SPECIAL DEPARTMENTS
Authors: M. Steven Piver, Franco M. Muggia, Mark F. Brady, Ronald Alvarez
Journal: Journal of Clinical Oncology (2000)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2000.18.8.1803 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 10764445 M. Steven PiverxM. Steven PiverSearch for articles by this author Franco M. MuggiaxFranco M. MuggiaSearch for articles by this author , Mark F. BradyxMark F. BradySearch for articles by this author , Ronald AlvarezxRonald AlvarezSearch for articles by this author Show More Sisters of Charity Hospital Gilda Radner Familial Ovarian Cancer Registry Roswell Park Cancer Institute BuffaloNYNew York University\NKaplan Comprehensive Cancer Center New YorkNYGynecologic Oncology Group BuffaloNYUniversity of Alabama BirminghamAL https://doi.org/10.1200/JCO.2000.18.8.1803 First Page Full Text PDF Figures and Tables © 2000 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse01042000In Reply:With 25,000 women in the United States diagnosed with ovarian cancer per year, there is urgency to answer questions on the treatment of this disease. When Gynecologic Oncology Group Protocol 132 was initiated,1 there was considerable hope that single-agent paclitaxel would prove as effective as cisplatin and that it would prove to be more suitable than the platinum compound for maintenance treatment. However, as this and additional trials reviewed in our Discussion have shown, the role of paclitaxel in the treatment of ovarian cancer may be more complex than initially conceived. For example, its effects on overall survival are disproportionate to its effect on progression-free survival. Moreover, agents such as topotecan, doxorubicin liposome injection, and gemcitabine now capture attention for their possible contributions in modifying the unsatisfactory outcome. In fact, the Gynecologic Oncology Group together with international collaborators, is planning to mount a five-arm study to explore additional therapy to the current standard platinum-paclitaxel treatment. Concepts such as sequential doublets combining these promising agents with carboplatin, before administering paclitaxel plus carboplatin, or triplets that include an agent such as gemcitabine without attenuating the combination of paclitaxel plus carboplatin will be tested in such a large study.Important therapeutic questions in ovarian cancer include the following: (1) are there more effective upfront therapies (this is being addressed by the above projected trial)? and (2) are there effective consolidation (or maintenance) strategies, including established or novel therapies directed by molecular markers, secondary cytoreductive surgery, and intraperitoneal chemotherapy? Although platinum-based therapies provide dramatic and sometimes durable clinical responses, relapses in the majority of patients have led to disappointment. Most large-scale clinical trials using such regimens have included six to eight courses of therapy as the standard regimen. There is, however, no supporting evidence from randomized trials that a longer duration of therapy is beneficial.2 Nevertheless, a recent workshop of clinical trialists concurred that the question of duration of front-line therapy deserves more attention.3 Therefore, although we agree that consolidation trials are important, we believe other options may be preferable to extending paclitaxel/carboplatin therapy. Piver himself cites one reason why this option may not be as attractive as others (ie, secondary leukemia). The challenge is to identify well-tolerated consolidation therapies (chemotherapy or others) that prolong remission and improve overall survival. The most convincing evidence supporting the benefits of a consolidation strategy will come from randomized controlled clinical trials.9. Muggia FM, Braly PS, Brady MF, et al: Phase III randomized study of cisplatin versus paclitaxel versus cisplatin and paclitaxel in patients with suboptimal stage III or IV ovarian cancer: A Gynecology Oncology Group study. J Clin Oncol 18::106,2000-115, Link, Google Scholar9. Bertelsen K, Grenman S, Rustin GJS: How long should first-line chemotherapy continue? Ann Oncol 10::17,1999-20, (suppl 1) Medline, Google Scholar9. Berek JS, Bertelsen K, du Bois A, et al: Advanced epithelial ovarian cancer: 1998 consensus statements. Ann Oncol 10::S87,1999–S92, (suppl 1) Crossref, Medline, Google Scholar