Adjuvant chemotherapy

Carboplatin + Paclitaxel
Carboplatin (Paraplatin) AUC 5-7.5 iv over 1 hr d1
Paclitaxel (Taxol) 175 mg/m2 iv over 3 hrs d1
Q3w x 6 cycles

Ozols, RF et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 2003; 21:3194 (link to the article).

Du Bois, A et al. A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. J Natl Cancer Inst 2003; 95:1320 (link to the article).

Neijt, JP et al. Exploratory phase III study of paclitaxel and cisplatin versus paclitaxel and carboplatin in advanced ovarian cancer. J Clin Oncol 2000; 18:3084 (link to the article).

Carboplatin + Paclitaxel qw
Carboplatin (Paraplatin) AUC 6 iv d1
Paclitaxel (Taxol) 80 mg/m2 iv d1, 8, 15
Q3w x 6-9 cycles

Isonishi S et al. Randomized phase III trial of conventional paclitaxel and carboplatin (c-TC) versus dose dense weekly paclitaxel and carboplatin (dd-TC) in women with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer: Japanese Gynecologic Oncology. 2008 ASCO annual meeting. Abstract 5506 (link to the abstract). 

Cisplatin + Paclitaxel
Cisplatin (CDDP) 75 mg/m2 iv over 30 min d1
Paclitaxel (Taxol) 135-175 mg/m2 iv over 3 hrs d1
Q3w x 6 cycles

Ozols, RF et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 2003; 21:3194 (link to the article).

Du Bois, A et al. A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. J Natl Cancer Inst 2003; 95:1320 (link to the article).

Neijt, JP et al. Exploratory phase III study of paclitaxel and cisplatin versus paclitaxel and carboplatin in advanced ovarian cancer. J Clin Oncol 2000; 18:3084 (link to the article).

Paclitaxel IV + Cisplatin IP + Paclitaxel IP
Paclitaxel (Taxol) 135 mg/m2 iv over 24 hrs d1
Cisplatin (CDDP) 100 mg/m2 in 2 L normal saline ip d2
Paclitaxel (Taxol) 60 mg/m2 in 2 L normal saline ip d8
Q3w x 6 cycles

Armstrong DK et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Eng J Med 2006; 354:34 (link to the article).

Maintenance chemotherapy (back to top)

Paclitaxel
Paclitaxel (Taxol) 135 mg/m2 iv
Q4w x 12 cycles

Markman, M et al. Phase III randomized trial of 12 versus 3 months of maintenance paclitaxel in patients with advanced ovarian cancer after complete response to platinum and paclitaxel-based chemotherapy: a Southwest Oncology Group and Gynecologic Oncology Group trial. J Clin Oncol 2003; 21:2460 (link to the article).

Chemotherapy for recurrent or metastatic cancer (back to top)

Etoposide 
Etoposide (VP-16) 50-60 mg/m2 po qd x 3wks every 4 wks

Rose, PG et al. Prolonged oral etoposide as second-line therapy for platinum-resistant and platinum-sensitive ovarian carcinoma: a Gynecologic Oncology Group study. J Clin Oncol 1998; 16:405 (link to the article).

Pegylated liposomal doxorubicin
Pegylated liposomal doxorubicin (Doxil) 40-50 mg/m2 iv over 1 h q4w

Ferrandina G et al. Phase III trial of gemcitabine compared with pegylated liposomal doxorubicin in progressive or recurrent ovarian cancer. J Clin Oncol 2008; 26:890 (link to the article). 

Mutch DG et al. Randomized phase III trial of gemcitabine compared with pegylated liposomal doxorubicin in patients with platinum-resistant ovarian cancer. J Clin Oncol 2007; 25:2811 (link to the article). 

Gordon, AN et al. Phase II study of liposomal doxorubicin in platinum- and paclitaxel-refractory epithelial ovarian cancer. J Clin Oncol 2000; 18:3093 (link to the article).

Topotecan iv
Topotecan (Hycamtin)
Regimen 1
1-1.5 mg/m2/d iv over 30 min d1-5 q3w

Gronlund, B et al. Efficacy of low-dose topotecan in second-line treatment for patients with epithelial ovarian carcinoma. Cancer 2002; 95:1656 (link to the article).

Bookman, MA et al. Topotecan for the treatment of advanced epithelial ovarian cancer: an open-label phase II study in patients treated after prior chemotherapy that contained cisplatin or carboplatin and paclitaxel. J Clin Oncol 1998; 16:3345 (link to the article).

Regimen 2
3.75-4 mg/m2 iv over 30 min d1, 8, 15 q4w

Abushahin F et al. Weekly topotecan for recurrent platinum resistant ovarian cancer. Gyn Oncol 2008; 108:53 (link to the article). 

Safra T et al. Efficacy and toxicity of weekly topotecan in recurrent epithelial ovarian and primary peritoneal cancer. Gyn Oncol 2007; 105:205 (link to the article). 

Levy T et al. Phase II study of weekly topotecan in patients with recurrent or persistent epithelial ovarian cancer. Gyn Oncol 2004; 95:686 (link to the article). 

Topotecan po
Topotecan (Hycamtin)
2.3 mg/m2/d po d1-5 q3w

Clarke-Pearson, DL et al. Oral topotecan as single-agent second-line chemotherapy in patients with advanced ovarian cancer. J Clin Oncol 2001; 19:3967 (link to the article).

Gemcitabine
Gemcitabine (Gemzar) 800-1000 mg/m2 iv over 1 h qw x 3 wks every 4 wks

Approved by FDA on 7/14/2006 

Ferrandina G et al. Phase III trial of gemcitabine compared with pegylated liposomal doxorubicin in progressive or recurrent ovarian cancer. J Clin Oncol 2008; 26:890 (link to the article).

Mutch DG et al. Randomized phase III trial of gemcitabine compared with pegylated liposomal doxorubicin in patients with platinum-resistant ovarian cancer. J Clin Oncol 2007; 25:2811 (link to the article).

Markman, M et al. Phase 2 trial of single-agent gemcitabine in platinum-paclitaxel refractory ovarian cancer. Gynecol Oncol 2003; 90:593 (link to the article).

Vinorelbine
Vinorelbine(Navelbine) 30 mg/m2 iv bolus d1 and 8
Q3w

Sorensen, P et al. Phase II study of vinorelbine in the treatment of platinum-resistant ovarian carcinoma. Gynecol Oncol 2001; 81:58 (link to the article).

Ifosfamide
Ifosfamide 1-1.2 gram/m2/d iv d1-5
Q4w
 
Markman, M et al. Ifosfamide and mesna in previously treated advanced epithelial ovarian cancer: activity in platinum-resistant disease. J Clin Oncol 1992; 10:243 (link to the article).

5-FU + LV
Leucovorin 200 mg/m2/d iv bolus followed by 5-FU 370 mg/m2/d iv bolus d1-5
Q4w

Look, KY et al. A phase II trial of 5-fluorouracil and high-dose leucovorin in recurrent epithelial ovarian carcinoma. A Gynecologic Oncology Group Study. Am J Clin Oncol 1995; 18:19 (link to the article).

Carboplatin + Paclitaxel
Carboplatin (Paraplatin) AUC 5-6 iv d1
Paclitaxel (Taxol) 175 mg/m2 iv over 3 hrs d1
Q3w

The ICON and AGO collaborators. Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet 2003; 361:2099 (link to the article). 

Cisplatin + Paclitaxel
Cisplatin (CDDP) 50 mg/m2  iv d1
Paclitaxel (Taxol) 175 mg/m2 iv over 3 hrs d1
Q3w

The ICON and AGO collaborators. Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet 2003; 361:2099 (link to the article).

Carboplatin + Gemcitabine
Carboplatin (Paraplatin) AUC 4 iv d1
Gemcitabine (Gemzar) 1000 mg/m2 iv d1 and 8
Q3w x 6 cycles

Pfisterer J et al. Combination chemotherapy with gemcitabine and carboplatin in recurrent ovarian cancer. Int J Gynecol Cancer 2005; 15:36 (link to the article).

Gemcitabine + Pegylated liposomal doxorubicin alternating with Cisplatin + Cyclophosphamide
Gemcitabine (Gemzar) 800 mg/m2 iv d1, 8
Pegylated liposomal doxorubicin (Doxil) 30 mg/m2 iv d1
Alternating with
Cisplatin (CDDP) 60 mg/m2 iv d1
Cyclophosphamide (Cytoxan) 600 mg/m2 iv d1
Q3w x 8 cycles

Pectasides D et al. Gemcitabine and pegylated liposomal doxorubicin alternating with cisplatin plus cyclophosphamide in platinum refractory/resistant, paclitaxel-pretreated, ovarian carcinoma. Gyn Oncol 2008; 108:47 (link to the article).    

Bevacizumab
Bevacizumab (Avastin) 15 mg/kg iv q3w until progression

Burger RA et al. Phase II trial of bevacizumab in persistent or recurrent epithelial ovarian cancer or primary peritoneal cancer: a Gynecologic Oncology Group study. J Clin Oncol 2007; 25:5165 (link to the article).

Cannistra SA et al. Phase II study of bevacizumab in patients with platinum-resistant ovarian cancer or peritoneal serous cancer. J Clin Oncol 2007; 25:5180 (link to the article). 

Cyclophosphamide + Bevacizumab
Cyclophosphamide (Cytoxan) 50 mg po qd
Bevacizumab (Avastin) 10 mg/kg iv qw x 3 followed by q2w
Continue until disease progression or limiting toxicity

Garcia AA et al. Phase II clinical trial of bevacizumab and low-dose metronomic oral cyclophosphamide in recurrent ovarian cancer: a trial of the California, Chicago, and Princess Margaret Hospital phase II consortia. J Clin Oncol 2008; 26:76 (link to the article). 

Tamoxifen
Tamoxifen 20 mg po bid

Kristensen G et al. Chemotherapy versus hormonal treatment in patients with platinum and taxane resistant ovarian cancer: a NSGO study. 2008 ASCO annual meeting. Abstract 5508 (link to the abstract).  

Ahlgren JD et al. Hormonal palliation of chemoresistant ovarian cancer: three consecutive phase II trials of the Mid-Atlantic Oncology Program. J Clin Oncol 2003; 11:1957 (link to the article).

Markman M et al. Tamoxifen in platinum-refractory ovarian cancer: a Gynecologic Oncol0gy Group Ancillary Report. Gynecol Oncol 1996; 62:4 (link to the article).

Hatch KD et al. Responsiveness of patients with advanced ovarian carcinoma to tamoxifen. A Gynecologic Oncology Group study of second-line therapy in 105 patients. Cancer 1991; 68:269 (link to the article).