Abstract
Ovarian cancer is the 5th leading cause of cancer mortality in the United States, and despite major advances in cytoreductive surgery and the use of chemotherapy with a platinum and a taxane in the first-line setting, recurrence is still a common problem. Efforts to improve the efficacy of conventional chemotherapy have been resulted in general in limited benefit. Metronomic chemotherapy represents an alternate schedule of chemotherapy administration. Preclinical and clinical data attest to the efficacy of metronomic chemotherapy as a treatment modality in ovarian cancer. Further research, including phase III clinical studies, is required to determine the role of this promising therapeutic approach in the management of ovarian cancer.
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References
National Cancer Institute. SEER stat fact sheets: ovary [internet]. National Cancer Institute, Bethesda. Available from: http://seer.cancer.gov/statfacts/html/ovary.html. Cited Oct 2013
Cannistra SA (2004) Cancer of the ovary. N Engl J Med 351:2519–2529
Pfisterer J, Plante M, Vergote I, du Bois A, Hirte H, Lacave AJ et al (2006) Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: an intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG. J Clin Oncol 24:4699–4707. doi:10.1200/JCO.2006.06.0913
Parmar M, Ledermann J, Colombo N, du Bois A, Delaloye J, Kristensen G et al (2003) Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet 361:2099–2106
Bamias A, Bamia C, Zaqouri F, Kostouros E et al (2013) Improved survival trends in platinum-resistant patients with advanced ovarian, fallopian or peritoneal cancer treated with first-line paclitaxel/platinum chemotherapy: the impact of novel agents. Oncology 84(3):158–165. doi:10.1159/000341366, Epub 2012 Dec 28
Lortholary A, Largillier R, Weber B, Gladieff L (2012) Weekly paclitaxel as a single agent or in combination with carboplatin or weekly topotecan in patients with resistant ovarian cancer: the CARTAXHY randomized phase II trial from Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens (GINECO). Ann Oncol 23(2):346–352. doi:10.1093/annonc/mdr149, Epub 2011 May 11
Bolis G, Parazzini F, Scarfone G et al (1999) Paclitaxel vs epidoxorubicin plus paclitaxel as second-line therapy for platinum-refractory and -resistant ovarian cancer. Gynecol Oncol 72:60–64
Monk BJ, Herzog TJ, Kaye SB et al (2010) Trabectedin plus pegylated liposomal doxorubicin in recurrent ovarian cancer. J Clin Oncol 28:3107–3114
Chabner BA, Roberts TG Jr (2005) Timeline: chemotherapy and the war on cancer. Nat Rev Cancer 5(1):65
Gasparini G (2001) Metronomic scheduling: the future of chemotherapy? Lancet Oncol 2:733–740
Kerbel RS, Kamen BA (2004) The anti-angiogenic basis of metronomic chemotherapy. Nat Rev Cancer 4:423–436
Scharovsky OG, Mainetti LE, Rozados VR (2009) Metronomic chemotherapy: changing the paradigm that more is better. Curr Oncol 16:7–15
Hanahan D, Bergers G, Bergsland E (2000) Less is more regularly: metronomic dosing of cytotoxic drugs can target tumor angiogenesis in mice. J Clin Invest 105:1045–1047
Su WH, Ho TY, Li YT, Lu CH, Lee WL, Wang PH (2012) Metronomic therapy for gynecologic cancers. Taiwan J Obstet Gynecol 51:167–178
Lien K, Georgsdottir S, Sivanathan L, Chan K, Emmenegger U (2013) Low-dose metronomic chemotherapy: a systematic literature analysis. Eur J Cancer 49(16):3387–3395
Ge Y, Domschke C, Stoiber N, Schott S, Heil J, Rom J, Blumenstein M, Thum J, Sohn C, Schneeweiss A et al (2012) Metronomic cyclophosphamide treatment in metastasized breast cancer patients: immunological effects and clinical outcome. Cancer Immunol Immunother 61(3):353–362, Epub 14 Sep 2011
Miller KD, Sweeney CJ, Sledge GW Jr (2001) Redefining the target: chemotherapeutics as antiangiogenics. J Clin Oncol 19(4):1195–1206
Browder T et al (2000) Antiangiogenic scheduling of chemotherapy improves efficacy against experimental drug-resistant cancer. Cancer Res 60:1878–1886
Bell J, Brady MF, Young RC, Lage J, Walker JL, Look KY, Rose GS, Spirtos NM (2006) Randomized phase III trial of three versus six cycles of adjuvant carboplatin and paclitaxel in early stage epithelial ovarian carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 102(3):432–439, Epub 24 Jul 2006
Bookman MA, Brady MF, McGuire WP, Harper PG et al (2009) Evaluation of new platinum-based treatment regimens in advanced-stage ovarian cancer: a Phase III Trial of the Gynecologic Cancer Intergroup. J Clin Oncol 27(9):1419–1425
Markman M, Bundy BN, Alberts DS, Fowler JM (2001) Phase III trial of standard-dose intravenous cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and intraperitoneal cisplatin in small-volume stage III ovarian carcinoma: an intergroup study of the Gynecologic Oncology Group, Southwestern Oncology Group, and Eastern Cooperative Oncology Group. J Clin Oncol 19(4):1001–1007
Armstrong DK, Bundy B, Wenzel L, Huang HQ, Baergen R et al (2006) Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 354(1):34–43
Alberts DS, Liu PY, Hannigan EV, O’Toole R (1996) Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. N Engl J Med 335(26):1950–1955
Gaillard S, Armstrong D (2011) Intraperitoneal chemotherapy for advanced epithelial ovarian cancer: many questions, much promise…. Oncology (Williston Park) 25(2):176, 178, 180
Katsumata N, Yasuda M, Takahashi F, Isonishi S (2009) Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial. Lancet 374(9698):1331–1338. doi:10.1016/S0140-6736(09)61157-0, Epub 2009 Sep 18
Burger RA, Brady MF, Bookman MA, Fleming GF (2011) Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med 365(26):2473–2483
Perren TJ, Swart AM, Pfisterer J, Ledermann JA (2011) A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med 365(26):2484–2496
Markman M, Liu PY, Wilczynski S, Monk B (2003) Phase III randomized trial of 12 versus 3 months of maintenance paclitaxel in patients with advanced ovarian cancer after complete response to platinum and paclitaxel-based chemotherapy: a Southwest Oncology Group and Gynecologic Oncology Group trial. J Clin Oncol 21(13):2460–2465
Mannel RS, Brady MF, Kohn EC, Hanjani P (2011) A randomized phase III trial of IV carboplatin and paclitaxel × 3 courses followed by observation versus weekly maintenance low-dose paclitaxel in patients with early-stage ovarian carcinoma: a Gynecologic Oncology Group Study. Gynecol Oncol 122(1):89–94
Morgan R, Alvarez R, Armstrong D, Burger R et al (2013) Ovarian cancer version 2.2013. J Natl Compr Canc Netw 11(10):1199–1209
Kikuchi Y, Kita T, Takano M, Kudoh K, Yamamoto K (2005) Treatment options in the management of ovarian cancer. Expert Opin Pharmacother 6(5):743–754
Lopes NM, Adams EF, Pitts TW, Bhuyan BK (1993) Cell kinetics and cell cycles effects of Taxol on human and hamster ovarian cell lines. Cancer Chemother Pharmacol 432:235–242
Georgiadis MS, Russel E, Gazdar AF, Johnson BE (1997) Paclitaxel cytotoxicity against human lung cancer cell lines increases with prolonged exposure duration. Clin Cancer Res 3:449–454
Yamamoto K, Kikuchi Y, Kudoh K, Nagata I (2000) Modulation of cisplatin sensitivity by Taxol in cisplatin-sensitive and –resistant human ovarian carcinoma cell lines. J Cancer Res Clin Oncol 126:168–172
Markman M, Hall J, Spitz D, Weiner S (2002) Phase II trial of weekly single-agent paclitaxel in platinum/paclitaxel-refractory ovarian cancer. J Clin Oncol 20(9):2365–2369
Markman M, Blessing J, Rubin SC, Connor J et al (2006) Phase II trial of weekly paclitaxel (80 mg/m2) in platinum and paclitaxel-resistant ovarian and primary peritoneal cancers: a Gynecologic Oncology Group study. Gynecol Oncol 101(3):436–440, Epub 2 Dec 2005
Perez EA, Vogel CL, Irwin DH et al (2001) Multicenter Phase II trial of weekly paclitaxel in women with metastatic breast cancer. J Clin Oncol 19:4216–4223
Socinski MA, Schell MJ, Bakri K et al (2002) Second-line, low-dose, weekly paclitaxel in patients with stage IIIB/IVnon-small cell lung carcinoma who fail first line chemotherapy with carboplatin plus paclitaxel. Cancer 95:1265–1273
Jaaback K, Johnson N, Lawrie TA (2011) Intraperitoneal chemotherapy for the initial management of primary epithelial ovarian cancer. Cochrane Database Syst Rev 11:1–59
National Cancer Institute. Issues clinical announcement for preferred method of treatment for advanced ovarian cancer. National Cancer Institute, Bethesda. Available on http://www.cancer.gov/cancertopics/pdq/treatment/ovarianepithelial/HealthProfessional. Cited 4 Jan 2006
Ledermann JA, Raja FA, Fotopoulou C, Gonzalez-Martin A et al (2013) Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 24(Suppl 6):vi24–vi32
Browder T, Butterfield CE, Kraling BM, Shi B, Marshall B, O’Reilly MS et al (2000) Antiangiogenic scheduling of chemotherapy improves efficacy against experimental drug-resistant cancer. Cancer Res 60:1878e86
Colleoni M, Rocca A, Sandri MT, Zorzino L, Masci G, Nole F et al (2002) Low dose oral methotrexate and cyclophosphamide in metastatic breast cancer: antitumor activity and correlation with vascular endothelial growth factor levels. Ann Oncol 13:73–80
Samaritani R, Corrado G, Vizza E, Sbiroli C (2007) Cyclophosphamide “metronomic” chemotherapy for palliative treatment of a young patient with advanced epithelial ovarian cancer. BMC Cancer 7:65
Garcia AA, Hirte H, Fleming G, Yang D, Tsao-Wei DD, Roman L et al (2007) Phase II clinical trial of bevacizumab and low dose metronomic oral cyclophosphamide in recurrent ovarian cancer. A study of the California, Chicago and Princess Margaret Hospital Phase II Consortia. J Clin Oncol 26:76–82
Sánchez-Muñoz A, Mendiola C, Pérez-Ruiz E, Rodríguez-Sánchez CA, Jurado JM et al (2010) Bevacizumab plus low dose metronomic oral cyclophosphamide in heavily pretreated patients with recurrent ovarian cancer. Oncology 79(1–2):98–104. doi:10.1159/000320602, Epub 15 Nov 2010
Barber EL, Zsiros E, Lurain JR, Rademaker A, Schink JC, Neubauer NL (2013) The combination of intravenous bevacizumab and metronomic oral cyclophosphamide is an effective regimen for platinum-resistant recurrent ovarian cancer. J Gynecol Oncol 24(3):258–264. doi:10.3802/jgo.2013.24.3.258, Epub 2013 Jul 4
Chura JC, Van Iseghem K, Downs LS Jr, Carson LF, Judson PL (2007) Bevacizumab plus cyclophosphamide in heavily pretreated patients with recurrent ovarian cancer. Gynecol Oncol 107(2):326–330, Epub 15 Aug 2007
Burger RA, Sill MW, Monk BJ, Greer BE, Sorosky JI (2007) Phase II trial of bevacizumab in persistent or recurrent epithelial ovarian cancer or primary peritoneal cancer: a Gynecologic Oncology Group Study. J Clin Oncol 25(33):5165–5171, (2007) J Clin Oncol 25(33):5180–6. (2008) Erratum in: J Clin Oncol 26(10):1773
Cannistra SA, Matulonis UA, Penson RT, Hambleton J et al (2007) Phase II study of bevacizumab in patients with platinum-resistant ovarian cancer or peritoneal serous cancer. J Clin Oncol 25(33):5180–5186, (2008) Erratum in: J Clin Oncol 26(10):1773
Kummar S, Oza AM, Fleming GF et al (2012) Randomized trial of oral cyclophosphamide (C) with or without veliparib (V), an oral poly (ADP-ribose) polymerase (PARP) inhibitor, in patients with recurrent BRCA-positive ovarian, or primary peritoneal or high-grade serous ovarian carcinoma. J Clin Oncol 30(Suppl): abstr 5020
Carmeliet P, Jain RK (2000) Angiogenesis in cancer and other diseases. Nature 407:249–257
Pugh CW, Ratcliffe PJ (2003) Regulation of angiogenesis by hypoxia: role of the HIF system. Nat Med 9:677–684
Pommier Y (2006) Topoisomerase I, inhibitors: camptothecins and beyond. Nat Rev Cancer 6:789–802
Clements MK, Jones CB, Cumming M, Daoud SS (1999) Antiangiogenic potential of camptothecin and topotecan. Cancer Chemother Pharmacol 44:411–416
Merritt W, Danes C, Shahzad M, Lin Y et al (2009) Anti-angiogenic properties of metronomic topotecan in ovarian carcinoma. Cancer Biol Ther 8(16):1596–1603
Hashimoto K, Man S, Xu P, Cruz-Munoz W, Tang T et al (2010) Potent preclinical impact of metronomic low-dose oral topotecan combined with the antiangiogenic drug pazopanib for the treatment of ovarian cancer. Mol Cancer Ther 9(4):996–1006
Denschlag D, Watermann D, Hörig K, Kissel C et al (2004) Topotecan as a continuous infusion over 14 days in recurrent ovarian cancer patients. Anticancer Res 24(2C):1267–1269
Hochster H, Wadler S, Runowicz C, Liebes L et al (1999) Activity and pharmacodynamics of 21-Day topotecan infusion in patients with ovarian cancer previously treated with platinum-based chemotherapy. New York Gynecologic Oncology Group. J Clin Oncol 17(8):2553–2561
Gore M, Rustin G, Schüller J, Lane SR et al (2001) Topotecan given as a 21-day infusion in the treatment of advanced ovarian cancer. Br J Cancer 84(8):1043–1046
Tillmanns TD, Buller R, Stewart CF et al (2008) Daily oral topotecan: utilization of a metronomic dosing schedule to treat recurrent or persistent solid tumors. J Clin Oncol 26(15S):257 (20 May Supplement)
Merritt WM, Nick AM, Carroll AR, Lu C et al (2010) Bridging the gap between cytotoxic and biologic therapy with metronomic topotecan and pazopanib in ovarian cancer. Mol Cancer Ther 9(4):985–995
Tillmanns T, Reed M, Privett M, Johns A et al (2012) Phase I trial of metronomic oral topotecan in combination with pazopanib. J Clin Oncol 30 (suppl; abstr 5014)
Turner DC, Tillmanns TD, Harstead KE, Throm SL, Stewart CF (2013) Combination metronomic oral topotecan and pazopanib: a pharmacokinetic study in patients with gynecological cancer. Anticancer Res 33(9):3823–3829
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Forte, V.A., Garcia, A.A. (2014). Metronomic Chemotherapy in Gynecological Cancers. In: Bocci, G., Francia, G. (eds) Metronomic Chemotherapy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-43604-2_14
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DOI: https://doi.org/10.1007/978-3-662-43604-2_14
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