Advanced epithelial ovarian cancer: 1998 consensus statements

Self Cite

262

215

CA125 is currently the most widely used tumor marker for ovarian epithelial cancer. The aim of this article is to provide guidelines for the routine clinical use of CA125 in patients with ovarian cancer. Due to lack of sensitivity for stage I disease and lack of specificity, CA125 is of little value in the detection of early ovarian cancer. At present, therefore, CA125, either alone or in combination with other modalities, cannot be recommended for screening for ovarian cancer in asymptomatic women outside the context of a randomized controlled trial. Preoperative levels in postmenopausal women, however, may aid the differentiation of benign and malignant pelvic masses. Serial levels during chemotherapy for ovarian cancer are useful for assessing response to treatment. Although serial monitoring following initial chemotherapy can lead to the early detection of recurrent disease, the clinical value of this lead-time is unclear. CA125 is the ovarian cancer marker against which new markers for this malignancy should be judged.

Section: Assessing Response To Therapymentioning

confidence: 99%

CA125 in ovarian cancer: European Group on Tumor Markers guidelines for clinical use

Duffy

Bonfrèr

Kulpa³

et al. 2005

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262

215

“…During the consensus meeting in 1998, it was agreed that patients with only a pleural effusion, a supraclavicular node, or a single cutaneous metastasis can be treated as stage III disease. Extensive primary debulking in patients with liver or lung metastases was regarded as most likely of no benefit (1) . This was confirmed by a retrospective study of Zang et al (33) .…”

Section: Figo Stage IV Diseasementioning

confidence: 99%

“…Primary cytoreductive (or debulking) surgery is an operation to remove as much of the tumor, and its metastases, as possible before subsequent therapy is instituted. This is in contrast to interval cytoreductive (or debulking) surgery, which is an operation performed in patients after a short course of induction chemotherapy, usually two, three, or four cycles of chemotherapy, to remove as much primary and metastatic disease as possible in order to facilitate response to subsequent chemotherapy and to improve survival (1) .…”

mentioning

confidence: 99%

Timing of debulking surgery in advanced ovarian cancer

Vergote

Gorp

Amant

et al. 2008

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It is clear that primary debulking remains the standard of care within the treatment of advanced ovarian cancer (FIGO stage III and IV). This debulking surgery should be performed by a gynecological oncologist without any residual tumor load, or so-called "optimal debulking." Over the last decades, interest in the use of neoadjuvant chemotherapy together with an interval debulking has increased. Neoadjuvant therapy can be used for patients who are primarily suboptimally debulked due to an extensive tumor load. In this situation, based on the randomized European Organization for Research and Treatment of Cancer-Gynaecological Cancer Group trial, interval debulking by an experienced surgeon improves survival in some patients who did not undergo optimal primary debulking surgery. Based on the GOG 152 data, interval debulking surgery does not seem to be indicated in patients who underwent primarily a maximal surgical effort by a gynecological oncologist. Neoadjuvant chemotherapy can also be used as an alternative to primary debulking. In retrospective analyses, neoadjuvant chemotherapy followed by interval debulking surgery does not seem to worsen prognosis compared to primary debulking surgery followed by chemotherapy. However, we will have to wait for the results of future randomized trials to know whether neoadjuvant chemotherapy followed by interval debulking surgery is a good alternative to primary debulking surgery in stage IIIc and IV patients. Open laparoscopy is probably the most valuable tool for evaluating the operability primarily or at the time of interval debulking surgery.

“…Therefore, the recommended treatment strategy for patients with advanced ovarian cancer is up-front radical cytoreductive surgery followed by combination chemotherapy with a taxoid and a platinum compound (25) . This recommendation is based on level I evidence of two large randomized trials, which established that a combination of paclitaxel plus cisplatin was superior to cyclophosphamide plus cisplatin (26,27) .…”

Section: Front-line Treatmentmentioning

confidence: 99%

Ovarian cancer treatment: what is new

Poveda

2003

Ovarian cancer is still the fourth cause of death by cancer among women and the most fatal among gynecological tumors. The purpose of this symposium is, year after year, to report and discuss the new developments in the treatment of patients with ovarian cancer, the majority of whom still present with advanced disease. It also tries to make it clear to the participants what is evidence-based and what is not. Mature data of both classic studies like GOG-111, OV-10, and more recent studies like GOG-158, AGO-OVAR-3, and the intergroup paclitaxel/epirubicin/carboplatin (TEC) versus paclitaxel/carboplatin (TC) study have been presented. Other current controversial issues included in this edition were sequential single-agent versus simultaneous administration of combination chemotherapy, the role of combination chemotherapy in second-line treatment, the role of consolidation therapy, the role of anthracyclines in the treatment, and cost-effectiviness studies in ovarian cancer. Although the main topic of the symposium is advanced disease, this edition included the results of two parallel randomized studies (ACTION and ICON1) on the treatment of early disease. In addition, new trends in early detection of ovarian cancer have been updated.The pace of new agent development has increased, and it would be helpful to have more efficient preclinical models and early phase-clinical trials to guide the selection of active agents for phase III evaluation. Reaching international consensus is a challenge but offers the opportunity to test multiple regimens more efficiently against a single-control population, rather than conducting multiple smaller studies with redundant internal controls. If indeed answers to the relevant questions are to be obtained more quickly, then, a network of current national or international groups could potentially facilitate this.