Abstract
Ovarian cancer, which ranks fifth in cancer deaths among women, is the most lethal gynecologic malignancy. Epithelial ovarian cancer (EOC) is the most common histologic type, with the 5-year survival for all stages estimated at 45.6%. This rate increases to more than 70% in the minority of patients who are diagnosed at an early stage, but declines to 35% in the vast majority of patients diagnosed at advanced stage. Recurrent EOC is incurable. Platinum sensitivity (or lack thereof) is a major determinant of prognosis. The current standard treatment is primary surgery followed by platinum-based chemotherapy. In recurrent platinum-resistant/platinum-refractory EOC, sequential single-agent salvage chemotherapy is superior to multiagent chemotherapy. Multiagent regimens increase toxicity without clear benefit; however, no preferred sequence of single agents is recommended. The impact of targeted therapies and immunotherapies on progression-free survival and overall survival, which remains dismal, is under active investigation. Currently, clinical trials offer the best hope for the development of a new treatment paradigm in this recalcitrant disease.
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References
Cont NT, Ferrero A, Peccatori FA, et al. Medical treatment of early stage and rare histological variants of epithelial ovarian cancer. ecancermedicalscience. 2015;9:584.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30.
National Institutes of Health. National Cancer Institute. Surveillance, epidemiology, and end results program. Cancer Stat Facts: Ovarian cancer https://seer.cancer.gov/statfacts/html/ovary.html. Accessed 19 Jan 2017.
Kaye S. Management of partially platinum-sensitive relapsed ovarian cancer. Eur J Cancer. 2008;6(Suppl):16–21.
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. https://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site. Accessed 19 Jan 2017.
Look KY. Epidemiology, etiology, and screening of ovarian cancer. In: Rubin SC, Sutton GP, editors. Ovarian cancer. Philadelphia: Lippincott, Williams and Wilkins; 2001. p. 168–74.
Erickson BK, Conner MG, Landen CN Jr. The role of the fallopian tube in the origin of ovarian cancer. Am J Obstet Gynecol. 2013;209(5):409–14.
Winter WE III, Maxwell GL, Tian C, Sundborg MJ, Rose GS, Rose PG, Rubin SC, Muggia F, McGuire WP, Gynecologic Oncology Group. Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2008;26(1):83.
Jayson GC, et al. Ovarian Cancer. Lancet. 2014;384(9951):1376–88.
Bankhead C, Collins C, Stokes-Lampard H, Rose P, Wilson S, Clements A, Mant D, Kehoe S, Austoker J. Identifying symptoms of ovarian cancer: a qualitative and quantitative study. BJOG. 2008;115:1008–14.
Jasen P. From the “Silent Killer” to the “Whispering Disease”: ovarian cancer and the uses of metaphor. Med Hist. 2009;53(4):489–512.
Au KK, Josahkian JA, Francis JA, Squire JA, Koti M. Current state of biomarkers in ovarian cancer prognosis. Future Oncol. 2015;11(23):3187–95.
Liu CM. Cancer of the ovary. N Engl J Med. 2005;352:1268–9.
Bamias A, Bamia C, Zagouri F, Kostouras E, Kakoyianni K, Rodolakis A, Vlahos G, Haidopoulos D, Thomakos N, Antsaklis A, Dimopoulos MA. Improved survival trends in platinum-resistant patients with advanced ovarian, fallopian or peritoneal cancer treated with first-line paclitaxel/platinum chemotherapy: the impact of novel agents. Oncology. 2013;84(3):158–65.
Hanker LC, Loibl S, Burchardi N, Pfisterer J, Meier W, Pujade-Lauraine E, Ray-Coquard I, Sehouli J, Harter P, du Bois A, AGO and GINECO study group. The impact of second to sixth line therapy on survival of relapsed ovarian cancer after primary taxane/platinum-based therapy. Ann Oncol. 2012;23(10):2605–12.
National Institutes of Health. National Cancer Institute. Surveillance, epidemiology, and end results program. Statistical summaries: cancer stat fact sheets (ovary) and cancer statistics review (CSR), 1975–2013. http://www.seer.cancer.gov/statistics/summaries.html. Accessed 19 Jan 2017.
Ushijima K. Treatment for recurrent ovarian cancer—at first relapse. J Oncol. 2010;2010:7 (Article ID 497429).
Morgan RJ Jr, Armstrong DK, Alvarez RD, Bakkum-Gamez JN, Behbakht K, Chen LM, Copeland L, Crispens MA, DeRosa M, Dorigo O, Gershenson DM, Gray HJ, Hakam A, Havrilesky LJ, Johnston C, Lele S, Martin L, Matulonis UA, O’Malley DM, Penson RT, Percac-Lima S, Pineda M, Plaxe SC, Powell MA, Ratner E, Remmenga SW, Rose PG, Sabbatini P, Santoso JT, Werner TL, Burns J, Hughes M. Ovarian Cancer, Version 1.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2016;14(9):1134–63.
Markman M, Bookman MA. Second-line treatment of ovarian cancer. Oncologist. 2000;5(1):26–35.
McGuire WP, Rowinsky EK, Rosenshein NB, et al. Taxol: a unique antineoplastic agent with significant activity in advanced ovarian adenocarcinoma. Ann Intern Med. 1989;111:273–9.
Markman M, Hall J, Spitz D, et al. Phase II trial of weekly single-agent paclitaxel in platinum/paclitaxel-refractory ovarian cancer. J Clin Oncol. 2002;20:2365–9.
Rose PG, Blessing JA, Ball HG, et al. A phase II study of docetaxel in paclitaxel-resistant ovarian and peritoneal carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2003;88:130–5.
Green AE, Rose PG. Pegylated liposomal doxorubicin in ovarian cancer. Int J Nanomedicine. 2006;1(3):229–39.
Berri G, Billingham M, Alderman E, et al. The use of cardiac biopsy to demonstrate reduced cardiotoxicity in AIDS Kaposi’s Sarcoma patients with pegylated liposomal doxorubicin. Ann Oncol. 1998;9:711–6.
Gordon AN, Tonda M, Sun S, Rackoff W. Doxil Study 30-49 Investigators. Long-term survival advantage for women treated with pegylated liposomal doxorubicin compared with topotecan in a phase 3 randomized study of recurrent and refractory epithelial ovarian cancer. Gynecol Oncol. 2004;95:1–8.
Abushahin G, Singh DK, Lurain JR, et al. Weekly topotecan for recurrent platinum resistant ovarian cancer. Gynecol Oncol. 2008;108:53–7.
Creemers GJ, Bolis G, Gore M, et al. Topotecan, an active drug in the second-line treatment of epithelial ovarian cancer: results of a large European phase II study. J Clin Oncol. 1996;14:3056–61.
ten Bokkel Huinink W, Gore M, Carmichael J, et al. Topotecan versus paclitaxel for the treatment of recurrent epithelial ovarian cancer. J Clin Oncol. 1997;15:2183–93.
Gore M, ten Bokkel Huinink W, Carmichael J, et al. Clinical evidence for topotecan-paclitaxel non-cross-resistance in ovarian cancer. J Clin Oncol. 2001;19:1893–900.
Lorusso D, Di Stefano A, Fanfani F, Scambia G. Role of gemcitabine in ovarian cancer treatment. Ann Oncol. 2006;17(Suppl 5):v188–94.
Ganghadaran SGD. Management of platinum resistant—refractory ovarian cancer: a short review. J Cancer Res Treat. 2016;4(2):32–6.
Friedlander M, Trimble E, Tinker A, et al. Clinical trials in recurrent ovarian cancer. Int J Gynecol Cancer. 2011;21:771–5.
Rothenberg ML, Liu PY, Wilczynski S, et al. Phase II trial of vinorelbine for relapsed ovarian cancer: a Southwest Oncology Group study. Gynecol Oncol. 2004;95(3):506–12.
Yokoyama Y, Mizunuma H. Recurrent epithelial ovarian cancer and hormone therapy. World J Clin Cases WJCC. 2013;1(6):187–90.
Schwartz PE, Chambers JT, Kohorn EI, Chambers SK, Weitzman H, Voynick IM, et al. Tamoxifen in combination with cytotoxic chemotherapy in advanced epithelial ovarian cancer. A prospective randomized trial. Cancer. 1989;63(6):1074–8.
Kothari R, Argenta P, Fowler J, Carter J, Shimp W. Antiestrogen therapy in recurrent ovarian cancer resulting in 28 months of stable disease: a case report and review of the literature. Arch oncol Inst Oncol Sremska Kamenica Yugosl. 2010;18(1–2):32–5.
Burger RA, Brady MF, Bookman MA, et al. Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med. 2011;365:2473–83.
Perren TJ, Swart AM, Pfisterer J, et al. A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med. 2011;365:2484–96.
McClung EC, Wenham RM. Profile of bevacizumab in the treatment of platinum-resistant ovarian cancer: current perspectives. Int J Women’s Health. 2016;8:59–75.
Pujade-Lauraine E, Hilpert F, Weber B, et al. Bevacizumab combined with chemotherapy for platinum-resistant recurrent ovarian cancer: the AURELIA open-label randomized phase III trial. J Clin Oncol. 2014;32(13):1302–8.
Kim G, et al. FDA approval summary: olaparib Monotherapy in patients with deleterious germline BRCA-mutated advanced ovarian cancer treated with three or more lines of chemotherapy. Clin Cancer Res. 2015;21(19):4257–61.
Brown JS, Kaye SB. Yap TA.PARP inhibitors: the race is on. Br J Cancer. 2016;114(7):713–5.
Carter CA, Oronsky BT, Caroen SZ, Scicinski JJ, Degesys A, Kim MM, Oronsky AL, Lybeck H, Cabrales P, Oronsky N, Reid T, Roswarski J, Brzezniak C. RRx-001 in refractory small-cell lung carcinoma: a case report of a partial response after a third reintroduction of platinum doublets. Case Rep Oncol. 2016;9(1):171–6.
Jabbour E, Garcia-Manero G, Cornelison AM, Cortes JE, Ravandi F, Daver N, Kadia T, Teng A, Kantarjian H. The effect of decitabine dose modification and myelosuppression on response and survival in patients with myelodysplastic syndromes. Leuk Lymphoma. 2015;56(2):390–4.
Abdallah BY, Horne SD, Kurkinen M, Stevens JB, Liu G, Ye CJ, Barbat J, Bremer SW, Heng HHQ. Ovarian cancer evolution through stochastic genome alterations: defining the genomic role in ovarian cancer. Syst Biol in Reprod Med. 2014;60(1):2–13.
Coukos G, Tanyi J, Kandalaft LE. Opportunities in immunotherapy of ovarian cancer. Ann Oncol. 2016;27(Suppl 1):i11–5.
Ojalvo LS, Nichols PE, Jelovac D, Emens LA. Emerging immunotherapies in ovarian cancer. Discov Med. 2015;20(109):97–109.
Hamanishi J, Mandai M, Ikeda T, et al. Safety and antitumor activity of anti-PD-1 antibody, nivolumab, in patients with platinum-resistant ovarian cancer. J Clin Oncol. 2015;33(34):4015–22.
Hamanishi J, Mandai M, Ikeda T, et al. Efficacy and safety of anti-PD-1 antibody (Nivolumab: BMS-936558, ONO-4538) in patients with platinum-resistant ovarian cancer. J Clin Oncol. 2014; 32, abstract 5511, ASCO Annual Meeting.
Varga A, Piha-Paul SA, Ott PA, et al. Antitumor activity and safety of pembrolizumab in patients with PD-L1 positive advanced ovarian cancer: Interim results from a phase Ib study. J Clin Oncol. 2015;33(15 Suppl.):5510.
Brahmer JR, Tykodi SS, Chow LQ, Hwu WJ, Topalian SL, Hwu P, Drake CG, Camacho LH, Kauh J, Odunsi K, Pitot HC, Hamid O, Bhatia S, Martins R, Eaton K, Chen S, Salay TM, Alaparthy S, Grosso JF, Korman AJ, et al. Safety and activity of anti-PD-L1 antibody in patients with advanced cancer. N Engl J Med. 2012;366(26):2455–65.
Itamochi H, Kigawa J, Terakawa N. Mechanisms of chemoresistance and poor prognosis in ovarian clear cell carcinoma. Cancer Sci. 2008;99(4):653–8.
FDA News Release. FDA grants accelerated approval to new treatment for advanced ovarian cancer. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm533873.htm. Accessed 19 Jan 2017.
Acknowledgements
The authors wish to thank and acknowledge Dr. Harry Lybeck, possibly the world’s longest living academic professor and physician, currently 98 years old (and counting), for his contributions to this manuscript. Having earned his M.D. and Ph.D. while serving in WWII, Dr. Lybeck climbed to the top of the academic hill but is far from over it. With 70 years of medical experience, Dr. Lybeck is the epitome of a caring, compassionate physician who prioritizes others over himself.
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Oronsky, B., Ray, C.M., Spira, A.I. et al. A brief review of the management of platinum-resistant–platinum-refractory ovarian cancer. Med Oncol 34, 103 (2017). https://doi.org/10.1007/s12032-017-0960-z
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DOI: https://doi.org/10.1007/s12032-017-0960-z