Quality of Life Becomes More Important

DALLAS—With "significant improvement" in both progression-free and 5-year survival of patients with ovarian cancer, "quality of life becomes important," stated Alan N. Gordon, MD, director of research in gynecologic oncology in the Division of Oncology at Texas Oncology in Dallas.

Addressing an industry-sponsored symposium held in conjunction with the Oncology Nursing Society annual meeting, Dr. Gordon noted that progress in the treatment of ovarian cancer in recent years has transformed a formerly "acute process to one of more chronic disease."

Palliation Becomes Goal

After relapse, palliation becomes the goal, with low toxicity highly desirable. At present, none of the widely used second-line therapies has yet been proven decisively superior to the others in survival, he reported.

Pegylated liposomal doxorubicin offers a combination of efficacy and lower toxicity because the drug’s structure permits it to concentrate in the tumor and spare normal tissues, he said. In platinum-sensitive patients it has also shown an "unexpected" increase in overall survival of 4 to 5 months as compared with topotecan (Hycamtin). The etiology of the "highly significant result" is not clear, he added.

Augmenting Primary Therapy

Integration of taxanes into front-line therapy was a "dominant research theme of the 1990s," and choosing the platinum compound and determining dosing and scheduling of the taxane were important issues, Dr. Gordon continued. Reviewing the results of four studies that explored the effects of augmenting primary therapy with paclitaxel (Taxol), he noted that results were "discordant."

Several issues remain unresolved in initial chemotherapy for ovarian cancer, Dr. Gordon said. These include:

• using neoadjuvant therapies;

• determining dosage, scheduling, and number of courses;

• the advisability of introducing a third agent;

• the utility of intraperitoneal therapy; and

• the role of antiangiogenic, antimetastatic, and other biological agents.

Issues also remain in chemotherapy for advanced disease, Dr. Gordon noted. Researchers continue to explore new approaches.