The Evolving Landscape of Chemotherapy in Newly Diagnosed Advanced Epithelial Ovarian Cancer
19
Citation
50
Reference
10
Related Paper
Citation Trend
Abstract:
The treatment of women with advanced-stage epithelial ovarian cancer (EOC) is aggressive surgical cytoreduction and a combination of platinum plus taxane chemotherapy. The timing and extent of surgery has direct implications on the selection of subsequent treatment as well as the prognosis of patients with EOC. Frontline chemotherapeutic regimens have evolved through a series of large multi-institutional randomized clinical trials that focused on targeted agents as maintenance therapy. On June 13, 2018, the U.S. Food and Drug Administration (FDA) approved adding bevacizumab to adjuvant intravenous chemotherapy followed by maintenance based on the results of Gynecologic Oncology Group protocol 218. Maintenance olaparib was FDA-approved on December 19, 2018, for frontline maintenance among those with advanced EOC who respond to frontline chemotherapy and harbor a germline or somatic BRCA1 or BRCA2 mutation. This was based on the results of SOLO-1. Despite a strong rationale and extensive study, intraperitoneal chemotherapy has not been adopted in clinical practice. Alternatively, heated intraperitoneal chemotherapy has shown promise as a more tolerable and technically feasible method of regional therapy, but widespread application will require more evidence. Significant strides have also been made in understanding the biology of EOC, resulting in a personalized approach to first-line therapy. One approach calls for recognizing differences in histologic subtypes and molecular alterations, which may open up alternative therapeutic interventions.Keywords:
Taxane
Olaparib
Overall survival for FIGO stage III–IV epithelial ovarian cancer remains low, with only 10% of women remaining disease-free at 10 years of follow-up. Cytoreductive surgery for newly diagnosed advanced ovarian carcinoma, when performed by high-volume surgeons at high-volume centers, has the potential to place the vast majority of patients (approximately 85%) into sustained clinical remission following completion of adjuvant systemic platinum- and taxane-based chemotherapy. However, because most of these patients are ultimately destined to relapse, there has been great interest in identifying effective and tolerable maintenance therapies that can significantly prolong progression-free survival (PFS) and even possibly improve overall survival (OS) in select subpopulations. The molecular signatures exhibited among patients with germline and/or somatic BRCA mutations, as well as those with homologous recombination deficient BRCA-wild type tumors, characterize distinct patient cohorts that may derive benefit from maintenance therapy using the poly-ADP-ribose polymerase I inhibitor olaparib alone or when combined with the anti-angiogenesis agent bevacizumab, respectively. Patients whose tumors are homologous recombination-proficient should be offered maintenance therapy with bevacizumab which can significantly improve PFS by approximately six months and possibly impact OS among those with FIGO stage IV disease.
Olaparib
Taxane
Maintenance therapy
Trabectedin
BRCA Mutation
Cite
Citations (0)
Recurrent ovarian cancer is a lethal disease, and few patients can be cured. Although most patients receive standardized surgery and chemotherapy, the status of recurrent disease is heterogeneous. The site of recurrence and the survival intervals after recurrence are also widely distributed. Among a number of factors, many clinical trials identified time to recurrence was the factor most related to chemosensitivity at first relapse. The current recommendation for platinum sensitive ovarian cancer is a carboplatin containing combination chemotherapy. Generally, a single agent is chosen for platinum resistant ovarian cancer. Patients with single site recurrence and a long disease free interval are candidates for secondary cytoreduction, which may provide longer survival. There are several treatment choices at first relapse, and disease status, chemotherapy-free interval, and the patient's condition play a major role in the decision making process.
Carboplatin
Cite
Citations (194)
Breast cancer is the second most common cancer in Korean women and its incidence has increased. Among the various treatment methods for breast cancer, chemotherapy plays an important role. The use chemotherapy to treat breast cancer began at the mid 20th century and first combination chemotherapy was conducted in mid 1970s. This chemotherapy reduced breast cancer mortality up to 25~30%, anthracycline and taxane based chemotherapeutic regimens are widely used. Chemotherapy could be classified to neoadjuavnt, adjuvant and palliative setting according to its aim and role. In this review, various drug therapeutic options and their backgrounds are considered based on neoadjuvant, adjuvant and metastatic systemic therapies.
Taxane
Adjuvant Chemotherapy
Cite
Citations (2)
Abstract On December 19, 2018, the U.S. Food and Drug Administration (FDA) granted approval to olaparib monotherapy for first-line maintenance treatment of BRCA-mutated (BRCAm) advanced ovarian cancer and, on May 8, 2020, expanded the indication of olaparib to include its use in combination with bevacizumab for first-line maintenance treatment of homologous recombination deficient (HRD)–positive advanced ovarian cancer. Both these approvals were based on randomized, double-blind, placebo-controlled trials. Approval for olaparib monotherapy was based on the SOLO-1 trial, comparing the efficacy of olaparib versus placebo in patients with BRCAm advanced ovarian, fallopian tube, or primary peritoneal cancer after surgical cytoreduction and first-line platinum-based chemotherapy. Two companion diagnostic (CDx) tests were approved with this indication: BRACAnalysis CDx, for germline BRCA1/2 alterations, and FoundationOne CDx, for BRCA1/2 alterations in tissue specimens. Approval for olaparib in combination with bevacizumab was based on the results of the PAOLA-1 trial that compared olaparib with bevacizumab versus placebo plus bevacizumab in patients with advanced high-grade epithelial ovarian cancer, fallopian tube, or primary peritoneal cancer after first-line platinum-based chemotherapy and bevacizumab. Myriad myChoice CDx was designated as a companion diagnostic device for use of olaparib plus bevacizumab combination for ovarian cancer associated with HRD-positive status. Both trials demonstrated clinically meaningful improvements in progression-free survival and favorable benefit-risk profiles for the indicated populations. This article summarizes the FDA thought process and data supporting the approval of olaparib as monotherapy and in combination with bevacizumab for maintenance therapy in this setting. Implications for Practice These approvals represent the first poly (ADP-ribose) polymerase inhibitor, alone or in combination with bevacizumab, approved in first-line maintenance treatment of women with advanced ovarian cancer after cytoreductive surgery and chemotherapy. In patients with BRCA-mutated tumors, olaparib monotherapy demonstrated a 70% reduction in the risk of disease progression or death compared with placebo, and olaparib in combination with bevacizumab demonstrated a 67% reduction in the risk of disease progression or death compared with bevacizumab alone in homologous recombination deficient–positive tumors. These approvals represent a major advance for the treatment of women with advanced ovarian cancer who are in complete or partial response after their initial platinum-based chemotherapy.
Olaparib
Maintenance therapy
Fallopian tube cancer
BRCA Mutation
Cite
Citations (129)
Objective:To observe effects of individual chemotherapy and individual intraperitoneal chemotherapy on recrudescent epithelial ovarian cancer with ascites after taxane and platinum treatment.Methods:Individual chemotherapy and intraperitoneal chemotherapy were administered to 37 recrudescent epithelial ovarian cancer patients with ascites after taxane and platinum treatment.Results:The reactions to individual intraperitoneal chemotherapy of recrudescent epithelial ovarian cancer with ascites were completed response(CR)67.57%,partial response(PC)16.21 %,nonresponse(NC)16.21%;the reactiongs of solid tumours to chemotherapy were(CR)68.00 %,(PR)16.00%,(NC)16.0%.Median overall survival time was 19 months;1-year survival rate 81.10%,2-year survival rate 67.57%.Patients serum CA-125 concentration was a potential prognostic factor positively correlated with tumor relapse and treatment effects.Conclusion:The effects are obvious on recrudescent epithelial ovarian cancer with ascites after taxane and platinum treatment with individual chemotherapy and individual intraperitoneal chemotherapy ;With a high specificity and sensibility,serum CA-125 concentration is an important biomarker to predict treatment effects and prognosis of recrudescent epithelial ovarian cancer with ascites.
Taxane
Cite
Citations (0)
Olaparib
Taxane
Targeted Therapy
Cite
Citations (39)
The majority of patients with advanced epithelial ovarian cancer respond to primary platinum/taxane-based combination chemotherapy. Unfortunately, recurrence is the rule rather than the exception in this clinical setting. In addition, multiple trials focused on the addition of a "third" cytotoxic drug to a platinum/taxane combination have failed to demonstrate any improvement in outcome. However, recent data reveal that addition of the antiangiogenic agent, bevacizumab, to either a primary platinum-based chemotherapy program or platinumbased therapy to manage recurrent disease can substantially improve time to subsequent disease progression and potentially favorably affect overall survival. This review discusses the rationale supporting the combination of cytotoxic and antiangiogenic therapy in advanced epithelial ovarian cancer, the existing evidence-based data supporting this strategy, and possible future research directions in this difficult malignancy.
Taxane
Combination therapy
Combination chemotherapy
Cite
Citations (0)
Current treatment for epithelial ovarian cancer involves a combination of surgery and chemotherapy with platinum- and taxane-based chemotherapy. With the recent approval of the anti-VEGF antibody bevacizumab by several regulatory bodies in colorectal and non-small-cell lung cancers, interest has developed regarding the potential role of bevacizumab therapy in ovarian cancer. Several case series and Phase II studies indicate that in ovarian cancer bevacizumab is active as a single agent or in combination with other drugs. Currently, ongoing Phase III trials are testing bevacizumab in front-line adjuvant therapy with carboplatin and paclitaxel. Bevacizumab has been generally well tolerated in ovarian cancer patients, but recent reports on increased risk of gastrointestinal perforations have gained attention. Bevacizumab offers a novel therapeutic modality in the treatment of epithelial ovarian cancers.
Carboplatin
Taxane
Cite
Citations (42)
Taxane
Targeted Therapy
Cite
Citations (26)