Advanced epithelial ovarian cancer: 1998 consensus statements

Background: During an international workshop held in September 1998, a grou p of specialists in the field of ovarian cancer reached consensus on a numb er of issues with implications for standard practice and for research of ad vanced epithelial ovarian cancer. Methods: Five groups of experts considered several issues which included: b iologic factors, prognostic factors, surgery, initial chemotherapy, second- line treatment, the use of CA 125, investigational drugs, intra-peritoneal treatment and high-dose chemotherapy. The group attempted to arrive at answ ers to questions such as: Are there prognostic factors, which help to ident ify patients who will not do well with current therapy? What is the current best therapy for advanced ovarian carcinoma? What directions should resear ch take in advanced ovarian cancer? These issues were discussed in a plenar y meeting. Results: One of the major conclusions drawn by the consensus committee was that in previously untreated advanced ovarian cancer, cisplatin plus paclit axel has been shown to be superior to previous standard therapy with cispla tin plus cyclophosphamide (level I evidence). However, for many patients, c arboplatin plus paclitaxel is a reasonable alternative because of toxicity and convenience considerations. Most participants felt that the benefits in terms of toxicity for the paclitaxel-carboplatin are such that its widespr ead adoption at this stage is justified. Until mature survival data are ava ilable a minority of investigators would recommend continued use of cisplat in plus paclitaxel, specifically for those patients with advanced disease w ith the best prognostic characteristics. For future clinical research in this area, new end points for randomised cl inical trials, together with a new Trials Network, are proposed.