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Endocrine aspects of ovarian cancer have been remarkably neglected in comparison with the huge research effort directed at the treatment of this condition with chemotherapy. The presence in ovarian cancer cells of receptors for oestrogen and progesterone (Holt et al., 1979; Rowland et al., 1985; Sutton et al., 1986), and for androgens (Hamilton et al., 1981), combined with the ability of these cells to synthesise steroid hormones (Heinonen et al., 1982; Backstrom et al., 1983), suggests that hormonal manoeuvres may be useful in the treatment of this condition. Objective responses to anti-oestrogen therapy have been observed in advanced ovarian cancer by a number of workers (Myers et al., 1981; Schwartz et al., 1982; Pagel et al., 1983; Campbell et al., 1984; Hamerlynck et al., 1985). However, the true value of this form of treatment remains unclear, since several studies have shown apparently negligible activity (Rowland et al., 1985; Shirey et al., 1985; Slevin et al., 1986). Heterogeneity of the patient population, especially with respect to factors such as performance status, oestrogen and progestogen receptor status and drug absorption (secondary to gastrointestinal dysfunction), may explain the varying response rates observed, which range from 0% (Rowland et al., 1985; Shirey et al., 1985; Slevin et al., 1986) to 28% (Pagel et al., 1983). In breast cancer response to tamoxifen often requires many weeks of treatment. This has been partially attributed to the pharmacokinetic behaviour of tamoxifen since plateau concentrations of the drug may only be achieved after several weeks of treatment with the standard oral regime of 10-20mgbd (Wilkinson et al., 1982). In advanced ovarian cancer treated with tamoxifen progression of disease has commonly occurred early (within 3 months) (Slevin et al., 1986). Although the concentration of tamoxifen required for therapeutic effect is unknown it is tempting to speculate that in some patients progression has occurred before adequate drug levels are achieved. In order to overcome this possibility, and thus permit a more adequate evaluation of the activity of tamoxifen we have treated patients with advanced ovarian cancer with a schedule of tamoxifen including a loading dose in an attempt to achieve therapeutic drug levels promptly. Such a regimen has been shown to produce stable plasma levels of tamoxifen in patients with breast cancer within 24h (Wilkinson et al., 1982). Fifty-three patients with stage III or IV ovarian cancer who had failed to respond, or who had relapsed following cytotoxic chemotherapy, were studied. All patients had histologically proven diagnosis of ovarian carcinoma, and all had measurable disease. Patients had an estimated life expectancy of at least 3 months. No patient had evidence of bowel obstruction. Patient characteristics are shown in Table I. Tamoxifen was given as a loading dose of lOOmgm-2 in 4 divided doses over 24h, followed by a maintenance dose of

Tamoxifen in refractory ovarian cancer: the use of a loading dose schedule