Survival Improves in Advanced Ovarian Cancer: SEER Study

SAN FRANCISCO—Five-year survival was significantly better for women with advanced-stage ovarian cancer diagnosed from 1988 to 1994 than for those diagnosed from 1983 to 1987, according to research presented at the 30th Annual Meeting of the Society of Gynecologic Oncologists. This improvement is thought to be due to increased use of surgical debulking and adjuvant platinum/paclitaxel (Taxol).

Edward L. Trimble, MD, and his associates from the National Cancer Institute (NCI) reported data from the NCI’s Surveillance, Epidemiology and End Results (SEER) database, which tracks cancer incidence and mortality for 14% of the US population.

The researchers examined data on 2,194 women diagnosed with ovarian cancer from1983 to 1987, and 2,082 women diagnosed from1988 to 1994. Dr. Trimble’s group compared 5-year relative survival between these two time periods for each FIGO stage using the z statistic.

Paclitaxel was approved by the FDA in 1992, and surgical staging was recommended by the NIH Consensus Panel of Ovarian Cancer in 1994. The positive effect of cisplatin (Platinol)/paclitaxel-based chemotherapy on survival in advanced ovarian cancer had been previously demonstrated in a phase III trial conducted by the Gynecologic Oncology Group.

The researchers found significantly improved 5-year survival for women with FIGO stages I, III, and IV ovarian cancer (see Table), which they believe reflects “more widespread acceptance of recommendations for surgical and chemotherapeutic interventions in ovarian cancer.”

In an interview, Dr. Trimble said that the researchers were surprised at the benefit observed in women with stage I disease, since a benefit for adjuvant chemotherapy in this group of patients has not been fully established.

“The fact that we are seeing improved survival in stage I suggests that there may be a benefit in adjuvant chemotherapy or that we may be staging patients more effectively, so that those classified as stage I actually are only those with early disease,” he said.

Surgery ‘Critically Important’

Dr. Trimble emphasized that the most important implication of the study is that it is possible to improve ovarian cancer survival by taking advantage of two relatively recent developments: recognition that surgery is “critically important” in controlling this disease and that paclitaxel can contribute to better outcomes. “If we combine effective debulking with chemotherapy based on platinum and paclitaxel, we can improve the prognosis for women with ovarian cancer,” he said.

There are European data suggesting that interval cytoreduction surgery can also improve survival, he added. “We need to explore that further, particularly in patients such as older women with comorbid conditions who may not be able to tolerate debulking surgery when they are first diagnosed,” he said. “Neoadjuvant chemotherapy followed by interval debulking is a reasonable option for patients who are very sick when they are first diagnosed.”

Dr. Trimble said that further research is also needed on intraperitoneal chemotherapy and on the best use of new drugs such as topotecan (Hycamtin) and gemcitabine (Gemzar).