2nd-line-Chemotherapie nach Platin- oder Platin-Paclitaxel-haltiger Primärtherapie beim Ovarialkarzinom: eine systematische Übersicht der publizierten Daten bis 1998

A. du Bois; H. J. Lück; T. Bauknecht

doi:10.1055/s-2000-9764

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Geburtshilfe Frauenheilkd 2000; 60(1): 41-58
DOI: 10.1055/s-2000-9764

ORIGINALARBEIT

Georg Thieme Verlag Stuttgart · New York

2nd-line-Chemotherapie nach Platin- oder Platin-Paclitaxel-haltiger Primärtherapie beim Ovarialkarzinom: eine systematische Übersicht der publizierten Daten bis 1998

Second-line Chemotherapie after Platinum or Platinum and Paclitaxel-based Chemotherapy for Ovarian Cancer: A Systematic ReviewA. du Bois¹ , H. J. Lück² , T. Bauknecht³

¹ Klinik für Gynäkologie und gynäkologische Onkologie, Dr. Horst-Schmidt-Kliniken, Wiesbaden
² Frauenklinik im Oststadtkrankenhaus, Medizinische Hochschule Hannover
³ Universitäts-Frauenklinik Bonn
⁴ Universitäts-Frauenklinik Kiel
⁵ Frauenklinik, ev. Krankenhaus Düsseldorf

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Publication Date:
31 December 2000 (online)

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Zusammenfassung

Trotz der in den letzten Jahrzehnten erreichten Fortschritte in der Primärbehandlung des fortgeschrittenen Ovarialkarzinoms erleidet die Mehrzahl der Patientinnen ein Rezidiv der Erkrankung. Die Entwicklung effektiver Rezidivtherapien ist klinisch relevant.

Diese Übersichtsarbeit re-analysiert die bis inklusive 1998 publizierten Daten zur systemischen Chemotherapie (366 Studien mit 13 584 Patientinnen). Hierbei werden die Patientinnenkollektive je nach der Art der Vortherapie (mit oder ohne Platin bzw. Paclitaxel) und dem Ansprechen auf die Vortherapie getrennt analysiert. Bei Letzterem werden Patientinnen mit platinsensiblem Ovarialkarzinom (d. h. Ansprechen auf eine platinhaltige Primärtherapie und Intervall bis zum Auftreten eines Rezidivs von mehr als 6 Monaten) und Patientinnen mit einem platinrefraktären Ovarialkarzinom (d. h. kein Ansprechen auf eine platinhaltige Primärtherapie oder Rezidiv innerhalb von 6 Monaten nach Abschluß der Primärtherapie) getrennt analysiert.

Beim platinsensiblen Ovarialkarzinom werden die besten Ergebnisse mit einer platinhaltigen Re-Induktionstherapie berichtet. Beim platinrefraktären Ovarialkarzinom unterscheiden sich die Ergebnisse verschiedener Chemotherapien nur unwesentlich, eine erneute Platintherapie erscheint wenig sinnvoll. Die Datenlage zu einer 2nd-line-Therapie nach Platin und Paclitaxel, dem aktuellen Standard in der Primärbehandlung ist ungenügend. Lediglich für Topotecan wurde bisher eine (begrenzte) Aktivität in ausreichend großen Studien bewiesen. Leider liegen nur unzureichende Daten aus prospektiv randomisierten Studien vor. Die bisher ungenügenden Therapieergebnisse und der offensichtliche Mangel an validen Daten sollte dazu führen, die 2nd-line-Therapien systematischer im Rahmen kooperativer klinischer Studien zu untersuchen. Die hier vorliegende retrospektive Analyse kann sowohl Hinweise für die Planung zukünftiger Studien geben, als auch helfen, Therapieentscheidung auf dem Boden der zur Verfügung stehenden Daten zu treffen.

Abstract

Purpose: Despite progress in the primary treatment of advanced ovarian cancer, most patients will still develop recurrent disease. We reviewed published studies on systemic second-line chemotherapy for patients with recurrent ovarian cancer.

Material and Methods: We systematically reviewed 366 studies including 13 584 patients published until 1998. Patients were divided into subgroups according to prior treatment (with or without platinum or paclitaxel) and response to prior treatment. Platinum-sensitive disease was defined as responce to platinum and progression-free survival of at least 6 months. Platinum-resistant disease was defined as no responce to platinum or a progression-free interval of less than 6 months after completion of primary treatment.

Results: Patients with platinum-sensitive disease did best after platinum-based reinduction therapy. For platinum-resistant disease there were no differences in response rates among the various published regimens; renewed platinum-based treatment was not effective. There are few data on second-line treatment for patients who have received platinum and paclitaxel. Only topotecan has been shown to have limited activity in adequately large studies. Few data are based on randomized trials.

Conclusions: Disappointing clinical results and a lack of valid data indicate a need for randomized clinical trials. Our data provide a basis for clinicians treating patients with recurrent ovarian cancer and suggest approaches for designing prospective trials.

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PD Dr. med. Andreas du Bois

Klinik für Gynäkologie und gynäkologische Onkologie

Dr.-Horst-Schmidt-Kliniken

Ludwig-Erhard-Straße 100

65199 Wiesbaden

Phone: Tel. 06 11/43 32 03

Fax: Fax 06 11/43 32 05

Email: E-mail: dubois.hsk-wiesbaden@uumail.de