Principles of chemotherapy for ovarian cancer

  Most patients with epithelial carcinoma require postoperative chemotherapy. G1 patients with stage IA or IB after full-stage surgery can be followed up postoperatively with observation only, as these patients have a survival rate of more than 90% after surgery alone. For G2 patients with stage IA or IB, observation or 3-6 courses of combination chemotherapy with paclitaxel plus carboplatin may be given as an option. For patients with stage IA and IB G3, stage IC (G1-G3) and clear cell carcinoma, a combination of paclitaxel plus carboplatin for 3-6 courses of chemotherapy is usually given. All chemotherapy regimens may be considered for epithelial ovarian cancer, primary peritoneal cancer, and fallopian tube cancer. Intravenous chemotherapy is recommended for stage I patients. For stage III patients who undergo satisfactory cytoreductive surgery and have residual tumors ≤1 cm in maximum diameter, laparoscopic chemotherapy is recommended. Stage II patients can also receive intraperitoneal chemotherapy. For patients who are not suitable for intraperitoneal chemotherapy (e.g., patients with poor physical status scores), the preferred chemotherapy regimen is: paclitaxel combined with carboplatin intravenous chemotherapy. Docetaxel combined with intravenous carboplatin chemotherapy or paclitaxel combined with cisplatin may also be used as an alternative regimen. For patients prone to neurological side effects after chemotherapy (e.g. diabetic patients), docetaxel combined with carboplatin regimen can be considered for chemotherapy. Six to eight courses of chemotherapy are recommended for advanced cases (stage II-IV), and three to six courses of chemotherapy are recommended for early cases.  The overall chemotherapy principles need to be followed as follows: 1. If the patient requires chemotherapy, the patient needs to be informed that there are several chemotherapy modalities available, including intravenous chemotherapy, intravenous combined with intraperitoneal chemotherapy, and other chemotherapy regimens in clinical trials (including different doses and dosing regimens).  2. Before starting chemotherapy, ensure that the patient’s general status and organ function can tolerate chemotherapy. Patients undergoing chemotherapy should be closely observed and followed up, and various complications arising during chemotherapy should be dealt with in a timely manner. Monitor the patient’s blood routine and biochemical indexes during chemotherapy. The chemotherapy regimen and dose need to be adjusted according to the toxic reactions and treatment goals that occur during chemotherapy.  3.For those who choose to combine intravenous and intraperitoneal chemotherapy, it is necessary to inform patients that the incidence and/or severity of toxic reactions such as myelosuppression, nephrotoxicity, abdominal pain, neurotoxicity, gastrointestinal toxicity, metabolic system toxicity and hepatotoxicity will be more pronounced in combination chemotherapy compared with intravenous chemotherapy alone.  4, Patients who choose cisplatin intraperitoneal chemotherapy and paclitaxel intraperitoneal chemotherapy/intravenous chemotherapy must have normal renal function, good tolerance for subsequent toxicity of the intraperitoneal/intravenous chemotherapy regimen, and must not have medical conditions that would significantly worsen during chemotherapy (e.g., pre-existing neuropathy).  5. All chemotherapeutic drugs can cause adverse drug reactions, even fatal ones, and physicians must have a detailed understanding of the clinical manifestations of chemotherapeutic drug reactions and be familiar with the management of chemotherapeutic reactions. Reactions may occur during or after the completion of drug infusion. Chemotherapeutic drugs that often cause adverse reactions include carboplatin, cisplatin, docetaxel, liposomal doxorubicin, oxaliplatin, and paclitaxel. Most drug reactions are mild infusion reactions (skin reactions, cardiovascular reactions, breathing or throat urgency), but more severe allergic reactions (e.g., life-threatening anaphylaxis) may also occur. Infusion reactions in patients commonly occur with paclitaxel, but mild reactions can also occur with liposomal doxorubicin. Allergic reactions are common with the use of platinum-based drugs (carboplatin, cisplatin or oxaliplatin).  6, Patients must be hydrated before and after each course of cisplatin to reduce nephrotoxicity by adequate intravenous rehydration. After each course of chemotherapy, patients must be carefully examined to clarify the presence of myelosuppression, dehydration, electrolyte disturbances, vital organ toxic reactions (e.g., liver and kidney) and other toxic reactions.  7. At the end of chemotherapy, assessment of treatment effects, follow-up treatment and the possibility of long-term complications is required.