This review outlines treatment sequencing considerations for patients with recurrent ovarian cancer.
In recent years, several treatment options have become available for the management of relapsed ovarian cancer. These therapies include antiangiogenics such as bevacizumab, and poly (ADP-ribose) polymerase (PARP) inhibitors such as olaparib, niraparib, and rucaparib, which now play an integral role in maintenance therapy for recurrent disease, following response to platinum-based chemotherapy. These agents are being investigated further in the first-line setting, which has implications for subsequent lines of therapy, as previous exposure to these agents can influence therapeutic options for recurrent disease. This review, published in the January 2021 issue of Future Oncology, outlines treatment sequencing considerations in patients with recurrent ovarian cancer.
Selection of systemic therapy for recurrent ovarian cancer is dictated by several disease-related and patient-related factors. In particular, tumor biology plays a key role in treatment selection, as tumors harboring specific genetic alterations resulting in homologous recombination deficiencies, such as germline or somatic BRCA1/2 mutations, exhibit specific clinical behaviors and responses to platinum-based chemotherapy and PARP inhibitors.
In potentially platinum-responsive patients with recurrent disease, the following options may be considered, and rechallenge with previously administered agents may be an option for select patients.
- If there has been no previous exposure to biological therapy, platinum-based rechallenge plus bevacizumab is recommended for those with a high disease burden and priority for a symptomatic response. Platinum-based rechallenge followed by a PARP inhibitor is recommended in remaining patients
- If there has been previous exposure to a PARP inhibitor, platinum-based rechallenge plus bevacizumab is recommended
- If there has been previous exposure to bevacizumab, platinum-based rechallenge followed by PARP-inhibitor maintenance therapy may be considered. PARP-inhibitor monotherapy can be considered for heavily pretreated patients.
A major goal in the management of ovarian cancer is delaying the emergence of resistance to platinum-based chemotherapy. A key strategy to delay platinum resistance and improve prognosis of recurrent disease is to alternate treatments with different mechanisms of action. Trabectedin plus pegylated liposomal doxorubicin is currently a nonplatinum combination approved to treat recurrence in patients with platinum-sensitive disease. Identifying additional strategies to delay treatment resistance in ovarian cancer is a key strategy toward improving patient outcomes.
Source: Pignata S, Cecere SC. How to sequence treatment in relapsed ovarian cancer. Future Oncol. 2021;17(3s):1-8.