Download Challenges in the Management of Recurrent Ovarian Cancer

Introduction
Ignace Vergote, MD
Department of Obstetrics and Gynaecology
Gynaecologic Oncology
Catholic University of Leuven
Leuven, Belgium
Background: Ovarian Cancer
Globally, 6th most common cause of cancer in women
(GLOBOCAN 2002 estimates: ~ 204,000 new cases; 125,000 deaths)
Vast majority (~ 75%) of patients present with advanced
disease
Recent treatment advances have led to gains in 5-y survival
rates
Treatment requires multimodality approach
Parkin et al. CA Cancer J Clin. 2005;55:74-108.
Advanced Ovarian Cancer: Therapeutic
Approach
Surgery and carboplatin-paclitaxel iv are the
cornerstones of first-line therapy
80%-85% respond to first-line therapy
Newer regimens including molecular targeted therapy are
under investigation
Most patients develop disease recurrence within 2 years of
diagnosis
Long-term remission dependent upon
surgical/chemotherapy approach
Several agents active in the second-line setting,
resulting in improved progression-free and overall
survival
Ozols R. Semin Oncol. 2006;33(suppl 6):S3-S11; Aletti et al. Mayo Clinic Proc. 2007;82:751-770.
Recurrent Ovarian Cancer (ROC):
Magnitude of the Problem
Patterns of Recurrence
Serologic relapse
(rising CA-125
only evidence of
disease)
Symptomatic or
asymptomatic
Extraperitoneal
metastases
Localized
Disseminated
intraperitoneal
disease
Secondary Cytoreductive Surgery
Retrospective Studies: Residual Tumor
Prognostic Factors for Survival After
Secondary Debulking Surgery
(Hauspy and Covens, Curr Opinion Oncology 2007)
Challenges in the Management of
Recurrent Ovarian Cancer (I)
Patient/disease factors – heterogeneous disease
Prior complete debulking or initial FIGO I/II
Ascites > 500ml
Performance status ECOG 0
Age
Presence/absence of symptoms
Platin-based chemotherapy
Parenchymal involvement
Relapse-free vs treatment-free interval (TFI)
Armstrong D. The Oncologist. 2002;7(suppl 5):20-28. –
DEKSTOP II IGCS Bangkok
Challenges in the Management of
Recurrent Ovarian Cancer (I)
Patient/disease factors – heterogeneous disease
Prior complete debulking or initial FIGO I/II
Ascites > 500ml
DESKTOP II
Performance status ECOG 0
Age
Presence/absence of symptoms
Platin-based chemotherapy
Parenchymal involvement
Relapse-free vs treatment-free interval (TFI)
Armstrong D. The Oncologist. 2002;7(suppl 5):20-28. –
IGCS Bangkok
Outcome by Treatment-Free Interval (TFI)
1000
800
100
Response
rate (%)
957
80
Survival (days)
Overall
survival
600
60
•
60
400
40
393
•
•
217
200
33
174
90
0
Pr
0-3
3-6
6-9
TFI (mos)
E. Pujade-Lauraine et al.
Response
rate
339
Progressionfree survival
20
9
0
•
9-12
12-18
>18
Recurrent Ovarian Cancer:
Population Characteristics
Initial
Response to
Platinum
Treatment-free
Interval
Platinum sensitive
Yes
> 12 mo
Platinum-partially sensitive
Yes
6-12 mo
Platinum-resistant
Yes
< 6 mo
Platinum-refractory
No
N/A
Gadducci et al. Anticancer Res. 2001;21:3525-3533.
Common Treatment Approaches to ROC
Platinum-Sensitive Disease
(TFI > 12 mo)
• Platinum combination
chemotherapy unless
contraindicated or
tolerability concern
Bookman. The Oncologist. 1999;4:87-94.
Platinum PartiallySensitive Disease
(TFI 6-12 mo)
• Platinum combination
chemotherapy unless
contraindicated or
tolerability concern
• New second-line noncross-resistant drug(s)
Platinum Resistant
(TFI < 6 mo)/Refractory
Disease
• Non-cross-resistant
single-agent
chemotherapy
• New treatment
strategies
ROC: Therapeutic Goals
Cure
Survival prolongation
Achievement of durable objective response
Improvement in cancer-related symptoms
Maintenance of quality of life (tend to correlate
with response rate)
Delayed time to (symptomatic) disease
progression
Markman and Bookman. The Oncologist. 2000;5(suppl 1):26-35.
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