Low response rate of second-line chemotherapy for recurrent or refractory clear cell carcinoma of the ovary: a retrospective Japan Clear Cell Carcinoma Study

• Published in: International journal of gynecological cancer Vol. 18; no. 5; pp. 937 - 942
• Main Authors: Takano, M, Sugiyama, T, Yaegashi, N, Sakuma, M, Suzuki, M, Saga, Y, Kuzuya, K, Kigawa, J, Shimada, M, Tsuda, H, Moriya, T, Yoshizaki, A, Kita, T, Kikuchi, Y
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.09.2008
• Subjects: Adenocarcinoma, Clear Cell - drug therapy; Adenocarcinoma, Clear Cell - epidemiology; Adenocarcinoma, Clear Cell - pathology; Adult; Aged; Antineoplastic Agents - therapeutic use; Cancer; Chemotherapy; Female; Humans; Japan - epidemiology; Middle Aged; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - pathology; Ovarian cancer; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - epidemiology; Ovarian Neoplasms - pathology; Ovaries; Retrospective Studies; Salvage Therapy; Survival Rate; Time Factors; Japan
• ISSN: 1048-891X; 1525-1438
• DOI: 10.1111/j.1525-1438.2007.01158.x

Clear cell carcinoma (CCC) of the ovary has been recognized to show resistance to anticancer agents in the first-line chemotherapy. Our aim was to evaluate the effect of second-line chemotherapy in a retrospective study. A total of 75 patients diagnosed with CCC and treated between 1992 and 2002 in collaborating hospitals were reviewed. Criteria for the patients' enrollment were 1) diagnosis of pure-type CCC at the initial operation, 2) treatment after one systemic postoperative chemotherapy, 3) measurable recurrent or refractory tumor, 4) at least two cycles of second-line chemotherapy and assessable for the response, and 5) adequate clinical information. Regimens of first-line chemotherapy were conventional platinum-based therapy in 33 cases, paclitaxel plus platinum in 24 cases, irinotecan plus platinum in 9 cases, and irinotecan plus mitomycin C in 7 cases. Treatment-free periods were more than 6 months in 24 cases (group A) and less than 6 months in 51 cases (group B). In group A, response was observed in two cases (8%): one with conventional platinum therapy and another with irinotecan plus platinum. In group B, three cases (6%) responded: two with platinum plus etoposide and one case with irinotecan plus platinum. Median overall survival was 16 months in group A and 7 months in group B (P = 0.04). These findings suggest recurrent or resistant CCC is extremely chemoresistant, and there is only small benefit of long treatment-free period in CCC patients. Another strategy including molecular-targeting therapy is warranted for the treatment of recurrent or refractory CCC.