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Maurie Markman

Publications and source records attributed to Maurie Markman.

At least 73 records · Page 4Linked to original sources
PubMed2005

Intraperitoneal carboplatin-based chemotherapy for epithelial ovarian cancer.

OBJECTIVE: Intraperitoneal (IP) chemotherapy is an attractive approach to the treatment of ovarian cancer because the disease remains confined to the peritoneal cavity for a large part of its natural history. In this review article, we discuss the current status and future perspectives of IP chemotherapy for ovarian cancer. METHODS: A systematic review of IP carboplatin-based chemotherapy for ovarian cancer treatment was conducted through evaluation of published manuscripts as well as abstracts from the proceedings of the American Society of Clinical Oncology and the Society of Gynecologic Oncologists. RESULTS: Despite the fact that survival or progression-free survival benefit has been demonstrated by three large randomized trials (Survival Hazard Ratio for GOG104/SWOG 0.76, Relative Risk Reduction of Progression: 0.78 for GOG114, and 0.73 for GOG172), IP chemotherapy has not been accepted as a standard treatment. This appears to be mainly due to the cisplatin-related toxicity and IP catheter failure. Substituting cisplatin with carboplatin may make this approach more tolerable. Recent pharmacological data suggest that carboplatin-based IP chemotherapy not only exposes the peritoneal cavity to higher doses of the agent, but also attains levels of systemic platinum comparable to intravenous (IV) administration. A large retrospective study has demonstrated excellent survival for patients with advanced ovarian cancer who underwent carboplatin-based IP chemotherapy. Low observed toxicity as well as infrequent catheter-related complications was significant findings in this report. CONCLUSION: A large scale phase III randomized trial is now urgently needed to clarify the role of carboplatin-based IP chemotherapy in ovarian cancer.

Antineoplastic Agents↗
PubMed2005

Skin toxicity associated with pegylated liposomal doxorubicin (40 mg/m2) in the treatment of gynecologic cancers.

OBJECTIVES: To characterize the incidence of skin toxicity of pegylated liposomal doxorubicin (PLD) administered at a lower dose (40 mg/m(2)) in the treatment of advanced gynecologic malignancies. METHODS: Medical charts of all patients who initiated PLD at a starting dose of 40 mg/m(2) from 1997 to 2003 for the treatment of gynecologic cancers were retrospectively reviewed. PLD was infused over 1-2 h and administered every 4-6 weeks. No patient had previously received doxorubicin. All patients were clinically assessed for adverse reactions including skin toxicity. RESULTS: Ninety patients (mean age 62 years, range 45-82 years) were included in this analysis. There were 55 ovarian, 16 endometrial, 2 fallopian, and 17 primary peritoneal cancers. The median cumulative dose of PLD was 120 mg/m(2) (range 40-855 mg/m(2)) with a median of 3 cycles (range 1-25). 33/90 (37%) developed a skin reaction during therapy. The overall incidence of grade 1, 2, and 3 skin toxicity was 23 (26%), 9 (10%), and 1 (1%), respectively. Of the 23 cases of grade 1 toxicity, 16 (70%) occurred within 1-3 cycles. All 9 cases of grade 2 toxicity occurred within 1-3 cycles. The only case of grade 3 toxicity occurred after the first cycle. 28/30 (93%) patients who continued treatment did not experience further episodes of skin toxicity with subsequent cycles after a dose reduction (5-20 mg/m(2)). PLD was stopped in only 2/90 (2%) cases due to a skin reaction. CONCLUSIONS: Severe skin toxicity (> or =grade 2) associated with PLD occurs infrequently when initial doses of 40 mg/m(2) are administered. When skin reactions appear, they usually occur early in the course of treatment, respond to dose reduction, and do not appear to limit the duration of treatment.

Aged↗
PubMed2005

Treatment patterns by decade of life in elderly women (> or =70 years of age) with ovarian cancer.

OBJECTIVE: Elderly patients are less likely to receive surgery and platinum-based combination chemotherapy than younger patients. We evaluated multi-institutional management of ovarian cancer in the elderly. METHODS: Charts of women with ovarian, primary peritoneal or fallopian tube cancer from 1/1996-6/2004, age > or =70 years were reviewed. Age, stage, medical co-morbidities, surgery, chemotherapy, treatment modification, toxicity and survival were analyzed. Chi-square, logistic regression and survival analysis were used. RESULTS: Of 131 patients, 90 were ages 70-79 (group 1 = G1) and 41 were >80 years of age (group 2 = G2). Surgery was performed in 80 patients in G1; 25 patients in G2 (P = 0.001). Among patients who underwent surgery, optimal debulking and post-operative complications did not differ between groups. Ninety-five percent of patients received platinum-based therapy and 83% received combination platinum/paclitaxel in G1, compared to 90% and 41%, respectively, in G2 (P < 0.001). Of those receiving platinum therapy, 36% in G1 and 41% in G2 required dose reductions or termination of therapy. Forty percent of G1 and 50% of G2 required a delay of therapy; the majority occurring in patients receiving combination therapy. Hematological toxicity increased with use of combination therapy, but not with advancing age or Charlson score. Successful debulking surgery significantly impacted survival, and when controlling for this factor, age was not a significant variable. CONCLUSION: The extreme elderly had a decreased likelihood of receiving surgery and combination chemotherapy despite equivalent co-morbidities. In this analysis, optimal surgical cytoreduction had the greatest impact on survival.

Age Factors↗
PubMed2005

Supportive care.

Explore the source record for details and available documents.

Antiemetics↗
PubMed2005

Topotecan as second-line therapy for ovarian cancer: dosage versus toxicity.

In this issue of The Oncologist, Armstrong et al. present an analysis of the use of topotecan (Hycamtin; GlaxoSmithKline, Philadelphia, http://www.gsk.com) in the second-line treatment of both ovarian cancer and small cell carcinoma of the lung. This cytotoxic agent has clearly been demonstrated to be a useful drug in a population of patients with both of these conditions. However, the description of the nature of the toxicity, as stated in the manuscript, must be questioned along with comments made regarding the relative toxicity of alternative cytotoxic agents frequently used in similar settings. The purpose of this discussion absolutely is not to negate the unquestioned, demonstrated usefulness of topotecan as second-line therapy in ovarian cancer but rather to point out that the U.S. Food and Drug Administration-approved dose level of 1.5 mg/m(2) per day x 5 days can cause substantial and highly clinically relevant bone marrow toxicity. Whether this toxicity, which can result in a level of fatigue that may cause responding patients to discontinue treatment, should simply be labeled "excessive" rather than "cumulative" appears to be a matter of semantics rather than an important distinction. Whether delivery of a lower dose of topotecan (1 mg/m(2)-1.25 mg/m(2) per day x 5 days) will essentially eliminate concern for the development of severe clinically relevant marrow toxicity is uncertain, but the risk will certainly be substantially reduced.

Antineoplastic Agents↗
PubMed2005

Prolonged disease-free and treatment-free survival in platinum-resistant ovarian cancer following extended (>1 year) administration of single-agent paclitaxel: A case report and discussion of potential clinical implications.

BACKGROUND: The optimal duration of therapy for women with platinum-resistant ovarian cancer who respond to second-line treatment programs remains undefined. CASE REPORT: A patient with well-documented platinum-resistant ovarian cancer who responded to single-agent paclitaxel (175 mg/m2 over 3 hours q 28-35 days) was continued on this program for a total of 15 cycles delivered over a period of 16 months. The patient has subsequently remained without evidence of disease recurrence >7 years following discontinuation of this treatment regimen. CONCLUSION: The prolonged administration of paclitaxel, a highly cycle-specific cytotoxic agent, is a rational management option in patients with platinum-resistant ovarian cancer who exhibit evidence of a response to therapy and who do not experience excessive treatment-associated toxicity (e.g., grade 2-3 peripheral neuropathy).

Antineoplastic Agents↗
PubMed2004

A rationale for neoadjuvant systemic treatment followed by surgical assessment and intraperitoneal chemotherapy in patients presenting with non-surgically resectable ovarian or primary peritoneal cancers.

PURPOSE: Optimal management of patients with advanced ovarian or primary peritoneal cancers who have received, and achieved an excellent response to, neoadjuvant chemotherapy remains undefined. METHODS: Five patients are briefly presented who were found to have extensive intra-abdominal carcinomatosis from ovarian/peritoneal cancers and were initially treated with a carboplatin/paclitaxel-based neoadjuvant chemotherapy program. Following major objective and subjective responses each patient underwent a surgical re-assessment and subsequently received single-agent intraperitoneal platinum (cisplatin or carboplatin). RESULTS AND CONCLUSION: In the absence of definitive data from randomized phase-3 trials defining optimal management in this setting, a rational argument can be provided supporting the use of this multi-modality management strategy (neoadjuvant chemotherapy followed by surgery and regional chemotherapy) in carefully selected patients presenting with extensive ovarian or primary peritoneal cancers.

Aged↗
PubMed2004

Thrombocytopenia associated with second-line carboplatin-based chemotherapy for ovarian, fallopian tube, and primary peritoneal cavity cancers.

PURPOSE: There are limited data available in the oncology literature regarding the risk of thrombocytopenia associated with carboplatin-based second-line treatment of ovarian cancer, outside the setting of patients participating in clinical trials. METHODS: To examine this clinically-relevant issue, we conducted a retrospective review of the medical records of women with ovarian cancer treated in the Gynecologic Cancer Program of the Cleveland Clinic from 1994 through November 2003, who received >2 second-line carboplatin-based regimens. RESULTS: A total of 176 second-line carboplatin-based programs were delivered to the 152 patients (median age 61 years; range 39-87 years) identified through this review. A total of ten (7%) patients experienced >grade 2 thrombocytopenia, with only four (3%) patients developing platelet count nadirs <50.0 x 10(9)/l. No patient required discontinuation of platinum-based therapy due to the development of thrombocytopenia. CONCLUSION: Second-line carboplatin-based chemotherapy of ovarian cancer is associated with a low incidence of serious thrombocytopenia, if a strategy of selecting modest initial dose levels, and instituting rapid reductions in dose with the development of significant bone marrow suppression, is employed.

Adult↗
PubMed2004

Chemotherapeutic management of recurrent/metastatic uterine carcinosarcomas (malignant mixed mullerian tumors): time for a re-appraisal?

PURPOSE: Optimal chemotherapeutic management of recurrent/metastatic uterine carcinosarcomas remains undefined. Despite this fact, the selection of a cytotoxic anti-neoplastic drug regimen for an individual patient with this rare malignancy may substantially impact both short-term symptomatic improvement and overall quality-of-life, which includes the toxicity of therapy. PATIENTS AND METHODS: Two women with metastatic uterine carcinosarcomas recently treated at the Cleveland Clinic received therapy (carboplatin/paclitaxel) directly aimed at the "adenocarcinoma" component of their mixed endometrial cancers. RESULTS: Both patients achieved substantial short-term objective and subjective improvement in cancer-related signs and symptoms, while experiencing limited treatment-associated toxicities. CONCLUSION: This limited experience, and additional available data, suggest it is rational to initially treat patients with recurrent/metastatic uterine carcinosarcomas with anti-neoplastic drug strategies currently employed in the management of endometrial adenocarcinomas.

Aged↗
PubMed2004

Duration of response to second-line, platinum-based chemotherapy for ovarian cancer: implications for patient management and clinical trial design.

PURPOSE: Limited information is available regarding the influence of the duration of a prior response on the length of a subsequent response to platinum chemotherapy in recurrent ovarian cancer. PATIENTS AND METHODS: We retrospectively reviewed the medical records of women with ovarian cancer treated at the Cleveland Clinic from 1993 through April 2003 who received two or more platinum-based regimens for recurrence of the malignancy. Patients were considered to have responded to second-line therapy if they satisfied specific criteria, including favorable effects on both measurable or assessable disease. RESULTS: A total of 211 platinum-based regimens were administered to 176 women with recurrent ovarian cancer during this time period, with a response being observed in 125 treatment episodes (59%). Only four (3%) of 121 currently assessable secondary responses were of longer duration than the prior response in a specific individual. In three of these four cases, the platinum-based regimen used in the second-line approach included a drug that had not been used in that patient's primary chemotherapy program. CONCLUSION: The length of a prior response to platinum-based therapy in ovarian cancer is highly predictive of the upper limit of the duration of response to a subsequent platinum program, assuming the same or similar drugs are used. Knowledge of this clinical parameter may assist in developing optimal management for an individual patient and may potentially be exploited in clinical trial designs examining novel maintenance strategies with both cytotoxic and cytostatic agents in women who achieve a secondary response to a platinum-based regimen.

Adult↗
PubMed2004

Experience with platinum-based and high-dose chemotherapy in patients with gestational trophoblastic disease: possible implications for future management.

PURPOSE: Despite the similarities between the chemotherapeutic management of advanced gestational trophoblastic disease (GTD) and ovarian germ cell tumors, important differences exist between the malignancies, particularly in the use of cisplatin. METHODS: Three patients with persistent or recurrent GTD cared for at the Cleveland Clinic received a high-dose chemotherapy program (with stem cell support), one as management for etoposide-associated acute leukemia resulting from her "standard dose" treatment program. RESULTS: While the indications for use of a dose-intensive strategy, and the ultimate clinical course, differed in the three patients, collectively these cases raise relevant questions regarding optimal management of high risk and recurrent GTD. CONCLUSION: The experience represented in this report support the earlier use of cisplatin-based chemotherapy in the management of high-risk and recurrent GTD, and the possible administration of a high-dose chemotherapy program in the rare patient who recurs following "standard dose" platinum-based treatment.

Adult↗