Chemotherapy Following Secondary Cytoreductive Surgery?
Chemotherapy Following Secondary Cytoreductive Surgery?
A 45-year-old woman presented with stage III epithelial ovarian carcinoma 3 years ago. She underwent optimally debulking surgery and received 6 cycles of adjuvant carboplatin and paclitaxel. She remained relapse-free for 3 years, when a rising serum CA125 was detected accompanied by 2 enlarged retroperitoneal lymph nodes. She underwent complete lymph node dissection. Would you recommend another round of chemotherapy?
The question describes a case of a woman with stage III epithelial ovarian cancer who underwent secondary cytoreductive surgery for a retroperitoneal recurrence after being disease-free for 3 years following primary therapy. Several retrospective reports have suggested that secondary surgery improves overall survival when optimal cytoreduction can be achieved and when the disease-free interval is longer than 18 months. The median survival after secondary surgery ranges from 16 to 29 months and seems to be longer in patients with optimally debulked disease.
The role of chemotherapy has not been prospectively studied in this group of patients. However, the use of second-line chemotherapy would seem prudent on the basis of data that indicate an improved response rate and survival in patients with platinum-sensitive disease. Traditionally, when the platinum-free interval is greater than 6 months, clinicians would re-treat patients with platinum using the same drug or alternating between carboplatin or cisplatin. However, with the recent publication of ICON4, a large prospective, randomized trial comparing paclitaxel plus platinum-based chemotherapy vs conventional platinum-based chemotherapy in relapsed ovarian cancer, many clinicians would advocate re-treating with the paclitaxel/platinum combination. In this study, progression-free survival and 2-year overall survival were significantly improved among patients who received the paclitaxel-plus-platinum combination compared with platinum alone.
Although this publication has been widely criticized for a variety of reasons, it remains the largest study to date to show a beneficial effect on survival for paclitaxel in combination with platinum chemotherapy among patients with platinum-sensitive relapsed ovarian cancer. It would seem that this patient with a disease-free interval of 3 years and an optimally debulked secondary surgery should be offered platinum-based chemotherapy and be considered for combination chemotherapy with platinum and paclitaxel.
A 45-year-old woman presented with stage III epithelial ovarian carcinoma 3 years ago. She underwent optimally debulking surgery and received 6 cycles of adjuvant carboplatin and paclitaxel. She remained relapse-free for 3 years, when a rising serum CA125 was detected accompanied by 2 enlarged retroperitoneal lymph nodes. She underwent complete lymph node dissection. Would you recommend another round of chemotherapy?
The question describes a case of a woman with stage III epithelial ovarian cancer who underwent secondary cytoreductive surgery for a retroperitoneal recurrence after being disease-free for 3 years following primary therapy. Several retrospective reports have suggested that secondary surgery improves overall survival when optimal cytoreduction can be achieved and when the disease-free interval is longer than 18 months. The median survival after secondary surgery ranges from 16 to 29 months and seems to be longer in patients with optimally debulked disease.
The role of chemotherapy has not been prospectively studied in this group of patients. However, the use of second-line chemotherapy would seem prudent on the basis of data that indicate an improved response rate and survival in patients with platinum-sensitive disease. Traditionally, when the platinum-free interval is greater than 6 months, clinicians would re-treat patients with platinum using the same drug or alternating between carboplatin or cisplatin. However, with the recent publication of ICON4, a large prospective, randomized trial comparing paclitaxel plus platinum-based chemotherapy vs conventional platinum-based chemotherapy in relapsed ovarian cancer, many clinicians would advocate re-treating with the paclitaxel/platinum combination. In this study, progression-free survival and 2-year overall survival were significantly improved among patients who received the paclitaxel-plus-platinum combination compared with platinum alone.
Although this publication has been widely criticized for a variety of reasons, it remains the largest study to date to show a beneficial effect on survival for paclitaxel in combination with platinum chemotherapy among patients with platinum-sensitive relapsed ovarian cancer. It would seem that this patient with a disease-free interval of 3 years and an optimally debulked secondary surgery should be offered platinum-based chemotherapy and be considered for combination chemotherapy with platinum and paclitaxel.
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