Optimal Chemotherapy of Ovarian Cancer with an Old Regimen

Abstract

When the optimal chemotherapy regimen for advanced ovarian cancer is discussed the following should be considered: the type and number of drugs, the dose of individual drugs and the number of cycles. Optimal chemotherapy should include a platinum compound, because platinum-based chemotherapy yields a superior response rate, progression-free survival and probably also superior long-term survival. However, the choice of platinum compound could be discussed. Several studies have shown similar effect of cisplatinum and carboplatin regimens, but if there is any difference in respect to effect, it is in favour of cisplatinum. Whether or not single drug platinum chemotherapy has an effect similar to that of combination chemotherapy is still under discussion, but most analyses favour combination chemotherapy. The combination should include at least an alkylating agent. Antracyclines are effective in advanced ovarian cancer and a meta-analysis including almost 1200 patients has shown superiority of regimens including antracyclines. However, the difference is not significant in individual randomized trials. Several randomized studies have examined the effect of the dose of chemotherapy, both cumulative dose and dose intensity. There is no convincing data to show that a higher dose will give better results. The number of cycles of chemotherapy is also discussed. Most studies employ five to ten cycles, but there are no well designed studies elucidating this question. It is generally agreed that at least six cycles should be given and that no concrete evidence is present about the benefit of additional treatment. In conclusion, a standard regimen for advanced ovarian cancer should include a platinum compound, cisplatinum or carboplatin and an alkylating agent. The dose should be cisplatinum 50–75 mg/m², cyclophosphamide 500–1000 mg/m² in six courses.

Key Words:

• chemotherapy
• ovarian cancer
• platinum
• alkylating agent