title: Second-line chemotherapy in recurrent clear cell ovarian cancer: results from the multicenter italian trials in ovarian cancer (MITO-9).
abstract: OBJECTIVE
  Ovarian clear cell carcinoma (CCC) has a poorer prognosis than other subtypes of ovarian cancer. In this study, we evaluated the responsiveness to second-line chemotherapy in recurrent ovarian CCC.
  
  
  METHODS
  The MITO-9 project investigated a cohort of patients observed between 1991 and 2007 in 20 centers. We identified 72 out of 240 patients with recurrent disease (28% stage I-II and 72% stage III-IV at diagnosis).
  
  
  RESULTS
  In 56% of patients, the clear cell histology was pure. Twenty-five patients were platinum-resistant, 18 were platinum-sensitive with a platinum-free interval (PFI) of 6-12 months, and 29 had a PFI >12 months. Upon recurrence, 47% of patients were treated with platinum chemotherapy according to the PFI. The overall response rate (RR) to platinum was 80%, with 55, 100, and 80% RR in patients with PFI of 6-12, >12, and >24 months. The RR to nonplatinum agents in resistant patients was 33%. Among the nonplatinum agents used in primary and secondary resistant cases, gemcitabine, administered in 12 cases, had a higher activity (RR = 66%) compared to topotecan or liposomal doxorubicin (n = 31; RR = 33 and 10%, respectively).
  
  
  CONCLUSIONS
  This study showed that the treatment of recurrent ovarian CCC should be based on the PFI as in the other subtypes. Data in platinum-resistant patients suggest gemcitabine as the drug with the highest activity. We recommend that gemcitabine be studied prospectively in a phase 2 trial.
authors.affiliation: Istituto Nazionale Tumori 'Fondazione G. Pascale', IRCCS, Naples, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Esposito
authors.forename: Sabrina Chiara
authors.initials: SC
authors.lastname: Cecere
authors.forename: Francescapaola
authors.initials: F
authors.lastname: Magazzino
authors.forename: Dionyssios
authors.initials: D
authors.lastname: Katsaros
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ottaiano
authors.forename: Angiolo
authors.initials: A
authors.lastname: Gadducci
authors.forename: Carmela
authors.initials: C
authors.lastname: Pisano
authors.forename: Simona
authors.initials: S
authors.lastname: Scalone
authors.forename: Emanuela
authors.initials: E
authors.lastname: Rabaiotti
authors.forename: Vanda
authors.initials: V
authors.lastname: Salutari
authors.forename: Gennaro
authors.initials: G
authors.lastname: Cormio
authors.forename: Emilie Marion
authors.initials: EM
authors.lastname: Canuto
authors.forename: Stefano
authors.initials: S
authors.lastname: Greggi
authors.forename: Antonella
authors.initials: A
authors.lastname: Savarese
authors.forename: Marco
authors.initials: M
authors.lastname: Marinaccio
authors.forename: Paolo
authors.initials: P
authors.lastname: Scollo
authors.forename: Davide Adriano
authors.initials: DA
authors.lastname: Santeufemia
authors.forename: Cosimo
authors.initials: C
authors.lastname: Sacco
authors.forename: Gaetano
authors.initials: G
authors.lastname: Facchini
authors.forename: Sandro
authors.initials: S
authors.lastname: Pignata
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000188:drug therapy* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D007558:Italy; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome