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Recurrent or Persistent Ovarian Epithelial Cancer Treatment

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    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,[3] 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:

    1. 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).
    2. 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.

    Platinum-Sensitive Recurrence

    Table 3. Regimens Used in First Relapse

    Eligibility (mo)RegimenPatient NumberComparatorComments 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.[4]
    Most Commonly Used
    Platinum sensitive (>6)Cisplatin or carboplatin + paclitaxel802Single or nontaxane + platinumsPFS 11 vs. 9; OS 24 vs. 19[5]
    Platinum sensitive (>6)Carboplatin + gemcitabine356CarboplatinPFS 8.6 vs. 5.8; OS 18 vs. 17[6]
    Platinum sensitive (> 6)Carboplatin + pegylated liposomal doxorubicin976Carboplatin + paclitaxelPFS 11.3 vs 9.4; OS not reported[7]
     
    Other Regimens
    Platinum sensitive (>6)Carboplatin + epirubicin190CarboplatinPowered for response differences; OS 17 vs. 15[5]
    Platinum sensitive (≥12)Cisplatin + doxorubicin + cyclophosphamide97PaclitaxelPFS 15.7 vs. 9; OS 34.7 vs. 25.8[6]
    Platinum sensitive + resistantPLD + trabectedina672PLDPFS 7.3 vs. 5.8; OS 20.5 vs. 19.4b
    1|2|3|4|5|6

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