Chemotherapy for Ovarian Cancer

ovaries

There are several chemotherapy strategies for the treatment of ovarian cancer at virtually every stage of the disease as well as for recurrence.

Ovarian cancers are staged across four stages; within each stage (except Stage IV) there are three levels of increasing severity labeled A, B and C. More importantly with regard to chemotherapy regimens for ovarian cancers, they are divided into early-stage disease (stage IA through Stage IIB) and advanced-stage disease (Stage IIC and above).

Early-Stage Disease (Stages IA, IB, IC, IIA, IIB)

Most ovarian cancer patients diagnosed as stage IA or IB do not need chemotherapy; rather, surgery has proven to be extremely successful in this patient population, offering a 95% 10 year survival rate.

When chemotherapy is used in early stage ovarian cancer, first-line regimens include the following:

  • Cisplatin + cyclophosphamide (3 cycles)
  • Paclitaxel + carboplatin (3-6 cycles)
  • Cisplatin (single agent)

Advanced-Stage Disease (Stages IIC, IIIA, IIIB, IIIC, IV)

There is no single first-line standard of care for treating advanced stage ovarian cancer; the decision is made through consultation and according to a number of mitigating factors. However, the following combination regimens are often used:

  • Paclitaxel + cisplatin (6 cycles)
  • Paclitaxel + carboplatin (6 cycles)

Research has indicated that these regimens are equally effective, but that carboplatin + paclitaxel is far less toxic. This is important because continued exposure to platinum-based chemotherapy can eventually produce an allergic reaction.

  • Docetaxel + carboplatin (6 cycles)
  • Dose-dense paclitaxel + carboplatin (6 cycles)
  • Paclitaxel + carboplatin + gemcitabine
  • Paclitaxel + carboplatin + topotecan
  • Paclitaxel + cisplatin + cyclophosphamide (generally for poor-prognosis disease, although this is regarded as the most effective three-drug regimen for this cancer)

Recurrent Disease

Finally, there are several chemotherapy regimens for recurrent ovarian cancer, all with varying degrees of efficacy:

  • Platinum retreatment with either cisplatin or carboplatin
  • Fluorouracil + leucovorin
  • Single-agent gemcitabine
  • Oral altretamine (hexamethylmelamine)
  • Doxorubicin HCI liposome injection
  • Vinorelbine
  • Paclitaxel 24 hour weekly infusion (3 cycles)
  • Topotecan HCI
  • Oral etopiside
  • Taxomifen

Side Effects

Common side effects experienced by ovarian cancer patients undergoing chemotherapy include myelosuppression, nausea/vomiting, kidney problems, neurotoxicity, fatigue, clinical depression, and sexual dysfunction.

References

  • Boyiadzis, Michael M. et al. Hematology-Oncology Therapy. 2007. New York: McGraw Hill, Medical Publishing Division.
  • Edge Stephen B et al. AJCC: Cancer Staging Handbook, 7th edition. 2010. New York: Spring.
  • National Comprehensive Cancer Network: Clinical Practice Guidelines in Oncology- V.2.2010. Ovarian cancer.

 

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