Intensive cisplatin/oral etoposide for epithelial ovarian cancer: the Cambridge Gynae-Oncology Centre experience: too toxic for relapse?

Intensive cisplatin and oral etoposide for relapsed epithelial ovarian cancer (EOC), commonly known as the van der Burg (VDB) protocol, has been reported to improve response rates and progression-free survival. We report on all patients with relapsed EOC treated on the VDB protocol at the Cambridge Gynae-Oncology Centre. From the institutional databases, we identified all patients treated since 2001. We extracted demographic, clinical, treatment, and toxicity data and outcomes. We used Cox regression to identify predictors of survival. A total of 35 patients were treated on the VDB protocol. Toxicity was significant, with grade 3/4 fatigue, nausea and vomiting affecting 46, 46 and 29% of patients, respectively. Six patients had grade 3/4 infection and four (11%) deaths occurred on treatment. Efficacy was encouraging, with a radiological response rate of 43%, a median progression-free survival of 5.8 months and a median overall survival of 14.1 months. No significant difference in efficacy was seen between platinum-resistant and sensitive patients. We report significant activity of the VDB protocol in a routine clinical setting. However, the high rates of serious toxicity and treatment-related deaths among patients treated with palliative intent proved unacceptable. The Cambridge Gynae-Oncology Centre no longer uses this regimen in women with relapsed EOC.

A study to evaluate the use of CA125 in ovarian cancer follow-up: A change in practice led by patient preference.

OBJECTIVES: To evaluate the use of CA125 in the follow-up of women with epithelial ovarian cancer in the Cambridge Gynaecologic Oncology Centre. To institute changes depending on patients' preferences. METHODS: A patient questionnaire was developed on follow-up, CA125 estimation and patient education in epithelial ovarian cancer and CA125. Initially, 100 patients were evaluated, and a change in practice was instituted. This was re-evaluated using the same patient population. RESULTS: 22/22 patients in clinic, and 68/78 patients who received the questionnaire by post, completed and returned it (n = 90). 81% wanted CA125 results available at clinic follow-up visits, with 82% willing to have the blood test done at their GP surgery before attending outpatients. CA125 follow-up practice was changed accordingly. This change was re-evaluated. A second questionnaire was sent to 35 surviving patients from the first cohort. 31/35 (90%) responses were received. Five patients were either no longer on follow-up, being > or =5 years from completing their original treatment or were being monitored elsewhere, leaving an 87% response rate (26/30). 92.3% felt that having CA125 results available in clinic had enhanced the quality of their follow-up. Patient education and basic understanding of CA125 also improved, with 88.5% aware of its role. CONCLUSIONS: The availability of CA125 results when patients attend for routine follow-up has improved their overall management in our clinics. It has reduced patient and physician anxiety and unsatisfactory out-of-clinic telephone communication. We recommend this change of practice to all Gynaecologic Oncology Centres engaged in active routine follow-up of their patients with epithelial ovarian cancer.