Recurrent Ovarian Epithelial Cancer
Note: Some citations in the text of this section are followed by a level of
evidence. The PDQ editorial boards use a formal ranking system to help the
reader judge the strength of evidence linked to the reported results of a
therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more
Of importance is to determine the interval between the completion of therapy
with cisplatin or carboplatin and the development of recurrent disease.
Patients who have had a significant response to cisplatin or carboplatin may
respond to treatment with one of these agents; the likelihood that a patient
will respond increases as the length of time since the patient was last treated
increases. Other platinum agents, such as oxaliplatin, have activity and could be considered (see Table 2). Intraperitoneal (IP) therapy is usually not given beyond consolidation but could be considered for those patients
with low-volume disease and no single nodule >1 cm.
For patients whose disease is platinum-refractory (i.e., with disease that has
progressed while on a platinum regimen or that has recurred shortly after
completion of a platinum-containing regimen), treatment with paclitaxel (Taxol)
historically provided the first agent with consistent activity in these patients and should be considered.[2,3,4,5,6] Responses have been
observed in patients whose disease is platinum-sensitive and those whose
disease is platinum-refractory. The primary toxic effect is reversible
neutropenia; other rare toxic effects include anaphylactoid reactions (possibly caused by the Cremophor vehicle and/or rapid intravenous administration),
cardiac arrhythmias, and peripheral neuropathy. The overall response rate is higher in patients with recurrent ovarian cancer treated
with paclitaxel and carboplatin or cisplatin.
Several randomized trials have addressed whether the use of combination therapy is superior to single agents (see Table 3), and the outcome of one of these studies has been published. In this report, the results of 3 trials that compared a paclitaxel plus platinum-based combination with a nonpaclitaxel-containing platinum-based chemotherapy are combined. The trials differed with respect to platinum-free interval, number of prior regimens allowed, and whether previous exposure to a taxane was required. A variety of platinum-containing control regimens were also allowed. Overall, in comparison to nonpaclitaxel-containing platinum-based treatment (carboplatin alone in 71%), the use of a platinum-containing regimen with paclitaxel (carboplatin + paclitaxel in 80%) resulted in a prolonged progression-free survival (hazard ratio [HR] = 0.76; 95% confidence interval [CI], 0.66-0.89; P = .0004; difference at 1 year 10% [50% vs. 40%] CI, 4%-15%). Survival was also improved on the carboplatin plus paclitaxel-containing arm (HR = 0.82; 95% CI, 0.69-0.97; P = .023; difference at 2 years 7% [57% vs. 50%] CI, 1%-12%).[Level of evidence: 1iiA]