Consolidation Bhemotherapy and Immuno-therapy in Ovarian Cancer

The optimal management of patients who do achieve a clinical complete remission after induction chemotherapy remains to be determined. Even patients who achieve a surgically confirmed complete remission have a 30% to 50% recurrence rate. Some investigators have suggested that second-look laparotomy should be performed to identify patients who may be candidates for intraperitoneal therapy. There is, however, currently no evidence that the routine sequential administration of intraperitoneal chemotherapy after intravenous induction chemotherapy leads to a prolongation of survival.

Clinical trials are in progress to determine whether consolidation therapies are of benefit in patients who achieve a surgically confirmed clinical complete remission. A recent study conducted by the GOG and SWOG compared 3 and 12 monthly cycles of “consolidation” chemotherapy with paclitaxel (135-175mg/m2 IV over 3 h) for patients who had achieved a clinical remission following primary paclitaxel and carboplatin chemotherapy. Progression free survival was 21 and 28 months in the 3-cycle and 12-cycle paclitaxel arms (p = .035). Consequently, 9 months of additional chemotherapy provided an additional 7 months of progression free survival. To date, there is no difference in overall survival between the two arms.

A number of experimental regimens are being tested including IP chemotherapy, high dose IV chemotherapy with stem cell support, immunotherapy with interferon, the IP administration of 90Y-labelled anti-MUC1 antibody, and the IP administration of 32P. Vaccine trials are about to begin with Ovarex, in an attempt to utilize anti-idiotypic immunity against antibodies reactive with CA 125. Outside of a clinical research setting, a standard approach is to follow patients carefully after the achievement of a clinical complete remission until recurrence.

Consolidation or Salvage Radiotherapy
Just as whole abdominal radiation therapy is used as primary postoperative therapy for some patients with ovarian cancer, it has also been used as consolidation or salvage therapy following combination chemotherapy. Fuksand collegues.were among the first to propose the use of sequential cisplatin-based chemotherapy, secondary cytoreductive surgery, followed by whole abdominal radiation therapy, in patients with advanced disease. Since that time, numerous reports of sequential multimodality therapy have appeared. A review of this subject examined the published results. Unfortunately, definitive conclusions about the value of such a strategy cannot be reached since most of the reported studies are single-arm trials without appropriate controls, and, in many situations, patients selected for the sequential therapy were inappropriate since they had large-volume residual disease following chemotherapy. Radiation therapy is not of benefit even as the initial postoperative therapy if residual disease measures more than 1 cm in the pelvis, or if there is any macroscopic disease in the upper abdomen. Salvage radiotherapy is inappropriate for most patients with any macroscopic disease after chemotherapy. When consolidative radiotherapy has been used, there does not appear to be any curative benefit.

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Revision date: June 20, 2011
Last revised: by Tatiana Kuznetsova, D.M.D.