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Chemotherapy Selection in Ovarian Cancer
There are multiple chemotherapy options for ovarian cancer and no diagnostic currently available to select from among these options. Virtually all ovarian cancer patients are treated with one of the cis- or carbo-platin and taxol combinations for 1st-line chemotherapy, as this treatment option has the highest efficacy rate (70%). However, 30% of ovarian cancers immediately fail to respond to this chemotherapy and must undergo a second round of chemotherapy with another chemotherapy agent.2 Of the 70% of patients who initially respond to the standard platin-taxol chemotherapy, 55% relapse within 6 months, most of whom are then placed on an alternative chemotherapy. 20% of the patients who do not respond well to platin-taxol do not survive long enough to receive a second line chemotherapy. Approximately 50% of 2nd-line chemotherapy recipients will survive to receive a 3rd-line option.
Ovarian cancer is the seventh most common cancer (25,580 diagnosed cases) and the fifth leading cause of cancer death (16,090 patients, 45%) among American women. An estimated 95% of patients eventually die from ovarian cancer; although, the 5-year survival rate for ovarian cancer has improved significantly in the last 20 years. The overall 5-year survival rate in 1975 was 37%, compared to nearly 50% in 1995.4 The standard of care for women with ovarian cancer includes definitive surgical staging and optimal tumor removal.5 This is why virtually all ovarian cancer patients receive post-surgical chemotherapy, regardless of disease stage at diagnosis.6
Aside from earlier diagnosis, the biggest factor in patient survival is optimal chemotherapy agent selection at the outset. Correct chemotherapy agent selection also limits the number of treatment rounds that a patient must endure, improving the patient's quality of life. The potentially avoidable rounds of platin-taxol therapy that are ineffective for 30% of patients also represent a $0.2-0.5B annual expenditure burden on the US healthcare system.
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2Garcia, A., Director Breast Cancer Program, Woman’s Cancer Research Institute, Cedars Sinai Medical Center, Ovarian Cancer (Dec. 27, 2004), http://www.emedicine.com/med/topic1698.htm.
4Garcia, A., Director Breast Cancer Program, Woman’s Cancer Research Institute, Cedars Sinai Medical Center, Ovarian Cancer (Dec. 27, 2004), http://www.emedicine.com/med/topic1698.htm.
5Podratz, K.C., Gynecologic Oncology: On the Eve of the New Millennium, Gynec. Oncol. 74, 157-162 (1999); Ovarian Cancer: Screening, Treatment, and Followup, NIH Consensus Statement. Volume 12 (3), 1-14 (1994).
6Munoz , K.A., Harlan, L.C., Trimble, E.L. Patterns of Care for Women With Ovarian Cancer in the United States, J. of Clinical Oncol. 15 (11) 3408-3415 (1997).
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