Clinical and Translational Oncology

, Volume 9, Issue 7, pp 443–451 | Cite as

Update in the management of ovarian and cervical carcinoma

  • A. Poveda
  • R. Salazar
  • J. M. del Campo
  • C. Mendiola
  • J. Cassinello
  • B. Ojeda
  • J. A. Arranz
  • A. Oaknin
  • J. García-Foncillas
  • M. J. Rubio
  • A. González Martín
Special Article


Ovarian and cervical cancers are significant health problems. This article provides an update in selected management topics. Paclitaxel and platinum derivatives are the first-line treatment for patients with advanced disease. In selected patients, intraperitoneal chemotherapy has been associated with improved survival but the broad applicability of this strategy is limited by issues of toxicity and feasibility. Management of patients with recurrent disease is based on a number of factors and includes surgery in selected cases, platinum-based chemotherapy for patients with platinum-sensitive disease and other agents such as topotecan and pegylated liposomal formulation of doxorubicin for patients with platinum-resistant disease. In cervical cancer, the most significant issue/event is the demonstration of superior survival with topotecan and cisplatin compared to cisplatin alone. Finally, new agents such as epidermal growth factor receptor inhibitors and antiangiogenic agents are being currently tested in these settings.

Key words

Ovarian cancer Chemotherapy Cervical cancer Update 


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  1. 1.
    Sugarbaker PH, Mora JT, Carmignani P et al (2005) Update on chemotherapeutic agents utilized for perioperative intraperitoneal CT. Oncologist 10:112–122PubMedCrossRefGoogle Scholar
  2. 2.
    Markman M (2003) Intraperitoneal antineoplastic drug delivery: rationale and results. Lancet Oncol 14:277–283CrossRefGoogle Scholar
  3. 3.
    Alberts DS, Liu PY, Hannigan EV et al (1996) Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. N Engl J Med 335:1950–1955PubMedCrossRefGoogle Scholar
  4. 4.
    Markman M, Bundy BN, Alberts DS et al (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 19:1001–1007PubMedGoogle Scholar
  5. 5.
    Armstrong DK, Bundy B, Wenzel L et al (2006) Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 354:34–43PubMedCrossRefGoogle Scholar
  6. 6.
    Jaaback K, Johnson N (2006) Intraperitoneal CT for the initial management of primary epithelial ovarian cancer. Cochrane Database Syst Rev 1:CD005340Google Scholar
  7. 7.
    Gore M, du Bois A, Vergote I (2006) Intraperitoneal CT in ovarian cancer remains experimental. J Clin Oncol 24:4528–4530PubMedCrossRefGoogle Scholar
  8. 8.
    Pecorelli S (2006) The standard of therapy for advanced ovarian cancer: a global perspective. Educational Session, ASCO annual meetingGoogle Scholar
  9. 9.
    Thigpen JT, Brady MF, Omura GA et al (1993) Age as a prognostic factor in ovarian carcinoma. The Gynecologic Oncology Group experience. Cancer 71:606–614PubMedCrossRefGoogle Scholar
  10. 10.
    Eisenhauer EA, Vermorken JB, Van Glabbeke M (1997) Predictors of response to subsequent CT in platinum pretreated ovarian cancer: a multivariate analysis of 704 patients. Ann Oncol 8:963–968PubMedCrossRefGoogle Scholar
  11. 11.
    Markman M, Reichman B, Hakes T et al (1991) Responses to second-line cisplatin-based intraperitoneal therapy in ovarian cancer: influence of a prior response to intravenous cisplatin. J Clin Oncol 9:1801–1805PubMedGoogle Scholar
  12. 12.
    Markman M, Markman J, Webster K et al (2004) Duration of response to second-line, platinum-based CT for ovarian cancer: implications for patient management and clinical trial design. J Clin Oncol 22:3120–3125PubMedCrossRefGoogle Scholar
  13. 13.
    Gore ME, Fryatt I, Wiltshaw E, Dawson T (1990) Treatment of relapsed carcinoma of the ovary with cisplatin or carboplatin following initial treatment with these compounds. Gynecol Oncol 36:207–211PubMedCrossRefGoogle Scholar
  14. 14.
    Spriggs D (2003) Optimal sequencing in the treatment of recurrent ovarian cancer. Gynecol Oncol 90:S39–S44PubMedCrossRefGoogle Scholar
  15. 15.
    Armstrong DK (2002) Relapsed ovarian cancer: challenges and management strategies for a chronic disease. Oncologist. 7:20–28PubMedCrossRefGoogle Scholar
  16. 16.
    Kavanagh J, Tresukosol D, Edwards C et al (1995) Carboplatin reinduction after taxane in patients with platinum-refractory epithelial ovarian cancer. J Clin Oncol 13:1584–1588PubMedGoogle Scholar
  17. 17.
    Spriggs DR (2002) Platinum treatment of presumed platinum resistant ovarian cancer after nonplatinum therapy [abstract]. Proc Am Soc Clin Oncol 21:A877Google Scholar
  18. 18.
    Ten Bokkel Huinink W, Gore M, Carmichael J et al (1997) Topotecan versus paclitaxel for the treatment of recurrent epithelial ovarian cancer. J Clin Oncol 15:2183–2193PubMedGoogle Scholar
  19. 19.
    Creemers GJ, Bolis G, Gore M et al (1996) Topotecan, an active drug in the second-line treatment of epithelial ovarian cancer: results of a large European phase II study. J Clin Oncol 14:3056–3061PubMedGoogle Scholar
  20. 20.
    Bookman MA, Malmstrom H, Bolis G et al (1998) Topotecan for the treatment of advanced epithelial ovarian cancer: an open-label phase II study in patients treated after prior CT that contained cisplatin or carboplatin and paclitaxel. J Clin Oncol 16:3345–3352PubMedGoogle Scholar
  21. 21.
    McGuire WP, Blessing JA, Bookman MA et al (2000) Topotecan has substantial antitumor activity as first-line salvage therapy in platinum-sensitive epithelial ovarian carcinoma: A Gynecologic Oncology Group Study. J Clin Oncol 18:1062–1067PubMedGoogle Scholar
  22. 22.
    Horowitz NS, Hua J, Giba R K et al (2004) The role of topotecan for extending the platinum-free interval in recurrent ovarian cancer: an in vitro model. Gynecol Oncol 94:67–73PubMedCrossRefGoogle Scholar
  23. 23.
    Parmar MK, Ledermann JA, Colombo N et al (2003) Paclitaxel plus platinum-based CT versus conventional platinum-based CT in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet 361:2099–2106PubMedCrossRefGoogle Scholar
  24. 24.
    González-Martin AJ, Calvo E, Bover I et al (2005) Randomized phase II trial of carboplatin versus paclitaxel and carboplatin in platinum-sensitive recurrent advanced ovarian carcinoma: a GEICO (Grupo Españole de Investigación en Cancer de Ovario) study. Ann Oncol 16:749–755PubMedCrossRefGoogle Scholar
  25. 25.
    Pfisterer J, Plante M, Vergote I 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 24:4699–4707PubMedCrossRefGoogle Scholar
  26. 26.
    Markman M, Rothman R, Hakes T et al (1991) Second-line platinum therapy in patients with ovarian cancer previously treated with cisplatin. J Clin Oncol 9:389–393PubMedGoogle Scholar
  27. 27.
    Markman M, Hoskins W (1992) Responses to salvage chemotherapy in ovarian cancer: a critical need for precise definition of the treated population. J Clin Oncol 10:513–514PubMedGoogle Scholar
  28. 28.
    Thigpen JT, Vance RB, Khansur T (1993) Second-line CT for recurrent carcinoma of the ovary. Cancer 71:1559–1564PubMedGoogle Scholar
  29. 29.
    (2005) Guidelines by the National Institute of Clinical Excellence (NICE). Available on WWW at
  30. 30.
    Chi DS, McCaughty K, Diaz JP (2006) Guidelines and selection criteria for secondary cytoreductive surgery in patients with recurrent, platinum-sensitive epithelial ovarian carcinoma. Cancer 106:1933–1939PubMedCrossRefGoogle Scholar
  31. 31.
    Harter P, du Bois A, Hahmann M (2006) Surgery in recurrent ovarian cancer: the Arbeitsgeminschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol 13:1702–1710PubMedCrossRefGoogle Scholar
  32. 32.
    Doyle C, Crump M, Pintilie M, Oza AM (2001) Does palliative CT palliate? Evaluation of expectations, outcomes, and costs in women receiving CT for advanced ovarian cancer. J Clin Oncol 19:1266–1274PubMedGoogle Scholar
  33. 33.
    Eisenhauer EA, Vermorken JB, Van Glabbeke M (1997) Predictors of response to subsequent CT in platinum pretreated ovarian cancer: a multivariate analysis of 704 patients. Ann Oncol 8:963–968PubMedCrossRefGoogle Scholar
  34. 34.
    Leitao MM, Hummer A, Dizon DS et al (2003) Platinum retreatment of platinum-resistant ovarian cancer after nonplatinum therapy. Gynecol Oncol 91:123–129PubMedCrossRefGoogle Scholar
  35. 35.
    Ten Bokkel, Huinink W, Lase SR, Ross GA (2004) Long-term survival in a phase III, randomized study of topotecan versus paclitaxel in advanced epithelial ovarian cancer. Ann Oncol 15:100–103CrossRefGoogle Scholar
  36. 36.
    Gordon AN, Fleagle JT, Guthrie D et al (2001) Recurrent epithelial ovarian carcinoma: a randomized phase III study of pegylated liposomal doxorubic in versus topotecan. J Clin Oncol 19:3312–3322PubMedGoogle Scholar
  37. 37.
    Bookman MA (2005) Is there still a role for hormonal therapy? Int J Gynecol Cancer 15:291–297PubMedCrossRefGoogle Scholar
  38. 38.
    Howley PM (2001) In: Fields BN, Knipe DM, Howley PM (eds) Fields virology, 4th Edn. Lippincott-Raven, Philadelphia, PA, pp 2197–2229Google Scholar
  39. 39.
    Rose PG, Bundy BN, Watkins EB (1999) Concurrent cisplatin-based radiotherapy and CT for locally advanced cervical cancer. N Engl J Med 340:1144–1153PubMedCrossRefGoogle Scholar
  40. 40.
    Bonomi P, Blessing JA, Stehman FB et al (1985) Randomized trial of three cisplatin dose schedules in squamous-cell carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol 3:1079–1085PubMedGoogle Scholar
  41. 41.
    Omura GA, Blessing JA, Vaccarello L et al (1997) Randomized trial of cisplatin versus cisplatin plus mitolactol versus cisplatin plus ifosfamide in advanced squamous carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol 15:165–171PubMedGoogle Scholar
  42. 42.
    Bloss JD, Blessing JA, Behrens BC et al (2002) Randomized trial of cisplatin and ifosfamide with or without bleomycin in squamous carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol 20:1832–1837PubMedCrossRefGoogle Scholar
  43. 43.
    Rose PG, Blessing JA, Gerhenson D, McGehee R (1999) Paclitaxel and cisplatin as first-line therapy in recurrent or advanced squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol 17:2676–2680PubMedGoogle Scholar
  44. 44.
    Moore DH, Blessing JA, McQuellon RP et al (2004) Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol 22:3113–3119PubMedCrossRefGoogle Scholar
  45. 45.
    Long H, Bundy BN, Grendys EC et al (2005) Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: a Gynecologic Oncology Group Study. J Clin Oncol 23:4626–4633PubMedCrossRefGoogle Scholar
  46. 46.
    Ciardiello F, Tortora G (2002) Anti-epidermal growth factor receptor drugs in cancer therapy. Expert Opin Invest Drugs 11:755–768CrossRefGoogle Scholar
  47. 47.
    Salomon DS, Brandt R, Ciardiello F, Nornanno N (1995) Epidermal growth factor-related peptides and their receptors in human malignancies. Crit Rev Oncol Hematol 19:183–232PubMedCrossRefGoogle Scholar
  48. 48.
    Nicodemus CF, Berek JS (2005) Monoclonal antibody therapy of ovarian cancer. Expert Rev Anticancer Ther 5:87–96PubMedCrossRefGoogle Scholar
  49. 49.
    Ciardiello F, Bianco R, Damiano V et al (1999) Antitumor activity of sequential treatment with topotecan and anti-epidermal growth factor receptor monoclonal antibody C225. Clin Can Res 5:909–916Google Scholar
  50. 50.
    Aghajanian C, Sabbatini P, Derosa F et al (2005) Phase II study of cetuximab/paclitaxel/carboplatin for the initial treatment of advanced stage ovarian, primary peritoneal and fallopian tube cancer. J Clin Oncol 23:5047CrossRefGoogle Scholar
  51. 51.
    Loibl R et al. Phase II study of gefitinib plus tamoxifen in patients refractory to platinum/taxane-based therapy (AGO Ovar 2.6)Google Scholar
  52. 52.
    Finkler N, Gordon A, Crozier M et al (2001) Phase 2 evaluation of OSI-774, a potent oral antagonist of the EGFR-TK in patients with advanced ovarian carcinoma [abstract]. Proc Am Soc Clin Oncol 20:A831Google Scholar
  53. 53.
    Clark GM, Pérez-Soler R, Sin L et al (2003) Rash severity is predictive of increased survival with erlotinib HCl [abstract]. Proc Am Soc Clin Oncol 22:A786Google Scholar
  54. 54.
    Shen GH, Ghazizaden M, Kawanami O et al (2000) Prognostic significance of vascular endothelial growth factor expression in human ovarian carcinoma. Br J Cancer 83:196–203PubMedCrossRefGoogle Scholar
  55. 55.
    Zebrowski BK, Liu W, Ramirez K et al (1999) Markedly elevated levels of vascular endothelial growth factor in malignant ascites. Ann Surg Oncol 6:373–378PubMedCrossRefGoogle Scholar
  56. 56.
    Presta L, Chen H, O’Connor SJ et al (1997) Humanization of an anti-vascular endothelial growth factor monoclonal antibody for the therapy of solid tumors and other disorders. Cancer Res 57:4593–4599PubMedGoogle Scholar
  57. 57.
    Burger RA, Sill M, Monk BJ et al (2005) Phase II trial of bevacizumab in persistent or recurrent epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC): a Gynecologic Oncology Group (GOG) study [abstract]. J Clin Oncol 23:A5009Google Scholar
  58. 58.
    Cannistra SA, Matulonis U, Penson R et al (2006) Bevacizumab in patients with advanced platinum-resistant ovarian cancer [abstract]. J Clin Oncol 24:A5006Google Scholar
  59. 59.
    Dupont J, Rothenberg ML, Spriggs DR et al (2005) Safety and pharmacokinetics of intravenous VEGF Trap in a phase I clinical trial of patients with advanced solid tumors. J Clin Oncol 23:A3029Google Scholar
  60. 60.
    Yao JC, Phan AT, Chang DZ et al (2006) Phase II study of RAD001 (everolimus) and depot octreotide (Sandostatin LAR) in patients with advanced low grade neuroendocrine carcinoma (LGNET) [abstract]. J Clin Oncol 24:A4042CrossRefGoogle Scholar
  61. 61.
    Cascinu S, Del Ferro E, Ligi M et al (2001) Inhibition of vascular endothelial growth factor by octreotide in colorectal cancer patients. Cancer Invest 19:8–12PubMedCrossRefGoogle Scholar
  62. 62.
    Pollak MN, Polychronakos C, Guyda H (1989) Somatostatin analogue SMS 201-995 reduces serum IGF-I levels in patients with neoplasms potentially dependent on IGF-I. Anticancer Res 9:889–891PubMedGoogle Scholar
  63. 63.
    Sessa C, de Braud F, Perotti A et al (2005) Trabectedin for women with ovarian carcinoma after treatment with platinum and taxanes fails. J Clin Oncol 23:1867–1874PubMedCrossRefGoogle Scholar
  64. 64.
    McMeekin DS, Krasner C, Chan S et al (2005) Final results of a phase II study of weekly trabectedin in second/third line ovarian carcinoma. J Clin Oncol 23:A5011Google Scholar
  65. 65.
    Del Campo J, Roszak A, Ciuleanu T et al (2006) Phase II open label randomized study of trabectedin (T) given as two different dosing schedules in women with platinum-sensitive, recurrent ovarian carcinoma: preliminary results. J Clin Oncol 23:A5031Google Scholar
  66. 66.
    Poveda A (2005) Ovarian cancer: are the news good enough? Int J Gynecol Cancer 15[Suppl 3]:298–306PubMedCrossRefGoogle Scholar

Copyright information

© Feseo 2007

Authors and Affiliations

  • A. Poveda
    • 1
  • R. Salazar
    • 2
  • J. M. del Campo
    • 3
  • C. Mendiola
    • 4
  • J. Cassinello
    • 5
  • B. Ojeda
    • 6
  • J. A. Arranz
    • 7
  • A. Oaknin
    • 2
  • J. García-Foncillas
    • 8
  • M. J. Rubio
    • 9
  • A. González Martín
    • 10
  1. 1.Servicio de Oncología MédicaInstituto Valenciano de OncologíaValenciaSpain
  2. 2.Instituto Catalán de OncologíaBarcelonaSpain
  3. 3.Division of Medical OncologyHospital Vall d’HebrónBarcelonaSpain
  4. 4.Division of Medical OncologyUniversity Hospital 12 de OctubreMadridSpain
  5. 5.Division of Medical OncologyHospital Universitario de GuadalajaraGuadalajaraSpain
  6. 6.Division of Medical OncologyHospital de Sant PauBarcelonaSpain
  7. 7.Division of Medical OncologyHospital General Universitario Gregorio MarañónMadridSpain
  8. 8.Division of Medical OncologyClínica Universitaria de NavarraPamplonaSpain
  9. 9.Division of Medical OncologyHospital Reina SofíaCórdobaSpain
  10. 10.Hospital Universitario Ramón y CajalMadridSpain

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