Maintenance treatment of recurrent ovarian cancer: Is it ready for prime time?

Abstract

Approximately 1% of women in the United States will be diagnosed with epithelial ovarian cancer (EOC) during their lifetime. It is most likely to present at a more advanced stage, requiring aggressive therapeutic measures, and most women will succumb to this illness. Due to advancements in therapy, the oncology community has begun to shift its focus to molecular targeted agents, alternative dosing schedules, and maintenance therapy. Women who achieve a response to initial adjuvant chemotherapy may be candidates for maintenance therapy, with the goal of inducing a lasting remission or prolonging the disease-free interval before recurrence. The rationale for maintenance therapy is to delay disease progression by eliminating residual, slowly-dying cancerous cells, or impeding cell turnover. This review discusses the goals of maintenance therapy for EOC with antiangiogenic agents or poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors, and reviews clinical studies that have demonstrated improvements in survival outcomes. The side-effect profiles for PARP inhibitors and the implications for preserving quality of life during maintenance therapy will also be discussed.

Rosmarinic Acid Methyl Ester Regulates Ovarian Cancer Cell Migration and Reverses Cisplatin Resistance by Inhibiting the Expression of Forkhead Box M1

“…This is due to the lack of warning signs or obvious symptoms in early-stage ovarian cancer; hence, ovarian cancer is usually called “the silent killer” [ 38 , 39 , 40 ]. Unfortunately, the diagnosis of ovarian cancer at advanced stages leads to the acquisition of resistance to conventional chemotherapy and poor prognosis [ 41 , 42 ]. For these reasons, there is an increasing need for an effective treatment against chemotherapy-resistant ovarian cancer.…”

Ovarian Cancer Treatment Stratification Using Ex Vivo Drug Sensitivity Testing

“…Standard treatment consists of surgery and systemic chemotherapy with a combination of a platinum compound and a taxane. While the majority of patients achieve remission in response to such combination treatments, 70% eventually experience relapse with a platinum-resistant tumor, at which point there are few treatment options (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”

Therapeutic options following second-line platinum-based chemotherapy in patients with recurrent ovarian cancer: Comparison of active surveillance and maintenance treatment

“…Maintenance treatments have recently been developed to delay disease recurrence or progression for patients who have achieved a complete response (CR) or partial response (PR) to chemotherapy. Maintenance treatment comprises either the introduction of a new therapy immediately after a patient achieves a response to chemotherapy (switch maintenance), or the ongoing administration of a drug following initial treatment with that drug in combination with chemotherapy (continuation maintenance) [6,7]. Maintenance treatment may be given over extended durations of time and so should have a manageable tolerability profile and no detrimental impact on patient QoL [6,7].…”

“…Currently, the angiogenesis inhibitor bevacizumab (as continuation maintenance), the poly(ADP-ribose) polymerase (PARP) inhibitors olaparib and niraparib (as switch maintenance), and the combination of bevacizumab and olaparib are approved in Europe and/or the United States (US) as maintenance treatment following first-line chemotherapy ( Fig. 1) [6,[8][9][10][11][12]. However, ovarian cancer generally remains incurable, and many women will experience multiple relapses.…”