A Prospective Randomized Comparison of 6 and 12 Cycles of Cyclophosphamide, Adriamycin, and Cisplatin in Advanced Epithelial Ovarian Cancer: A Danish Ovarian Study Group Trial (DACOVA)

Bertelsen, K.; Jakobsen, Anders; Strøyer, I.; Nielsen, Kirsten; Sandberg, Erik; Andersen, Jørn; Ahrons, S.; Nyland, M.; Pedersen, PK; Larsen, Gunnar; Rasmussen, Per Emil; Kiær, H.; Bichel, P.; Jacobsen, Marianne; Hølund, Berit

doi:10.1006/gyno.1993.1081

Cited by 139 publications

(42 citation statements)

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“…The overall response rate was 67% with 26% of the patients achieving pCR. This is comparable to other data in the literature for cisplatin-based chemotherapies delivered over 6-12 cycles [4,13]. Sixty-seven percent of the responses were pathologically evaluated.…”

Section: Discussionsupporting

confidence: 85%

Treatment of ovarian cancer with surgery, short-course chemotherapy and whole abdominal radiation

Buser

Bacchi²,

Goldhirsch

et al. 1996

Annals of Oncology

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SummaryBackground: The primary aim was to induce a high number of pCR in early (FIGO IC, KB + C) -and advanced (FIGO rQ-IV) -stage ovarian cancer with a surgery plus 4 cycles of cisplatin and melphalan (PAMP) regimen. The second objective was to prevent relapse with WAR in patients in remission after chemotherapy.Patients and methods: 218 eligible patients were treated after staging laparotomy with cisplatin 80 mg/sqm i.v. on day 1 and melphalan 12 mg/sqm i.v. on day 2 q 4 weeks. Response was verified by second-look laparotomy. WAR was carried out with the open field technique on a linear accelerator (daily dose: 1.3 Gy, total dose: 29.9 Gy) in patients with pathological or clinical CR or pathological PR with microscopical residual disease.Results: 146/218 patients (67%, 95% CI: 61%-73%) responded to PAMP: 56 (26%) achieved pCR, 24 (11%), cCR, 56 (26%) pPR and 10 (5%) cPR (c = clinical, p = pathological). Multivariate analyses revealed that in advanced stages (92 cases in remission), the achievement of

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Section: Discussionsupporting

confidence: 85%

Treatment of ovarian cancer with surgery, short-course chemotherapy and whole abdominal radiation

Buser

Bacchi²,

Goldhirsch

et al. 1996

Annals of Oncology

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“…However, a randomised phase III trial showed no benefit for interferon maintenance in terms of either OS or clinical event-free survival (22). It has also been reported that the phenotype of cancer progenitor cells depends on epigenetic alteration, Bertelsen et al (29) and cisplatin (CAP)…”

Section: Basis Of Ovarian Cancer Recurrence: Cancer Stem Cellsmentioning

confidence: 99%

“…in the past, numerous approaches were tested in this setting, i.e, prolongation of chemotherapy, hormonal therapy, targeted therapy and immunotherapy (Table I). The first trials were mainly based on prolonged administration of single-agent chemotherapy (28), extended cycles of combination chemotherapy (29)(30)(31) or intraperitoneal chemotherapy (32). The early trials provided negative results, with no prolongation of OS.…”

Section: Maintenance Therapy Approaches In Ovarian Cancermentioning

confidence: 99%

Maintenance therapy in ovarian cancer: Molecular basis and therapeutic approach

Binaschi

Simonelli

Goso

et al. 2011

Experimental and Therapeutic Medicine

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Abstract. Ovarian cancer has the highest mortality rate among gynaecological tumours despite the fact that the majority of patients with advanced disease achieve complete remission after first-line surgery and chemotherapy. Unfortunately, disease recurrence occurs in the majority of patients and second-line treatments are not curative. Clearly, the persistence of dormant and drug-resistant cells after front-line treatments results in the inability to cure the disease. The identification of cancer-initiating cells or cancer stem cells as key players in the development of recurrence has opened up a novel field of research aimed at identifying additional innovative therapeutic approaches. Strategies of maintenance therapy to extend the survival of patients have been studied, but to date no overall survival benefit has been detected. Currently, numerous clinical trials have just been completed or are ongoing involving patients achieving a complete clinical response after first-line chemotherapy in order to evaluate the efficacy of different therapeutic approaches in terms of disease-free survival and overall survival. At the 2010 ASCO meeting, the first positive results of a phase iii clinical trial in this setting were presented: bevacizumab (15 mg/kg i.v. every 21 days) added to first-line chemotherapy and continued for an additional 15 cycles was found to prolong progression-free survival of 3.8 months in comparison to 6 cycles of chemotherapy alone or only 6 cycles of chemotherapy plus bevacizumab. In addition, positive results were announced for a second phase iii trial testing bevacizumab in the same setting, but at half dose. The final assessment of the overall clinical benefit and the approval of bevacizumab in maintenance therapy by regulatory agencies is expected to be positive, as are the final results of abagovomab phase III trial MIMOSA, another antibody-based therapy tested as a maintenance treatment for advanced ovarian cancer patients. Encouraging preliminary results confirming the safety profile and the immunogenic activity of abagovomab were presented at the last ASCO meeting. The final results are expected to be released in the first half of 2011.

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“…Although few studies have been performed to address the question of optimal treatment duration, the results of several reports have failed to establish a positive benefit of prolonged treatment on survival (8,12,21,30). In an early, prospective, randomized trial comparing 10 cycles of cyclophosphamide, doxorubicin, and cisplatin (CAP) versus 5 cycles of CAP, patients treated with 10 cycles of CAP experienced greater myelosuppression, nephrotoxicity, and neurotoxicity than those receiving 5 cycles of CAP.…”

Section: Rationale Against Treatment To Progressionmentioning

confidence: 99%

Recurrent Ovarian Cancer

Herzog

2004

Clinical Cancer Research

132

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Ovarian cancer is increasingly recognized as a chronic disease whose treatment is often characterized by administration of multiple, sequential active agents, each of which may or may not be accompanied by a tumor response. Despite the large proportion of patients who relapse and undergo longer-term treatment, the question of optimal treatment duration has not been fully addressed to date. For patients who progress on therapy, the answer is straightforward: they are switched to another active agent, presumably having a different mechanism of action from previous therapies with, ideally, limited overlapping toxicities. However, for patients who remain in partial response or who have stable disease, the answer is less apparent and less clear. The majority of oncologists believe that treatment beyond 6 cycles of a given therapy does not provide any additional benefit to patients. There are some data to support that treatment strategy. However, with the advent of new, less toxic agents, treatment to progression should be further explored. Agents that are potentially well suited for extended treatment intervals may include such properties as absence of cumulative toxicity, non-cross-resistance, positive benefit on quality of life, and convenient schedule. A number of active agents in ovarian cancer (platinum, paclitaxel, topotecan, liposomal doxorubicin, docetaxel, gemcitabine, and etoposide) will be reviewed in the context of what is known about cumulative toxicity, potential adverse effects on patients' quality of life, and evidence addressing the potential benefits of longer-term treatment.

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A Prospective Randomized Comparison of 6 and 12 Cycles of Cyclophosphamide, Adriamycin, and Cisplatin in Advanced Epithelial Ovarian Cancer: A Danish Ovarian Study Group Trial (DACOVA)

Cited by 139 publications

References 0 publications

Treatment of ovarian cancer with surgery, short-course chemotherapy and whole abdominal radiation

Treatment of ovarian cancer with surgery, short-course chemotherapy and whole abdominal radiation

Maintenance therapy in ovarian cancer: Molecular basis and therapeutic approach

Recurrent Ovarian Cancer

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