[Second-Line Therapy of Ovarian Carcinoma]

Despite the high response rate of ovarian cancer patients, 70% of them will relapse and have to be considered as candidates for second-line treatment. If the relapse is diagnosed within the first year after initial standard treatment with paclitaxel/carboplatinum, the tumor has to be classified as platinum-resistant disease with an expected response rate to second-line treatment between 10 and 20% and a median survival time of about 12 months. The following drugs are used for second-line treatment: topotecan, gemcitabine, liposomal doxorubicine, vinorelbine, docetaxel, oral VP 16, oral treosulfane or hormones like tamoxifen, medroxyprogesteroneacetate, and GnRH analogues. Is the tumor relapse diagnosed later, re-treatment with the same first-line therapy achieves a response rate between 25 and 60%. If the tumor relapses again, only then second-line treatment as mentioned above will be given. If possible, radical surgical excision of the tumor is an additional useful treatment option. In addition to second-line treatment, palliation with analgesic drugs, puncture of pleural effusion or ascites with interferon instillation, palliative surgery of mechanical ileus, psycho-oncologic support, and substitution of tumor cachexia are of importance. Copyright 2000 S. Karger GmbH, Freiburg