Therapeutic Strategies for Recurrent Ovarian Cancer
Therapeutic Strategies for Recurrent Ovarian Cancer
Advanced epithelial ovarian cancer, cancer of the fallopian tube and primary peritoneal cancer have a poor prognosis and a high rate of disease recurrence following primary therapy. Recurrent ovarian cancer is currently classified according to sensitivity to platinum-based chemotherapy. Data on targeted therapy provide evidence of improvement with systemic treatment in addition to chemotherapy. Other strategies, although not proven in randomized trials, offer interesting options for future research and therapeutic development. In this review, the covered treatment modalities include surgery, chemotherapy and targeted therapy, immunological approaches and irradiation.
Women with ovarian cancer are threatened by disease recurrence and progression and eventually symptom deterioration. Inclusive of all tumor stages, the majority of women with primary ovarian cancer will suffer a relapse. The therapeutic option in relapsed ovarian cancer is composed of surgery, chemotherapy and targeted therapy, the latter being regarded as the most important strategy for therapeutic improvement. This review will feature the progress made recently and will point out ongoing research in recurrent ovarian cancer therapy, covering epithelial ovarian cancer, cancer of the fallopian tube and primary peritoneal cancer.
Clinical criteria determine the prognosis and therapeutic pathways in relapsed ovarian cancer. The time interval of relapse after the end of first-line chemotherapy is used to classify the recurrent disease: platinum-sensitive ovarian cancer relapsing >6 months after the end of first-line chemotherapy (the platinum-sensitive group is further divided into ovarian cancer recurring >6 and ≤12 months after the end of first-line chemotherapy and those recurring >12 months after last platinum dose); platinum-resistant ovarian cancer relapsing within 6 months after the end of first-line chemotherapy; and finally, platinum-refractory disease demonstrating cancer persistence or progression during chemotherapy or within 4 weeks of last platinum dose (Figure 1). Molecular characterization of ovarian cancer has not yet been able to substitute for this clinical classification.In vitro chemosensitivity testing has not yet been proven to be a better prediction of clinical chemosensitivity. Carboplatin and paclitaxel is the standard chemotherapy for primary ovarian cancer. Recently, bevacizumab was shown to improve therapeutic outcome when added as a third agent to first-line chemotherapy and applied as maintenance therapy after end of chemotherapy. In recurrent ovarian cancer, the predominant role of platinum-based chemotherapy is considered differently according to the clinical classification mentioned previously. Similarly, the role of surgery and targeted therapy has to be determined in the perspective of the clinical classification.
(Enlarge Image)
Figure 1.
Clinical classification of recurrent ovarian cancer according to time since last application of first-line platinum-based chemotherapy.
Platinum-refractory disease includes patients with residual or progressing cancer after last platinum-based first-line chemotherapy. The INOVATYON[37] and Mito-8[38] trials investigated the role of artificially prolonging the platinum-free interval by imposing a nonplatinum-based chemotherapy in patients with recurrent ovarian cancer between 6 and 12 months after prior platinum-based chemotherapy.
Abstract and Introduction
Abstract
Advanced epithelial ovarian cancer, cancer of the fallopian tube and primary peritoneal cancer have a poor prognosis and a high rate of disease recurrence following primary therapy. Recurrent ovarian cancer is currently classified according to sensitivity to platinum-based chemotherapy. Data on targeted therapy provide evidence of improvement with systemic treatment in addition to chemotherapy. Other strategies, although not proven in randomized trials, offer interesting options for future research and therapeutic development. In this review, the covered treatment modalities include surgery, chemotherapy and targeted therapy, immunological approaches and irradiation.
Introduction
Women with ovarian cancer are threatened by disease recurrence and progression and eventually symptom deterioration. Inclusive of all tumor stages, the majority of women with primary ovarian cancer will suffer a relapse. The therapeutic option in relapsed ovarian cancer is composed of surgery, chemotherapy and targeted therapy, the latter being regarded as the most important strategy for therapeutic improvement. This review will feature the progress made recently and will point out ongoing research in recurrent ovarian cancer therapy, covering epithelial ovarian cancer, cancer of the fallopian tube and primary peritoneal cancer.
Clinical criteria determine the prognosis and therapeutic pathways in relapsed ovarian cancer. The time interval of relapse after the end of first-line chemotherapy is used to classify the recurrent disease: platinum-sensitive ovarian cancer relapsing >6 months after the end of first-line chemotherapy (the platinum-sensitive group is further divided into ovarian cancer recurring >6 and ≤12 months after the end of first-line chemotherapy and those recurring >12 months after last platinum dose); platinum-resistant ovarian cancer relapsing within 6 months after the end of first-line chemotherapy; and finally, platinum-refractory disease demonstrating cancer persistence or progression during chemotherapy or within 4 weeks of last platinum dose (Figure 1). Molecular characterization of ovarian cancer has not yet been able to substitute for this clinical classification.In vitro chemosensitivity testing has not yet been proven to be a better prediction of clinical chemosensitivity. Carboplatin and paclitaxel is the standard chemotherapy for primary ovarian cancer. Recently, bevacizumab was shown to improve therapeutic outcome when added as a third agent to first-line chemotherapy and applied as maintenance therapy after end of chemotherapy. In recurrent ovarian cancer, the predominant role of platinum-based chemotherapy is considered differently according to the clinical classification mentioned previously. Similarly, the role of surgery and targeted therapy has to be determined in the perspective of the clinical classification.
(Enlarge Image)
Figure 1.
Clinical classification of recurrent ovarian cancer according to time since last application of first-line platinum-based chemotherapy.
Platinum-refractory disease includes patients with residual or progressing cancer after last platinum-based first-line chemotherapy. The INOVATYON[37] and Mito-8[38] trials investigated the role of artificially prolonging the platinum-free interval by imposing a nonplatinum-based chemotherapy in patients with recurrent ovarian cancer between 6 and 12 months after prior platinum-based chemotherapy.
