Long-term survival with consolidation intraperitoneal chemotherapy for patients with advanced ovarian cancer with pathological complete remission

Tournigand, Christophe; Louvet, Christophe; Molitor, JL; Fritel, Xavier; Dehni, Nidal; Sezeur, A.; Pigné, A; Cady, J; Milliez, Jacques; Gramont, Aimery de

doi:10.1016/s0090-8258(03)00474-8

Cited by 33 publications

(13 citation statements)

References 20 publications

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“…The standard concept of six cycles of a platinum/ taxane combination as adjuvant chemotherapy for ovarian cancer has recently been challenged (18,19). Omission of chemotherapy for adequately staged early-stage disease (20), a neoadjuvant chemotherapy approach for patients expected not to be optimally debulked at primary cytoreductive surgery (21), and consolidation chemotherapy for patients at high risk for recurrent disease have been advocated (22). Additional prognostic variables to more individually tailor adjuvant therapy would be of considerable clinical value.…”

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confidence: 99%

Serum C-Reactive Protein as Independent Prognostic Variable in Patients with Ovarian Cancer

Hefler

Concin²,

Hofstetter³

et al. 2008

Clinical Cancer Research

179

151

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Purpose: To evaluate serum C-reactive protein (CRP) as prognostic variable in patients with epithelial ovarian cancer (EOC). Experimental Design: In a multicenter study, preoperative serum CRP was evaluated in 623 patients with EOC. Results were correlated with clinical data. Results: Mean (SD) preoperative serum CRP was 3.6 (4.8) mg/dL. Serum CRP was significantly associated with International Federation of Gynecologists and Obstetricians stage (P < 0.001) and postoperative residual tumor mass (P < 0.001) but not with histologic grade (P = 0.1) and type (P = 0.7), patients'age (Pearson's correlation coefficient = 0.05; P = 0.2), and serum CA125 (Pearson's correlation coefficient = 0.02; P = 0.6). Patients with platinum-resistant EOC had significantly higher CRP serum levels compared with patients with platinum-sensitive EOC [6.0 (6.6) mg/dL versus 2.8 (3.8) mg/dL; P < 0.001]. Higher International Federation of Gynecologists and Obstetricians stage (P < 0.001), presence of postoperative residual tumor mass (P < 0.001), tumor grade (P = 0.001), serum CA 125 (P = 0.03), and serum CRP (P = 0.001) were independently associated with overall survival. Patients with serum CRP V1 mg/dL versus >1mg/dL had an overall 5-year survival of 82% versus 58.5% (P < 0.001).Conclusion: Serum CRP can be seen as a novel, widely available independent prognostic variable of ovarian cancer.

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mentioning

confidence: 99%

Serum C-Reactive Protein as Independent Prognostic Variable in Patients with Ovarian Cancer

Hefler

Concin²,

Hofstetter³

et al. 2008

Clinical Cancer Research

179

151

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“…Studies investigating the use of IP chemotherapy in patients with stage III and IV EOC after second-look assessment have noted prolonged survival in select patients with minimal residual disease at the time of second-look assessment. [6][7][8] Recent large, randomized, controlled phase 3 trials of up-front IP chemotherapy for optimally debulked stage III EOC have shown an improvement in overall survival and progression-free survival compared with intravenous chemotherapy. [10][11][12] Up-front IP therapy in optimally debulked patients with stage IV EOC is controversial, however, because its anticipated added benefit derived from enhanced drug exposure is thought not applicable to extraperitoneal sites.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for patients with stage IV epithelial ovarian cancer receiving intraperitoneal chemotherapy after second‐look assessment

Zivanovic

Barakat

Sabbatini

et al. 2008

Cancer

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BACKGROUND.The aim was to determine the long‐term outcome for patients with FIGO stage IV epithelial ovarian carcinoma (EOC) treated with intraperitoneal (IP) chemotherapy after second‐look assessment.METHODS.By using data from a retrospective cohort of 433 patients who received IP therapy after second‐look assessment after primary surgery and initial systemic therapy for EOC between 1984 and 1998 at our institution, all FIGO stage IIIC and IV patients were identified. Standard statistical methods were used.RESULTS.Overall, 297 patients met study criteria (246 stage IIIC; 51 stage IV). The median survival for patients with stage IV disease was 34 months compared with 42 months for patients with stage IIIC disease (P = .02). The only significant predictor of overall survival in patients with stage IV disease was the presence of gross residual disease at initiation of IP therapy (P = .027). When comparing stage IV patients with and without pleural effusions to all stage IIIC patients, there was a significant trend toward improved survival in the patients with pleural effusions only compared with other stage IV patients (P = .01).CONCLUSIONS.Prolonged overall survival was observed in patients with no gross residual disease at the time of IP chemotherapy initiation. When compared with similarly treated stage IIIC patients, stage IV patients with malignant pleural effusions appear to have a better outcome than those with other sites of metastasis. Future prospective trials should evaluate the use of IP therapy for patients with stage IV EOC by virtue of malignant pleural effusions only who responded to initial systemic therapy. Cancer 2008. ©2008 American Cancer Society.

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“…A relationship between tumor size at the initiation of intraperitoneal therapy and long-term survival was observed. A similar study was conducted by Tournigand et al [30] to investigate the impact of intraperitoneal therapy (mitoxantrone, cisplatin and etoposide) on survival administered by a totally implantable port in 68 EOC patients who had negative second-look laparotomy following induction chemotherapy. The median PFS for the whole population was 34 months, 34% of the patients being estimated to be free of disease at 5 years.…”

Section: Maintenance Therapymentioning

confidence: 96%

Maintenance or Consolidation Therapy in Advanced Ovarian Cancer

Pectasides

Pectasides²

2006

Oncology

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Most patients with advanced epithelial ovarian cancer (EOC) achieve a clinical complete response (CR) or have no clinical evidence of disease after aggressive cytoreductive surgery and 6 cycles of platinum-/taxane-based chemotherapy. From the reported randomized trials using different durations or different cycles of chemotherapy, none of these showed improvement in survival beyond 6 cycles. Data from the literature do not support a relationship between the number of cycles and response or between the cumulative dose and response. In addition, no benefit in survival was detected with high-dose and intensity chemotherapy administered for a short time compared with standard-dose chemotherapy given for a longer time. However, statistically significant differences in progression-free survival were found in patients who achieved a clinically defined CR to a platinum (CDDP)-/paclitaxel-based chemotherapy and who continued single-agent paclitaxel for an extended time period. Notably, this randomized trial most likely did not offer any survival advantage, as it was closed prematurely by the Data Safety Monitoring Committee in accordance with the guidelines planned for interim analysis of primary end-points.

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Long-term survival with consolidation intraperitoneal chemotherapy for patients with advanced ovarian cancer with pathological complete remission

Cited by 33 publications

References 20 publications

Serum C-Reactive Protein as Independent Prognostic Variable in Patients with Ovarian Cancer

Serum C-Reactive Protein as Independent Prognostic Variable in Patients with Ovarian Cancer

Prognostic factors for patients with stage IV epithelial ovarian cancer receiving intraperitoneal chemotherapy after second‐look assessment

Maintenance or Consolidation Therapy in Advanced Ovarian Cancer

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