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Low response rate of second-line chemotherapy for recurrent or refractory clear cell carcinoma of the ovary: a retrospective Japan Clear Cell Carcinoma Study
  1. M. Takano*,
  2. T. Sugiyama,
  3. N. Yaegashi,
  4. M. Sakuma,
  5. M. Suzuki§,
  6. Y. Saga§,
  7. K. Kuzuya,
  8. J. Kigawa,
  9. M. Shimada,
  10. H. Tsuda#,
  11. T. Moriya**,
  12. A. Yoshizaki,
  13. T. Kita* and
  14. Y. Kikuchi*
  1. * Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Saitama, Japan;
  2. Department of Obstetrics and Gynecology, Iwate Medical University, Morioka, Iwate, Japan;
  3. Department of Obstetrics and Gynecology, Tohoku University, Sendai, Miyagi, Japan;
  4. § Department of Obstetrics and Gynecology, Jichi Medical College, Kawachi-gun, Tochigi, Japan;
  5. Department of Gynecology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan;
  6. Department of Obstetrics and Gynecology, Tottori University, Yonago, Tottori, Japan;
  7. # Department of Pathology II, National Defense Medical College, Tokorozawa, Saitama, Japan; and
  8. ** Pathology Laboratory of Central Clinical Facilities, Tohoku University, Sendai, Miyagi, Japan
  1. Address correspondence and reprint requests to: Masashi Takano, MD, PhD, Department of Obstetrics and Gynecology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan. Email: mastkn{at}


Clear cell carcinoma (CCC) of the ovary has been recognized to show resistance to anticancer agents in the first-line chemotherapy. Our aim was to evaluate the effect of second-line chemotherapy in a retrospective study. A total of 75 patients diagnosed with CCC and treated between 1992 and 2002 in collaborating hospitals were reviewed. Criteria for the patients' enrollment were 1) diagnosis of pure-type CCC at the initial operation, 2) treatment after one systemic postoperative chemotherapy, 3) measurable recurrent or refractory tumor, 4) at least two cycles of second-line chemotherapy and assessable for the response, and 5) adequate clinical information. Regimens of first-line chemotherapy were conventional platinum-based therapy in 33 cases, paclitaxel plus platinum in 24 cases, irinotecan plus platinum in 9 cases, and irinotecan plus mitomycin C in 7 cases. Treatment-free periods were more than 6 months in 24 cases (group A) and less than 6 months in 51 cases (group B). In group A, response was observed in two cases (8%): one with conventional platinum therapy and another with irinotecan plus platinum. In group B, three cases (6%) responded: two with platinum plus etoposide and one case with irinotecan plus platinum. Median overall survival was 16 months in group A and 7 months in group B (P= 0.04). These findings suggest recurrent or resistant CCC is extremely chemoresistant, and there is only small benefit of long treatment-free period in CCC patients. Another strategy including molecular-targeting therapy is warranted for the treatment of recurrent or refractory CCC.

  • ovarian clear cell carcinoma
  • recurrent
  • refractory
  • second-line chemotherapy

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