Salvage therapy in epithelial ovarian cancer.
Table 1 summarizes studies in which clinical or pathologic response rates can be determined. The majority of patients in these studies had macroscopic drug-resistant tumors, and most had received cisplatin-based chemotherapy. It is noteworthy that the response rate in this group of patients is considerably higher than the 30% to 36% seen with the most active salvage therapies, such as taxol (paclitaxel). Like most trials of salvage chemotherapy for refractory ovarian carcinoma, many responses were short-lived. Toxicity in these studies is comparable to that seen in trials of ASCT in other solid tumors. The promising results observed in these small studies of ASCT in ovarian carcinoma warrant further investigation focused on defining which groups of patients are likely to benefit from this approach. Based on evidence from the lymphohematopoietic malignancies, it would seem reasonable to use ASCT in patients early in the course of their disease before extensive pretreatment and preferably at a time of minimal tumor burden. Some groups have been exploring ASCT as consolidation therapy after surgery and limited debulking chemotherapy. Based on kinetic models of tumor growth, other investigators have suggested that multiple courses of high-dose chemotherapy with ASCT after debulking surgery may result in more cures than a single ASCT after conventional chemotherapy. The feasibility of performing sequential ASCT has been well documented. So far the best drug regimens, the number of cycles that should be used, and the patients who should be candidates for high-dose chemotherapy and ASCT remain undefined. Presently, there is no role for this therapeutic modality outside of well-designed clinical trials.
Johns Hopkins Oncology Center, Baltimore, Maryland.
C
C
Caldas
L E
LE
Morris
W P
WP
McGuire
D000970:Antineoplastic Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D004351:Drug Resistance; D005260:Female; D006801:Humans; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016879:Salvage Therapy
D000970:Antineoplastic Agents