Randomised trials in ovarian cancer: trial design considerations

A retrospective review of gemcitabine use in advanced epithelial ovarian cancer

Background. In North America, epithelial ovarian cancer (EOC) is the fifth most common cause of cancer death among women. Many drugs are used in the treatment of EOC, with gemcitabine showing recent promise. The objective of this study was to determine whether gemcitabine is a beneficial treatment option for patients with EOC.

Methods. The charts of 20 heavily pretreated women (median: four previous treatment protocols, range: 1-6) with a histological diagnosis of EOC were retrospectively reviewed to determine response. Eligible patients were treated with gemcitabine at a starting dose of 800 mg/m2 as an intravenous infusion on days 1, 8, and 15 of each 28-day cycle. The patients had a median age of 56 years (range 37-81).

Results. Response to treatment was assessed both clinically and serologically (CA-125 tumor marker was monitored). Of the 20 enrollees, 17 were evaluable clinically and 16 were evaluable serologically (2 were not evaluable by either technique).

There were two (12%) patients with a clinical partial response, six (35%) patients with clinical stable disease, nine (53%) patients with clinical progressive disease, and three patients that were not evaluable clinically. There were four (25%) patients with sero-logical partial response, six (38%) patients with stable serological disease, six (38%) patients with serological progressive disease, and four patients that were not evaluable serologically. Physician-reported toxicity included fatigue; however, this information was recorded inconsistently.

Conclusion. Gemcitabine showed modest activity in heavily pretreated EOC with a 12% clinical partial response rate and a 25% serological partial response rate. No serious toxicities were encountered.

Intergroup collaboration in ovarian cancer: the Gynecologic Cancer Intergroup (GCIG)

Randomized clinical trials are considered the definitive source of evidence for guiding decisions in clinical practise. In patients with ovarian cancer many of the randomized trials from the 1970s and 1980s did not have the statistical power to detect realistic and clinically important differences. Therefore, evolution of so-called "optimal therapy" has been rather slow and some important questions have gone unanswered. In order to overcome this challenge, representatives of different Cooperative Groups started an Ovarian Cancer Trials Intergroup Network in the mid 1990s, as a vehicle to develop future trial collaboration and as a mechanism for communication about strategic directions of phase I/II trials within individual Groups. In 1997 this network became more formalized, going beyond ovarian cancer as a single focus, and the Gynecologic Cancer Intergroup (GCIG) was created. At present GCIG includes representatives of 12 Cooperative Groups and the NCI-US, and functions as a forum for development of global trial collaborations, which hopefully will answer important questions in a more timely fashion and make them more rapidly available for the oncologic community.

Photodetection with 5-Aminolevulinic acid-induced protoporphyrin IX in the rat abdominal cavity: drug-dose-dependent fluorescence kinetics

In 75% of cases, ovarian carcinoma has already metastasized in the abdominal cavity at the time of diagnosis. For determination of the necessity for a supplementary therapy, in addition to surgical resection, it is important to localize and stage microscopical intraperitoneal metastases of the tumor. Intraperitoneal photodetection of tumor metastases is based on preferential tumor distribution of a fluorescent tumor marker. The time-dependent differences in drug concentration between tumor and normal (T/N) tissues can be used to visualize small tumors. We performed fluorescence measurements on abdominal organs and tumor in the peritoneal cavity of rats. 5-Aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) was used as the fluorescent marker. Three different drug doses (100, 25 and 5 mg/kg) were used and PpIX fluorescence profiles were followed up to 24 h after intravenous administration. Maximum T/N ratios were found 2-3 h after administration of ALA with all drug doses. A significant T/N tissue contrast was obtained for all abdominal organs tested after administration of 5 mg/kg.