Background: It has been accepted for many years that patients with advanced ovarian cancer require a platinum compound, although there has been some controversy over whether or not other drugs need to be combined with platinum. Meta-analysis involving 1200 patients suggested a small but statistically significant survival advantage for combination platinum chemotherapy (Advanced Ovarian Cancer Trialist Group 1991) but in many countries, a combination based on cisplatin was considered the standard regimen. In order to avoid the toxicity of cisplatin many investigators utilised carboplatin instead because it is less emetogenic and causes less nephro-, oto- and neurotoxicity than the parent compound although it is more myelosuppressive (Rosenberg B 1985; du Bois A 1994). However, 2 nd -line treatment is strictly palliative and essentially non-curative. 2 nd -line treatment should combine both optimal tumour control and prolongation of survival. However, there is no consensus as to which is the most effective treatment for this advanced cancer disease.

Objective: (1) To assess the effect of different chemotherapy regiments used as treatment in patients with ovarian cancer failing first platinum-based front-line treatment. (2) Furthermore the relation between different outcome parameters (response rate, progression free interval, survival) will be investigated.

Methods: For this systematic review all available randomised controlled trials (RCTs) involving therapeutic interventions for the effectiveness of systemic non high dose 2 nd line chemotherapy for advanced human ovarian cancer failing platinum-based first-line chemotherapy will be analysed. The outcomes expected to be available in reports will include response to treatment, progression free survival, overall survival, duration of response and patient satisfaction. The search strategy implied will follow the Cochrane Collaborative Review Group search strategy and will include RCTs as derived from Medline, EMBASE and other electronic database searches.

Results: (preliminary) A manual search in the two largest international medical databases (MEDLINE and EMBASE), searching in selected conference proceedings and checking reference list has to be identified by the two reviewers. The systematic review is ongoing and the preliminary results will be presented at the 10th h Cochrane Collaboration Colloquium in Oslo, Norway in Juli/August 2002.

Conclusions: The results of the ongoing systematic review are expected to provide first evidence to inform clinicians and other decision-makers on the values of interventions for the effectiveness of systemic non high dose 2 nd line chemotherapy for advanced human ovarian cancer failing platinum-based first-line chemotherapy.

* Advanced Ovarian Cancer Trialist Group Chemotherapy in advanced ovarian cancer: an overview of randomized clinical trials. BMJ 1991, 303: 884 - 93 Rosenberg B. (1985) Fundamental studies with cisplatin. Anticancer Chemotherapy 55: 2303-231683du Bois A., Meerpohl H.G, Madjar H, Spinner D, Dall P, Pfisterer J, Bauknecht T (1994a) Phase II study of pirarubicin combined with cispalatin in recurrent ovarian cancer J Cancer Res Clin Oncol 120(3) 173-8