Treatment of recurrent disease: randomized trials of monotherapy versus combination chemotherapy

Abstract

Recurrent ovarian carcinoma is normally an incurable disease situation in which chemotherapy is the usual treatment for palliation. The probability of response to chemotherapy depends on the time from last chemotherapy and the previous response observed. The issue of combination chemotherapy versus monotherapy is a clinically relevant dilemma for medical and gynecologic oncologist involved in the treatment of recurrent patients. In those patients with platinum-resistant relapse, combination chemotherapy has been associated with higher toxicity without a clear clinical benefit in randomized clinical trials. Therefore, a less toxic sequential monotherapy approach should be the choice for resistant patients. On the other hand, two large randomized clinical trials have proved the superiority of a platinum-based doublet over platinum monotherapy in platinum-sensitive recurrent patients. The ICON-4/AGO-OVAR 2.2 trial demonstrated that the combination of paclitaxel-carboplatin (or cisplatin) is likely to provide a survival benefit compared with carboplatin monotherapy. This benefit was more clear in patients with a treatment free-interval >12 months. Moreover, the AGO-OVAR 2.5 trial, with the cooperation of NCIC CTG and EORTC GCG, has confirmed the advantage in response rate and progression free survival of the doublet carboplatin-gemcitabine compared to carboplatin.

Adenosine A2A and Beta-2 Adrenergic Receptor Agonists: Novel Selective and Synergistic Multiple Myeloma Targets Discovered through Systematic Combination Screening

“…As a result, the diversity of combination therapies is limited as synergistic drug pairings have been relatively few. Although there is clear evidence that cancer combinations can work better than monotherapies (1)(2)(3), to date, combination activities have not been systematically explored.…”

GSTP1-1 in Ovarian Cyst Fluid and Disease Outcome of Patients With Ovarian Cancer

“…Platinumresistant disease includes patients who do not respond to platinum-based chemotherapy at all and those who relapse within 6 months following primary chemotherapy. These patients have a poor prognosis, with an expected median OS of <10 months (3). Early identification of platinumresistant disease will provide the opportunity to change usual regimens, which may improve the prognosis of this group of patients with EOC.…”

Medikamentöse Therapie des Ovarialkarzinomrezidivs

“…Mehr als 400 Patientinnen wurden in diese Studie eingeschlossen. Erste Auswertungen in Hinblick auf die Toxizität ergeben keinen signifikanten Unterschied in den drei Therapiearmen [11].…”

“…Zusätzlich sollen Gesamtüberleben, Toxizität und Lebensqualität verglichen werden. Die Kombination von 4-wöchentlich gegebenem Carboplatin AUC 5 und pegyliertem liposomalem Doxorubicin 30 mg/ m 2 stellte sich in einer Phase-II-Studie aus Frankreich bei insgesamt niedrigem Toxizitätsprofil als sehr effektiv heraus[11].…”