Several general conclusions are beginning to emerge from the series of prospective trials in the treatment of
ovarian cancer.
Combination chemotherapy continues to demonstrate higher overall response rates and higher complete remission rates than single
alkylating agents, although in some studies survival is not significantly different. Nevertheless, long-term disease-free survivals, although uncommon, are more frequent with combinations, particularly when the dose intensity of the combination is adequate. Although CAP is the most commonly used combination, evidence continues to suggest that
cyclophosphamide/
cisplatin alone may be equivalent. Several studies have incorporated
alkylating agent maintenance into their clinical trials and each reports acute leukemic complications. In light of the absence of a major contribution for this approach,
alkylating agent maintenance in
ovarian cancer should not be encouraged. Several studies this year emphasize the discouraging results associated with the use of total abdominal
radiation therapy post-
induction chemotherapy even with patients with minimal or no residual disease. In light of the publications this year and of previously published studies, this approach, although based on sound rationale, appears to be of limited benefit. Salvage
chemotherapy, in general, has been unsatisfactory. The 2 interesting reports this year were the activity of low-dose
mitomycin C and the potential utility of
VP-16/
cisplatin combinations in a salvage setting. In cervix
carcinoma, trials have documented significant activity for the new drugs,
carboplatin (28% response) and
ifosfamide (30%), but each has significant side effects. Whether these will prove more active than
cisplatin or whether they may be used in combination is unresolved. The continued investigation into the use of
radiation sensitizers in cervical
carcinoma is of interest and several studies using weekly low-dose
cisplatin have established the feasibility of this approach, although long-term survival benefits have not yet been documented. In
endometrial carcinoma, epidemiologic studies continue to define the role of postmenopausal
estrogens in
endometrial carcinoma risk. This year a Swedish study documents a smaller overall risk from
estrogen treatment, perhaps related to a substantially lower use of
conjugated estrogens in that country.
Combination chemotherapy continues to show some activity, although the contribution of combinations in excess of the single agent activity of
doxorubicin is still poorly documented. One study does demonstrate significant activity for the commonly used CAP regimen with an overall response rate of 56% and 28% complete remissions.(ABSTRACT TRUNCATED AT 400 WORDS)