, Volume 5, Issue 5, pp 341-354
Date: 09 Aug 2012

Management Strategies for Partially Platinum-Sensitive Ovarian Cancer

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Abstract

The majority of women with advanced ovarian cancer will relapse after first-line chemotherapy. Treatment decisions are based most commonly on the probability of a further response to platinum-based therapy. Many women will respond to second and subsequent lines of therapy with platinum and other drugs such as liposomal doxorubicin, topotecan, paclitaxel, gemcitabine, and etoposide. The decision to include platinum drugs is based mainly on a categorization of patients into those with a partially platinum-sensitive relapse (platinum-free interval of 6–12 months) or a platinum-sensitive relapse (platinum-free interval of >12 months). These categories are based on empirical observations made >15 years ago. Most trials with newer agents have been either non-randomized phase II studies or performed in a heterogeneous population of women, including those with platinum-resistant tumors. Interpretation of the activity of these new drugs is often difficult, and this affects decision-making in clinical practice. Recent randomized trials comparing platinum-based combinations with platinum alone (mainly carboplatin) have shown a benefit in favor of combination therapy. The prolonged chemosensitivity in many cases of ovarian cancer and the use of serum CA125 antigen levels as a surrogate marker of response provide an opportunity to study the activity of new anticancer agents in relapsed disease. However, future studies need to be randomized to reduce selection bias and should stratify for factors known to influence response. Many patients with relapsed ovarian cancer will survive for many years and knowledge of the disease, its response to different treatments, and the appropriate timing of drug delivery and length of treatment requires considerable clinical judgment.