Strategies to Improve Treatment - Recurrent Ovarian Cancer

This content has been reviewed and approved by

Maurie Markman, MD
Vice President, Clinical Research
MD Anderson Cancer Center
University of Texas

The following are all new treatment strategies for treatment of ovarian cancer. Clinical trials are currently underway to evaluate these strategies alone or in combination. Given the poor outcomes of treatment for ovarian cancer, the greatest benefit to patients wishing to pursue aggressive or potentially curative treatments may be participation in clinical studies that combine more than one of the following treatment strategies.

Phase I Trials: New chemotherapy drugs continue to be developed and evaluated in patients with recurrent cancers in phase I clinical trials. The purpose of phase I trials is to evaluate new drugs in order to determine the best method for administering the drug and whether the drug has any anti-cancer activity in patients.

Monoclonal Antibodies: Monoclonal antibodies can be produced in a laboratory and are able to identify specific proteins on the surface of certain cells and bind to them. This binding action stimulates the immune system to attack and kill the cells to which the monoclonal antibody is bound.

Higher-Dose Chemotherapy: Since conventional-dose chemotherapy appears to cure some women with ovarian cancer and since more chemotherapy kills more cancer cells, the delivery of very high doses of chemotherapy may be able to destroy enough cancer to improve a patient's chance of cure.

Dose-Dense Treatment: Rapid administration of several different single chemotherapy compounds at the maximum tolerated dose allows higher doses of chemotherapy to be delivered and may prevent cancer cells from developing chemotherapy resistance. Dose-dense treatment approaches are being evaluated in clinical trials.

High-Dose Chemotherapy and Autologous Stem Cell Transplant: Chemotherapy targets and kills rapidly dividing cells such as cancer cells. High-dose chemotherapy (HDC) kills more cancer cells than lower-dose conventional chemotherapy. Unfortunately, HDC also kills more normal cells, especially the blood-producing stem cells in the bone marrow.

Stem cells are immature cells produced in the bone marrow, which is the spongy material inside bones. Stem cells eventually become either red blood cells, which provide oxygen to tissues, white blood cells, which fight infection; or platelets, which aid in blood clotting.

HDC destroys cancer as well as bone marrow stem cells. When bone marrow is destroyed, stem cell stores are depleted, which leads to low levels of circulating blood cells. When these cells reach critically low levels, complications such as anemia, infection and bleeding can occur. As these complications could result in death, it is imperative to restore stem cell levels as quickly as possible.

Stem cell transplantation is an attempt to restore the blood-producing stem cells after HDC has reduced them to dangerously low levels. In autologous stem cell transplantation, the patient’s own stem cells are collected before chemotherapy treatment, frozen, and infused back into the patient after treatment to “rescue” the bone marrow.

Biological Response Modifiers: Biological response modifiers are naturally occurring or synthesized substances that direct, facilitate or enhance the body's normal immune defenses and are being evaluated as intraperitoneal therapy. Biologic response modifiers include interferons, interleukins, vaccines, and monoclonal antibodies. In an attempt to improve survival rates, these and other agents are being tested alone or in combination with chemotherapy in clinical trials.

Proleukin Therapy: Proleukin is a biological modifier that has been used extensively to treat others cancers. Recently, phase I studies in women with ovarian cancer whose disease progressed following Platinol-based chemotherapy have established a dose and schedule of Proleukin that can be administered intraperitoneally (into the abdominal cavity).

Tamoxifen: Tamoxifen is a hormonal agent that blocks some of the actions of the female hormone estrogen. Some patients who are resistant to Platinol will experience cancer shrinkage with tamoxifen. The advantage of tamoxifen is that it is taken by mouth and has minimal side effects.

Combined Approaches: Combining one or more new strategies may offer the greatest hope for patients. For example, a patient could receive dose-dense induction chemotherapy, followed by interval debulking and high-dose chemotherapy and autologous stem cell transplant, which together should produce the highest chance of achieving a complete remission. Patients in remission could then receive additional treatment with anti-cancer agents, such as maintenance chemotherapy.