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Progress in Gynecologic Oncology

1999; AlphaMed Press; Volume: 4; Issue: 4 Linguagem: Inglês

10.1634/theoncologist.4-4-293

1549-490X

Richard T. Penson, Michael V. Seiden,

Endometriosis Research and Treatment

The Oncologist 1999;4:293-298 Correspondence: Michael V. Seiden, M.D., Ph.D., Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. Telephone: 617-724-3123; Fax: 617-724-3166; e-mail: Seiden.Michael@MGH.Harvard.edu Accepted for publication July 6, 1999. ©AlphaMed Press 1083-7159/99/$5.00/0 INTRODUCTION The gynecologic oncology presentations at the 1999 ASCO meeting in Atlanta continue to focus on defining the optimal treatment strategies for women with advanced gynecologic malignancies. While there were no dramatic shifts in treatment paradigms at ASCO, a large number of well-controlled randomized trials addressed key areas and defined standard of care. Indeed, 10 of the 43 clinical trials presented were phase III trials that randomized a total of 5,664 patients. These studies add incrementally to both our knowledge base and improved outcomes. The most important data were from trials of patients with ovarian cancer. Two randomized studies provided evidence that optimal first-line chemotherapy is paclitaxel 175 mg/m2 over 3 h and carboplatin AUC 4 7.5. An increasing number of studies examined the incorporation of relatively new agents into first-line therapy. No studies addressed the potential role of intraperitoneal treatment. Lastly, although the role of high-dose chemotherapy in ovarian cancer is uncertain, for the most active agents the dose response curves in ovarian cancer and breast cancer are similar. High-dose chemotherapy in breast cancer was reviewed in ASCO’s plenary session. Four studies evaluating highdose therapy were presented and in general the results were not encouraging. A single study, presented by Dr. Bezwoda of South Africa demonstrated a disease-free and overall survival advantage for up-front tandem transplant, which raises the issue of whether immediate high-dose chemotherapy may overcome drug resistance and avoid the induction of resistance by moderate doses of the same agents [1]. While no specific randomized data were presented for ovarian cancer, it is notable that Gynecologic Oncology Group (GOG) 164, a study that investigates high-dose chemotherapy as consolidation for first-line treatment for ovarian cancer, has been closed because of poor accrual. Further information on the role of high-dose therapy in this disease awaits the completion of randomized trials ongoing in Europe.