___________________________________________ ___________________________________________ HORMONAL THERAPY In general response rate to hormonal therapy is in the vicinity of 20%. Agent of Choice is a progestin ie medroxyprogesterone 200 mg po QD. It is the first line systemic therapy for grade-1 or receptor positive tumors. It can also be used as salvage therapy after chemotherapy failure. In general, in grade 1 tumors, hormonal therapy is equivalent to chemotherapy. However, in grade2 or 3 disease, chemotherapy seems to be superior to hormonal therapy. MEDROXYPROGESTERONE 100-200 mg PO, MEGESTROL ACETATE 160 mg PO, TAMOXIFEN 20 mg po qd --2nd line or salvage RR 0-13%. ___________________________________________ ___________________________________________ CHEMOTHERAPY (receptor negative or hormone refractory): ___________________________________________ Single Agents: Doxorubicin RR=27% Epirubicin RR=26% Cisplatin RR=29% Carboplatin RR=31% Taxol RR=36% ___________________________________________ ___________________________________________ COMBINATION CHEMOTHERAPY: DOXORUBICN + CISPLATIN (GOG-107) DOXORUBICIN 60 mg/m2 CISPLATIN 50 mg/m2 Q 3wks X 8 This regimen produced a higher RR, CR, & PFI than single agent DOX. (i.e. RR 45% vs 27%) but median survival was not improved (8.7% vs 9.2). ___________________________________________ PACLITAXEL & CISPLATIN + GCSF PACLITAXEL 175 mg/m(2) IV over a 3-h period, followed by CISPLATIN 75mg/m(2) IV, Followed with G-CSF. Repeat Q3 weeks for a maximum of six courses. REF: Gynecol Oncol 2000 Jul;78(1):52-7 16 patients (67%; 95% confidence interval, 45-84%) achieved OR, including 7 CRs and 9 PRs. The median duration of response was 7 months, and the median TTP & survival for all patients were 8.4 & 17.6 months, respectively. ___________________________________________ JMF-M REGIMEN: CARBOPLATIN (300 mg/m2), METHOTREXATE (30 mg/m2),& 5FU (500 mg/m2) Given on day 1, in a 3-weekly schedule, in combination with MEDROXYPROGESTERONE ACETATE (MPA) 300 mg PO QD., until progression REF: Oncology 1999 Apr;56(3):198-201. REPORT: OR 17/23 patients (74%, 95% confidence interval = 52-90%), with 2 long-lasting CRs (9%). The median response duration was 10+ months (3-45+). The median survival was 16+ months (2-45+). SIDE EFFECTS: Myelosuppression (less than 14% leukopenia, anemia and thrombocytopenia). The MPA-related side effects were: weight gain (22%), hypertension (17%) and thromboplebitis (17%). ___________________________________________ DOXORUBICIN + PACLITXEL GOG-163 results pending! DOXORUBICIN + CISPLATIN + PACLITXEL GOG-177 results pending! ___________________________________________ CARBOPLATIN+TAXOL Carboplatin AUC=5 to 7) Paclitaxel 175 mg/m2 for 3 hours Q 4-weeks: REF= JCO 19, Issue 20 (October), 2001: 4048-4053 N=60 group 1 (n = 21), primarily advanced, nonpapillary serous cancers; RR78% (95% CI, 51%-100%); group 2 (n = 20), the same as group 1 but with papillary serous cancers; RR60% (95% CI, 35%-85%), group 3 (n = 18), recurrent, nonpapillary serous cancers; RR 56% (95% CI, 34% to 78%) group 4 (n = 4), recurrent, papillary serous cancers;RR 50% Involved-field irradiation was used in groups 1 & 2 for those with radioencompassable disease. 19 patients (90%) in group 1 were irradiated, and the median failure-free survival time for all 21 patients was 23 months, with a 62% 3-year overall survival rate. 11 patients (55%) in group 2 were irradiated, & the median FFS for all 18 patients = 18 months, with a 39% 3-year OS. The median FFS in the patients in group 3 = 6 months, with a 15-month median OS. Toxicity was manageable, reversible, and predominantly hematologic. 2 patients developed neutropenic fever, & 3 patients, including these two, were hospitalized for complications. ___________________________________________
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