What are the chemotherapy recommendations for patients with ovarian cancer after suboptimal primary debulking?

Updated: Jan 14, 2019
  • Author: Shannon M Grabosch, MD; Chief Editor: from Memorial Sloan-Kettering - Yukio Sonoda, MD  more...
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Answer

Answer

Given the reduced penetrance of tumors by IP chemotherapy, women with suboptimally debulked disease should be treated with IV chemotherapy, as follows:

  • Paclitaxel 175 mg/m2 IV over 3 h plus  carboplatin AUC 7.5 IV over 1 h on day 1; every 21 d for six cycles, provided that the disease is responsive [13] or

  • Docetaxel 75 mg/m2 IV over 1 h plus  carboplatin AUC 5 IV over 1 h on day 1; every 21 d for six cycles, provided that the disease is responsive [8]

The addition of bevacizumab to front-line therapy is still controversial with benefits of around 4 months PFS but no improvement in OS. [17]  However, the addition could be considered particularly in women women with significant ascites.

Dose-dense chemotherapy is an alternative in women who have undergone optimal surgical debulking, but it appears to be of particular benefit in those with greater residual disease, [18]  although there may be a greater rate of toxicity resulting in treatment delay or discontinuation. Possible regimens include the following: 

  • Carboplatin AUC 6 IV on day 1  plus  paclitaxel 80 mg/m 2 IV on day 1, day 8, and day 15 of a 21-day cycle for six cycles [19, 20]   or
  • Carboplatin AUC 2 IV  and  paclitaxel 60 mg/m 2 IV on day 1, day 8, and day 15 of a 21-day cycle for six cycles, for those with poor performance status or other comorbidities limiting the capacity to tolerate standard dose-dense regimens [21]

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