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- To highlight the importance of the BRCA status and homologous recombination deficiency in ovarian cancer
- To elaborate PARP inhibition in platinum sensitive recurrences
- To discuss surgery and anti-angiogenic therapy as further options in the recurrent setting
In this E-Learning module the authors place emphasis on the changing paradigm in terms of treatment considerations for relapsed platinum sensitive ovarian cancer. Now the platinum-free interval is not the only parameter to be considered to select therapy in the recurrent setting. The authors underline that other parameters including biology, pathology and previous targeted maintenance therapy, need to be taken into account as well.
The authors explain that, according to platinum free interval, patients with ovarian cancer are divided into well defined categories. These categories are not anecdotic but represent completely different situations of disease in which the endpoint of treatment, the possibility to respond to therapy, the prognosis and the expectation of cure vary widely.
In terms of platinum-sensitive relapse, the authors discuss three scenarios: the role of surgery, non-platinum-based therapy, as well as platinum-based therapy as an option and illustrate the module with findings from recent clinical studies.
By summarising the current evidence, the authors conclude that indication for surgery must be assessed although final results from trials are still pending.
Patients with recurrent ovarian cancer are classified for being candidates or not to a platinum re-treatment. Platinum combination chemotherapy is more effective than single agent platinum. In patients who respond to a platinum-based therapy, PARP inhibitor maintenance is effective in prolonging progression-free survival (PFS), with higher effect in BRCA mutated patients.
Platinum based therapy plus bevacizumab prolongs PFS compared to chemotherapy alone, both in patients who are bevacizumab naive or bevacizumab pre-treated. Bevacizumab-containing regimens are given preferentially to patients at high risk of quick progression and large bulk of disease.
In patients with treatment-free interval between 6–12 months, who are not candidates for platinum-based treatment, trabectedin plus pegylated liposomal doxorubicin should be considered.
Declaration of interest
Sabrina Chiara Cecere has reported:
Participation in Tumour Boards meetings sponsored by Astra Zeneca, TESARO and ROCHE.
Sandro Pignata has reported:
honoraria from AZ, TESARO, Clovis Oncology, MSD, Pfizer, ROCHE and research funding from AZ and ROCHE.
This E-Learning module was published in 2019. The CME test expired in 2021.