Ovarian Cancer

Available data show that women tend to overestimate their risk of developing breast cancer. Available models allow for the rapid identification of women who are at increased risk for breast cancer, along with a quantitative

Fennelly and Schneider review a controversial area in ovarian cancer management in a comprehensive, objective, and thoughtful manner. This review is particularly timely in light of the ever-increasing number of ovarian cancer patients in whom high-dose chemotherapy, with either bone marrow transplantation or peripheral stem-cell transfusion, is being proposed as a treatment option. The authors support the contention that the majority of such patients are being offered a treatment that has little likelihood of providing a meaningful benefit. The take home message from this review is that outside of an appropriately designed clinical trial, there is no established role for high-dose chemotherapy with hematologic support in any subset of patients with advanced ovarian cancer. At the conclusion of this commentary, I will return to the issue of what constitutes an appropriate clinical trial design to evaluate the efficacy of high-dose chemotherapy in ovarian cancer.

Cisplatin (Platinol) has been the most active agent against ovarian cancer. The question of a relationship between platinum dose and response remains unresolved.

We agree with Drs. Fennelly and Schneider that data from prior clinical trials performed in patients with suboptimally debulked ovarian cancer indicate that increasing the dose intensity of cisplatin (Platinol) does not translate into meaningfully higher response rates, longer response durations, or improved survival. The Gynecologic Oncology Group study is most persuasive in showing that doubling the standard dose of cisplatin and cyclophosphamide (Cytoxan, Neosar) while delivering the same total dose does not improve outcome [1].

Combining bone marrow transplant with high-dose chemotherapy improves survival rates for women with advanced ovarian

SAN FRANCISCO--Enhanced concern by the medical community and by women themselves prompted the National Institutes of Health's Office of Medical Applications of Research to convene last year's consensus conference on ovarian cancer, Vicki Seltzer, MD, said at the annual meeting of the American College of Obstetricians and Gynecologists (ACOG).

SEATTLE--In patients with advanced epithelial ovarian cancer, CA 125 concentrations after two cycles of chemotherapy are a powerful independent predictor of survival, a Southwest Oncology Group Study (SWOG) has shown.

WASHINGTON--Only a screening test that can reliably find stage I tumors will have any real impact on overall ovarian cancer mortality, and transvaginal ultrasound does not appear to fulfill that requirement. Although the technique can detect stage I ovarian cancers, its specificity is not high enough to make it useful as a general screening test, Beth Y. Karlan, MD, said at the American Cancer Society National Conference on Gynecological Cancers.

BALTIMORE--Some 60% to 80% of ovarian cancer patients recur after the first round of treatment, and "only about 15% of ovarian cancer patients who test positive at second-look laparotomy survive as long as 5 years," Karl F. Hubner, MD, of the University of Tennessee, Knoxville, said at a nuclear oncology conference sponsored by the Johns Hopkins Medical Institutions.

ROCKVILLE, Md--The Food and Drug Administration's Oncologic Drugs Advisory Committee (ODAC) has voted unanimously to recommend accelerated approval of Ethyol (amifostine injection) as a cytoprotective agent against cumulative renal toxicities associated with cyclophosphamide (Cytoxan, Neosar) and cisplatin (Pla-tinol) in patients with advanced solid tumors of non-germ-cell origin.

ASCO LOS ANGELES--A review of survival data from a phase I study of intraperitoneal interleukin-2 (IL-2) performed from 1987 to 1990 has shown durable responses in women with refractory ovarian cancer.

PARIS, France--Postoperative whole abdominal radiation (WAR) therapy has no place in the management of ovarian cancer, David Gershenson, MD, of the University of Texas M.D. Anderson Cancer Center, said in a debate at the American Radium Society meeting.

Antibodies against a variety of tumor-associated antigens have been studied, as well as a number of modifications to the antibodies themselves, including Fab' fragments and chimeric, humanized, and human

Numerous new antifolate drugs have been developed in an attempt to overcome the potential mechanisms of tumor cell resistance to methotrexate, which can include decreased drug transport into cells; decreased

A large number of organizations are currently developing practice guidelines in oncology. These include federal agencies; medical societies and groups, including both oncologic and nononcologic specialty societies; and

WASHINGTON--Applying a newly developed mathematical model to an updated version of a familiar tumor marker may increase the chance of finding ovarian cancers at an earlier stage, Robert C. Knapp, MD, said at the American Cancer Society Conference on Gynecological Cancers.

LOS ANGELES--Administration of cisplatin (Platinol) by the intraperitoneal rather than intravenous route to patients with optimally debulked stage III ovarian cancer reduced toxicity and improved survival by about 25%, David S. Alberts, MD, said at the ASCO meeting.

This is the seventh in a well-known series of conference summaries, organized and edited by Dr. Salmon. A perusal of the contents of these volumes over the past two decades reveals the evolution of concepts related to combined-modality therapy

Swedish researchers have, for the first time, used a combination of methods to accurately diagnose high-risk patents with early-stage ovarian cancer, thereby identifying those who would benefit from more aggressive treatment.

SAN FRANCISCO--Approximately 6% of all women diagnosed with ovarian cancer have had a previous diagnosis of breast cancer, Jeffrey G. Schneider, MD, said at the annual conference of the Society of Gynecologic Oncologists.

LOS ANGELES--Using paclitaxel (Taxol) rather than cyclophosphamide in combination with cisplatin (Platinol) significantly increases both progression-free and overall survival in patients with advanced ovarian cancer, William P. McGuire, MD, said in his presentation at the plenary session of ASCO.

SAN FRANCISCO--Retinoic acid appeared to enhance the efficacy of cisplatin (Platinol) and paclitaxel (Taxol) in two of three ovarian cancer cell lines tested, James R. Bosscher, MD, said in his poster presentation at the Society of Gynecologic Oncologists meeting.

MALVERN, Penn--Centocor Diagnostics has introduced Centocor CA 125 II, a second-generation radioimmunoassay for the management of ovarian cancer. The new assay, a more sensitive version of Centocor CA 125, uses the same tracer antibody, OC125, but a new capture antibody, M11, to measure serum CA 125 levels.

NEW YORK--The earth's oceans are yielding a multitude of new sources of anticancer and anti-HIV agents, possibly with unique mechanisms of action (see illustration on page 1). In only 8 years of operation, Pharma Mar, s.a. (Madrid, Spain) has developed a library of more than 20,000 marine samples and has isolated some 350 novel marine-based compounds, including 40 that have been patented.

LISBON, Portugal--Encouraging news for women with platinum-resistant advanced ovarian cancer has emerged from a large phase II trial of docetaxel (Taxotere) conducted by the European Organization for Research and Treatment of Cancer (EORTC) Early Clinical Trials Group.