Second-line chemotherapy in recurrent clear cell ovarian cancer: Results from the Multicenter Italian Trials in Ovarian cancer (MITO-9)

Francesca Esposito, Sabrina Chiara Cecere, Francescapaola Magazzino, Dionyssios Katsaros, Alessandro Ottaiano, Angiolo Gadducci, Carmela Pisano, Simona Scalone, Emanuela Rabaiotti, Vanda Salutari, Gennaro Cormio, Emilie Marion Canuto, Stefano Greggi, Antonella Savarese, Marco Marinaccio, Paolo Scollo, Davide Adriano Santeufemia, Cosimo Sacco, Gaetano Facchini, Sandro Pignata

Research output: Contribution to journalArticlepeer-review


Background and Aims: Ovarian clear cell carcinoma (CCC) has a poorer prognosis than other subtypes of ovarian cancer. In this study, we evaluated the responsiveness to second-line chemotherapy in recurrent ovarian CCC. Methods: The MITO-9 project investigated a cohort of patients observed between 1991 and 2007 in 20 centers. We identified 72 out of 240 patients with recurrent disease (28% stage I-II and 72% stage III-IV at diagnosis). Results: In 56% of patients, the clear cell histology was pure. Twenty-five patients were platinum-resistant, 18 were platinum-sensitive with a platinum-free interval (PFI) of 6-12 months, and 29 had a PFI >12 months. Upon recurrence, 47% of patients were treated with platinum chemotherapy according to the PFI. The overall response rate (RR) to platinum was 80%, with 55, 100, and 80% RR in patients with PFI of 6-12, >12, and >24 months. The RR to nonplatinum agents in resistant patients was 33%. Among the nonplatinum agents used in primary and secondary resistant cases, gemcitabine, administered in 12 cases, had a higher activity (RR = 66%) compared to topotecan or liposomal doxorubicin (n = 31; RR = 33 and 10%, respectively). Conclusions: This study showed that the treatment of recurrent ovarian CCC should be based on the PFI as in the other subtypes. Data in platinum-resistant patients suggest gemcitabine as the drug with the highest activity. We recommend that gemcitabine be studied prospectively in a phase 2 trial.

Original languageEnglish
Pages (from-to)351-358
Number of pages8
Issue number5-6
Publication statusPublished - 2014


  • Clear cell
  • Gemcitabine
  • Ovarian carcinoma
  • Second-line chemotherapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology


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