杨志新-BOA Discussion for ovarian cancer.pptVIP

Discussion Ovarian Cancer Chih-Hsin Yang M.D., Ph.D. Professor Graduate Institute of Clinical Medicine, NTUCM Department of Oncology, NTUH 楊志新教授 台大醫學院 臨床醫學研究所 臺大醫院 腫瘤醫學部 GOG 182-ICON5 ADDING A THIRD CYTOSTATIC DRUG TO TC RESULT Triplet combination Gemcitabine3 AGO-GINECO-NSGO GOG-ANZGOG-MRC Epirubicin1,2 AGO-GINECO NSGO-EORTC-NCIC-GEICO Peg.-lip. Dox3 GOG-ANZGOG-MRC Sequential doublet Gemcitabine3 GOG-ANZGOG-MRC Topotecan3,4 NCIC-EORTC-GEICO GOG-ANZGOG-MRC Sequential single Topotecan5 AGO-GINECO Why adding a third drug failed? Added toxicity One drug is already effective ICON3 (carbo vs. carbo/paclitaxel) GOG132 (cisp vs. cisp/pac vs. pac) Strength blinded, randomized Large number of patients Balanced for stage, histology Endpoints overall survival time to 2nd or 3rd chemotherapy quality of life Weakness Lack of 2nd or 3rd line chemotherapy information Two most important prognostic factors were lacking: 1. surgical considerations Optimal vs. suboptimal 2. platinum sensitive and resistant Long span of accrual and follow up time, new treatment, diagnosis such as PET not considered For patients CA125 culture in patient society Some individual may benefit from CA125 quarterly check – e.g. patients after optimal debulking, chemosensitive, early stage, combining with PET imaging follow up, 2nd or 3rd debulking as salvage may be beneficial Disease-free survival vs. Progression-free survival vs. Symptom-free survival vs. Toxicity-free survival vs. QOL survival vs. Anxiety-free survival Conclusion Without patient selection, it is unlikely that one regimen is superior to the other in primary chemotherapy Early 2nd line chemotherapy based on CA125 elevation failed to improve OS PLD-carboplatin is non-inferior in PFS to paclitaxel carboplatin as salvage treatment Ovaria