Title: Topotecan Compared With No Therapy After Response to Surgery and Carboplatin/Paclitaxel in Patients With Ovarian Cancer: Multicenter Italian Trials in Ovarian Cancer (MITO-1) Randomized Study

Authors: De Placido, Sabino, Scambia, Giovanni, Di Vagno, Giovanni, Naglieri, Emanuele, Lombardi, Alessandra Vernaglia, Biamonte, Rosalbino, Marinaccio, Marco, Carteni, Giacomo, Manzione, Luigi, Febbraro, Antonio, de Matteis, Andrea, Gasparini, Gianpietro, Valerio, Maria Rosaria, Danese, Saverio, Perrone, Francesco, Lauria, Rossella, De Laurentiis, Michele, Greggi, Stefano, Gallo, Ciro, Pignata, Sandro

Source: J Clin Oncol 2004 22: 2635-2642

Summary:  This trial investigated whether additional cycles of topotecan (1.5mg/m2 days 1-5 every 21 days) could prolong PFS. The use of Topotecan as a consolidation agent is attractive as it does not exhibit cross-resistance with carboplatin or Taxol. There were 273 patients that were randomized to treatment with Topotecan or observation. The majority (75%) had stage III or IV disease and 87% had achieved a complete response to initial therapy. 66% of the randomized group had an optimal (<1cm) initial surgical cytoreduction. However there was no description of the surgical procedures or extent of staging that were necessary for inclusion in the study. There was no difference in the PFS between the two groups. The PFS for the Topotecan arm was 18.2 months versus 28.4 months for the control group. These findings contrast with those by Markman who noted that consolidation with 12 cycles of Taxol was superior to 3 cycles with respect to PFS. The authors note that this difference may represent the superior nature of Taxane-based consolidation schemes due to their inferred anti angiogenic activity.

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Nothing of interest this month

Nothing of interest this month

Nothing of interest this month

Title: The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma

Authors: Dowdy SD, Mullany, SA, Brandt, KR, Hyppert BJ, Cliby WA

Source: Cancer 2004; 101: 346-52

Summary:  This retrospective study determined the usefulness of preoperative CT scans and CA 125 levels in predicting cytoreduction.  87 patients with stage III/IV disease were identified between 1966 and 2001. Two blinded radiologists used 17 criteria to determine the extent of disease on CT images. Optimal cytoreduction was completed in 71% of patients and 29 % of patients had > 1 cm of residual disease (suboptimal). Forty-five patients (52%) received a radical surgical operation including radical hysterectomy; resections of bowel, diaphragm, liver, or spleen; and inguinal lymphadenectomy. The mortality rate within the first 30 days was 5.2%. The median preoperative CA 125 level was 388 units/mL.  There was no correlation between preoperative CA 125 levels and the ability to obtain an optimal cytoreduction. Of the 17 factors evaluated only DPT was found to be an independent predictor of the success of cytoreduction on multivariate analysis (P = 0.016).  A model using both DPT and ascites had a positive predictive value of 68% and sensitivity of 52% for predicting suboptimal debulking.  The authors concluded that presence of DPT and large-volume ascites was associated with a low rate of optimal cytoreduction and should therefore be treated with neoadjuvant chemotherapy.

Click here for abstract from Cancer

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Nothing of interest this month

Nothing of interest this month

American Journal of Surgical Pathology – Sarah E. Ferguson

Nothing of interest this month

This issue of the Virtual Journal Club is sponsored by GlaxoSmithKline.