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Tamoxifen for biochemical-recurrent ovarian cancer

lindaprocopio's picture
lindaprocopio
Posts: 2022
Joined: Oct 2008

new research that came out this month:

"Tamoxifen may be a reasonable treatment alternative for patients with biochemical-recurrent ovarian cancer," concluded Dr. Jean Hurteau and his coinvestigators from the Gynecologic Oncology Group (GOG). But he cautioned that the findings need to be validated in other randomized trials.

Tamoxifen plays an important role in the treatment of hormone-driven breast cancer, but evidence for its use in recurrent ovarian cancer is lacking, according to a recent Cochrane Review article in which the authors found no randomized trials on which to base recommendations (Cochrane Database Syst. Rev. 2010 [doi:10.1002/14651858.CD001034.pub2]).
Dr. Hurteau of the NorthShore University Health System in Chicago presented the results of GOG Study 198 at the annual meeting of the Society of Gynecologic Oncologists. The rationale for the trial was that the comparative effectiveness of tamoxifen (a hormonal therapy) and thalidomide (an antiangiogenesis agent) was not known in recurrent ovarian cancer.

All participants had biochemical-recurrent ovarian cancer (defined as a rise in CA 125 of at least twice the upper limit of normal with no evidence of disease by RECIST [Response Evaluation Criteria in Solid Tumors] 1.0 criteria). The investigators reported on 68 women who were randomized to receive a minimum of 200 mg oral thalidomide once daily (with a weekly dose escalation of 100 mg to a maximum of 400 mg), and 70 women randomized to receive 20 mg oral tamoxifen twice daily.

The study group included women with FIGO stage III or IV confirmed epithelial ovarian, tubal, or primary peritoneal cancer who had completed first-line chemotherapy and whose CA 125 had normalized. The average age of the patients was 64 years, and 67% had grade III tumors, Dr. Hurteau said. The women were assessed for toxicity every 4 weeks, and for disease progression every 12 weeks, until either disease progression or death.

Women who received thalidomide had a 31% increased risk of disease progression (hazard ratio, 1.31), compared with those who were given tamoxifen. Median progression-free survival was 3.2 months in the thalidomide group vs. 4.5 months in the tamoxifen group.

In terms of overall survival, women in the thalidomide group had a 76% increased risk of death (HR, 1.76) after 48 months, compared with those who took tamoxifen.

In addition, women in the thalidomide group experienced more grade III/IV toxicity, compared with the tamoxifen group (55% vs. 3%, respectively). Venous thromboembolism occurred in 6% of the thalidomide group and 1.4% of the tamoxifen group.

Serum vascular endothelial growth factor (VEGF) levels were not significantly correlated with either progression-free survival or overall survival.

"The reason for the findings is uncertain," Dr. Hurteau said.
Dr. Hurteau said he had no financial conflicts to disclose.

azgrandma's picture
azgrandma
Posts: 576
Joined: Feb 2010

thanks for posting this

BonnieR's picture
BonnieR
Posts: 1549
Joined: Jan 2004

Hey Linda ... thanks for sharing. Hugs Bonnie

Barbara53's picture
Barbara53
Posts: 659
Joined: Aug 2009

Hi Linda,
My mother is considered chemo resistant, and was put on tamoxifen last Sept, after surgery and first line chemo. It seems to have worked very well for her. Until the last couple of months, her CA125 stayed below 50, and she says has had no side effects. She hasn't noticed that she's grown a downy little beard, and I'm not telling.

After taking her case to consult last month, Mom's onc doubled her tamoxifen "because it seems to be working for you." Last year, I did a lot of research on this using my daughter's student number to access a medical school library. The broad stroke I came away with is that OVCA typically responds to tamoxifen for 4 to 11 months. Mom went 7 months before she started having new symptoms and a rise in her CA125.

kayandok
Posts: 1223
Joined: Jun 2008

Thanks for sharing this, Linda. I am hoping to take a break from chemo soon, and since I am estrogen positive was considering tamoxifen or femara. It seems that it is a toss up, but one of my docs in Seattle says he has seen more success with the tamoxifen for OvCa. I love the line at the end of this abstract, "reason for findings is uncertain". I hate to think it is all just a crap shoot, but sometimes the negative side of me wonders.

kathleen:)

lindaprocopio's picture
lindaprocopio
Posts: 2022
Joined: Oct 2008

Yeah, it's a little disconcerting that they don't really know why these hormone-repressors sometimes work and sometimes don't. My own cancer is PR-negative and 'moderately' PR-positive (whatever THAT means!) and megace and tamoxifen were both still discussed for me, so I went into high-research mode. I registered as a gyne-onc at OncologySTAT (HA!) and get the latest info that way! (I'm not proud of the deception, but we do what we have to.) I have a rare grade 3 recurrent endometrial cancer, and here's what I found for myself that may also be worth considering for OVC:

Patients in a second trial were treated with continuous tamoxifen plus alternating weekly cycles of medroxyprogesterone acetate (Megace: a progesterone receptor). The response rate was 33%,with a median progression-free interval of 3 months. Although these response rates are higher than those reported for progestins alone, the progression-free intervals and overall survival rates are similar. A correlative study to this second trial explored the relationship between hormone receptor status and response to the combination of tamoxifen and megestrol. Interestingly, response rates were high even in patients with estrogen- and progesterone-negative tumors (a response rate of 26% for estrogen-negative tumors and 32% for progesterone-negative tumors). The toxicities, which principally were weight gain and thromboembolic events, were tolerable with both regimens of tamoxifen plus progestin.

Right now my gyne-onc wants to save megace/tamoxifen for a time when I am seeing disease progression and my bone marroow isn't strong enough to get chemo.

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