High-dose chemotherapy and autologous hematopoietic stem cell transplantation in the treatment of ovarian cancer

Abstract

Ovarian cancer accounted leading mortality in gynecologic cancer, about 80% of patients having platinum-based response. Current conventional therapy with carboplatin and paclitaxel has the response rate of about 75%. Due to Neurotoxicity and thrombocytopenia, the efforts to further doses of paclitaxel are still controversial. The dose intensity with the use in peritoneal cavity was increased 20-fold. In case of relapse and drug resistance, Platinum based high-dose chemotherapy showed an improvement in median overall survival. The protocol of 6 first cycles of cisplatin and cyclophosphamide with usual dose, and then followed by high-dose cisplatin, carboplatin, etoposide had the complete cure rate of 42%. The second approach with uses right of high-dose chemotherapies with stem cell support also showed encouraging results. With the hematological advances in hematopoietic support, including the development of the Colony Stimulating Factors (CSFs) and transplantation of peripheral blood stem cells allows for increasing doses of chemotherapy higher than doses in the conventional treatment. The study of high-dose chemotherapy with carboplatin and paclitaxel is supported by transplanted hematopoietic stem cells and cytokines in patients with recurrent ovarian cancer, or in late stage showed a significant improvement for the rate of response to treatment, up to 89% (SWOG 9106), while the average overall survival (OS) was 18 months and the overalsurvival at 60 months was 14%.