Although each subsequent line of therapy is characterized by shorter advanced ovarian cancer anemia prognosis intervals, median survival for these patients ranges from 12 months to 24 months. Emerging therapies in the advanced ovarian cancer anemia prognosis of ovarian cancer have resulted in a shift in paradigm, including in the appropriate time to institute therapy, and in the selection of therapy.
This review focuses on chemotherapy and emerging biologic agents that present a therapeutic option for patients with recurrent ovarian cancer. The search was restricted to English-language articles published from through July Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries also were consulted, advanced ovarian cancer anemia prognosis. Recent abstracts of research presented at symposia and scientific conferences were also considered.
The selection of therapy for women with recurrent disease is in large part determined by response to first-line therapy. The goals of therapy should focus on palliation of cancer-related symptoms, prolongation of life, and optimization of quality of life.
This review will focus on the medical treatment, specifically chemotherapy options, available for women with recurrent ovarian cancer, advanced ovarian cancer anemia prognosis.
Recurrent ovarian cancer can be heralded by onset of new symptoms, radiologic evidence of recurrent disease, or a rising CA level in an asymptomatic patient. CA elevation may precede radiologic detection or onset of symptoms by several months. Given that recurrent disease is incurable, advanced ovarian cancer anemia prognosis, the goals of therapy outlined earlier should guide decisions about initiation of subsequent therapy. For asymptomatic recurrences rising CA level, for exampletiming of therapy is much more controversial.
Those who advocate institution of immediate treatment argue that treating small-volume disease is more likely to succeed in achieving a complete response following early intervention. The controversy surrounding the appropriate timing of institution of therapy was addressed in a prospective study of 1, women with ovarian cancer. The trial was conducted among patients in full clinical remission, with a normal CA level following completion of primary surgical treatment and platinum-based systemic therapy.
Serum CA levels were checked every 3 months, advanced ovarian cancer anemia prognosis. Women randomized to immediate therapy initiated chemotherapy a median of advanced ovarian cancer anemia prognosis months earlier than those who initiated therapy with the onset of symptoms.
Survival and remission duration were comparable between the two arms at month follow-up. However, quality of life was worse advanced ovarian cancer anemia prognosis the women undergoing immediate treatment. The investigators concluded that early institution of second-line therapy did not advanced ovarian cancer anemia prognosis patients, advocating for treatment to be delayed until symptoms develop or patients have signs of recurrent disease. In general, platinum-sensitive recurrent ovarian cancer is treated with a platinum agent alone or in combination with another agent.
If combination therapy is elected, then the specific combination regimen chosen should also take these factors into account, to optimize outcome and minimize overlapping toxicities. The platinum-free interval—the time between the last cycle of platinum and evidence of disease progression—is now accepted as an important, significant predictor of response to second-line chemotherapy see Table 1.
Some experts have proposed that early use of nonplatinum agents can prolong the platinum-free interval and optimize subsequent retreatment with platinum. Combination regimens are associated with a longer response rate and PFI. However, combination therapy is more toxic. In two parallel randomized phase III trials, women with platinum-sensitive recurrent ovarian cancer were treated with a single-agent platinum vs paclitaxel in combination with a platinum agent.
A second phase III trial of single-agent carboplatin compared with a platinum-containing doublet confirmed the observation that doublets are superior to single agents. The reported PFS for patients randomized to carboplatin was 5. The results of this trial resulted in the US Food and Drug Administration approval of combination gemcitabine plus carboplatin in platinum-sensitive second-line ovarian cancer in Notably, there were no cases of gastrointestinal perforation reported during advanced ovarian cancer anemia prognosis. Overall survival was similar at 35 months of follow-up 33 vs 35 months, advanced ovarian cancer anemia prognosis.
Table 2 summarizes these phase III combination trials in platinum-sensitive recurrent ovarian cancer. Non—platinum-based combination regimens are another emerging option for patients with platinum-sensitive disease. There are numerous single-agent therapeutic options or patients with platinum-sensitive ovarian cancer. Table 3 lists some of these chemotherapeutic options and their documented response rates. These agents are appropriate for patients with platinum-sensitive recurrent ovarian cancer who have had progression of disease on platinum-based second-line therapy.
Bevacizumab, a humanized monoclonal antibody that targets vascular endothelial growth factor, has been studied in several phase II studies alone and in combination with cytotoxic chemotherapy. San juan valley and cancer has been shown to be an active agent in patients with recurrent ovarian cancer. However, these trials have failed to show an OS advantage. Thus, for patients with recurrent platinum-sensitive disease, it may be more appropriate to use combination chemotherapy alone as second-line therapy, rather than combination chemotherapy plus bevacizumab.
Bevacizumab may be appropriate to use in combination with single-agent therapy for subsequent lines of treatment or as single-agent therapy. Several clinical trials have evaluated the role of agents aimed at prolonging the second remission. One of these is the OCEANS trial, evaluating the role of bevacizumab, as noted above, in combination with chemotherapy and as maintenance therapy. In a trial of women with platinum-sensitive recurrent ovarian cancer who achieved a response to their most recent line of therapy, patients were randomized to placebo or the poly ADP-ribose polymerase PARP inhibitor olaparib at mg orally twice a day.
Other agents are the subject of ongoing clinical trials. Farletuzumab, a humanized monoclonal antibody to the folate receptor alpha, has been the subject of a phase II study. In the post hoc exploratory analysis, a trend toward improved PFS in some patient subsets was noted. Further analysis of the findings is ongoing. Another agent, iniparib, may be an irreversible PARP inhibitor potentially with other cytotoxic actions. CA Cancer J Clin. Adjuvant therapy in stage I and stage II epithelial ovarian cancer, advanced ovarian cancer anemia prognosis.
Results of two prospective randomized trials. N Engl J Advanced ovarian cancer anemia prognosis. Second-line chemotherapy for recurrent carcinoma of the ovary, advanced ovarian cancer anemia prognosis. Duration of response to second-line, platinum-based chemotherapy for ovarian cancer: Predicting the effectiveness of chemotherapy Cx in patients with recurrent ovarian cancer ROC: Risk of epithelial ovarian cancer recurrence in patients with rising serum CA levels within the normal range.
An early signal of CA progression for ovarian cancer patients receiving maintenance treatment after complete clinical response to primary therapy. New guidelines to evaluate the response to treatment in solid tumors [ovarian cancer]. J Natl Cancer Inst. Does palliative chemotherapy palliate? Evaluation of expectations, outcomes, and costs in women receiving chemotherapy for advanced ovarian cancer.
Randomized controlled trial of single-agent paclitaxel versus cyclophosphamide, doxorubucin, and cisplatin in patients with recurrent ovarian cancer who responded to first-line platinum-based regimens. Second-line platinum therapy in patients with ovarian cancer previously treated with cisplatin.
Docetaxel and oxaliplatin in the second-line treatment of platinum-sensitive recurrent ovarian cancer: Randomized controlled trial of single-agent paclitaxel versus cyclophosphamide, doxorubicin, and cisplatin in patients with recurrent ovarian cancer who responded to first-line platinum-based regimens.
Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: A randomized, phase III study of carboplatin and pegylated liposomal doxorubicin versus carboplatin and paclitaxel in relapsed platinum-sensitive ovarian cancer OC.
Phase II trial of bevacizumab in persistent or recurrent epithelial ovarian cancer or primary peritoneal cancer: Phase II clinical trial of bevacizumab and low-dose metronomic oral cyclophosphamide in recurrent ovarian cancer: Phase II study of bevacizumab in patients with platinum-resistant ovarian singulair and other drug interactions or peritoneal serous cancer.
Avoiding bevacizumab related gastrointestinal toxicity for recurrent ovarian cancer by careful patient screening. Phase II study and long-term follow-up of patients treated with Taxol for advanced ovarian adenocarcinoma. Phase II trial of paclitaxel in patients with progressive ovarian carcinoma after platinum-based chemotherapy: Randomized phase III trial of gemcitabine compared to pegylated liposomal doxorubicin in patients with platinum-resistant ovarian cancer.
Combined PEG liposomal doxorubicin and gemcitabine are active and have acceptable toxicity in patients with platinum-refractory and —resistant ovarian cancer after previous platinum-taxane therapy: Patient-reported outcomes in relapsed ovarian cancer: Recurrent epithelial ovarian carcinoma: Gordon AN, Teitelbaum A.
Overall survival advantage for pegylated liposomal doxorubicin compared to topotecan in epithelial ovarian cancer. Proc Am Soc Clin Oncol. Phase II study of liposomal doxorubicin in refractory ovarian cancer: Liposomal doxorubicin in ovarian, peritoneal, and tubal carcinoma: Phase II study of intravenous topotecan as a 5-day infusion for refractory epithelial ovarian carcinoma.
Randomized phase II study of two schedules of topotecan in previously treated patients with ovarian cancer: Phase II study of vinorelbine in the treatment of platinum-resistant ovarian carcinoma.
Phase II trial of vinorelbine in recurrent and progressive epithelial ovarian cancer. Phase II trial of VP in the treatment of advanced squamous cell carcinoma of the cervix and adenocarcinoma of the ovary: Prolonged oral etoposide as second-line therapy for platinum-resistant and platinum-sensitive ovarian carcinoma: A phase II study of docetaxel in paclitaxel-resistant ovarian and peritoneal carcinoma: Phase 2 trial of single agent docetaxel in platinum and paclitaxel-refractory ovarian cancer, fallopian tube cancer, and primary carcinoma of the peritoneum.
Ifosfamide and mesna in previously treated advanced epithelial ovarian cancer: A phase II evaluation of pemetrexed LY, IND in the treatment of recurrent or persistent platinum-resistant ovarian or primary peritoneal carcinoma: Olaparib maintenance therapy in platinum-sensitive relapsed ovarian cancer, advanced ovarian cancer anemia prognosis. Exploratory phase 2 efficacy study of MORAb, a monoclonal antibody against folate receptor alpha, in platinum-sensitive epithelial ovarian cancer in first relapse.
Morphotek announces top-line results of a phase III study of farletuzumab in patients with relapsed platinum-sensitive epithelial ovarian cancer.