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Treatment Perspectives for Ovarian Cancer in Europe and the United States: Initial Therapy and Platinum-Sensitive Recurrence after PARP Inhibitors or Bevacizumab Therapy

  • Gynecologic Cancers (J Brown and RW Naumann, Section Editors)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Although the survival rate of patients with ovarian cancer (OC) has significantly improved, OC is still one of the most common causes of gynecologic cancer death in women worldwide. The current advances in primary treatment are based on recent regulatory approvals and recurrency of such treatments, challenging the development of a unified approach to care. Herein, we examine how integration of these new approaches is applied to patient’s treatment.

Recent Findings

We and others have recently reported clinical trials using bevacizumab and/or inhibitors of Poly (ADP-ribose) polymerase (PARP), which have greatly affected the change in first-line treatments for OC.

Summary

As first-line therapy has evolved, therapeutic agents once designated for recurrent disease are increasingly being incorporated, changing our standard of care following previously indexed trials. Here, we provide an overview of the current treatment for OC patients, and we highlight practice patterns in Europe and in the USA with corresponding opinions on current and future treatments for platinum-sensitive recurrent OC.

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References

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  1. Ledermann JA, Raja FA, Fotopoulou C, Gonzalez-Martin A, Colombo N, Sessa C. Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24:24–32. https://doi.org/10.1093/annonc/mdt333.

    Article  Google Scholar 

  2. Schorge JO, Eisenhauer EE, Chi DS. Current surgical management of ovarian cancer. Hematol Oncol Clin North Am. 2012;26(1):93–109. https://doi.org/10.1016/j.hoc.2011.10.004.

    Article  PubMed  Google Scholar 

  3. Bamberger ES, Perrett CW. Angiogenesis in epithelian ovarian cancer. Mol Pathol. 2002;55(6):348–59.

    Article  CAS  Google Scholar 

  4. Chelariu-Raicu A, Coleman RL, Sood AK. Anti-angiogenesis therapy in ovarian cancer: which patient is it most likely to benefit? Oncol Williston Park N. 2019;33(7):629378.

  5. Decio A, Taraboletti G, Patton V, et al. Vascular endothelial growth factor c promotes ovarian carcinoma progression through paracrine and autocrine mechanisms. Am J Pathol. 2014;184(4):1050–61. https://doi.org/10.1016/j.ajpath.2013.12.030.

    Article  CAS  PubMed  Google Scholar 

  6. Bekes I, Friedl TWP, Köhler T, et al. Does VEGF facilitate local tumor growth and spread into the abdominal cavity by suppressing endothelial cell adhesion, thus increasing vascular peritoneal permeability followed by ascites production in ovarian cancer? Mol Cancer. 2016;15(1):13. https://doi.org/10.1186/s12943-016-0497-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Horikawa N, Abiko K, Matsumura N, et al. Expression of vascular endothelial growth factor in ovarian cancer inhibits tumor immunity through the accumulation of myeloid-derived suppressor cells. Clin Cancer Res. 2017;23(2):587–99. https://doi.org/10.1158/1078-0432.CCR-16-0387.

    Article  CAS  PubMed  Google Scholar 

  8. Colombo N, Sessa C, du Bois A, et al. ESMO–ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease. Int J Gynecol Cancer. 2019;29(4):728–60. https://doi.org/10.1136/ijgc-2019-000308. Last ESMO/ESGO guidelines regarding OC patient care.

  9. Karam A, Ledermann JA, Kim J-W, et al. Fifth ovarian cancer consensus conference of the gynecologic cancer intergroup: first-line interventions. Ann Oncol Off J Eur Soc Med Oncol. 2017;28(4):711–7. https://doi.org/10.1093/annonc/mdx011.

    Article  CAS  Google Scholar 

  10. Burger RA, Brady MF, Bookman MA, et al. Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med. 2011;365(26):2473–83. https://doi.org/10.1056/NEJMoa1104390Phase III trial GOG-0218 showing importance of combining bevacizumab to platinum-based chemotherapy for the treatment of newly diagnosed, advanced OC. This result changed standard of care of this patients.

  11. Perren TJ, Swart AM, Pfisterer J, et al. A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med. 2011;365(26):2484–96. https://doi.org/10.1056/NEJMoa1103799Phase III trial GOG-0218 showing importance of combining bevacizumab to platinum-based chemotherapy for the treatment of newly diagnosed, advanced OC. This result changed standard of care of this patients.

  12. Rouzier R, Gouy S, Selle F, et al. Efficacy and safety of bevacizumab-containing neoadjuvant therapy followed by interval debulking surgery in advanced ovarian cancer: Results from the ANTHALYA trial. Eur J Cancer Oxf Engl. 1990;2017(70):133–42. https://doi.org/10.1016/j.ejca.2016.09.036.

    Article  CAS  Google Scholar 

  13. Coleman RL, Fleming GF, Brady MF, et al. Veliparib with first-line chemotherapy and as maintenance therapy in ovarian cancer. N Engl J Med. 2019;381(25):2403–15. https://doi.org/10.1056/NEJMoa1909707. Phase III trial VELIA aimed at testing veliparib efficacy in induction phase along with platinum-based chemotherapy or both induction and maintenance phase on OC stage III-IV patients. This study was conclusive about the use of the PARPi compared to chemotherapy alone.

  14. González-Martín A, Pothuri B, Vergote I, et al. Niraparib in patients with newly diagnosed advanced ovarian cancer. N Engl J Med. 2019;381(25):2391–402. https://doi.org/10.1056/NEJMoa1910962Phase III trial PRIMA showing an improvement of the median PFS of OC patients treated with niraparib, regardless of their BRCA1/2 status and who present a high risk of recurrence after surgery and who respond to first-line platinum-based chemotherapy.

  15. Ledermann JA, Drew Y, Kristeleit RS. Homologous recombination deficiency and ovarian cancer. Eur J Cancer. 2016;60:49–58. https://doi.org/10.1016/j.ejca.2016.03.005.

    Article  CAS  PubMed  Google Scholar 

  16. Moore K, Colombo N, Scambia G, et al. Maintenance olaparib in patients with newly diagnosed advanced ovarian cancer. N Engl J Med. 2018;379(26):2495–505. https://doi.org/10.1056/NEJMoa1810858Phase III trial SOLO-1 that aimed to test efficacy of olaparib on patients with BRCA1/2-mutated tumors after complete or partial response to platinum-based chemotherapy. This study changed the standard of care of these patients.

  17. Ray-Coquard I, Pautier P, Pignata S, et al. Olaparib plus bevacizumab as first-line maintenance in ovarian cancer. N Engl J Med. 2019;381(25):2416–28. https://doi.org/10.1056/NEJMoa1911361Phase III trial PAOLA-1 showing benefits of combining bevacizumab with olaparib in maintenance phase of OC patients regardless of their BRCA1/2-mutation status.

  18. Chan JK, Brady MF, Penson RT, et al. Weekly vs. every-3-week paclitaxel and carboplatin for ovarian cancer. N Engl J Med. 2016;374(8):738–48. https://doi.org/10.1056/NEJMoa1505067.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Tewari KS, Burger RA, Enserro D, et al. Final overall survival of a randomized trial of bevacizumab for primary treatment of ovarian cancer. J Clin Oncol. 2019;37(26):2317–28. https://doi.org/10.1200/JCO.19.01009.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Oza AM, Cook AD, Pfisterer J, et al. Standard chemotherapy with or without bevacizumab for women with newly diagnosed ovarian cancer (ICON7): overall survival results of a phase 3 randomised trial. Lancet Oncol. 2015;16(8):928–36. https://doi.org/10.1016/S1470-2045(15)00086-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Tew WP, Lacchetti C, Ellis A, et al. PARP inhibitors in the management of ovarian cancer: ASCO guideline. J Clin Oncol. 2020;38(30):3468–93. https://doi.org/10.1200/JCO.20.01924.

    Article  PubMed  Google Scholar 

  22. Aghajanian C, Blank SV, Goff BA, et al. OCEANS: a randomized, double-blind, placebo-controlled phase III trial of chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent epithelial ovarian, primary peritoneal, or fallopian tube cancer. J Clin Oncol. 2012;30(17):2039–45. https://doi.org/10.1200/JCO.2012.42.0505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Coleman RL, Brady MF, Herzog TJ, et al. Bevacizumab and paclitaxel-carboplatin chemotherapy and secondary cytoreduction in recurrent, platinum-sensitive ovarian cancer (NRG oncology/gynecologic oncology group study GOG-0213): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2017;18(6):779–91. https://doi.org/10.1016/S1470-2045(17)30279-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Pignata S, Lorusso D, Joly F, et al. Chemotherapy plus or minus bevacizumab for platinum-sensitive ovarian cancer patients recurring after a bevacizumab containing first line treatment: the randomized phase 3 trial MITO16B-MaNGO OV2B-ENGOT OV17. J Clin Oncol. 2018;36(15_suppl):5506–5506. https://doi.org/10.1200/JCO.2018.36.15_suppl.5506.

    Article  Google Scholar 

  25. Pfisterer J, Shannon CM, Baumann K, et al. Bevacizumab and platinum-based combinations for recurrent ovarian cancer: a randomised, open-label, phase 3 trial. Lancet Oncol. 2020;21(5):699–709. https://doi.org/10.1016/S1470-2045(20)30142-X.

    Article  CAS  PubMed  Google Scholar 

  26. Parmar MKB, 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 Lond Engl. 2003;361(9375):2099–106. https://doi.org/10.1016/s0140-6736(03)13718-x.

    Article  CAS  Google Scholar 

  27. Pfisterer J, Plante M, Vergote I, et al. Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: an intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG. J Clin Oncol Off J Am Soc Clin Oncol. 2006;24(29):4699–707. https://doi.org/10.1200/JCO.2006.06.0913.

    Article  CAS  Google Scholar 

  28. Wagner U, Marth C, Largillier R, et al. Final overall survival results of phase III GCIG CALYPSO trial of pegylated liposomal doxorubicin and carboplatin vs paclitaxel and carboplatin in platinum-sensitive ovarian cancer patients. Br J Cancer. 2012;107(4):588–91. https://doi.org/10.1038/bjc.2012.307.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Ferriss JS, Java JJ, Bookman MA, et al. Ascites predicts treatment benefit of bevacizumab in front-line therapy of advanced epithelial ovarian, fallopian tube and peritoneal cancers: an NRG Oncology/GOG study. Gynecol Oncol. 2015;139(1):17–22. https://doi.org/10.1016/j.ygyno.2015.07.103.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Burger RA, Brady MF, Bookman MA, et al. Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med. 2011;365(26):2473–83. https://doi.org/10.1056/NEJMoa1104390.

    Article  CAS  PubMed  Google Scholar 

  31. Perren TJ, Swart AM, Pfisterer J, et al. A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med. 2011;365(26):2484–96. https://doi.org/10.1056/NEJMoa1103799.

    Article  CAS  PubMed  Google Scholar 

  32. Pignata S, Lorusso D, Joly F, et al. Carboplatin-based doublet plus bevacizumab beyond progression versus carboplatin-based doublet alone in patients with platinum-sensitive ovarian cancer: a randomised, phase 3 trial. Lancet Oncol. 2021;22(2):267–76. https://doi.org/10.1016/S1470-2045(20)30637-9.

    Article  CAS  PubMed  Google Scholar 

  33. Gelmon KA, Tischkowitz M, Mackay H, et al. Olaparib in patients with recurrent high-grade serous or poorly differentiated ovarian carcinoma or triple-negative breast cancer: a phase 2, multicentre, open-label, non-randomised study. Lancet Oncol. 2011;12(9):852–61. https://doi.org/10.1016/S1470-2045(11)70214-5.

    Article  CAS  PubMed  Google Scholar 

  34. Ledermann J, Harter P, Gourley C, et al. Olaparib maintenance therapy in platinum-sensitive relapsed ovarian cancer. N Engl J Med. 2012;366(15):1382–92. https://doi.org/10.1056/NEJMoa1105535.

    Article  CAS  PubMed  Google Scholar 

  35. Mirza MR, Monk BJ, Herrstedt J, et al. Niraparib maintenance therapy in platinum-sensitive, recurrent ovarian cancer. N Engl J Med. 2016;375(22):2154–64. https://doi.org/10.1056/NEJMoa1611310.

    Article  CAS  PubMed  Google Scholar 

  36. Coleman RL, Oza AM, Lorusso D, et al. Rucaparib maintenance treatment for recurrent ovarian carcinoma after response to platinum therapy (ARIEL3): a randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet. 2017;390(10106):1949–61. https://doi.org/10.1016/S0140-6736(17)32440-6.

    Article  CAS  Google Scholar 

  37. Pujade-Lauraine E, Ledermann JA, Selle F, et al. Olaparib tablets as maintenance therapy in patients with platinum-sensitive, relapsed ovarian cancer and a BRCA1/2 mutation (SOLO2/ENGOT-Ov21): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Oncol. 2017;18(9):1274–84. https://doi.org/10.1016/S1470-2045(17)30469-2.

    Article  CAS  PubMed  Google Scholar 

  38. Final overall survival (OS) results from SOLO2/ENGOT-ov21: a phase III trial assessing maintenance olaparib in patients (pts) with platinum-sensitive, relapsed ovarian cancer and a BRCA mutation. | Journal of Clinical Oncology. Accessed January 24, 2021. https://ascopubs.org/doi/abs/https://doi.org/10.1200/JCO.2020.38.15_suppl.6002

  39. Penson RT, Valencia RV, Cibula D, et al. Olaparib versus nonplatinum chemotherapy in patients with platinum-sensitive relapsed ovarian cancer and a germline BRCA1/2 mutation (SOLO3): a randomized phase III trial. J Clin Oncol. 2020;38(11):1164–74. https://doi.org/10.1200/JCO.19.02745.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Rafii S, Gourley C, Kumar R, et al. Baseline clinical predictors of antitumor response to the PARP inhibitor olaparib in germline BRCA1/2 mutated patients with advanced ovarian cancer. Oncotarget. 2017;8(29):47154–60. https://doi.org/10.18632/oncotarget.17005.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Murai J, Huang SN, Das BB, et al. Differential trapping of PARP1 and PARP2 by clinical PARP inhibitors. Cancer Res. 2012;72(21):5588–99. https://doi.org/10.1158/0008-5472.CAN-12-2753An interesting paper showing that PARPi can have different catalytic activities thereby raising the question that patients who receive one PARPi might be treated with another one in case of platinum-sensitive recurrent OC. This question can only be solved with future clinical trials.

  42. Du Bois A, Sehouli J, Vergote I, et al. Randomized phase III study to evaluate the impact of secondary cytoreductive surgery in recurrent ovarian cancer: final analysis of AGO DESKTOP III/ENGOT-ov20. J Clin Oncol. 2020;38(15_suppl):6000–6000. https://doi.org/10.1200/JCO.2020.38.15_suppl.6000.

    Article  Google Scholar 

  43. Coleman RL, Spirtos NM, Enserro D, et al. Secondary surgical cytoreduction for recurrent ovarian cancer. N Engl J Med. 2019;381(20):1929–39. https://doi.org/10.1056/NEJMoa1902626.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Zang R, Zhu J, Shi T, et al. A randomized phase III trial of secondary cytoreductive surgery in later recurrent ovarian cancer: SOC1/SGOG-OV2. J Clin Oncol. 2020;38(15_suppl):6001–6001. https://doi.org/10.1200/JCO.2020.38.15_suppl.6001.

    Article  Google Scholar 

  45. Mackay HJ, Brady MF, Oza AM, et al. Prognostic relevance of uncommon ovarian histology in women with stage III/IV epithelial ovarian cancer. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2010;20(6):945–52. https://doi.org/10.1111/IGC.0b013e3181dd0110.

    Article  Google Scholar 

  46. Grabowski JP, Harter P, Heitz F, et al. Operability and chemotherapy responsiveness in advanced low-grade serous ovarian cancer. An analysis of the AGO study group metadatabase. Gynecol Oncol. 2016;140(3):457–62. https://doi.org/10.1016/j.ygyno.2016.01.022.

    Article  PubMed  Google Scholar 

  47. Pennington KP, Walsh T, Harrell MI, et al. Germline and somatic mutations in homologous recombination genes predict platinum response and survival in ovarian, fallopian tube, and peritoneal carcinomas. Clin Cancer Res Off J Am Assoc Cancer Res. 2014;20(3):764–75. https://doi.org/10.1158/1078-0432.CCR-13-2287.

    Article  CAS  Google Scholar 

  48. Friedlander M, Trimble E, Tinker A, et al. Clinical trials in recurrent ovarian cancer. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2011;21(4):771–5. https://doi.org/10.1097/IGC.0b013e31821bb8aa.

    Article  Google Scholar 

  49. Bouberhan S, Pujade-Lauraine E, Cannistra SA. Advances in the management of platinum-sensitive relapsed ovarian cancer. J Clin Oncol. 2019;37(27):2424–36. https://doi.org/10.1200/JCO.19.00314.

    Article  CAS  PubMed  Google Scholar 

  50. Pujade-Lauraine E, Banerjee S, Pignata S. Management of platinum-resistant, relapsed epithelial ovarian cancer and new drug perspectives. J Clin Oncol. 2019;37(27):2437–48. https://doi.org/10.1200/JCO.19.00194.

    Article  CAS  PubMed  Google Scholar 

  51. Ledermann J, Harter P, Gourley C, et al. Olaparib maintenance therapy in platinum-sensitive relapsed ovarian cancer. N Engl J Med. 2012;366(15):1382–92. https://doi.org/10.1056/NEJMoa1105535.

    Article  CAS  PubMed  Google Scholar 

  52. Gore ME, Fryatt I, Wiltshaw E, Dawson T. Treatment of relapsed carcinoma of the ovary with cisplatin or carboplatin following initial treatment with these compounds. Gynecol Oncol. 1990;36(2):207–11. https://doi.org/10.1016/0090-8258(90)90174-j.

    Article  CAS  PubMed  Google Scholar 

  53. Wilson MK, Pujade-Lauraine E, Aoki D, et al. Fifth Ovarian cancer consensus conference of the gynecologic cancer intergroup: recurrent disease. Ann Oncol Off J Eur Soc Med Oncol. 2017;28(4):727–32. https://doi.org/10.1093/annonc/mdw663.

    Article  CAS  Google Scholar 

  54. Hanker LC, Loibl S, Burchardi N, et al. The impact of second to sixth line therapy on survival of relapsed ovarian cancer after primary taxane/platinum-based therapy. Ann Oncol Off J Eur Soc Med Oncol. 2012;23(10):2605–12. https://doi.org/10.1093/annonc/mds203.

    Article  CAS  Google Scholar 

  55. 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 Off J Am Soc Clin Oncol. 2014;32(13):1302–8. https://doi.org/10.1200/JCO.2013.51.4489.

    Article  CAS  Google Scholar 

  56. Domchek SM, Postel-Vinay S, Im S-A, et al. Olaparib and durvalumab in patients with germline BRCA-mutated metastatic breast cancer (MEDIOLA): an open-label, multicentre, phase 1/2, basket study. Lancet Oncol. 2020;21(9):1155–64. https://doi.org/10.1016/S1470-2045(20)30324-7.

    Article  CAS  PubMed  Google Scholar 

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Lainé, A., Sims, T.T., Le Saux, O. et al. Treatment Perspectives for Ovarian Cancer in Europe and the United States: Initial Therapy and Platinum-Sensitive Recurrence after PARP Inhibitors or Bevacizumab Therapy. Curr Oncol Rep 23, 148 (2021). https://doi.org/10.1007/s11912-021-01128-5

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