Prolonged disease-free survival by maintenance chemotherapy among patientswith recurrent platinum-sensitive ovarian cancer

Objective. The aim of this study was to determine the potential benefit and complications of prolonged salvage and maintenance chemotherapy among pati ents with recurrent epithelial ovarian cancer who achieve response to salva ge chemotherapy. Methods. Patients with recurrent platinum-sensitive epithelial ovarian canc er who were treated between 1982 and 1996 and achieved complete response to platinum-based salvage chemotherapy were offered prolonged (1 year) monthl y salvage followed by maintenance (every 8 weeks) chemotherapy. Patients wh o accepted such treatment (n = 16) were compared to those who refused and d iscontinued therapy (n = 11) with regard to overall survival from time of i nitial diagnosis and overall and disease-free survival from time of recurre nce. Chemotherapy-related toxicity in the study group was recorded. Surviva l curves were constructed according to the Kaplan and Meier method and surv ival curves were compared using the log-rank test. Results. Patients in the study and control groups were similar with regard to age, stage, histology, grade, performance status, primary cytoreductive surgery, type of primary and salvage chemotherapy, and method of assessment of tumor response. The study group had a significantly longer disease-free interval from date of recurrence than the control group (median: 35.0 vers us 6.0 months, respectively, P = 0.001). The study group had longer overall survival from date of recurrence than the control group. However, the diff erence did not achieve statistical significance (median: 119 versus 90 mont hs, respectively, P = 0.056). There was no significant difference between t he study group and the control group as to survival from date of initial di agnosis (median: 157 versus 124 months, respectively, P = 0.28). Chemothera py-related toxicity was minimal. Conclusions. Prolonged salvage and maintenance chemotherapy is a safe metho d of treatment that may extend disease-free interval among patients with pl atinum-sensitive recurrent epithelial ovarian cancer who achieve response t o salvage chemotherapy. These preliminary results need to be confirmed by a larger prospective randomized trial. (C) 1998 Academic Press.