Small study of ovarian cancer: delayed second-line chemo merits further study.(Gynecology)

SAN DIEGO -- The adoption of maintenance chemotherapy immediately after a patient demonstrates a complete clinical response following surgery and first-line chemotherapy may not always make the most sense for patients with advanced ovarian cancer, results of a retrospective study suggest.

"Because most women with advanced stage ovarian cancer respond well to the first chemotherapy, but ultimately recur, many have suggested that we should consolidate on the initial gains of treatment by adding second-line chemotherapy just as soon as the first-line therapy ends. But before we embark on giving patients additional therapy like this we should prove that it's worth it," study investigator Dr. Scott McMeekin said in an interview at the meeting.

The strategy behind maintenance chemotherapy--instituting second-line chemotherapy immediately following a clinical response but before evidence of recurrence--has gained popularity with many oncologists, after last year's release of results from GOG 178, a large study by the Southwest Oncology Group and the Gynecologic Oncology Group (J. Clin. Oncol. 21[13]:2460-65, 2003).

The objective of the GOG 178 study was to compare two different durations of consolidation treatment. The results suggested that a longer course (12 vs. 3 cycles of paclitaxel) gave patients a longer median progression-free survival (28 vs. 21 months).

Many oncologists have adopted this strategy without even questioning the best timing for initiating second-line therapy, Dr. McMeekin of the Oklahoma University Health Science Center, Oklahoma City, said during the annual meeting of the Society of Gynecologic Oncologists.

"Obviously, after a big surgery and 6 months of initial chemotherapy, giving another year of consolidation chemotherapy immediately can have a negative impact on a patient's quality of life," he commented.

Dr. McMeekin noted that GOG 178 did not examine quality of life issues. Indeed, 23% of patients on the long duration treatment had peripheral neuropathy in that trial.