GYNECOLOGIC CANCER: TOPICS FOR MEDICAL TREATMENT OF OVARIAN CANCER 2012

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Abstract

Ovarian cancer is the most lethal gynecologic malignancy. The standard treatment is surgery plus chemotherapy. The standard chemotherapy regimen is carboplatin plus paclitaxel (TC). Although TC is very effective in the first-line setting, many patients recur and become resistant to the chemotherapy. Topics of medical treatment of ovarian cancer include (i) optimization of chemotherapy and (ii) bringing new agents into armamentarium. (1) Optimization of chemotherapy: (i) dose dense TC: weekly paclitaxel is superior to tri-weekly paclitaxel for patients with breast cancer in both adjuvant and metastatic setting (CALGB, ECOG1199). JGOG 3016 trial (NOVEL trial) showed significant improvement of PFS and OS. Confirmatory trials (MITO 8 and GOG 232) are ongoing. (ii) Irinotecan + cisplatin for clear cell carcinoma: clear cell carcinoma (CCC) is a distinct subtype of ovarian cancer, known as resistant for TC. Irinotecan is comparatively effective for CCC. Irinotecan plus cisplatin was very promising for CCC in phase 2 trials, then JGOG 3017 trial has began. Patient accrual has already finished, now we are waiting for the results. If this trial is positive, same approach (histology based regimen, such as XELOX or FOLFOX for mucinous carcinoma) would be pursued more. (2) Bringing new agents into armamentarium: (i) Bevacizumab: angiogenesis is a key biologic component for progression of ovarian cancer. Efficacy of bevacizumab monotherapy for ovarian cancer (response rate is A % in phase 2 trials) is highest among the solid tumors. ICON7 and GOG 218 trial proved its efficacy in the first-line setting. Moreover, OCEANS trial showed even better efficacy in the second-line setting. (ii) PARP inhibitors: very promising results in phase 1 and 2 trials had accelerated the developments of this class of agents. Unfortunately, ambitiously designed phase 3 trial of iniparib (this agent is no longer regarded as PARP inhibitor) for triple-negative breast cancer could not meet primary end point, although the P-value was numerically <0.05. Another bad news was the halt of development of olaparib for ovarian cancer, although randomized phase 2 trial for patients with platinum-sensitive relapse met the primary end point.

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