The Pharmaceutical Journal
Vol 270 No 7233 p104
25 January 2003

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Journal of the National Cancer Institute (jncicancerspectrum.oupjournals.org)

Still unclear which patients with ovarian cancer will benefit from adjuvant chemotherapy after surgery

Adjuvant chemotherapy given immediately after surgery for early-stage ovarian cancer improves both overall and recurrence-free survival for some patients, results from two European studies suggest.

However, in an editorial published in the Journal of the National Cancer Institute, Dr Robert Young of the Fox Chase cancer centre, Philadelphia, says that the trials do not address which patients can be spared unnecessary adjuvant chemotherapy and calls for further studies (2003;95:94).

In both trials, patients were randomly assigned to either adjuvant platinum-based chemotherapy or observation following surgery. The first — the adjuvant chemotherapy in ovarian neoplasm (ACTION) trial — also examined the impact of completeness of surgical staging on survival. Taking all 448 patients in the ACTION trial into account, adjuvant chemotherapy improved recurrence-free survival (76 per cent vs 68 per cent, hazard ratio 1.59, 95 per cent confidence interval 1.09–2.31, P=0.02) but not overall survival.

However, a sub-analysis revealed that adjuvant chemotherapy appeared only to benefit patients whose cancers were not optimally staged (ie, patients at greater risk of residual disease). "This finding suggests that adjuvant chemotherapy in early-stage ovarian cancer may work predominantly by affecting small-volume or microscopic tumour implants or metastases that remain unnoticed at the time of surgical staging," the researchers say (ibid, p113).

In the second trial, women who received adjuvant chemotherapy had a 9 per cent greater overall survival and an 11 per cent greater recurrence-free survival at five years than women who did not receive immediate adjuvant therapy (ibid, p125). A combined analysis of the two trials gave similar results.

Dr Young comments: "The combined results of the two trials ... would seem to be definitive proof of the benefit of platinum-based adjuvant chemotherapy for all patients with early-stage ovarian cancer. Unfortunately they are not."

He suggests that selecting only high-risk patients for additional treatment can narrow the use of chemotherapy. "This approach should be used until such a time as a randomised trial can demonstrate that good prognosis, early-stage patients benefit from such therapy," he concludes.