There are several chemotherapy strategies for the treatment of ovarian cancer at virtually every stage of the disease as well as for recurrence.
Ovarian cancers are staged across four stages; within each stage (except Stage IV) there are three levels of increasing severity labeled A, B and C. More importantly with regard to chemotherapy regimens for ovarian cancers, they are divided into early-stage disease (stage IA through Stage IIB) and advanced-stage disease (Stage IIC and above).
Early-Stage Disease (Stages IA, IB, IC, IIA, IIB)
Most ovarian cancer patients diagnosed as stage IA or IB do not need chemotherapy; rather, surgery has proven to be extremely successful in this patient population, offering a 95% 10 year survival rate.
When chemotherapy is used in early stage ovarian cancer, first-line regimens include the following:
- Cisplatin + cyclophosphamide (3 cycles)
- Paclitaxel + carboplatin (3-6 cycles)
- Cisplatin (single agent)
Advanced-Stage Disease (Stages IIC, IIIA, IIIB, IIIC, IV)
There is no single first-line standard of care for treating advanced stage ovarian cancer; the decision is made through consultation and according to a number of mitigating factors. However, the following combination regimens are often used:
- Paclitaxel + cisplatin (6 cycles)
- Paclitaxel + carboplatin (6 cycles)
Research has indicated that these regimens are equally effective, but that carboplatin + paclitaxel is far less toxic. This is important because continued exposure to platinum-based chemotherapy can eventually produce an allergic reaction.
- Docetaxel + carboplatin (6 cycles)
- Dose-dense paclitaxel + carboplatin (6 cycles)
- Paclitaxel + carboplatin + gemcitabine
- Paclitaxel + carboplatin + topotecan
- Paclitaxel + cisplatin + cyclophosphamide (generally for poor-prognosis disease, although this is regarded as the most effective three-drug regimen for this cancer)
Recurrent Disease
Finally, there are several chemotherapy regimens for recurrent ovarian cancer, all with varying degrees of efficacy:
- Platinum retreatment with either cisplatin or carboplatin
- Fluorouracil + leucovorin
- Single-agent gemcitabine
- Oral altretamine (hexamethylmelamine)
- Doxorubicin HCI liposome injection
- Vinorelbine
- Paclitaxel 24 hour weekly infusion (3 cycles)
- Topotecan HCI
- Oral etopiside
- Taxomifen
Side Effects
Common side effects experienced by ovarian cancer patients undergoing chemotherapy include myelosuppression, nausea/vomiting, kidney problems, neurotoxicity, fatigue, clinical depression, and sexual dysfunction.
References
- Boyiadzis, Michael M. et al. Hematology-Oncology Therapy. 2007. New York: McGraw Hill, Medical Publishing Division.
- Edge Stephen B et al. AJCC: Cancer Staging Handbook, 7th edition. 2010. New York: Spring.
- National Comprehensive Cancer Network: Clinical Practice Guidelines in Oncology- V.2.2010. Ovarian cancer.
