Consolidation and maintenance therapy for patients with advanced epithelial ovarian cancer

Kim, Seung Cheol

Abstract

The current therapy for patients with advanced ovarian cancer consists of maximal cytoreductive surgery followed by six cycles of combination chemotherapy with paclitaxel/carboplatin. With this therapy, approximately 75% of patients with advanced epithelial ovarian cancer will achieve a clinical complete remission (normal CT, normal CA-125, normal pelvic exam), but the majority of patients will recur. Therefore, the strategy to consolidate and to prolong the duration of response is very important because cure for patients with recurrent disease is highly improbable. Several treatments for consolidation/maintenance have been attempted, such as whole abdominal radiation, intraperitoneal chromic phosphate, radioimmunotherapy, intraperitoneal chemotherapy, high-dose chemotherapy with hematopoietic support, prolonged administration of the first-line regimen, second-line single-agent chemotherapy, and biological agents. Unfortunately, many clinical studies have been conflicting, inconclusive, and generally disappointing. Recently, the GOG, together with SWOG, showed that prolonged treatment with single-agent paclitaxel (175 mg/m2 every 4 weeks) significantly improved the progression- free survival of complete responders to paclitaxel/platinum-based chemotherapy. Alternative less toxic, and more effective schedules of administration of chemotherapy (i.e. weekly paclitaxel) might provide a better balance between quality of life and anti-tumor activity in patients previously exposed to chemotherapy.