title: Outcomes after multiple lines of chemotherapy for platinum-resistant epithelial cancers of the ovary, peritoneum, and fallopian tube.
abstract: BACKGROUND
  Platinum-resistant and refractory cancers of the ovary, fallopian tube, and peritoneum have a poor prognosis, yet in some cases, they can respond to multiple lines of chemotherapy. Uncertainty remains over optimal drug choice and when therapeutic focus should be switched from active therapy to supportive care.
  
  
  METHODS
  A retrospective case note review was performed on 274 women treated for platinum-resistant/refractory ovarian, fallopian tube, or peritoneal carcinoma at the Christie Hospital between 2004 and 2008. Baseline data at onset of platinum resistance and outcomes from subsequent lines of therapy were recorded.
  
  
  RESULTS
  A total of 689 lines of therapy were administered with a median overall survival from initiation of first-line therapy for platinum-resistant disease of 61 weeks. Twenty-eight percent of women commenced cytotoxic therapy in the last 3 months of life. Treatment efficacy declined rapidly with successive lines of therapy particularly if disease progression occurred during first-line therapy. Factors independently associated with worse overall survival at recognition of platinum resistance were performance status, presence of stage IV disease, elevated cancer antigen 125, and platinum-refractory disease.
  
  
  CONCLUSIONS
  A significant proportion of women who were treated received therapy within the last few months of life with little clinical benefit. Disease progression on 2 consecutive lines of therapy should be used as a guide to discontinue cytotoxic treatment. A subset of patients with poor prognosis at the onset of platinum resistance, who may have little gain from anticancer treatment, can be identified.
authors.affiliation: Department of Medical Oncology, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK.
authors.forename: Richard Wyn
authors.initials: RW
authors.lastname: Griffiths
authors.forename: Ying-Kiat
authors.initials: YK
authors.lastname: Zee
authors.forename: Saran
authors.initials: S
authors.lastname: Evans
authors.forename: Claire L
authors.initials: CL
authors.lastname: Mitchell
authors.forename: Gireesh C
authors.initials: GC
authors.lastname: Kumaran
authors.forename: Richard S
authors.initials: RS
authors.lastname: Welch
authors.forename: Gordon C
authors.initials: GC
authors.lastname: Jayson
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Clamp
authors.forename: Jurjees
authors.initials: J
authors.lastname: Hasan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001952:Bridged-Ring Compounds / Q000008:administration & dosage; D018394:CA-125 Antigen / Q000097:blood; D002277:Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D000077216:Carcinoma, Ovarian Epithelial; D002945:Cisplatin / Q000008:administration & dosage; D003603:Cytotoxins / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage; D005185:Fallopian Tube Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D017239:Paclitaxel / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D010984:Platinum / Q000008:administration & dosage; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D001952:Bridged-Ring Compounds; D018394:CA-125 Antigen; D003603:Cytotoxins; D043823:Taxoids; C506643:liposomal doxorubicin; D003841:Deoxycytidine; C080625:taxane; D011092:Polyethylene Glycols; D010984:Platinum; D005047:Etoposide; D004317:Doxorubicin; D017239:Paclitaxel; D002945:Cisplatin; D000093542:Gemcitabine