Dose Finding Study for Combination Treatment with Topotecan and Gemcitabine of Patients with Recurrent Ovarian Cancer after Failure of First-Line Chemotherapy with Paclitaxel and Platinum

Ovarian carcinoma with simultaneous breast and rectum metastases

BACKGROUND

Metastatic involvement of the breast and the rectum from ovarian carcinoma are very rare events.

CASE REPORT

We report a case of ovarian carcinoma with metastasis to the breast and rectum simultaneously, 6 years after initial diagnosis.

RESULTS

Morphologic and immunohistochemical findings from pathologic samples of all involved sites confirmed the ovarian origin, which spared the patient unnecessary breast and rectal surgery. To our knowledge, this is the first case of ovarian carcinoma with simultaneous metastases to the breast and rectum reported to date.

CONCLUSION

Accurate differential diagnosis from primary breast and rectal carcinoma is very important because the prognosis and treatment differ significantly.

Optimal therapy for platinum-resistant recurrent ovarian cancer: doxorubicin, gemcitabine or topotecan?

Ovarian cancer is more fatal than all the other gynaecological malignancies combined. Although most patients respond to first-line combination chemotherapy, the vast majority (50-75%) of patients with advanced disease will relapse. The management of patients with recurrent ovarian cancer is based on their response profile to platinum: patients with platinum-sensitive disease can be rechallenged with platinum-based chemotherapy, whereas the management of patients with platinum-resistant or -refractory disease remains an area of active investigation. In this review, the data for second-line therapy in this latter group of patients will be summarised and recommendations for their optimal management will be made.

Treatment of recurrent disease: randomized trials of monotherapy versus combination chemotherapy

Recurrent ovarian carcinoma is normally an incurable disease situation in which chemotherapy is the usual treatment for palliation. The probability of response to chemotherapy depends on the time from last chemotherapy and the previous response observed. The issue of combination chemotherapy versus monotherapy is a clinically relevant dilemma for medical and gynecologic oncologist involved in the treatment of recurrent patients. In those patients with platinum-resistant relapse, combination chemotherapy has been associated with higher toxicity without a clear clinical benefit in randomized clinical trials. Therefore, a less toxic sequential monotherapy approach should be the choice for resistant patients. On the other hand, two large randomized clinical trials have proved the superiority of a platinum-based doublet over platinum monotherapy in platinum-sensitive recurrent patients. The ICON-4/AGO-OVAR 2.2 trial demonstrated that the combination of paclitaxel-carboplatin (or cisplatin) is likely to provide a survival benefit compared with carboplatin monotherapy. This benefit was more clear in patients with a treatment free-interval >12 months. Moreover, the AGO-OVAR 2.5 trial, with the cooperation of NCIC CTG and EORTC GCG, has confirmed the advantage in response rate and progression free survival of the doublet carboplatin-gemcitabine compared to carboplatin.

Review of gemcitabine-based combinations for platinum-resistant ovarian cancer

Gemcitabine, an analog of deoxycytidine, is an anticancer nucleoside with proven activity in different solid malignancies. The efficacy of gemcitabine as a single agent or as part of a combination treatment has been evaluated in several trials, and antitumor activity has been observed in patients with sensitivity and resistance to both platinum and paclitaxel. In this context, preclinical studies have shown that gemcitabine-based combinations increase the cytotoxic action of the treatment and can potentially overcome drug resistance. The toxicity profile of gemcitabine, and its proven action in relapsed ovarian cancer, allows for the development of a hypothesis stating that a specific choice of drugs with different mechanisms and non-cross-resistance can increase the chance of response and prolong its duration and that of other outcome measures. This article provides an update of new clinical approaches with gemcitabine in combination with other nonplatinum drugs for the management of patients with platinum-resistant ovarian cancer.