Abstract
Background
Recurrent or persistent clear cell carcinoma (CCC) of the ovary is particularly chemotherapy resistant. The purpose of this study was to review our extensive institutional experiences with recurrent or persistent CCC with the aim of finding a more effective chemotherapy regimen.
Methods
The medical records of 67 patients treated for CCC of the ovary were retrospectively reviewed to select patients subsequently treated for recurrence or persistence of the disease.
Results
The review identified 20 patients treated for recurrent or persistent CCC. For these 20 patients, 9 chemotherapeutic regimens, with 125 cycles, were administered. Gemcitabine monotherapy showed the best response rate [1 partial response (20%) and 2 stable diseases out of 5 patients so treated]. A partial response was observed with a combination of docetaxel plus irinotecan in 1 of 11 patients (9%). Stable disease was observed in 1 of 9 cases on a paclitaxel/carboplatin doublet and in 1 case on a docetaxel/carboplatin doublet. The median overall survival time was 8 months (range, 2–52). One group of patients who received gemcitabine therapy showed significantly better survival (n = 5, median 18 months) compared with a group who did not (n = 15, median 7 months) (P = 0.0108, by univariate analysis). In addition, multivariate Cox proportional hazards analysis revealed that gemcitabine administration was a significant factor for survival (hazard ratio: 13.0, 95% CI: 1.4727–115.2255, P = 0.02).
Conclusion
Although most chemotherapeutic regimens for recurrent or persistent CCC have little or no effect, gemcitabine showed modest activity and is the most effective agent we have tested to date.
Similar content being viewed by others
References
Parkin DM, Bray F, Ferlay J et al (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108
Ushijima K (2009) Current status of gynecologic cancer in Japan. J Gynecol Oncol 20:67–71
Sugiyama T, Kamura T, Kigawa J et al (2000) Clinical characteristics of clear cell carcinoma of the ovary: a distinct histologic type with poor prognosis and resistance to platinum-based chemotherapy. Cancer 88:2584–2589
Enomoto T, Kuragaki C, Yamasaki M et al (2003) Is clear cell carcinoma and mucinous carcinoma of the ovary sensitive to combination chemotherapy with paclitaxel and carboplatin? Proc Am Soc Clin Oncol 22:447
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 9:389–393
Harries M, Gore M (2002) Part II: chemotherapy for epithelial ovarian cancer—treatment of recurrent disease. Lancet Oncol 3:537–545
Takano M, Kikuchi Y, Yaegashi N et al (2006) Adjuvant chemotherapy with irinotecan hydrochloride and cisplatin for clear cell carcinoma of the ovary. Oncol Rep 16:1301–1306
Nagai Y, Inamine M, Hirakawa M et al (2007) Postoperative whole abdominal radiotherapy in clear cell adenocarcinoma of the ovary. Gynecol Oncol 107:469–473
Ohno S, Kyo S, Myojo S et al (2009) Wilms’ tumor 1 (WT1) peptide immunotherapy for gynecological malignancy. Anticancer Res 29:4779–4784
Ozols RF (2001) The current role of gemcitabine in ovarian cancer. Semin Oncol 28:18–24
Plunkett W, Huang P, Searcy CE et al (1996) Gemcitabine: preclinical pharmacology and mechanisms of action. Semin Oncol 23:3–15
Mackey JR, Mani RS, Selner M et al (1998) Functional nucleoside transporters are required for gemcitabine influx and manifestation of toxicity in cancer cell lines. Cancer Res 58:4349–4357
Lund B, Hansen OP, Theilade K et al (1994) Phase II study of gemcitabine (2′,2′-difluorodeoxycytidine) in previously treated ovarian cancer patients. J Natl Cancer Inst 86:1530–1533
Lorusso D, Ferrandina G, Fruscella E et al (2005) Gemcitabine in epithelial ovarian cancer treatment: current role and future perspectives. Int J Gynecol Cancer 15:1002–1013
Mutch DG, Orlando M, Goss T et al (2007) Randomized phase III trial of gemcitabine compared with pegylated liposomal doxorubicin in patients with platinum-resistant ovarian cancer. J Clin Oncol 25:2811–2818
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 24:4699–4707
Crotzer DR, Sun CC, Coleman RL et al (2007) Lack of effective systemic therapy for recurrent clear cell carcinoma of the ovary. Gynecol Oncol 105:404–408
Parmar MK, Ledermann JA, Colombo N 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
Komiyama S, Nakamura M, Murakami I et al (2008) A heavily pretreated patient with recurrent clear cell adenocarcinoma of the ovary in whom carcinomatous peritonitis was controlled successfully by salvage therapy with gemcitabine. Arch Gynecol Obstet 278:565–568
Ferrandina G, Legge F, Mey V et al (2007) A case of drug resistant clear cell ovarian cancer showing responsiveness to gemcitabine at first administration and at re-challenge. Cancer Chemother Pharmacol 60:459–461
Conflict of interest
The authors declare that there are no potential conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Yoshino, K., Enomoto, T., Fujita, M. et al. Salvage chemotherapy for recurrent or persistent clear cell carcinoma of the ovary: a single-institution experience for a series of 20 patients. Int J Clin Oncol 18, 148–153 (2013). https://doi.org/10.1007/s10147-011-0357-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10147-011-0357-5