Protocol Development for Ovarian Cancer Treatment in Kenya: A Brief Report

Abstract

Introduction:Ovarian cancer is a leading cause of cancer death for Kenyan women. Most women are diagnosed with an advanced stage of disease. The current North American standard of care includes surgery followed by carboplatin and paclitaxel. Neither drug is available for Kenyan women. We performed a literature search investigating chemotherapy in low-resource countries with the aim to write an evidence-based chemotherapy protocol for women diagnosed with ovarian cancer in Eldoret, Kenya, at the Moi Teaching and Referral Hospital.Methods:We systematically searched PubMed and EMBASE for articles describing chemotherapy treatment outcomes of ovarian epithelial cancer in low-resource settings. After data analysis, a secondary review was undertaken on randomized controlled trials (RCTs) aligning with chemotherapy availability in Kenya.Results:We identified 1184 articles. Fourteen met our criteria: ovarian epithelial cancer, low resource, chemotherapy use, and survival or response data. No publications were RCTs or had a cohort larger than 100 patients. There was no consistency in drug choice between studies. After this search, we reviewed commonly quoted and relevant RCTs and meta-analyses conducted on ovarian cancer since the 1980s. Although RCTs in the developed world suggest carboplatin and taxol provide optimal survival benefit, these drugs are unavailable in Kenya. Cyclophosphamide and cisplatin provide the next most optimal survival benefit, with acceptable and manageable toxicity. Because these drugs are more available and affordable in Kenya, we have developed a protocol recommending their use, which has been accepted by the Moi Teaching and Referral Hospital.Conclusions:Currently, there is a paucity of published RCTs that may guide treatment in low-resource settings. One considerable barrier to establishing and evaluating chemotherapy protocols in low-resource settings may be the cost of chemotherapy drugs. There needs to be an international movement to make cancer chemotherapeutics available at lower prices in low-resource settings.

Development of a comprehensive and sustainable gynecologic oncology training program in western Kenya, a low resource setting

“…We could not develop an ovarian cancer protocol that would necessitate the use of paclitaxel and carboplatin. We used the literature primarily from GOG studies to justify using cisplatin and cyclophosphamide for ovarian cancer and we published a paper on their use in low resource settings (Sterling et al, 2011). …”

Comparing Anti-VEGF Antibodies and Aptamers on Paper Microfluidic-Based Platforms

“…However, the effort put forward toward the detection of cancer in the developing world is minimal. Yet, numbers of cancer patients have begun to skyrocket in recent years and there is a need to help detect this disease with lower cost platforms [11,34].…”

“…The higher number implies that the tumor has grown larger, or the cancer has spread from the area in which it first appeared to other organs. With that said, the main three types of treatment out there currently are radiation, chemotherapy, and surgery [12,27,34,37]. These therapies are often combined for one patient as well.…”

“…This spans from taking a biopsy of a tumor, to blood tests, bone marrow biopsies, chest x-rays, complete blood counts, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans [12,27,34,37]. These diagnostic tools are used depending on the location and type of cancer that is suspected.…”

“…However, much recognition has been gained, forming a large-scale effort to diagnose and treat these diseases abroad. There is now a growing burden for non-communicable diseases, such as cancer, in low-income countries [11,12,34,37]. Yet, health systems in the developing world are designed to cope with infectious disease and do not have the resources to deal with chronic care [12].…”