Systemic Therapy for Recurrent Epithelial Ovarian Cancer: A Clinical Practice Guideline

Abstract

Objective The purpose of this guideline is to recommend systemic therapy options for women with recurrent epithelial ovarian cancer, including fallopian tube and primary peritoneal cancers. Methods This document updates the recommendations published in the 2011 Optimal Chemotherapy forRecurrent Ovarian Cancer guideline from Cancer Care Ontario. Draft recommendations were formulated based on evidence obtained through a systematic review of phase ii and iii randomized controlled trials (rcts). The draft recommendations underwent internal review by clinical and methodology experts, and external review by clinical practitioners through a survey assessing the clinical relevance and overall quality of the guideline. Feedback from the internal and external reviews was integrated into the clinical practice guideline. ResultsThe primary literature search yielded thirty-six primary research papers representing thirty rcts that met the eligibility criteria. The guideline provides recommendations for patients with serous tumour histologies and with recurrent, platinum-resistant, and platinum-sensitive ovarian cancer. ConclusionsThe body of evidence from trials that included olaparib and bevacizumab consistently shows a benefit in progression-free survival (pfs) without a corresponding benefit in overall survival (os). The Working Group for this guideline designated pfs, which is associated with symptom control, as a critical outcome. A finding of net benefit can therefore be concluded based on significant differences in pfs. However, that benefit is not without identified harms. Given the identified harms, patient involvement in the decision-making process must take into consideration the side effect profiles of olaparib and bevacizumab within the context of improved pfs but minimal change in os.

Prognostic significance of baseline T cells, B cells and neutrophil-lymphocyte ratio (NLR) in recurrent ovarian cancer treated with chemotherapy

“…Recurrent ovarian cancer represents a therapeutic challenge. Advances in the area of PARP-inhibitors have improved the outcome for some patients [1], but chemotherapy options for platinum-resistant disease or third line treatment are of minimal or no benefit [2,3]. Checkpoint immunotherapy has been promising in other malignancies, but it has only shown a modest effect as single agent in ovarian cancer [4].…”

Long-term fatigue and quality of life among epithelial ovarian cancer survivors: a GINECO case/control VIVROVAIRE I study

“…However, in recent decades, greater surgical expertise and multimodal therapies have improved the survival rate of these patients, amounting 44% at 5 years [2]. Initial treatment includes extended abdominal and pelvic surgery, mostly followed by chemotherapy, usually platinum-taxane combinations with optional bevacizumab [3][4][5]. During the treatment periods, EOC patients experience a wide range of symptoms that may persist after chemotherapy: fatigue, pain, nausea, vomiting, abdominal discomfort, peripheral neuropathy, change in body image, anxiety, and depressive symptoms [4].…”

Immune Heterogeneity Between Primary Tumors and Corresponding Metastatic Lesions and Response to Platinum Therapy in Primary Ovarian Cancer

“…Tumor biology has an increasing impact in the treatment of recurrent ovarian cancer, extending the classification according to time to relapse after chemotherapy: platinum-resistant (<6 months), partially platinum-sensitive (6–12 months), and platinum-sensitive (>12 months) [6,7]. This clinical classification has been used when choosing second-line chemotherapy [8]. Further stratification factors are required for specifying first-line therapy [9].…”