Oral etoposide for the treatment of recurrent ovarian cancer.

Oral etoposide has been studied in numerous clinical trials for the treatment of recurrent ovarian cancer. In different studies there has been a varied response rate, and it appears that the activity of this drug is dependent to a large part on the extent of prior therapy. On the basis of data from more than 270 patients in 9 different studies, the overall response rate is 20.4%. However, in the largest study performed by the Gynecologic Oncology Group (GOG), in which 82 previously treated patients received oral etoposide, the response rate was 30.5%. The GOG study categorised patients who received oral etoposide according to their response to initial therapy: patients were deemed either platinum sensitive or platinum resistant. No patients had received more than one prior regimen at the time they were entered into the oral etoposide trial. In 41 platinum-resistant patients, the overall response rate was 26.8%, including a 7.3% clinical complete remission rate. In patients who were platinum sensitive, the overall response rate was 34.1%, with a 14.6% clinical complete remission rate. Toxicity was acceptable, with myelosuppression being the dose-limiting toxicity. This GOG study confirms the activity of oral etoposide as second-line therapy both for platinum-resistant and platinum-sensitive ovarian cancer patients. Additional studies are in progress to determine how oral etoposide can be combined with paclitaxel and a platinum compound for use as initial therapy for previously untreated patients with advanced disease.