Do all patients with recurrent ovarian cancer need systemic therapy?

Friedlander, Michael

doi:10.1002/cncr.32476

Cited by 7 publications

(5 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous treatment with bevacizumab or other previous maintenance therapies are also decisive criteria. It is also important to discuss which patients are less likely to benefit from systemic therapy, e.g., patients with an extremely poor prognosis, patients with histological subtypes such as clear-cell, mucinous, low-grade serous tumors, and asymptomatic patients with rising CA 125 after initially responding to first-line therapy [8].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Recurrent Epithelial Ovarian Cancer

Claussen

Rody

Hanker

2020

Geburtshilfe Frauenheilkd

View full text Add to dashboard Cite

Epithelial ovarian cancer is the most common cause of death from gynecological tumors. Most patients with advanced ovarian cancer develop recurrence after concluding first-line therapy, making further lines of therapy necessary. The choice of therapy depends on various criteria such as tumor biology, the patientʼs general condition (ECOG), toxicity, previous chemotherapy, and response to chemotherapy. The platinum-free or treatment-free interval determines the potential response to repeat platinum-based therapy. If patients have late recurrence, i.e. > 6 months after the end of the last platinum-based therapy (i.e., they were previously platinum-sensitive), then they are usually considered suitable for another round of a platinum-based combination therapy. Patients who are not considered suitable for platinum-based chemotherapy are treated with a platinum-free regimen such as weekly paclitaxel, pegylated liposomal doxorubicin (PLD), gemcitabine, or topotecan. Treatment for the patient subgroup which is considered suitable for platinum-based therapy but cannot receive carboplatin due to uncontrollable hypersensitivity reactions may consist of trabectedin and PLD. While the use of surgery to treat recurrence has long been a controversial issue, new findings from the DESKTOP III study of the AGO working group have drawn attention to this issue again, particularly for patients with a platinum-free interval of > 6 months and a positive AGO score. Clinical studies have also shown the efficacy of angiogenesis inhibitors such as bevacizumab and the PARP inhibitors olaparib, niraparib and rucaparib. These drugs have substantially changed current treatment practice and expanded the range of available therapies. It is important to differentiate between purely maintenance therapy after completing CTX, continuous maintenance therapy during CTX, and the therapeutic use of these substances. The PARP inhibitors niraparib, olaparib and rucaparib have already been approved for use by the FDA and the EMA. The presence of a BRCA mutation is a predictive factor for a better response to PARP inhibitors.

show abstract

Section: Introductionmentioning

confidence: 99%

Treatment of Recurrent Epithelial Ovarian Cancer

Claussen

Rody

Hanker

2020

Geburtshilfe Frauenheilkd

View full text Add to dashboard Cite

show abstract

“…If treatment fails, symptoms usually progress quickly leading to death shortly after cessation of systemic treatment [16].…”

Section: Discussionmentioning

confidence: 99%

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis.

Broekman

Nijman

et al. 2022

JCO

View full text Add to dashboard Cite

e17612 Background: Patients with advanced ovarian cancer have a poor prognosis and can experience debilitating abdominal symptoms in the last phase of life. Several analyses, mainly performed in the United States (US), show high rates of chemotherapy administration, and emergency room and hospital visits near the end-of-life in this patient category. No large European studies are available, while the organisation of palliative care differs between the US and Europe and between European countries. We aimed to analyse the intensity of inpatient care near the end-of-life in the Netherlands and perform a cross-study comparison with previous reports. Methods: All patients with ovarian cancer that died in 2016 and 2017 were identified from the database of the foundation Dutch Hospital Data (DHD). For the last six months of life the following parameters of aggressive care were extracted: administration of chemotherapy, emergency room (ER) visits, surgical procedures, hospital and intensive care unit (ICU) admissions. Data were analysed for the cohort as a whole and separately for three age categories: < 60, 60-75 and > 75 years of age. The intensity of inpatient care was compared to previously reported European and US data. Results: A total of 2172 patients died with ovarian cancer in 2016 and 2017 in the Netherlands. Data on medical care use was available for 1775 patients. During the last 6 months of life, chemotherapy was given to half of the ovarian cancer patients and the same percentage of patients was admitted to hospital. Chemotherapy administration near the end-of-life was infrequent, with only 12% of patients receiving chemotherapy in the last month of life. Surgery and ICU admissions in the final 6 months of life were rare (< 10%). Our cohort showed the lowest percentages of all five indicators of aggressive care reported thus far. The use of chemotherapy in the six months prior to death was highest in patients 60-75 years of age compared to younger or older patients. ER visits and hospital admissions were less frequent in patients > 75 years of age compared to the younger age groups. Conclusions: Aggressive medical care use in the final 6 months of life in this Dutch cohort of ovarian cancer patients was lower than in other previously reported cohorts.

show abstract

“…The treatment of ovarian cancer typically includes surgical treatment (staging or debulking) and intraperitoneal, intravenous, or combined chemotherapy (9). There is growing acceptance of the importance of a personalized approach to treatment in patients with ROC and the recognition of the complex interplay between patient-and tumor-related factors that impact the likelihood of patient prognosis (10). If it is possible to predict the likelihood of postoperative recurrence before the first treatment, this may assist in the selection of individualized treatment options.…”

Section: Discussionmentioning

confidence: 99%

“…The lethality of EOC is mainly due to the higher risk of recurrence (4,5). Recurrent ovarian cancers (ROCs) have a very poor prognosis, and most patients with ROC eventually develop resistance to chemotherapy drugs (6). Because of the complexity of the patients' situation, it is more difficult to choose treatment options for them.…”

Section: Introductionmentioning

confidence: 99%

A Preliminary Exploration Using Imaging Methods to Predict the Possibility of the Recurrence of Serous Ovarian Cancer in Patients Undergoing Total Resection

et al. 2022

View full text Add to dashboard Cite

BackgroundThe purpose of our research was to explore the value of preoperative CT and MRI examinations and clinical indicators in the prediction of recurrence of ovarian serous carcinoma in patients who underwent satisfactory staging surgery.ProcedureDetailed inclusion and exclusion criteria were installed to screen all patients collected and the eligible patients were divided into two groups. The CT and MRI features and some clinical characteristics of two groups were analyzed, in addition, the apparent diffusion coefficient (ADC) value in tumor solid region was measured. Univariate analysis was used in this study.ResultsThere were 78 patients with histologically proven ovarian serous carcinoma. According to the strict inclusion and exclusion criteria, we retained 29 patients (recurrence group: 11 patients, no recurrence group: 18 patients). For the peritoneal implantation metastasis in CT or MRI images and Ki67 proliferation index (Ki67 PI), the differences between two cohorts were statistically significant (P < 0.05). The rate of peritoneal metastasis in the recurrence cohort (10/11, 91%) was higher than that in the no recurrence cohort (7/18, 39%). Patients with high Ki67 PI expression had lower recurrence risk than those with low Ki67 PI expression, HR=0.172 (95%CI: 0.050-0.589, P=0.005), and patients without peritoneal planting had lower recurrence risk than those with it, HR=9.373 (95%CI: 1.194-73.551, P=0.033). For FIGO III patients, ipsilateral fallopian tube involvement was statistically significant between the two groups (P < 0.05). The differences in the other preoperative imaging characteristics of ovarian serous cancer, including the volume; capsule of the mass; main components; ADC value; cystic change; bleeding; degree of enhancement of the mainly solid region in 3 periods; and range of tumor involvement in the ovary, uterus, bladder, bowel, and pelvic wall, were not statistically significant. In addition, the differences in the other clinical indicators (i.e., age, FIGO stage) between the two cohorts were not statistically significant.ConclusionsIn CT and MRI examinations before surgery, peritoneal implantation metastasis was suggestive of the possibility of the recurrence of serous ovarian carcinoma in the near future. In addition to that, ipsilateral fallopian tube involvement and Ki67 PI may also indicate the possibility of recurrence (the former was only applicable to FIGO III patients).

show abstract

Do all patients with recurrent ovarian cancer need systemic therapy?

Cited by 7 publications

References 38 publications

Treatment of Recurrent Epithelial Ovarian Cancer

Treatment of Recurrent Epithelial Ovarian Cancer

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis.

A Preliminary Exploration Using Imaging Methods to Predict the Possibility of the Recurrence of Serous Ovarian Cancer in Patients Undergoing Total Resection

Contact Info

Product

Resources

About