Second-line chemotherapie after platinum or platinum and paclitaxel-based chemotherapy for ovarian cancer:: A systematic review

Purpose: Despite progress in the primary treatment of advanced ovarian cancer, most patients will still develop recurrent disease. We reviewed published studies on systemic second-line chemotherapy for patients with recurrent ovarian cancer. Material and Methods: We systematically reviewed 366 studies including 13 584 patients published until 1998. Patients were divided into subgroups according to prior treatment (with or without platinum or paclitaxel) and response to prior treatment. Platinum-sensitive disease was defined as responce to platinum and progression-free survival of at least 6 months. Platinum-resistant disease was defined as no responce to platinum or a progression-free interval of less than 6 months after completion of primary treatment. Results: Patients with platinum-sensitive disease did best after platinum-based reinduction therapy. For platinum-resistant disease there were no differences in response rates among the various published regimens; renewed platinum-based treatment was not effective. There are few data on second-line treatment for patients who have received platinum and paclitaxel. Only topotecan has been shown to have limited activity in adequately large studies. Few data are based on randomized trials. Conclusions: Disappointing clinical results and a lack of valid data indicate a need for randomized clinical trials. Our data provide a basis-for clinicians treating patients with recurrent ovarian cancer and suggest approaches for designing prospective trials.