Recurrent Epithelial Ovarian Cancer: An Update on Treatment

摘要

Abstract: An estimated 85% of patients with epithelial ovarian cancer who achieve a full remission following first-line therapy will develop recurrent disease. Although each subsequent line of therapy is characterized by shorter disease-free intervals, median survival for these patients ranges from 12 months to 24 months. Emerging therapies in the management of ovarian cancer have resulted in a shift in paradigm, including in the appropriate time to institute therapy, and in the selection of therapy. This review focuses on chemotherapy and emerging biologic agents that present a therapeutic option for patients with recurrent ovarian cancer. Introduction An estimated 75% of women with ovarian cancer present with advanced-stage (III or IV) disease. For patients with low residual disease (all lesions < 1 cm in size following surgical de-bulking), the risk for recurrence after completion of primary therapy is 60% to 70%; however, for women with large-volume residual disease, the risk is estimated at 80% to 85%. We conducted a systematic review using the MEDLINE database, PubMed, EMBASE, and the Cochrane Library. The search was restricted to English-language articles published from 1979 through July 2012. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries also were consulted. Recent abstracts of research presented at symposia and scientific conferences were also considered. The selection of therapy for women with recurrent disease is in large part determined by response to first-line therapy. Specifically, recurrent ovarian cancer has been dichotomized to either platinum-sensitive (progression-free interval [PFI] > 6 months) or platinum-resistant (PFI <= 6 months) disease, with PFI predicting the expected response rate (RR) and duration of response. Irrespective of treatment selected, recurrent ovarian cancer remains incurable. The goals of therapy should focus on palliation of cancer-related symptoms, prolongation of life, and optimization of quality of life. This review will focus on the medical treatment, specifically chemotherapy options, available for women with recurrent ovarian cancer. Role of Timing in the Treatment of Recurrent Ovarian Cancer Recurrent ovarian cancer can be heralded by onset of new symptoms, ra-diologic evidence of recurrent disease, or a rising CA-125 level in an asymptomatic patient. CA-125 elevation may precede radiologic detection or onset of symptoms by several months.