Treatment options in recurrent ovarian cancer: latest evidence and clinical potential

Abstract

Ovarian cancer (OC) is the fifth most common cause of cancer death in women. Although significant progress has been made in the treatment of OC, the majority of patients experience disease recurrence and receive second-line and sometimes several lines of treatment. Here we review the options available for the treatment of recurrent disease and discuss how different agents are selected, combined and offered in a rationale sequence in the context of multidisciplinary care. We reviewed published work between 1990 and 2013 and meeting abstracts related to the use of chemotherapy and surgery in patients with recurrent ovarian cancer. We discuss treatment regimens, efficacy endpoints and safety profiles of the different therapies. Platinum-based drugs are the most active agents and are selected on the basis of a probability of response to retreatment. Nonplatinum-based chemotherapy regimens are usually given in the 'platinum-resistant' setting and have a modest effect on outcome. Molecular targeted therapy of ovarian cancer given alone or integrated with chemotherapy is showing promising results. Many patients are now receiving more than one line of therapy for recurrent disease, usually platinum based until platinum resistance emerges. The sequential use of chemotherapy regimens and the incorporation of molecularly targeted treatments, either alone or in combination with chemotherapy, have over the last decade significantly extended the median survival of patients with ovarian cancer.

Keywords: bevacizumab; platinum resistant; platinum sensitive; poly-ADP ribose polymerase inhibitors; relapsed ovarian cancer.

Figure 1.

Overview of new emerging compounds in the treatment of recurrent ovarian cancer. AKT, Protein Kinase B;, Ang-1&2, angiopoietins 1 and 2; DSB double-strand break; FAK, focal adhesion kinase; HR, homologous repair; PARP, poly-ADP ribose polymerase; PI3K phosphatidylinositol-4,5-bisphosphate 3 kinase; TIE, tyrosine kinase with immunoglobulin-like and EGF-like domains; VEGF, vascular endothelial growth factor.