Gemcitabine salvage chemotherapy for patients with gynecologic malignancies of the ovary, fallopian tube, and peritoneum

The efficacy and toxicity of gemcitabine salvage chemotherapy was evaluated in 27 heavily pretreated patients with recurrent and progressive ovarian, fallopian tube, or peritoneal cancer. At least one platinum-based chemother apeutic regimen had failed in each patient. The median number of previous c hemotherapy regimens and cycles of chemotherapy was 4 and 23, respectively. A total of 124 cycles of gemcitabine were delivered (median, 3 cycles). He matologic toxicity included four patients with grade 3/4 thrombocytopenia a nd two patients with grade 3/4 neutropenia. Thrombocytopenia and neutropeni a resulted in eight dose reductions and a single 1-week treatment delay. No nhematologic side effects were well tolerated and largely self-limiting. No complete responses were observed. Three patients (11%) demonstrated partia l responses to therapy. The duration of response was 7 months for two of th e responders and 5 months for the third responder. Stable disease was obser ved in 14 patients (52%), in whom the median progression-free interval was 5 months. In conclusion, among heavily pretreated patients, gemcitabine has limited antitumor activity in platinum-resistant carcinomas of the ovary, fallopian tube, and peritoneum. The role of gemcitabine in the treatment of gynecologic malignancies of the ovary, fallopian tube, and peritoneum will be determined by studies that define the efficacy of multiagent regimens o f chemotherapy that include gemcitabine and by studies that include patient s who have been less heavily pretreated.