Treatment of recurrent epithelial ovarian cancer

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.

Specific Effects of Trabectedin and Lurbinectedin on Human Macrophage Function and Fate—Novel Insights

“…In parallel to caspase 3 activation, cleavage of PARP-1 was observed, suggesting a functional role for this pro-apoptotic process in the decrease of hMF-S cell viability. This activation of PARP-1 has been described as one of the therapeutic actions against different tumor cells [ 6 , 11 ]. In fact, depletion of hTAMs by LUR has been described as one of the mechanisms of action against pancreatic ductal adenocarcinoma [ 47 ].…”

“…TRB is indicated for the treatment of adult patients with advanced soft tissue sarcoma [ 5 ] after the failure of anthracyclines and ifosfamide or who are unsuited to receive these agents [ 6 , 7 ]. Trabectedin, in combination with pegylated liposomal doxorubicin, is indicated for the treatment of patients with relapsed platinum-sensitive ovarian cancer [ 6 , 7 , 8 ].…”

“…TRB is indicated for the treatment of adult patients with advanced soft tissue sarcoma [ 5 ] after the failure of anthracyclines and ifosfamide or who are unsuited to receive these agents [ 6 , 7 ]. Trabectedin, in combination with pegylated liposomal doxorubicin, is indicated for the treatment of patients with relapsed platinum-sensitive ovarian cancer [ 6 , 7 , 8 ]. Moreover, it is used in non-operable liposarcomas and leiomyosarcomas [ 9 , 10 ], breast cancer with Breast Cancer type 1 Susceptibility Protein (BRCA1) loss [ 11 ], soft-tissue osteosarcoma and has been assessed in a phase II study of extraskeletal myxoid chondrosarcoma and a phase III study of mesenchymal chondrosarcoma [ 12 ].…”

Copper Complexes as Anticancer Agents Targeting Topoisomerases I and II

“…Top inhibitors used in chemotherapy are limited in number [ 61 , 167 , 168 ]. Top1 inhibitors’ camptothecin derivatives used are irinotecan (colorectal [ 169 ], pancreatic (in combination) [ 170 ], and small cell lung cancers (in clinical trials and in combination) [ 171 , 172 ]), and topotecan (ovarian [ 173 , 174 ], cervical [ 175 ], and small cell lung cancers [ 176 ]). Top2 anticancer drugs commonly used are from the anthracycline group such as doxorubicin (acute leukemia [ 177 ], lymphomas [ 178 ], sarcomas [ 179 , 180 ], and solid tumors [ 181 ]), epirubicin (breast cancer [ 182 ]), valrubicin (bladder cancer [ 183 ]), and idarubicin (acute myeloid leukemia [ 184 ]), from the anthracenedione classes: mitoxantron and pixantron (lymphoma, [ 185 , 186 , 187 ]), and from the epipodopodophyllotoxins group such as etoposide (testicular [ 188 ] and small cell lung cancers [ 189 ]) and teniposide (brain [ 190 ] and small cell lung [ 191 ] cancers, acute lymphocytic leukemia [ 192 ]).…”

Combined and expanded operations in patients with relapsed ovarian cancer and affected retroperitoneal lymph nodes

“…Этот критерий следует учитывать при отборе пациенток для выполнения повторных циторедуктивных вмешательств. В работах других авторов прогностическое значение имели безрецидивный период более 30 мес и наличие единственной анатомической зоны, в которой определялась рецидивная опухоль [10][11][12][13]. В 2019 г. V. Gallota и соавт.…”