Adjuvant chemo for ovarian cancer – pro

Following surgery, many women with ovarian cancer are given adjuvant chemotherapy, normally using a platinum compound. In women with no residual disease, the recent randomized controlled trial (RCT) ICON1, indicated that platinum-based chemotherapy does improve survival. Another RCT investigating the effectiveness of adjuvant chemotherapy (ACTION) found no difference in overall survival but that disease-free survival was improved in women in the treatment arm. A meta-analysis of five trials of adjuvant chemotherapy compared with no further treatment in early ovarian cancer (including the two mentioned above) showed an improvement in both overall survival and disease-free survival (hazards ratios of 0.71,95% CIs 0.63 to 0.80; and 0.68, 95%CIs 0.59 to 0.79, respectively). A pre-planned combined analysis of the ICON1 and ACTION trials also came to the same conclusion. However, the largest study, ICON3, suggested that there was no difference in outcome with combination therapy. Debate continues with regard to these findings, and NICE recommendations are that women requiring chemotherapy should have a platinum agent administered, and the possible addition of paclitaxel should be discussed on an individual basis. In the USA, however, it is standard of care. The National Institutes of Health (NIH) guideline recommends carboplatin chemotherapy for patients with early stage disease and additional risk factors, to reduce the risk of disease recurrence and ensuing risk of death and it has not been changed.

Gynecology Cancer Disease Site Group. Elit L, Fyles A, Chambers A, Fung Kee Fung M, Covens A, Carey M. Adjuvant care for stage I ovarian cancer [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2004 May 3. 33 p. (Practice guideline report; no. 4-13). [62 references]

Scottish Intercollegiate Guidelines Network (SIGN). Epithelial ovarian cancer. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2003 Oct. 36 p. (SIGN publication; no. 75). [182 references], ovarian 2012

Winter-Roach BA, Kitchener HC, Lawrie TA. Adjuvant (post-surgery) chemotherapy for early stage epithelial ovarian cancer. Cochrane Database Syst Rev 2012; 3:CD004706.

Mannel RS, Brady MF, Kohn EC, et al. A randomized phase III trial of IV carboplatin and paclitaxel × 3 courses followed by observation versus weekly maintenance low-dose paclitaxel in patients with early-stage ovarian carcinoma: a Gynecologic Oncology Group Study. Gynecol Oncol 2011; 122:89.

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