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Protocol Development for Ovarian Cancer Treatment in Kenya: A Brief Report
  1. Lynn Sterling, MD*,
  2. Luc van Lonkhuijzen, MD†,
  3. Job Nyangena, MD‡,
  4. Elkanah Orango, MD‡,§,
  5. Matthew Strother, MD‡∥,
  6. Nafthali Busakhala, MD‡,§ and
  7. Barry Rosen, MD, FRCSC†
  1. * University of Toronto Medical School, Ontario, Canada;
  2. † Division of Gynecology-Oncology, University of Toronto, Ontario, Canada;
  3. ‡ Moi University School of Medicine, Eldoret, Kenya;
  4. § Moi Teaching and Referral Hospital, Eldoret, Kenya; and
  5. ∥ Indiana University School of Medicine, Indianapolis, IN.
  1. Address correspondence and reprint requests to Luc van Lonkhuijzen, MD, Division of Gynecology-Oncology, University of Toronto, 610 University Ave M-700, Toronto, Ontario, Canada M5G 2M9. E-mail: Luc{at}vanLonkhuijzen.com.

Abstract

Introduction: Ovarian cancer is a leading cause of cancer death for Kenyan women. Most women are diagnosed with an advanced stage of disease. The current North American standard of care includes surgery followed by carboplatin and paclitaxel. Neither drug is available for Kenyan women. We performed a literature search investigating chemotherapy in low-resource countries with the aim to write an evidence-based chemotherapy protocol for women diagnosed with ovarian cancer in Eldoret, Kenya, at the Moi Teaching and Referral Hospital.

Methods: We systematically searched PubMed and EMBASE for articles describing chemotherapy treatment outcomes of ovarian epithelial cancer in low-resource settings. After data analysis, a secondary review was undertaken on randomized controlled trials (RCTs) aligning with chemotherapy availability in Kenya.

Results: We identified 1184 articles. Fourteen met our criteria: ovarian epithelial cancer, low resource, chemotherapy use, and survival or response data. No publications were RCTs or had a cohort larger than 100 patients. There was no consistency in drug choice between studies. After this search, we reviewed commonly quoted and relevant RCTs and meta-analyses conducted on ovarian cancer since the 1980s. Although RCTs in the developed world suggest carboplatin and taxol provide optimal survival benefit, these drugs are unavailable in Kenya. Cyclophosphamide and cisplatin provide the next most optimal survival benefit, with acceptable and manageable toxicity. Because these drugs are more available and affordable in Kenya, we have developed a protocol recommending their use, which has been accepted by the Moi Teaching and Referral Hospital.

Conclusions: Currently, there is a paucity of published RCTs that may guide treatment in low-resource settings. One considerable barrier to establishing and evaluating chemotherapy protocols in low-resource settings may be the cost of chemotherapy drugs. There needs to be an international movement to make cancer chemotherapeutics available at lower prices in low-resource settings.

  • Chemotherapy
  • Developing countries
  • Guideline
  • Ovarian carcinoma
  • Review

https://doi.org/10.1097/IGC.0b013e3182060316

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