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Is Single-Agent Chemotherapy Acceptable in Platinum-Sensitive Relapsed Ovarian Cancer?

Rony M. Abou-Jawde, Satinderjit S. Oberoi

Hematology/Medical Oncology, Saint Joseph Oncology, St Joseph, MO

To the Editor:

We read with great interest the article by Ferrandina et al,¹ entitled "Phase III Trial of Gemcitabine Compared With Pegylated Liposomal Doxorubicin in Progressive or Recurrent Ovarian Cancer," which showed comparable results between single-agent gemcitabine and pegylated liposomal doxorubicin (PLD), and recommended gemcitabine to be considered in the spectrum of drugs used in the salvage of ovarian cancer patients who experience recurrence within 12 months after their primary therapy.

However, several important issues were not addressed: two different patient groups (platinum sensitive and platinum resistant), and the decision to use single-agent chemotherapy for the entire cohort. In our opinion, this would put to question the generalized conclusion of the article.

The authors decided to include two patient categories, approximately 56% with relapse lasting 6 months or less and 43% with relapse lasting between 7 and 12 months, together with regard to treatment at relapse. The first group of patients (relapse 6 months), traditionally known as platinum resistant, are less likely to respond, and have a worse outcome than the platinum-sensitive group (relapse > 6 months).^2-4

In contrast, the standard treatment for platinum-sensitive disease usually includes combination chemotherapy, on the basis of survival advantage seen in a phase III trial using paclitaxel plus platinum combination⁵ and progression-free survival advantage using a platinum/gemcitabine combination⁶ and a recent large meta-analysis⁷ showing superiority of combination chemotherapy versus monotherapy with regard to response rate, disease progression, and mortality. Put together, that means approximately 43% of patients in the current trial were suboptimally treated, and single-agent gemcitabine or PLD should not be recommended for this group.

As such, the conclusion of the trial should be interpreted carefully. It was important, at least, to see that in a randomized phase III trial, a more acceptable dose of PLD could be used without adversely influencing the outcomes and reducing adverse effects. Also it validated the activity of single-agent gemcitabine in selected patients with relapsed ovarian cancer.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

NOTES

published online ahead of print at www.jco.org on April 28, 2008

REFERENCES

1. Ferrandina G, Ludovisi M, Lorusso D, et al: Phase III trial of gemcitabine compared with pegylated liposomal doxorubicin in progressive or recurrent ovarian cancer. J Clin Oncol 26:890-896, 2008[Abstract/Free Full Text]

2. Thigpen JT, Vance RB, Khansur T: Second-line chemotherapy for recurrent carcinoma of the ovary. Cancer 71:1559-1564, 1993[Medline]

3. Markman M, Markman J, Webster K, et al: Duration of response to second-line, platinum-based chemotherapy for ovarian cancer: Implications for patient management and clinical trial design. J Clin Oncol 22:3120-3125, 2004[Abstract/Free Full Text]

4. Markman M, Rothman R, Hakes T, et al: Second-line platinum therapy in patients with ovarian cancer previously treated with cisplatin. J Clin Oncol 9:389-393, 1991[Abstract]

5. Parmar MK, Ledermann JA, Colombo N, et al: Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: The ICON4/AGO-OVAR-2.2 trial. Lancet 361:2099-2106, 2003[CrossRef][Medline]

6. Pfisterer J, Plante M, Vergote I, et al: Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: An intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG. J Clin Oncol 24:4699-4707, 2006[Abstract/Free Full Text]

7. Orlando M, Costanzo MV, Chacon RD, et al: Randomized trials of combination chemotherapy (combo) versus monotherapy (mono) in relapsed ovarian carcinoma (ROC): A meta-analysis of published data. J Clin Oncol 25:280s, 2007 (suppl; abstr 5524)

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Abou-Jawde, R. M. Articles by Oberoi, S. S. Search for Related Content PubMed Articles by Abou-Jawde, R. M. Articles by Oberoi, S. S. Social Bookmarking                            What's this?