initial chemotherapy

Last reviewed 01/2018

Adjuvant systemic chemotherapy for stage I disease (1)

• do not offer adjuvant chemotherapy to women who have had optimal surgical staging13 and have low-risk stage I disease (grade 1 or 2, stage Ia or Ib)
• offer women with high-risk stage I disease (grade 3 or stage Ic) adjuvant chemotherapy consisting of six cycles of carboplatin.

Stage III and Stage IV:

• platinum based chemotherapy there appears to be no difference in overall or progression free survival from regimens based on carboplatin or cisplatin
  • carboplatin based regimens are associated with less gastrointestinal toxicity but more haematological adverse effects compared with cisplatin based regimens
• there is evidence that the addition of paclitaxel to platinum did not significantly improve outcomes compared with platinum based chemotherapy alone (2,3) This has led to the suggestion that consensus that taxane/platinum combination treatment should not be exclusively recommended as first line therapy (3)

Doxorubicin has anti-ovarian carcinoma activity. Systematic reviews of randomised trials have shown that cyclophosphamide, doxorubicin and cisplatin is more effective than cyclophosphamide and cisplatin alone (4).

NICE guidance states that (5):

• paclitaxel in combination with a platinum-based compound (carboplatin or cisplatin) is recommended as an option for the second-line (or subsequent) treatment of women with platinum-sensitive or partially platinum-sensitive advanced ovarian cancer, except in women who are allergic to platinum-based compounds
• single-agent paclitaxel is recommended as an option for the second-line (or subsequent) treatment of women with platinum-refractory or platinum-resistant advanced ovarian cancer, and for women who are allergic to platinum-based compounds
• doxorubicin and topetecan are also recommended as options for second-line treatment

Single agent therapy, typically melphalan, is commonly used for frail or elderly patients.

Reference:

1. NICE (March 2011). Ovarian cancer The recognition and initial management of ovarian cancer
2. BMJ (October 2006). Clinical Evidence - advanced ovarian cancer.
3. The International Collaborative Ovarian Neoplasm (ICON) Group (2002). Paclitaxel plus carboplatin versus standard chemotherapy with either single-agent carboplatin or cyclophosphamide, doxorubicin, and cisplatin in women with ovarian cancer: the ICON3 randomised trial. Lancet 2002; 360: 505-15
4. Tattersal, MHN (2002). Ovarian cancer chemotherapy: carboplatin as standard. BMJ, 360, 500-1.
5. NICE (May 2005). Paclitaxel, pegylated liposomal doxorubicin hydrochloride and topotecan for second-line or subsequent treatment of advanced ovarian cancer.