Recurrent Ovarian Cancer

Abstract

Ovarian cancer is increasingly recognized as a chronic disease whose treatment is often characterized by administration of multiple, sequential active agents, each of which may or may not be accompanied by a tumor response. Despite the large proportion of patients who relapse and undergo longer-term treatment, the question of optimal treatment duration has not been fully addressed to date. For patients who progress on therapy, the answer is straightforward: they are switched to another active agent, presumably having a different mechanism of action from previous therapies with, ideally, limited overlapping toxicities. However, for patients who remain in partial response or who have stable disease, the answer is less apparent and less clear. The majority of oncologists believe that treatment beyond 6 cycles of a given therapy does not provide any additional benefit to patients. There are some data to support that treatment strategy. However, with the advent of new, less toxic agents, treatment to progression should be further explored. Agents that are potentially well suited for extended treatment intervals may include such properties as absence of cumulative toxicity, non-cross-resistance, positive benefit on quality of life, and convenient schedule. A number of active agents in ovarian cancer (platinum, paclitaxel, topotecan, liposomal doxorubicin, docetaxel, gemcitabine, and etoposide) will be reviewed in the context of what is known about cumulative toxicity, potential adverse effects on patients' quality of life, and evidence addressing the potential benefits of longer-term treatment.

Treatment of recurrent ovarian cancer relapsing 6–12 months post platinum-based chemotherapy

“…This brings into question the traditional strategy of limiting treatment to six to eight cycles and begs the potential benefit of extended treatment and symptom palliation until disease progression in patients who achieve a partial response or sta- ble disease. Treating until disease progression may allow for better disease management with the limited therapeutic options available in women with ovarian cancer [30]. While this approach may not be appropriate when using toxic regimens with intensive administration requirements (e.g., platinum-taxane combinations), it can be accomplished with less toxic agents with extended administration intervals (e.g., PLD).…”

Computed tomography features of recurrent ovarian carcinoma according to time to relapse

“…Despite limited success in treating recurrent disease up to now, recent studies have suggested treating ovarian cancer as a ''chronic disease'' (10). These studies advocate the early detection of recurrent disease, enabling the use of lower doses of chemotherapeutic agents to control disease progression, although the results of these studies on the effect on survival are still awaited.…”

Whole Abdominopelvic Radiotherapy Using Intensity-Modulated Arc Therapy in the Palliative Treatment of Chemotherapy-Resistant Ovarian Cancer With Bulky Peritoneal Disease: A Single-Institution Experience

“…The response rates have varied from 7% to 25% (17,18), and the incidence of Grade 4 toxicity (19) has not been negligible (10,20). The review by Salom et al (10) included information on new products and ongoing trials but did not, surprisingly enough, mention RT at all.…”