SAN FRANCISCOFive-year survival was significantly better
for women with advanced-stage ovarian cancer diagnosed from 1988 to
1994 than for those diagnosed from 1983 to 1987, according to
research presented at the 30th Annual Meeting of the Society of
Gynecologic Oncologists. This improvement is thought to be due to
increased use of surgical debulking and adjuvant platinum/paclitaxel (Taxol).
Edward L. Trimble, MD, and his associates from the National Cancer
Institute (NCI) reported data from the NCIs Surveillance,
Epidemiology and End Results (SEER) database, which tracks cancer
incidence and mortality for 14% of the US population.
The researchers examined data on 2,194 women diagnosed with ovarian
cancer from1983 to 1987, and 2,082 women diagnosed from1988 to 1994.
Dr. Trimbles group compared 5-year relative survival between
these two time periods for each FIGO stage using the z statistic.
Paclitaxel was approved by the FDA in 1992, and surgical staging was
recommended by the NIH Consensus Panel of Ovarian Cancer in 1994. The
positive effect of cisplatin (Platinol)/paclitaxel-based chemotherapy
on survival in advanced ovarian cancer had been previously
demonstrated in a phase III trial conducted by the Gynecologic
The researchers found significantly improved 5-year survival for
women with FIGO stages I, III, and IV ovarian cancer (see Table),
which they believe reflects more widespread acceptance of
recommendations for surgical and chemotherapeutic interventions in
In an interview, Dr. Trimble said that the researchers were surprised
at the benefit observed in women with stage I disease, since a
benefit for adjuvant chemotherapy in this group of patients has not
been fully established.
The fact that we are seeing improved survival in stage I
suggests that there may be a benefit in adjuvant chemotherapy or that
we may be staging patients more effectively, so that those classified
as stage I actually are only those with early disease, he said.
Surgery Critically Important
Dr. Trimble emphasized that the most important implication of the
study is that it is possible to improve ovarian cancer survival by
taking advantage of two relatively recent developments: recognition
that surgery is critically important in controlling this
disease and that paclitaxel can contribute to better outcomes.
If we combine effective debulking with chemotherapy based on
platinum and paclitaxel, we can improve the prognosis for women with
ovarian cancer, he said.
There are European data suggesting that interval cytoreduction
surgery can also improve survival, he added. We need to explore
that further, particularly in patients such as older women with
comorbid conditions who may not be able to tolerate debulking surgery
when they are first diagnosed, he said. Neoadjuvant
chemotherapy followed by interval debulking is a reasonable option
for patients who are very sick when they are first diagnosed.
Dr. Trimble said that further research is also needed on
intraperitoneal chemotherapy and on the best use of new drugs such as
topotecan (Hycamtin) and gemcitabine (Gemzar).