CASE REPORT Thinking twice before abandoning first-line chemotherapy in ovarian cancer: report of two cases and literature review. Passing from tri-weekly to weekly regimens Claudia Marchetti • Filippo Bellati • Angela Musella • Chiara Napoletano • Giorgia Perniola • Violante Di Donato • Sandro Pignata • Marianna Nuti • Pierluigi Benedetti Panici Received: 10 May 2011 / Accepted: 20 July 2011 / Published online: 3 September 2011 Ó Japan Society of Clinical Oncology 2011 Abstract We present two cases of advanced ovarian cancer treated with neoadjuvant chemotherapy with stan- dard tri-weekly carboplatin and paclitaxel. Therapy was converted to weekly regimens because of disease pro- gression, resulting in disease response. Weekly regimens could overcome drug resistance and this strategy should be attempted before abandoning first-line chemotherapy in favor of palliation. Keywords Weekly paclitaxel Á Carboplatin Á Ovarian cancer Introduction Ovarian cancers are the second most common gynecolog- ical malignancies worldwide, with 21,880 estimated new cases and 13,850 estimated deaths in the United States in 2010 [1]. Primary cytoreduction followed by six cycles of carbo- platin (AUC = 6) and paclitaxel (175 mg/m 2 ) adminis- tered every 3 weeks represent the gold standard first-line treatment [2]. Procrastinating surgery after three cycles of neoadjuvant chemotherapy yields similar results [3]. Although the vast majority of patients responds to tra- ditional first-line treatment, a minority of women will suffer from disease progression. This condition is generally considered rapidly fatal and patients are switched to pal- liative second-line treatment with a median survival of 13–20% [4]. Recently, some authors have observed a superior effi- cacy of weekly regimens with paclitaxel compared to tra- ditional first-line tri-weekly administration [5]. Some authors have suggested a pivotal role of the immune system in tumorogenesis, response to treatment [6, 7] and prognosis in ovarian cancer [8]. We present two cases of advanced ovarian cancer refractory to tri-weekly carboplatin and paclitaxel but who responded to the weekly regimen. We also describe the immunological changes observed during treatment. Case report Case 1 A 63-year-old woman was referred to our Department complaining of pelvic pain and abdominal distension. Gynecological examination, blood examination, ultrasound and computed tomography (CT) scans revealed bilateral adnexal masses over 9 cm in size bilaterally, ascites and peritoneal carcinosis. CA125 was 343 U/ml. At diagnostic laparoscopy [9] a poorly differentiated serous advanced ovarian cancer (stage IIIC according FIGO and TNM) was diagnosed, with no evidence of bulky pelvic [10] or para- aortic lymph nodes at palpation. The patient was judged unable to achieve optimal residual disease at upfront C. Marchetti Á F. Bellati (&) Á A. Musella Á G. Perniola Á V. Di Donato Á P. B. Panici Department of Gynecology and Obstetrics, ‘‘Sapienza’’ University of Rome, Viale del Policlinico 155, 00161 Rome, Italy e-mail: filippo.bellati@uniroma1.it F. Bellati Á C. Napoletano Á M. Nuti Department of Experimental Medicine, ‘‘Sapienza’’ University of Rome, Rome, Italy S. Pignata Medical Oncology, National Cancer Institute, Naples, Italy 123 Int J Clin Oncol (2012) 17:385–389 DOI 10.1007/s10147-011-0300-9