Results of a prospective dose-intensive regimen in 27 patients with small cell carcinoma of the ovary of the hypercalcemic type

Abstract

Background:The evaluation of first-line intensive combination therapy in small cell carcinoma of the ovary (SCCO). Patients and methods: Debulking surgery; four to six cycles of chemotherapy with cisplatin (P) 80 mg/m 2 day 1, adriamycin (A) 40 mg/m 2 day 1, vepeside (V) 75 mg/m 2 /day days 1-3, cyclophosphamide (EP) 300 mg/m 2 /day days 1-3, every 3 weeks and granulocyte colony-stimulating factor with, in case of a complete remission, high-dose chemotherapy with carboplatin, vepeside, cyclophosphamide and stem-cell support.Results: Twenty-seven patients (median age 25 years); International Federation of Gynecology and Obstetrics stage:five I, four IIC, 17 IIIC-IV and one unknown. Twenty patients underwent complete surgery. Eight patients progressed under chemotherapy. Among 18 patients in complete response (CR), 10 received high-dose chemotherapy (CT) (three stem-cell collection failures, two protocol violations, two disease progression and one refusal). The main grade 3-4 toxic effects were hematologic. There were eight relapses among the 18 CR, four of which were pelvic alone. Among the 27 patients, 13 died and 10 patients are in CR1, three in CR2. The median follow-up is 37 months (8-166) and the median duration of the 18 CR is 30 months (5-111). Overall survival at 1 and 3 years is 58% [confidence interval (CI) 40% to 75%] and 49% (CI 30% to 67%).Conclusions: Initial dose-intensive therapy achieves interesting overall survival in SCCO.

Dose-dense and dose-intense chemotherapy for small cell ovarian cancer: 2 cases and review of literature

“…The second developed isolated brain metastases but remains in remission after cranial irradiation and further chemotherapy. Pautier et al have shown the 3-year survival to improve to 49% in their series of 27 patients with dose-intense chemotherapy [26]. The important aspect of our patients' treatment may be the weekly dose-dense and dose-intense scheduling rather than the individual drugs.…”

Small Cell Carcinoma of the Ovary: Report of Three Cases of a Poor Prognosis Disease

“…Nevertheless, the prognosis generally remains dramatically poor. Few large studies have been conducted [1,[5][6][7], the more significant one by Young [4]. Adjuvant regimens were derived from epithelial carcinoma therapies, consisting of cisplatinum, cyclophosphamide with or without doxorubicine and hexamethylmelamine; in all cases only short-term favourable responses have been obtained [5].…”

“…Another limited number of long-term survivors with advanced stages disease at diagnosis had received regimens consisting of 5 to 6 antineoplastic agents (combination of vinblastine, cisplatin, cyclophosphamide, bleomycin, adriamycin, etoposide) [8,9]. Other series, the most recent of which by Pautier in 2007, describe poli-chemotherapy as first line treatment in SCCO of the hypercalcemic type followed by high dose consolidation chemotherapy leading to an exceptionally better outcome [6,7]. In our experience, this therapeutic attempt was unsuccessful.…”

“…Many different therapeutical options have been considered in the treatment of SCCO, but nevertheless the outcome remains very poor and the mortality rate extremely high. A limited number of published studies are available, mainly represented by case reports [1,[4][5][6][7]. We report of three cases of SCCO with an extremely rapid progression and spreading of the disease, with ineffectiveness of the different treatment approaches utilized.…”

Case 2 – Ovarian small cell carcinoma: a case report and review of the literature

“…Optimal management of patients is not well defined; in literature several and different treatment strategies and chemotherapy are reported but in few cases due to the rareness of the disease, Harrison et al presented a review of the management of 17 cases in a Gynecological Cancer Intergroup (GCIG) study, with poor results showed [7]. In this context there are no evidence based recommendations nor guide lines (Table 2) [1,3,[8][9][10][11][12][13][14]. We present and discuss a case of SCCOHT in a young patient, as well a review of the literature about ovarian small cell tumors treatment.…”