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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. REMINDER Please complete the evaluation form and return to the hostesses