Therapie bei Progression und Rezidiv des Ovarialkarzinoms

Secondary surgery after failure of primary treatment is a promising and reasonable option only for patients with a relapse-free interval of at least 6-12 months who should have ideally achieved a tumor-free status after primary therapy. As after primary surgery, size of residual tumor is the most significant predictor of survival after secondary surgery. Even in the case of multiple tumor sites, complete removal of the tumor can be achieved in nearly 30% of the patients. Treatment results are much better in specialized oncology centers with optimal interdisciplinary cooperation compared with smaller institutions. Chemotherapy can be used both for consolidation after successful secondary surgery and for palliation in patients with inoperable recurrent disease. Since paclitaxel has been integrated into first-line chemotherapy, there is no defined standard for second-line chemotherapy. Several cytotoxic agents have shown moderate activity in this setting, including treosulfan, epirubicin, and newer agents such as topotecan, gemcitabine, vinorelbine, and PEG(polyethylene glycol)-liposomal doxorubicin. Thus, the German Arbeitsgemeinschaft Gynakologische Onkologie (AGO) has initiated several randomized studies in patients with recurrent ovarian cancer in order to define new standards for second-line chemotherapy

Mouse Chromosome 11

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46996/1/335_2004_Article_BF00648429.pd

Final results from GCIG/ENGOT/AGO-OVAR 12, a randomised placebo-controlled phase III trial of nintedanib combined with chemotherapy for newly diagnosed advanced ovarian cancer

Contains fulltext : 218867.pdf (Publisher’s version ) (Closed access)AGO-OVAR 12 investigated the effect of adding the oral triple angiokinase inhibitor nintedanib to standard front-line chemotherapy for advanced ovarian cancer. At the primary analysis, nintedanib demonstrated significantly improved progression-free survival (PFS; primary endpoint) compared with placebo. We report final results, including overall survival (OS). Patients with primary debulked International Federation of Gynaecology and Obstetrics (FIGO) stage IIB-IV newly diagnosed ovarian cancer were randomised 2:1 to receive carboplatin (area under the curve 5 or 6) plus paclitaxel (175 mg/m(2) ) on day 1 every 3 weeks for six cycles combined with either nintedanib 200 mg or placebo twice daily on days 2-21 every 3 weeks for up to 120 weeks. Between December 2009 and July 2011, 1,366 patients were randomised (911 to nintedanib, 455 to placebo). Disease was considered as high risk (FIGO stage III with >1 cm residuum, or any stage IV) in 39%. At the final analysis, 605 patients (44%) had died. There was no difference in OS (hazard ratio 0.99, 95% confidence interval [CI] 0.83-1.17, p = 0.86; median 62.0 months with nintedanib vs. 62.8 months with placebo). Subgroup analyses according to stratification factors, clinical characteristics and risk status showed no OS difference between treatments. The previously reported PFS improvement seen with nintedanib did not translate into an OS benefit in the nonhigh-risk subgroup. Updated PFS results were consistent with the primary analysis (hazard ratio 0.86, 95% CI 0.75-0.98; p = 0.029) favouring nintedanib. The safety profile was consistent with previous reports

Aktuelle und zukünftige Entwicklungen in der Diagnostik und Therapie des Ovarialkarzinoms

Das Ovarialkarzinom ist das fünfthäufigste Karzinom der Frau. Die Prognose des frühen epithelialen Ovarialkarzinoms ist günstig mit einer 5-Jahres-Überlebensrate von über 80 %. Bei den fortgeschrittenen Stadien hat die 5-Jahres-Überlebensrate für das Stadium FIGO IIIC laut FIGO Annual Report seit den 60er-Jahren von weit unter 10 auf 28,7 % in den Jahren 1993 - 1995 zugenommen. Seit Mitte der 90er-Jahre ist jedoch nur eine geringfügige Verbesserung der Überlebensrate auf 32,5 % (1999 - 2001) zu verzeichnen [[1]]. Im Folgenden werden deshalb die aktuellen und zukünftigen Entwicklungen in Diagnostik und Therapie des Ovarialkarzinoms dargestellt, von denen eine Verbesserung der Prognose erhofft wird. Bezüglich des aktuellen Therapiestandards beim Ovarialkarzinom wird auf die 2007 von der Kommission Ovar der AGO herausgegebene interdisziplinäre S2k-Leitlinie verwiesen. Abstract Ovarian cancer is the fifth most common cancer diagnosis in women. The prognosis for early epithelial ovarian carcinoma is favorable with a five-year survival rate of more than 80 %. According to the FIGO annual report, even for advanced stages the 5-year survival rate for FIGO Stage IIIC improved in the years 1993 - 1995 from far below 10 to 28.7 %. However, since the mid nineties only a small improvement in survival (five-year survival rate 32.5 %) was noted. Present and future developments in the diagnosis and treatment of ovarian cancer expected to improve patient outcomes are summarized below. Reference is made to the current standards for ovarian cancer treatment outlined in the interdisciplinary S2 Consensus Guidelines published by the Kommission Ovar of the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) in 2007