Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Adjuvant chemotherapy improves survival in early-stage ovarian cancer

15.01.2003


Results from two large European studies suggest that adjuvant chemotherapy immediately after surgery for early-stage ovarian cancer can increase some patients’ chances of both overall and recurrence-free survival. The findings are reported in three articles in the January 15 issue of the Journal of the National Cancer Institute.



As many as 50% of patients with early-stage ovarian cancer relapse after surgery, and these subsequent tumor recurrences are often resistant to treatment. Adjuvant chemotherapy has been used to prevent recurrence; however, definitive data are lacking on the effectiveness of adjuvant therapy, and there is no information available about which patients may benefit the most. In addition, previous trials have been too small to provide clear answers.

In the early 1990s, two large randomized clinical trials were initiated to compare survival between patients treated with adjuvant chemotherapy immediately after surgery for early-stage ovarian cancer and patients who received no additional treatments until clinically indicated.


In the Adjuvant ChemoTherapy in Ovarian Neoplasm (ACTION) trial, a team of researchers from the European Organisation for Research and Treatment of Cancer (EORTC) randomly assigned 448 patients from across Europe to either adjuvant platinum-based chemotherapy or observation following surgery. This trial also examined the impact of completeness of surgical staging on survival. One-third of the patents received optimal surgical staging for their cancers. This meant that clinicians performed all the requirements to determine the extent of the disease, or its stage. The remaining two-thirds of patients received nonoptimal surgical staging.

At 5 years, there was no statistically significant difference in overall survival between patients who were treated with adjuvant chemotherapy and patients who were in the observation group. However, recurrence-free survival was statistically significantly improved, with 76% of patients treated with adjuvant chemotherapy surviving without a recurrence, compared with 68% of patients in the observation arm.

Moreover, the authors found that among patients who did not receive adjuvant chemotherapy, optimal staging was associated with a statistically significant improvement in overall and recurrence-free survival. In contrast, optimal staging was not associated with any survival benefit in patients who received adjuvant chemotherapy. Adjuvant chemotherapy appeared to only benefit patients whose cancers were not optimally staged.

"This finding suggests that adjuvant chemotherapy in early-stage ovarian cancer may work predominantly by affecting small-volume or microscopic tumor implants or metastases that remain unnoticed at the time of surgical staging," the authors write. They add that the observed benefit of adjuvant chemotherapy primarily in nonoptimally staged patients suggests a benefit of adjuvant chemotherapy predominantly in patients with unrecognized residual disease.

In a second trial, the International Collaborative Ovarian Neoplasm (ICON1) study, collaborators randomly assigned 477 patients to receive either adjuvant chemotherapy immediately after surgery for early-stage ovarian cancer or no immediate adjuvant chemotherapy. (Information on the completeness of surgical staging was not collected in this trial.)

At 5 years, women who received adjuvant chemotherapy had a 9% greater overall survival and an 11% greater recurrence-free survival than women who did not receive immediate adjuvant therapy.

In a separate paper, researchers reported findings from a combined analysis of the two trials. Similar to the ICON1 trial, the combined analysis found that 5-year overall survival was 8% greater in the adjuvant chemotherapy arm than in the observation arm. The analysis also found that 5-year recurrence-free survival was 11% better in the adjuvant chemotherapy arm than in the observation arm.

In an accompanying editorial, Robert C. Young, M.D., of the Fox Chase Cancer Center in Philadelphia, says that the trials add important information on adjuvant chemotherapy but do not address which patients can be spared unnecessary adjuvant chemotherapy.

He recommends that future trials focus on identifying patients who do not require additional therapy while also seeking to improve therapy in patients who do. "Selecting only high-risk patients for additional treatment can narrow the use of chemotherapy, and this approach should be used until such time as a randomized trial can demonstrate that good prognosis, early-stage patients benefit from such therapy," he writes.


Contact: Dr. J. Baptist Trimbos, Leiden University Medical Center, Netherlands, 31-71-526-2845, J.B.M.Z.Trimbos@lumc.nl

Dr. David Guthrie, Derbyshire Royal Infirmary, 44-122-852-3444, DGJCGuthrie@aol.com

Editorial: Karen Carter Mallet, Fox Chase Cancer Center, 215-728-2700; fax: 215-728-2594, k_carter@fccc.edu

International Collaborative Ovarian Neoplasm Trial 1 and Adjuvant ChemoTherapy in Ovarian Neoplasm Trial: two parallel randomized phase III trials of adjuvant chemotherapy in patients with early-stage ovarian carcinoma. J Natl Cancer Inst 2003;95:105–112.

Trimbos J, Vergote I, Bolis G, Vermorken J, Mangioni C, Madronal C, et al. Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma: European Organisation for Research and Treatment of Cancer–Adjuvant ChemoTherapy in Ovarian Neoplasm trial. J Natl Cancer Inst 2003;95:113–25.

International Collaborative Ovarian Neoplasm Trial 1: a randomized trial of adjuvant chemotherapy in women with early-stage ovarian cancer. J Natl Cancer Inst 2003;95:125–32.

Editorial: Young R. Early-stage ovarian cancer: To treat or not to treat. J Natl Cancer Inst 2003;95:94–5.

Note: The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage.

Linda Wang | EurekAlert!
Further information:
http://jncicancerspectrum.oupjournals.org/

More articles from Health and Medicine:

nachricht Study suggests possible new target for treating and preventing Alzheimer's
02.12.2016 | Oregon Health & Science University

nachricht The first analysis of Ewing's sarcoma methyloma opens doors to new treatments
01.12.2016 | IDIBELL-Bellvitge Biomedical Research Institute

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

Im Focus: MADMAX: Max Planck Institute for Physics takes up axion research

The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.

The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...

Im Focus: Molecules change shape when wet

Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water

In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...

Im Focus: Fraunhofer ISE Develops Highly Compact, High Frequency DC/DC Converter for Aviation

The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.

Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

UTSA study describes new minimally invasive device to treat cancer and other illnesses

02.12.2016 | Medical Engineering

Plasma-zapping process could yield trans fat-free soybean oil product

02.12.2016 | Agricultural and Forestry Science

What do Netflix, Google and planetary systems have in common?

02.12.2016 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>