Skip to main content

Advertisement

SpringerLink
Log in

The current treatment of recurrent ovarian cancer

  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Contemporary management of recurrent ovarian, primary peritoneal, and fallopian tube cancers has continued to evolve and now offers women the hope of extended survival with an improved quality of life. Platinum continues to be the single most active agent in the treatment of ovarian cancer, but acquired resistance to platinum often emerges. Fortunately, a number of novel agents and treatment strategies have been developed to meet the goals of ameliorating symptoms while extending survival. Classically, patients have been treated based upon the interval from last platinum administration during front-line therapy until time of recurrence. This review focuses upon the current treatment strategies used for platinum-refractory, platinum-resistant, and platinumsensitive patients. The incorporation of targeted biologic agents is also discussed, along with the role of secondary cytoreduction. It is hoped that the results of future and ongoing clinical trials will offer further advances in the treatment of this devastating disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2006. CA Cancer J Clin 2006, 56:106–130.

    Article  PubMed  Google Scholar 

  2. Bristow RE, Tomacruz RS, Armstrong DK, et al.: Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 2002, 20:248–259.

    Article  Google Scholar 

  3. Armstrong DK, Bundy B, Wenzel L, et al.: Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 2006, 354:34–43. One of two important papers that report the results of the definitive clinical trials showing the potential advantages for intraperitoneal and maintenance therapy.

    Article  PubMed  CAS  Google Scholar 

  4. Markman M, Liu PY, Wilczynski S, et al.: Phase III randomized trial of 12 versus 3 months of maintenance paclitaxel in patients with advanced ovarian cancer after complete response to platinum and paclitaxelbased chemotherapy: a Southwest Oncology Group and Gynecologic Oncology Group trial. J Clin Oncol 2003, 21:2460–2465 The second of two important papers that report the results of the definitive clinical trials showing the potential advantages for intraperitoneal and maintenance therapy.

    Article  PubMed  CAS  Google Scholar 

  5. Markman M, Rothman R, Hakes T, et al.: Second-line platinum therapy in patients with ovarian cancer previously treated with cisplatin. J Clin Oncol 1991, 9:389–393.

    PubMed  CAS  Google Scholar 

  6. Herzog TJ: Recurrent ovarian cancer: how important is it to treat to disease progression? Clin Cancer Res 2004, 10:7439–7449. This paper includes a thorough discussion of treatment options in recurrent ovarian cancer and discusses the important concept of treating primary and secondary platinum-resistant patients until disease progression.

    Article  PubMed  CAS  Google Scholar 

  7. Sehouli J, Oskay-Ozcelik G, Kuhne J, et al.: Biweekly pegylated liposomal doxorubicin in patients with relapsed ovarian cancer: results of a multicenter phase-II trial. Ann Oncol 2006, 17:957–961.

    Article  PubMed  CAS  Google Scholar 

  8. Rose PG: Pegylated liposomal doxorubicin: optimizing the dosing schedule in ovarian cancer. Oncologist 2005, 10:205–214.

    Article  PubMed  CAS  Google Scholar 

  9. Markman M, Gordon AN, McGuire WP, Muggia FM: Liposomal anthracycline treatment for ovarian cancer. Semin Oncol 2005, 31(Suppl 13):91–105.

    Google Scholar 

  10. Gordon N, Fleagle JT, Guthrie D, et al.: Recurrent epithelial ovarian carcinoma: A randomized phase III study of pegylated liposomal doxorubicin versus topotecan. J Clin Oncol 2001, 19:3312–3322.

    PubMed  CAS  Google Scholar 

  11. Gordon AN, Tonda M, Sun S, et al.: 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.

    Article  PubMed  CAS  Google Scholar 

  12. Kudelka AP, Tresukosol D, Edwards CL, et al.: Phase II study of intravenous topotecan as a 5-day infusion for refractory epithelial ovarian carcinoma. J Clin Oncol 1996, 14:1552–1557.

    PubMed  CAS  Google Scholar 

  13. 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, 14:3056–3061.

    PubMed  CAS  Google Scholar 

  14. Swisher EM, Mutch DG, Rader JS, et al.: Topotecan in platinum- and paclitaxel-resistant ovarian cancer. Gynecol Oncol 1997, 66:480–486.

    Article  PubMed  CAS  Google Scholar 

  15. Rodriguez M, Rose PG: Improved therapeutic index of lower dose topotecan chemotherapy in recurrent ovarian cancer. Gynecol Oncol 2001, 83:257–262.

    Article  PubMed  CAS  Google Scholar 

  16. Morris RT: Weekly topotecan in the management of ovarian cancer. Gynecol Oncol 2003, 90:S34-S38.

    Article  PubMed  CAS  Google Scholar 

  17. Bhoola SM, Coleman RL, Herzog T, et al.: Retrospective analysis of weekly topotecan as salvage therapy in relapsed ovarian cancer. Gynecol Oncol 2004, 95:564–569.

    Article  PubMed  CAS  Google Scholar 

  18. Levy T, Inbar M, Menczer J, et al.: Phase II study of weekly topotecan in patients with recurrent or persistent epithelial ovarian cancer. Gynecol Oncol 2004, 95:686–690.

    Article  PubMed  CAS  Google Scholar 

  19. Brown J, Peters W III, Rettenmaier M, et al.: Three consecutive-day topotecan is an active regimen for recurrent epithelial ovarian cancer. Gynecol Oncol 2003, 88:136–140.

    Article  PubMed  CAS  Google Scholar 

  20. Miller D, Blessing J, Lentz S, McMeekin DS: Phase II evaluation of three-day topotecan in recurrent platinum sensitive ovarian cancer. Cancer 2003, 98:1664–1669.

    Article  PubMed  CAS  Google Scholar 

  21. Herzog TJ, Powell MA, Rader JS, et al.: Phase II evaluation of a 3-day infusion of topotecan in patients with recurrent ovarian or primary peritoneal cancer. Gynecol Oncol 2006 Jun 14, [Epub ahead of print].

  22. Lund B, Hansen OP, Neijt JP, et al.: Phase II study of gemcitabine in previously platinum-treated ovarian cancer patients. Anticancer Drugs 1995, 6(Suppl 6):61–62.

    Article  PubMed  CAS  Google Scholar 

  23. Markman M, Webster K, Zanotti K, et al.: Phase 2 trial of single-agent gemcitabine in platinum-paclitaxel refractory ovarian cancer. Gynecol Oncol 2003, 90:593–596.

    Article  PubMed  CAS  Google Scholar 

  24. Shapiro JD, Millward MJ, Rischin D, et al.: Activity of gemcitabine in patients with advanced ovarian cancer: responses seen following platinum and paclitaxel. Gynecol Oncol 1996, 63:89–93.

    Article  PubMed  CAS  Google Scholar 

  25. Rose PG, Mossbruger K, Fusco N, et al.: Gemcitabine reverses cisplatin resistance: demonstration of activity in platinum- and multidrug-resistant ovarian and peritoneal carcinoma. Gynecol Oncol 2003, 88:17–21.

    Article  PubMed  CAS  Google Scholar 

  26. Brewer CA, Blessing JA, Nagourney RA, et al.: Cisplatin plus gemcitabine in platinum-refractory ovarian or primary peritoneal cancer: A phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2006 Apr 24 [Epub ahead of print].

  27. Rose PG, Blessing JA, Ball HG, et al.: Phase II study of docetaxel in paclitaxel-resistant ovarian and peritoneal carcinoma: A Gynecologic Oncology Group study. Gynecol Oncol 2003, 88:130–135.

    Article  PubMed  CAS  Google Scholar 

  28. Schink JC, Harris LS, Grosen ER, et al.: Altretamine (Hexalin) An effective salvage chemotherapy after paclitaxel (Taxol) in women with recurrent platinum resistant ovarian cancer [abstract]. Proc ASCO 1995, 14:275.

    Google Scholar 

  29. Markman M, Blessing JA, Moore D, et al.: Altretamine (hexamethylmelamine) in platinum-resistant and platinumrefractory ovarian cancer: a Gynecologic Oncology Group Phase II trial. Gynecol Oncol 1998, 69:226–229.

    Article  PubMed  CAS  Google Scholar 

  30. Rose PG, Blessing JA, Mayer AR, et al.: Prolonged oral etoposide as second line therapy for platinum resistant and platinum sensitive ovarian carcinomas: A Gynecologic Oncology Group Study. J Clin Oncol 1998, 16:405–410.

    PubMed  CAS  Google Scholar 

  31. Markman M, Hakes T, Reichman B, et al.: Ifosfamide and mesna in previously treated advanced epithelial ovarian cancer: Activity in platinum-resistant disease. J Clin Oncol 1992, 10:243–248.

    PubMed  CAS  Google Scholar 

  32. Markman M, Iseminger KA, Hatch KD, et al.: Tamoxifen in platinum-refractory ovarian cancer: A Gynecologic Oncology Group ancillary report. Gynecol Oncol 1996, 62:4–6.

    Article  PubMed  CAS  Google Scholar 

  33. Bajetta E, Di Leo A, Biganzoli L, et al.: Phase II study of vinorelbine in patients with pretreated advanced ovarian cancer: activity in platinum-resistant disease. J Clin Oncol 1996, 14:2546–2551.

    PubMed  CAS  Google Scholar 

  34. Parmar MK, Ledermann JA, Colombo N, et al.: Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet 2003, 361:2099–2106. This study introduced the concept of treatment with platinum-based doublets in platinum-sensitive recurrent ovarian cancer and showed an overall survival advantage for those treated with doublets.

    Article  PubMed  CAS  Google Scholar 

  35. Pfisterer J, Plante M, Vergote I, et al.: Gemcitabine/carboplatin (GC) vs. carboplatin (C) in platinum sensitive recurrent ovarian cancer (OVCA). Results of a Gynecologic Cancer Intergroup randomized phase III trial of the AGO OVAR, the NCIC CTG and the EORTC GCG [abstract]. Proc ASCO 2004, 23:449. This study further reinforces the concept of treatment with a platinum-based doublet in patients with recurrent ovarian cancer, but only a progression-free advantage, rather than an overall survival advantage, was shown.

    Google Scholar 

  36. Markman M, Webster K, Zanotti K, et al.: Survival following the documentation of platinum and taxane resistance in ovarian cancer: a single institution experience involving multiple phase 2 clinical trials. Gynecol Oncol 2004, 93:699–701.

    Article  PubMed  CAS  Google Scholar 

  37. Markman M, Reichman B, Hakes T, et al.: Responses to second-line cisplatin-based intraperitoneal therapy in ovarian cancer: influence of a prior response to intravenous cisplatin. J Clin Oncol. 1991, 9:1801–1805.

    PubMed  CAS  Google Scholar 

  38. Aghajanian C: Clinical update: novel targets in gynecologic malignancies. Semin Oncol 2004, 31(Suppl 16):22–26.

    Article  PubMed  CAS  Google Scholar 

  39. Tew KD: TLK-286: a novel glutathione S-transferase-activated prodrug. Expert Opin Investig Drugs 2005, 14:1047–1054.

    Article  PubMed  CAS  Google Scholar 

  40. Bookman MA, Darcy KM, Clarke-Pearson D, et al.: Evaluation of monoclonal humanized anti-HER2 antibody, trastuzumab, in patients with recurrent or refractory ovarian or primary peritoneal carcinoma with overexpression of HER2: a phase II trial of the Gynecologic Oncology Group. J Clin Oncol 2003, 21:283–290.

    Article  PubMed  CAS  Google Scholar 

  41. D’Incalci M, Colombo T, Ubezio P, et al.: (2003) The combination of Yondelis and cisplatin is synergistic against human tumor xenografts. Eur J Cancer 2003, 39:1920–1926.

    Article  PubMed  CAS  Google Scholar 

  42. Burger RA, Sill M, Monk B, et al.: Phase II trial of bevacizumab in persistent or recurrent epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC): a Gynecologic Oncology Group (GOG) study [abstract]. Proc ASCO 2005, 23:457s.

    Google Scholar 

  43. Garcia AA, Oza AM, Hirte H, et al.: Interim report of a phase II clinical trial of bevacizumab (Bev) and low dose metronomic oral cyclophosphamide (mCTX) in recurrent ovarian (OC) and primary peritoneal carcinoma: A California Cancer Consortium Trial [abstract]. Proc ASCO 2005, 23:455s.

    Google Scholar 

  44. Cannistra S, Matulonis U, Penson R, et al.: Bevacizumab in patients with advanced platinum-resistant ovarian cancer [abstract]. Proc ASCO 2006, 24:5006.

    Google Scholar 

  45. Wright JD, Hagemann A, Rader JS, et al.: Bevacizumab combination therapy in recurrent, platinum-refractory, epithelial ovarian carcinoma: a retrospective analysis. Cancer 2006, 107:83–89.

    Article  PubMed  CAS  Google Scholar 

  46. Podratz KC, Schray MF, Wieand HS, et al.: Evaluation of treatment and survival after positive second-look laparotomy. Gynecol Oncol 1998, 31:9–24.

    Article  Google Scholar 

  47. Hoskins WJ, Rubin SC, Dulaney E, et al.: Influence of secondary cytoreduction at the time of second-look laparotomy on the survival of patients with epithelial ovarian carcinoma. Gynecol Oncol 134:365–371.

  48. McCreath WA, Chi DS: Surgical cytoreduction in ovarian cancer. Oncology 2004, 18:645–653.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University, Herbert Irving Cancer Center, 161 Fort Washington Avenue, 10032, New York, NY, USA

    Thomas J. Herzog MD

Authors
  1. Thomas J. Herzog MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas J. Herzog MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Herzog, T.J. The current treatment of recurrent ovarian cancer. Curr Oncol Rep 8, 448–454 (2006). https://doi.org/10.1007/s11912-006-0074-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11912-006-0074-9

Keywords

Search

Navigation