Earlier chemotherapy treatment shows no survival benefit or better quality of life for women with relapsed ovarian cancer

September 30, 2010

Contrary to popular belief, starting chemotherapy early does not improve survival or quality of life compared with postponing treatment until clinical symptoms of relapse are evident in women with ovarian cancer. These are the findings of the first randomised trial to investigate timing of treatment for relapsed ovarian cancer published in an Article in this week's Cancer Special Issue of The Lancet.

The level of the CA125 protein produced by ovarian cancer cells in the blood often increases several months before signs or symptoms of relapse appear in women with ovarian cancer. Current practices concerning whether or not regular CA125 tests are done and when to start second-line chemotherapy vary widely. Additionally, concerns about CA125 testing and the implications of positive results can cause patients considerable anxiety.

The Medical Research Council (MRC) OV05 and European Organisation for Research and Treatment of Cancer (EORTC) 55955 trials were established to compare the benefits of early treatment on the basis of rising CA125 levels versus delaying treatment until clinical or symptomatic relapse.

1442 women in complete remission with ovarian cancer were enrolled in the trial. Clinical examinations and a CA125 blood test were done every 3 months. If CA125 level increased to twice the upper limit of normal, patients were randomly assigned to early (treatment starting as soon as possible) or delayed (treatment starting when signs or symptoms of relapse were detected) chemotherapy. A total of 529 women were randomly assigned to treatment--265 to early and 264 to delayed.

After a median follow-up of 56•9 months, no difference in overall survival was shown between early and delayed treatment--370 women died, 186 in the early treatment group and 184 in the delayed group.

Median survival after randomisation was 25•7 months for patients having early treatment and 27•1 months for those having delayed treatment.

Additionally, quality of life deteriorated sooner in patients being treated earlier, with significant disadvantages for role, emotional, social, and fatigue associated with early treatment.

The authors say: "Women should be informed that there is no evidence of a benefit from early treatment on the basis of rising CA125 concentration, and no deterioration in quality of life by delaying chemotherapy. If CA125 concentration rises during follow-up, chemotherapy can be safely delayed until symptoms or signs of tumour recurrence develop."

They conclude: "For the first time women can be given evidence-based advice and can make informed choices about follow-up...The results of this trial suggest that they can opt to forgo routine CA125 monitoring if their disease is in complete remission after first-line treatment."

In a Comment, Robert Morris from Wayne State University in Detroit and Bradley Monk from Creighton University School of Medicine in Arizona, USA, say: "This clinical trial should be appreciated for its bold challenge to the assumption that early treatment of relapsed disease must be better than delayed treatment. Indeed, the article provides some evidence that early retreatment might be detrimental. Rustin and colleagues should be commended on this endeavour, which, like other provocative studies, begs more questions than it answers. From their study, principles that we have considered fundamental are deservedly brought into question."
-end-
Cathy Beveridge, Medical Research Council Senior Press Officer, London, UK. T) +44 (0)20 7670 5138 E) catherine.beveridge@headoffice.mrc.ac.uk

Dr Robert Morris, Wayne State University, Detroit, USA. T) +1 313 576 9435 E) rmorris@med.wayne.edu

For full Article and Comment see: http://press.thelancet.com/ovar.pdf

NOTE: THE ABOVE LINK IS FOR JOURNALISTS ONLY; IF YOU WISH TO PROVIDE A LINK TO THE FREE ABSTRACT OF THIS PAPER FOR YOUR READERS, PLEASE USE THE FOLLOWING, WHICH WILL GO LIVE AT THE TIME THE EMBARGO LIFTS: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61268-8/abstract

Lancet

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.