Multiple lines of chemotherapy for patients with high‐grade ovarian cancer: Predictors for response and effect on survival

Abstract

Guidelines for the treatment of tubo‐ovarian cancer patients beyond third line are lacking. We aimed to evaluate the effect of response in each line on patient's outcome as well as identify variables that predict response for additional line of chemotherapy. A cohort study was performed including all patients with advanced high‐grade ovarian cancer. Survival analysis was performed using Kaplan‐Meier curves and log‐rank tests. Odds ratios and hazard ratios were calculated using multilevel, mixed‐effects logistic regression and Cox regression, adjusting for repeated measures within individual patients. Two‐hundred thirty‐eight patients were included and underwent up to 10 lines of chemotherapy. The median progression‐free survival was 15.6 and overall survival (OS) was 55.6 months. Response rates dropped with each additional line and by line 5, most patients (61%) became refractory and only 16% had any type of response (complete 4% or partial 12%). By line 2, whether a patient had partial disease (PR), stable disease (SD) or progressive disease (PD) did not have an effect on the OS. From line 2, whether a patient had PR, SD or PD did not have an effect on chemotherapy‐free interval. Number of previous lines and time from previous line were the only variables that significantly correlated with both outcome of patients and response to the next line. In conclusion, time interval from the previous line of chemotherapy is the major clinical factor that predicts beneficial effect of another line of treatment in patients with ovarian cancer.

Management of Patients with Hypersensitivity to Platinum Salts and Taxane in Gynecological Cancers: A Cross-Sectional Study by the European Network of Young Gynaecologic Oncologists (ENYGO)

“…Clinicians treating gynecological cancers regularly experience HSRs to platinum- and taxane-based chemotherapy (8–16% and 10–13%, respectively) [ 11 , 12 , 17 , 19 , 21 , 23 , 24 ], which is also due to the fact that more lines of treatment are being used in gynecological cancer than 1–2 decades ago [ 25 ]. Additionally, real HSR rates are likely to be underestimated, as oncologists often report only severe reactions [ 10 , 26 ].…”

Development and characterization of a patient‑derived orthotopic xenograft of therapy‑resistant breast cancer

“…Patients who progress following multiple rounds of therapy constitute a major proportion of patients with cancer who attain mortality. Such cancers are difficult to treat and lead to rapid degeneration of patient health (18)(19)(20). In the majority of these cases, all potential therapeutic interventions are exhausted in the treatment of these patients.…”

Randomized phase II trial of weekly ixabepilone ± biweekly bevacizumab for platinum- resistant or refractory ovarian / fallopian tube / primary peritoneal cancer (NCT03093155): updated survival and subgroup analyses

“…3,4 Unfortunately, heavily pre-treated patients continue to suffer from a lack of effective treatment options. After 5 lines, response rates are as low as 10-16% 5 and median overall survival after 3 lines may be as low as 5-9 months. 6 Proposed mechanisms of taxane resistance include enhanced drug e ux from the cell, rapid drug metabolism, dysregulation of microtubule-stabilizing proteins, altered binding a nity, upregulation of mediators of cell cycle progression, blunted spindle cell assembly checkpoint signals, 7 and alterations in signal transduction pathways that affect autophagy, senescence and in ammation.…”