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Treatment of recurrent epithelial ovarian cancer.
Cancer 2019; 125 Suppl 24:4609-4615C

Abstract

The majority of patients with advanced ovarian cancer progress after first-line therapy and require further treatment. Tumor biology, prior chemotherapy, responses to previous therapy, performance status, and toxicity are the characteristics that influence treatment choice. These criteria have been linked to the time between relapse and last platinum therapy: the platinum-free interval. Today, patients are classified as either those who are eligible for a new platinum-based therapy or those for whom platinum is not an option. A nonplatinum regimen should be administered to patients who are not candidates for platinum re-treatment. This group includes patients with early relapse after, or progression during, previous platinum-based chemotherapy and patients with platinum intolerability. A single agent such as weekly paclitaxel, pegylated liposomal doxorubicin (PLD), gemcitabine, or topotecan represents the standard. For patients not treated with bevacizumab in the first line, this drug should be added to chemotherapy. For patients for whom platinum rechallenge is an option (because they are potentially platinum-responsive), different strategies are available with the incorporation of biological drugs targeting angiogenesis or the mechanisms of DNA repair. A BRCA mutation status predicts a better response to platinum and poly(adenosine diphosphate-ribose) polymerase (PARP) inhibition. PARP inhibitors and antiangiogenic drugs have proven efficacy as maintenance therapy after chemotherapy and concurrently with chemotherapy, respectively. These agents have changed current practice, although few biomarkers are available to guide decisions. Patients potentially responsive to platinum who cannot receive the drug again can be treated with a combination of trabectedin and PLD, the most active nonplatinum therapy in this setting.

Authors+Show Affiliations

Department of Urogynecology, National Cancer Institute, Pascale Foundation (Scientific Institute for Research and Healthcare), Naples, Italy.Department of Urogynecology, National Cancer Institute, Pascale Foundation (Scientific Institute for Research and Healthcare), Naples, Italy.Department of Urogynecology, National Cancer Institute, Pascale Foundation (Scientific Institute for Research and Healthcare), Naples, Italy.Department of Urogynecology, National Cancer Institute, Pascale Foundation (Scientific Institute for Research and Healthcare), Naples, Italy.Department of Urogynecology, National Cancer Institute, Pascale Foundation (Scientific Institute for Research and Healthcare), Naples, Italy.Department of Urogynecology, National Cancer Institute, Pascale Foundation (Scientific Institute for Research and Healthcare), Naples, Italy.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31967680

Citation

Pignata, Sandro, et al. "Treatment of Recurrent Epithelial Ovarian Cancer." Cancer, vol. 125 Suppl 24, 2019, pp. 4609-4615.
Pignata S, Pisano C, Di Napoli M, et al. Treatment of recurrent epithelial ovarian cancer. Cancer. 2019;125 Suppl 24:4609-4615.
Pignata, S., Pisano, C., Di Napoli, M., Cecere, S. C., Tambaro, R., & Attademo, L. (2019). Treatment of recurrent epithelial ovarian cancer. Cancer, 125 Suppl 24, pp. 4609-4615. doi:10.1002/cncr.32500.
Pignata S, et al. Treatment of Recurrent Epithelial Ovarian Cancer. Cancer. 2019 Dec 15;125 Suppl 24:4609-4615. PubMed PMID: 31967680.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of recurrent epithelial ovarian cancer. AU - Pignata,Sandro, AU - Pisano,Carmela, AU - Di Napoli,Marilena, AU - Cecere,Sabrina Chiara, AU - Tambaro,Rosa, AU - Attademo,Laura, PY - 2019/07/18/received PY - 2019/08/02/accepted PY - 2020/1/23/entrez KW - BRCA KW - bevacizumab KW - ovarian cancer KW - poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors KW - recurrence SP - 4609 EP - 4615 JF - Cancer JO - Cancer VL - 125 Suppl 24 N2 - The majority of patients with advanced ovarian cancer progress after first-line therapy and require further treatment. Tumor biology, prior chemotherapy, responses to previous therapy, performance status, and toxicity are the characteristics that influence treatment choice. These criteria have been linked to the time between relapse and last platinum therapy: the platinum-free interval. Today, patients are classified as either those who are eligible for a new platinum-based therapy or those for whom platinum is not an option. A nonplatinum regimen should be administered to patients who are not candidates for platinum re-treatment. This group includes patients with early relapse after, or progression during, previous platinum-based chemotherapy and patients with platinum intolerability. A single agent such as weekly paclitaxel, pegylated liposomal doxorubicin (PLD), gemcitabine, or topotecan represents the standard. For patients not treated with bevacizumab in the first line, this drug should be added to chemotherapy. For patients for whom platinum rechallenge is an option (because they are potentially platinum-responsive), different strategies are available with the incorporation of biological drugs targeting angiogenesis or the mechanisms of DNA repair. A BRCA mutation status predicts a better response to platinum and poly(adenosine diphosphate-ribose) polymerase (PARP) inhibition. PARP inhibitors and antiangiogenic drugs have proven efficacy as maintenance therapy after chemotherapy and concurrently with chemotherapy, respectively. These agents have changed current practice, although few biomarkers are available to guide decisions. Patients potentially responsive to platinum who cannot receive the drug again can be treated with a combination of trabectedin and PLD, the most active nonplatinum therapy in this setting. SN - 1097-0142 UR - https://www.unboundmedicine.com/medline/citation/31967680/Treatment_of_recurrent_epithelial_ovarian_cancer L2 - https://doi.org/10.1002/cncr.32500 DB - PRIME DP - Unbound Medicine ER -