Chemotherapy for Ovarian Cancer

Early Stage Disease (Stages I & II)

These patients are usually treated with a combination of Carboplatin and Taxol intravenously. This is administered over a 5 hr period in our office, every 21 days for a total of 6 cycles (rounds of chemotherapy). In selected cases, some patients may be treated with only Carboplatin, or may only receive 3 cycles instead of 6.

Advanced Stage Disease- Optimal Debulking (all tumor surgically removed to <1cm)

These patients have recently been shown to benefit the most from Intraperitoneal Chemotherapy. This is chemotherapy that is administered directly into the abdominal cavity via a special catheter- this allows us to achieve chemotherapy concentrations to the tumor cells that are up to 1000-fold higher than can be achieved with intravenous chemotherapy. This chemotherapy has been shown to significantly improve survival over traditional intravenous chemotherapy.

Comparison of Intraperitoneal Chemotherapy with Intravenous Chemotherapy
Study Author
#Patients
Median Overall Survival (months)
 
Intravenous
Intraperitoneal
GOG#104
546
41
49
Polyzos
90
52
63
Gaducci
113
25
26
GOG#114
462
51
67
Yen
118
48
43
GOG#172
415
49
67
EORTC
153
78
91
All combined
1897
49
61

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In early 2006, the National Cancer Institute looked at this data for Intraperitoneal Chemotherapy- despite overwhelming evidence of improved survival with intraperitoneal chemotherapy, clinicians were not taking advantage of this. In response, they issued an NCI Clinical Alert stating that all optimally debulked ovarian cancer patients should be offered intraperitoneal chemotherapy as an option for treatment.

Advanced Stage Disease- Suboptimal Debulking (residual tumor of >1cm)

Chemotherapy for these patients usually involves Taxol and Carboplatin given intravenously. Each infusion lasts approximately 5hrs and is given every 21 days. If the patients had an aggressive maximal attempt at debulking by a competent gynecologic oncologist, further attempts at surgical tumor removal during or after chemotherapy are usually unsuccessful. However, certain patients are operated on by a non-gynecologic oncologist with their initial surgery. These patients may sometimes benefit from an interval debulking- a repeat surgery after 3-6 cycles of chemotherapy to attempt to remove all disease. This is usually followed by additional chemotherapy.

Recurrent or Persistent Ovarian Cancer

If the tumor persists after chemotherapy, or the recurrence of cancer is ‹6-12 months after completion of their initial chemotherapy, these patients are termed platinum resistant (resistant to cisplatin or carboplatin based chemotherapy drugs). Further chemotherapy may involve single agent or combinations of the following:

Other options, including research protocols with novel agents are also available.

If the tumor has stayed in remission (no clinical evidence of tumor), for at least 6 months after completion of chemotherapy (preferably at least 12 months), then they are termed platinum sensitive. They are generally treated with either Taxol and Carboplatin or Carboplatin alone since their tumors had a significant and prolonged response to these agents with front-line chemotherapy. If the recurrence is at a single, surgically accessible site, then they are offered secondary debulking. This is surgery to attempt removal of any tumor, to be followed by chemotherapy. Secondary debulking has not been shown to prolong survival in patients with Platinum Resistant tumors however.

For More Information Regarding Chemotherapy Drugs Used*

Taxol (paclitaxel)
Paraplatin (Carboplatin)
Taxotere (docetaxel)
Platinol (Cisplatin)
Hycamtin (Topotecan)
Gemzar (gemcitabine)
Doxil (liposomal doxorubicin)
Avastin (bevacizumab)

*This information is from a third-party site. West Coast Gynecologic Oncology neither endorses nor is responsible for the information contained herein.