Changes to This Summary (01/31/2014)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Added text to state that findings from risk-reducing surgeries in healthy women with BRCA1/2 mutations have reinforced the hypothesis that many high-grade serous cancers may arise from precursor lesions that originate in the fimbriae of the fallopian tubes (cited Levanon et al. as reference 5). Also added that histologically similar cancers diagnosed as primary peritoneal carcinomas share molecular findings, such as loss or inactivation of the tumor-suppressors p53 and BRCA1/2 proteins; therefore, high-grade serous adenocarcinomas arising from the fallopian tube and elsewhere in the peritoneal cavity, together with most ovarian epithelial cancers, represent "extrauterine adenocarcinomas of Müllerian epithelial origin" and are staged and treated similarly to ovarian cancer. On the other hand, clear cell and endometrioid ovarian cancers that are linked to endometriosis have different gene-expression signatures, as do mucinous subtypes (cited Birrer as reference 6).
Added text to state that patients with stage II ovarian cancer were also enrolled in a Japanese Gynecology Oncology Group (JGOG) study that tested a weekly dosing schedule versus the conventional every-3-week dosing schedule in first-line ovarian cancer (cited 2009 Katsumata et al., 2013 Katsumata et al., and Scambia et al. as references 16, 17, and 18, respectively).
Added text to state that a JGOG trial circumvented the standard treatment trend and included patients with stage II through stage IV disease in addition to the patients undergoing neoadjuvant therapy. Also added that with results initially published in 2009 and long-term results updated in 2013, the JGOG-3601 trial has stimulated a number of other trials that address weekly dosing schedules versus the conventional every-3-week dosing in first-line epithelial ovarian cancer (cited 2009 Katsumata et al., 2013 Katsumata et al., and Scambia et al. as references 6, 7, and 8, respectively). Also added that, conducted between 2003 and 2006, the Japanese trial accrued 637 patients and randomly assigned them to a range of six to nine cycles of the weekly 80 mg/m2 of paclitaxel versus the usual intermittent schedule of paclitaxel at 180 mg/m2; both regimens were given with carboplatin (area under the curve 6) in every-3-weeks cycles. With a primary endpoint of progression-free survival (PFS), an increase from 16 to 21 months in the PFS of the weekly paclitaxel-based regimen was sought.
Added text to state that the PFS surpassed expectations at the 1.5-year follow-up after cessation of treatment; the weekly regimen had a median PFS of 28.0 months, and the intermittent median PFS was 17.2 months, favoring the weekly regimen. The 3-year overall survival also favored the weekly regimen. Added that the 2013 updated results revealed unexpected median survival results for the weekly regimen; the intermittent regimen results are also noteworthy relative to other clinical trials of weekly dosing schedules. Other than ethnicity, the JGOG-3601 trial population differed from other studies in terms of median age, number of stage II patients, use of the neoadjuvant setting, number of patients with histologies other than high-grade serous or endometrioid, and number of patients without high-grade histologies.
Added text to state that several ongoing trials include an intermittent dosing arm comparing both intraperitoneal chemotherapy and conventional-schedule intravenous treatment in patients after both optimal and suboptimal cytoreduction. When these results are available, it will be easier to identify the patient populations that are best suited for intermittent dosing.
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.