title: Primary chemotherapy-associated effect of second-line chemotherapy on survival of patients with advanced ovarian cancer.
abstract: BACKGROUND
  The current treatment of patients with recurrent ovarian cancer who have received initial platinum- or taxane-based chemotherapy depends on the results of the initial chemotherapy. The purpose of this study was to evaluate how to make the selection of second-line agents for patients with recurrent ovarian carcinoma initially diagnosed as stage II to IV.
  
  
  METHODS
  We conducted a retrospective crossover study in patients who received second-line chemotherapy at Jikei University School of Medicine. We evaluated the responses, progression-free survivals, survivals of second-line chemotherapy, and overall survivals after primary surgery for 51 patients. The treatment cohorts were defined as follows: TC1, patients who were given paclitaxel and carboplatin as first-line chemotherapy and who, upon recurrence, were treated with a platinum-based combination as second-line; and TC2, patients who were given a non-taxane-based platinum combination as first-line chemotherapy, followed, at the time of recurrence, with paclitaxel and carboplatin.
  
  
  RESULTS
  The response rates of the second-line chemotherapy for the TC1 and TC2 groups were 44% and 25% (P=0.09). The median progression-free survivals of TC1 and TC2 were 12.9 and 6.4 months (P=0.018; hazard ratio [HR], 2.42; 95% confidence interval [CI], 1.16-5.04). The median survivals after second-line chemotherapy for the two groups were 16.8 and 10.4 months (P=0.007; HR, 2.78; 95% CI, 1.33-5.84) and overall survivals after primary surgery were 36.6 and 27.9 months (P=0.007; HR, 2.36; 95% CI, 1.07-5.21).
  
  
  CONCLUSIONS
  The TC1 group demonstrated a significantly better response and extension of progression-free survival, as well as significantly better survival after crossover and overall survival after primary surgery. As this was a retrospective analysis, this effect should be considered as hypothesis-generating and assessed prospectively in other trials comparing these two chemotherapy schedules.
authors.affiliation: Department of Obstetrics and Gynecology, Jikei University School of Medicine, 4-11-1 Izumi-honchou, Komae, Tokyo, 201-8601, Japan. isonishi@jikei.ac.jp
authors.forename: Seiji
authors.initials: S
authors.lastname: Isonishi
authors.forename: Masanori
authors.initials: M
authors.lastname: Hirama
authors.forename: Motoaki
authors.initials: M
authors.lastname: Saitou
authors.forename: Makoto
authors.initials: M
authors.lastname: Yasuda
authors.forename: Tadao
authors.initials: T
authors.lastname: Tanaka
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D018592:Cross-Over Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D017239:Paclitaxel / Q000008:administration & dosage; D017671:Platinum Compounds / Q000008:administration & dosage; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D017671:Platinum Compounds; D017239:Paclitaxel