Recurrent or Persistent Ovarian Epithelial Cancer Treatment
Median survival for patients randomly assigned to early treatment (n = 265) was 25.7 months compared with 27.1 months for those patients in the delayed-treatment group (n = 264) (HR, 0.98; 95% CI, 0.8–1.2). The median delay in instituting second-line chemotherapy was 4.8 months, and the median delay in instituting third-line chemotherapy was 4.6 months. Treatments for second-line chemotherapy were comparable among the two groups (mostly platinum- and taxane-based), whereas third-line treatments were less often applied to the delayed-treatment group. The study concluded that there was no benefit in the detection of early presence of disease by CA 125; this is consistent with the failure of second-look surgeries to provide improved outcomes after early detection of persistent disease. Monitoring CA 125 levels in follow-up may play a role in identifying appropriate candidates for secondary cytoreduction, although this strategy awaits confirmation with a randomized trial.
Local Modalities: Surgery and Radiation Therapy
Cytoreduction is often employed, but such intervention only now is being studied in the setting of a randomized clinical trial (GOG-0213). The role of radiation therapy in patients with recurrent ovarian cancer has not been defined.
Systemic treatment options for patients with recurrent disease are subdivided as follows:
- Platinum-sensitive recurrence: for patients whose disease recurs more than 6 months after cessation of the induction (usually retreated with a platinum [cisplatin or carboplatin] and referred to as platinum sensitive).
- Platinum-refractory or platinum-resistant recurrence: for patients who progress prior to cessation of induction therapy (platinum refractory) or within 6 months after cessation (platinum resistant); in these patients, platinums are generally deemed toxic and not sufficiently useful to be part of the treatment plan.
Table 3. Regimens Used in First Relapse
|Eligibility (mo)||Regimen||Patient Number||Comparator||Comments on Outcome (mo)|
|OS = overall survival; PFS = progression-free survival; PLD = pegylated liposomal doxorubicin.|
|a Trabectedin has been approved for use in treating recurrent ovarian cancer in Europe and Canada.|
|b OS data were not mature at the time the manuscript was published.|
|Most Commonly Used|
|Platinum sensitive (>6)||Cisplatin or carboplatin + paclitaxel||802||Single or nontaxane + platinums||PFS 11 vs. 9; OS 24 vs. 19|
|Platinum sensitive (>6)||Carboplatin + gemcitabine||356||Carboplatin||PFS 8.6 vs. 5.8; OS 18 vs. 17|
|Platinum sensitive (> 6)||Carboplatin + pegylated liposomal doxorubicin||976||Carboplatin + paclitaxel||PFS 11.3 vs 9.4; OS not reported|
|Platinum sensitive (>6)||Carboplatin + epirubicin||190||Carboplatin||Powered for response differences; OS 17 vs. 15|
|Platinum sensitive (≥12)||Cisplatin + doxorubicin + cyclophosphamide||97||Paclitaxel||PFS 15.7 vs. 9; OS 34.7 vs. 25.8|
|Platinum sensitive + resistant||PLD + trabectedina||672||PLD||PFS 7.3 vs. 5.8; OS 20.5 vs. 19.4b|