
achieve pathologic CR in GOG trials.
"Patients with suboptimally debulked ovarian cancer and an elevated
CA-125 after three cycles of treatment are a very high risk group for an
inadequate response to primary treatment. High-dose chemotherapy unfortunately
produced no improvement, so we looked at the possibility of adding different
drugs," Dr. Spriggs said.
"Current treatment of ovarian cancer is graphically shown in the
accompanying figure. A primary treatment such as with platinum and paclitaxel
will give an early excellent response. When the disease recurs 6 to 12 months
later, a second round of platinum/paclitaxel can induce a second response, but
eventually all these patients die of the resistant clone, which is shown in red
in the figure."