Use of tamoxifen in asymptomatic patients with recurrent small-volume ovarian cancer.

OBJECTIVES: Tamoxifen, a well-tolerated oral hormonal agent with biological activity in ovarian cancer, is a potentially attractive option in asymptomatic patients with recurrent disease. Unfortunately, the clinical utility of the drug in this specific setting has not been well documented. PATIENTS AND METHODS: A retrospective review was conducted of patients with cancers of the ovary, fallopian tube, and primary cancer of the peritoneum at the Cleveland Clinic who experienced recurrence of the malignancy, in the absence of large volume disease (by physical exam and radiographic evaluation) or any cancer-related symptoms, and who received tamoxifen (20 mg [most patients] or 40 mg/day) before re-initiation of cytotoxic chemotherapy.
RESULTS: Fifty-six patients (45 after primary chemotherapy; 12 after second-line treatment) satisfied the criteria noted above. The median duration of treatment was 3 months (range 1-30 months), with 42% and 19% of patients remaining on tamoxifen for >/=6 and >/=12 months, respectively. Reasons for discontinuation were equally divided between three causes: (a) continued rise in CA-125 antigen level without symptoms or other objective signs of cancer; (b) evidence of progressive disease by physical exam or radiographic evaluation in the absence of symptoms; and (c) development of cancer-related symptoms.
CONCLUSION: In the absence of data from a randomized controlled trial which defines optimal management of the asymptomatic ovarian cancer patient with documented recurrent disease, tamoxifen is a rational management option, although it remains unknown if the delay in subsequent administration of chemotherapy in some individuals for periods greater than 6-12 months results from a direct effect of this agent or simply reflects the natural history of disease in a subset of patients in this clinical setting.