The CancerWeb Report, What's New In Cancer: December, 1996
Ovarian Cancer

• Survival characteristics of ovarian cancer with germ-line mutations of BRCA1 - Between 5% and 10% of ovarian cancers show a pattern of family occurrence, and most of these involve mutations of the BRCA1 gene, which functions as a tumor suppressor. A report published in the November 7, 1996 issue of the New England Journal of Medicine by a group of researchers from across the US describes patients with BRCA1 mutations as having a more favorable outcome than those with the usual randomly-occurring disease. Of 53 patients with BRCA1 mutations, the 43 with advanced cancer (38 Stage III and 5 Stage IV) had a median survival of 77 months compared with 29 months for patients lacking such hereditary mutations who were matched by age, stage, and subtype of cancer. (Rubin, New Engl J Med 335:1413, 1996)

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• Topotecan is a useful new second-line drug for ovarian cancer - A study of 111 patients at cancer centers in 7 European countries, has concluded that the drug topotecan, given daily for 5 days by 30-minute infusions in 3-weekly cycles, is effective second-line treatment for Stage III or IV ovarian cancer. Second-line treatment is what is recommended for patients who do not respond to, or relapse after cessation of the initial treatment regimen. In an article in the December, 1996 issue of the Journal of Clinical Oncology, these researchers reported an overall response rate of 16.3% in patients who had failed to respond to initial chemotherapy. When broken down by category, response rates were 26.%, 17.8%, and 5.9% in cisplatin-sensitive (responded but relapsed more than 6 months after stopping therapy), cisplatin-resistant (responded but relapsed within 6 months of stopping therapy), and cisplatin-refractory (never responded) patients, respectively. Major side effects were low white blood cell counts, hair loss, and nausea/vomiting. (Creemers, J Clin Oncol 14:3056, 1996)

  Editor's Comment: - Ovarian cancer is the leading cause of gynecologic cancer death in the US. The overall 5-year survival rate is around 30%, ranging widely according to grade, and invasive disease is most often (60-75%) disseminated beyond the ovary when it is diagnosed. Although generally sensitive to chemotherapy, there is still great need for second-line drugs to treat the cancer when it becomes resistant to first-line chemotherapy, so the development of additional drugs is welcome. Topotecan is a drug whose range of usefulness is still being explored.