Skip to content

    Ovarian Cancer Health Center

    Font Size

    Ovarian Epithelial Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - 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,[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) 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.[4]
    Most Commonly Used
    Platinum sensitive (>6) Cisplatin or carboplatin + paclitaxel 802 Single or nontaxane + platinums PFS 11 vs. 9; OS 24 vs. 19[5]
    Platinum sensitive (>6) Carboplatin + gemcitabine 356 Carboplatin PFS 8.6 vs. 5.8; OS 18 vs. 17[6]
    Platinum sensitive (> 6) Carboplatin + pegylated liposomal doxorubicin 976 Carboplatin + paclitaxel PFS 11.3 vs 9.4; OS not reported[7]
    Other Regimens
    Platinum sensitive (>6) Carboplatin + epirubicin 190 Carboplatin Powered for response differences; OS 17 vs. 15[5]
    Platinum sensitive (≥12) Cisplatin + doxorubicin + cyclophosphamide 97 Paclitaxel PFS 15.7 vs. 9; OS 34.7 vs. 25.8[6]
    Platinum sensitive + resistant PLD + trabectedina 672 PLD PFS 7.3 vs. 5.8; OS 20.5 vs. 19.4b
    1 | 2 | 3 | 4 | 5 | 6
    Next Article:

    Today on WebMD

    Ovarian cancer illustration
    What are the symptoms?
    doctory with x-ray
    Get to know the symptoms.
    cancer cell
    HPV is the top cause. Find out more.
    Lung cancer xray
    See it in pictures, plus read the facts.
    Integrative Medicine Cancer Quiz
    Lifestyle Tips for Depression Slideshow
    Screening Tests for Women
    Graphic of ovaries within reproductive system
    Ovarian Cancer Marker
    Pets Improve Your Health
    Vitamin D
    Healthy meal with salmon