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

Abstract

Most women with advanced ovarian cancer respond to initial treatment, consisting of surgical resection and ≈6 cycles of platinum-based chemotherapy. However, disease recurrence occurs in most patients, and subsequent therapies become necessary. Historically, close monitoring following treatment (active surveillance) was the only available option, as continued maintenance chemotherapy treatment led to increased toxicity without providing any meaningful clinical benefit. Recently, targeted therapy with the angiogenesis inhibitor bevacizumab and the poly(ADP-ribose) polymerase (PARP) inhibitors olaparib, niraparib, and rucaparib have demonstrated significant clinical benefits as maintenance treatment for recurrent disease. Despite consensus guidelines recommending their use, maintenance treatments are currently underutilized. Here, we review evidence from pivotal clinical trials of approved second-line maintenance treatments demonstrating efficacy in terms of progression-free survival and postprogression efficacy outcomes for patients with recurrent ovarian cancer. Adverse events frequently associated with bevacizumab include hypertension, proteinuria, and noncentral nervous system bleeding, whereas PARP inhibitors are associated with nausea, vomiting, fatigue, and anemia. Patient-centered outcomes analyses show that PARP inhibitors provide significant benefits to patient health status, even when accounting for the toxicities associated with treatment. Many factors influence the selection of second-line maintenance treatment for patients with recurrent ovarian cancer, including the maintenance treatment received in the first-line setting. Overall, targeted maintenance treatment represents a new standard of care for patients with ovarian cancer, and we recommend that maintenance treatment should be offered to all eligible patients with recurrent ovarian cancer.

Asparagus officinalis Exhibits Anti-Tumorigenic and Anti-Metastatic Effects in Ovarian Cancer

“…The mainstay of treatment for ovarian cancer is tumor debulking surgery followed by platinum and paclitaxel chemotherapy. Bevazizumab and PARP inhibitors are now additional drugs in advanced ovarian cancer (4). Patients typically have high initial response rates, but the majority of patients are ultimately faced with a recurrence and platinum resistance despite significant advances in treatment strategies (3,5).…”

Dacomitinib improves chemosensitivity of cisplatin‑resistant human ovarian cancer cells

“…Current OC therapy includes optimal primary cytoreductive surgery and systemic chemotherapies comprising taxanes (paclitaxel) and platinum (cisplatin or carboplatin) compounds (4). Inspite significant advances in surgery and chemotherapy for OC over the last two decades, this cancer is associated with poor overall survival of patients (5). In addition, traditional therapy is characterized by severe side effects and increased drug resistance, hence novel drugs with higher efficacy should be explored (6).…”

Treatment Experience and Predictive Factors Associated with Response in Platinum-Resistant Recurrent Ovarian Cancer: A Retrospective Single-Institution Study

“…As such, patients with platinum-sensitive disease, who relapse after at least 6 months treatment-free interval, can still have a highly effective response to platinum-containing rechallenge (up to 60%), showing a prolonged PFS and overall survival (OS) [8][9][10][11]. Moreover, associating targeted therapy as a maintenance treatment further prolongs PFS in the second-line setting [12]. Regarding the platinum-resistant subgroup, where relapse occurs in the first 6 months, response and survival rates are lower than the opposite when non-platinum therapies are used, a slightly better outcome being observed with the addition of targeted therapies than without them-PFS of 6.7 months for the addition of bevacizumab versus 3.4 months with chemotherapy alone [13].…”