Ovarian cancer treatment: The end of empiricism?

Lheureux, Stéphanie; Karakasis, Katherine; Kohn, Elise C.; Oza, Amit M.

doi:10.1002/cncr.29481

Cited by 29 publications

(28 citation statements)

References 90 publications

(127 reference statements)

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“…Therefore, it is possible that combining bevacizumab with paclitaxel plus carboplatin could decrease the platinum-resistant recurrence rate. Recurrence eventually affects 70–80% of patients with advanced epithelial ovarian cancer [2, 22], with platinum sensitivity and primary PFI being repowered as prognostic factors for recurrent epithelial ovarian cancer [22, 23]. Furthermore, it is currently reported that the concept of “platinum sensitivity” based on the platinum-free interval may also be applicable to patients who have been previously treated with bevacizumab plus platinum-based chemotherapy [24].…”

Section: Discussionmentioning

confidence: 99%

Bevacizumab combined with platinum–taxane chemotherapy as first-line treatment for advanced ovarian cancer: a prospective observational study of safety and efficacy in Japanese patients (JGOG3022 trial)

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Bevacizumab combined with platinum–taxane chemotherapy as first-line treatment for advanced ovarian cancer: a prospective observational study of safety and efficacy in Japanese patients (JGOG3022 trial)

et al. 2018

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“…It is imperative to consider disease biology when evaluating choice of therapy as well as the sequence of surgery/systemic therapy. Surgery clearly has a major impact on reducing tumor burden, and this is important when systemic therapy is less effective, as in low‐grade serous, clear cell, and mucinous carcinoma subtypes . Evaluating and incorporating biologic predictive biomarkers for R0 debulking remains an active area of development.…”

Section: Treatment Of Ovarian Cancer—surgery Systemic Therapy and Rmentioning

confidence: 99%

Epithelial ovarian cancer: Evolution of management in the era of precision medicine

Lheureux

Braunstein

Oza

2019

CA A Cancer J Clinicians

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981

867

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Ovarian cancer is the second most common cause of gynecologic cancer death in women around the world. The outcomes are complicated, because the disease is often diagnosed late and composed of several subtypes with distinct biological and molecular properties (even within the same histological subtype), and there is inconsistency in availability of and access to treatment. Upfront treatment largely relies on debulking surgery to no residual disease and platinum‐based chemotherapy, with the addition of antiangiogenic agents in patients who have suboptimally debulked and stage IV disease. Major improvement in maintenance therapy has been seen by incorporating inhibitors against poly (ADP‐ribose) polymerase (PARP) molecules involved in the DNA damage‐repair process, which have been approved in a recurrent setting and recently in a first‐line setting among women with BRCA1/BRCA2 mutations. In recognizing the challenges facing the treatment of ovarian cancer, current investigations are enlaced with deep molecular and cellular profiling. To improve survival in this aggressive disease, access to appropriate evidence‐based care is requisite. In concert, realizing individualized precision medicine will require prioritizing clinical trials of innovative treatments and refining predictive biomarkers that will enable selection of patients who would benefit from chemotherapy, targeted agents, or immunotherapy. Together, a coordinated and structured approach will accelerate significant clinical and academic advancements in ovarian cancer and meaningfully change the paradigm of care.

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“…None of these agents stand out as superior over others in terms of safety or efficacy. Furthermore, the clinical experience in advanced and relapsed EOC has shown that addition of a third cytotoxic compound to existing chemotherapeutic regimens results in increased toxicity without improving disease control [19][20][21]. Maintenance therapy with conventional cytotoxic agents has not demonstrated any meaningful OS benefit, yet cumulative toxicity associated with long-term chemotherapy has emerged as a major clinical concern [22].…”

Section: Ovarian Cancer Landscapementioning

confidence: 99%

A Review of Mirvetuximab Soravtansine in the Treatment of Platinum-Resistant Ovarian Cancer

et al. 2017

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Resistance to platinum-based therapy poses a significant clinical challenge for the management of advanced ovarian cancer, a leading cause of cancer mortality among women. Mirvetuximab soravtansine is a novel antibody-drug conjugate that targets folate receptor-α, a validated molecular target for therapeutic intervention in this disease. Here, we examine mirvetuximab soravtansine's mechanism of action and pharmacology, and review its clinical evaluation in ovarian cancer to date. We focus on the favorable tolerability and encouraging signals of efficacy that have emerged, most notably in patients with platinum-resistant disease. Ongoing Phase III monotherapy and Phase Ib/II combination trials evaluating its activity in the setting of platinum resistance are emphasized, which will help define its role in the evolving landscape of ovarian cancer therapy. Ovarian cancer landscapeOvarian cancer remains a leading cause of gynecological cancer mortality, responsible for 152,000 deaths annually worldwide [1]. In the USA alone, it is estimated that 22,440 women will be diagnosed with ovarian cancer in 2017 and more than 14,000 will die due to this disease [2]. The remarkable degree of cellular and molecular heterogeneity exhibited by tumors of the ovary (including those arising from the fallopian tubes and primary peritoneum) is such that ovarian cancer is no longer considered a single disease entity with variable morphology, but rather a collection of neoplasms each associated with their own distinct histological subtypes and response to therapy [3,4]. Among these, epithelial ovarian cancer (EOC) accounts for approximately 95% of ovarian cancer malignancies [5,6]. The foundation of current standard-of-care treatment for women diagnosed with EOC is cytoreductive (debulking) surgery and chemotherapy using a platinum-based combination regimen, most commonly the carboplatin-paclitaxel doublet. This strategy has largely reached a plateau of effectiveness in improving overall patient survival [7,8]. The continuing high mortality is associated, at least in part, with the fact that EOC is overwhelmingly diagnosed at an advanced stage. Furthermore, while EOC is highly chemosensitive and most individuals achieve remission with front-line therapy, up to 80% of patients relapse and require further treatment without the expectation of cure [9].The development of platinum resistance in EOC appears to be a dynamic and multifactorial process, although the underlying molecular mechanisms remain poorly defined [10,11]. Recurrent EOC is classified based on the length Drug Evaluation Moore, Martin, O'Malley et al. of time, empirically divided into 6-month blocks, since receiving treatment with a platinum agent, known as the platinum-free interval [7,12]. The classification is as follows:r Refractory: progression during or within 4 weeks of platinum-based chemotherapy; r Primary resistant: relapse within 6 months of completing initial platinum therapy; r Partially platinum sensitive: relapse between 6 and 12 months; r Platinum sensitiv...

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Ovarian cancer treatment: The end of empiricism?

Cited by 29 publications

References 90 publications

Bevacizumab combined with platinum–taxane chemotherapy as first-line treatment for advanced ovarian cancer: a prospective observational study of safety and efficacy in Japanese patients (JGOG3022 trial)

Bevacizumab combined with platinum–taxane chemotherapy as first-line treatment for advanced ovarian cancer: a prospective observational study of safety and efficacy in Japanese patients (JGOG3022 trial)

Epithelial ovarian cancer: Evolution of management in the era of precision medicine

A Review of Mirvetuximab Soravtansine in the Treatment of Platinum-Resistant Ovarian Cancer

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