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Advanced ovarian cancer. Dose intensity
R F Ozols1, J T Thigpen, J Dauplat
1Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA.
Summary
High-dose chemotherapy, particularly platinum-based, shows potential for refractory cancer patients but lacks consistent survival benefits in randomized trials. Future research should target specific patient groups with sensitive tumors and minimal disease volume.
Area of Science:
- Oncology
- Clinical Pharmacology
- Cancer Therapeutics
Background:
- Dose intensity rationale stems from preclinical models and retrospective studies linking higher doses to improved outcomes.
- Investigating dose intensity's impact on cancer treatment response and survival is crucial.
Purpose of the Study:
- To review clinical trials comparing different dose intensities of platinum agents (cisplatin, carboplatin) and combination therapies.
- To evaluate high-dose chemotherapy regimens requiring hematologic support.
Main Methods:
- Systematic review of trials comparing varying dose intensities of cisplatin and carboplatin.
- Analysis of studies involving platinum combinations and high-dose chemotherapy with hematologic support.
Main Results:
- Early trials suggested a dose-response relationship for platinum, but randomized trials have not consistently confirmed significant benefits of high-dose therapy.
- High response rates are achievable in refractory patients with high-dose therapy and support, albeit with substantial toxicity.
- Paclitaxel dose intensity is an area of ongoing investigation.
Conclusions:
- Future dose intensity trials should prioritize patients with minimal disease burden and tumors sensitive to chemotherapy.
- Optimizing patient selection is key to demonstrating the efficacy of high-dose chemotherapy.