In this E-learning module, the authors explain the role of surgery, non-platinum-based and platinum-based therapies in patients with relapse of epithelial ovarian cancer. They elaborate on treatments in case of BRCA-mutated and BRCA-wild type tumours among patients with no prior PARP inhibitor and no prior bevacizumab exposure, as well as in those previously treated with these therapies. The authors further explain the potential overlap of platinum resistance and resistance to PARP inhibitors and provide an overview of novel treatments aiming to overcome resistance to these agents.
The authors explain that in the pilot phase III studies (SOLO1, PRIMA or PAOLA 1), less than 10% of patients progressed in the first 6 months during the chemotherapy period. In relapsed patients, especially those with treatment-free interval period of at least 12 months, surgical evaluation for complete secondary, tertiary and so on, cytoreduction should be done.
In the next chapter, the authors elaborate on alternatives for the management of relapse when platinum is not an option, as well as on recommendations for treatments to consider when platinum is an option. They recommend that the decision for second line treatment should take into consideration tumour biology, previous treatments, extent of disease, presence of symptoms and whether the disease recurrence has occurred during or after maintenance treatment with PARP inhibitor.
The authors underline that relapse during maintenance therapy with PARP inhibitor is associated with platinum cross resistance. Clinical trials that evaluated re-challenge maintenance with bevacizumab or olaparib reported statistically significant benefit in relapsed epithelial ovarian cancer, but it is not the standard-of-care.
In the next chapter, the authors explore antibody-drug conjugates, which represent a promising therapeutic option for the future, especially in patients progressing during PARP inhibitor.
At the end of the module, the authors explain sensitivities of patients who are experiencing relapse for ovarian cancer and who are facing many challenges, therefore they emphasize that a palliative care team or provider could help to address and alleviate the symptoms.
