Medical treatment for relapsed epithelial ovarian, fallopian tubal, or peritoneal cancer: Platinum-resistant disease
- Michael J Birrer, MD, PhD
Michael J Birrer, MD, PhD
- Professor of Medicine
- Harvard Medical School
- Keiichi Fujiwara, MD, PhD
Keiichi Fujiwara, MD, PhD
- Professor of Gynecologic Oncology
- Saitama Medical University
Epithelial cancers of ovarian, fallopian tubal, and peritoneal origin in women exhibit similar clinical characteristics and behavior. As such, these are often combined and define epithelial ovarian cancer (EOC) in clinical trials and clinical practice. This topic will consider all three tumors under the heading EOC.
Despite initial therapy, the majority of women will relapse and require retreatment. Taking into account the frequency of each stage of disease and its projected relapse rate, the overall likelihood of relapse after initial therapy for all stages of disease for women with EOC is 62 percent; it is 80 to 85 percent for women who present with abdominal (stage III) or extra-abdominal (eg, liver or lung involvement, stage IV) disease.
The management of relapsed disease is stratified based upon the amount of time that has elapsed between the completion of platinum-based treatment and the detection of relapse, known as the platinum-free interval (PFI) (see "First-line chemotherapy for advanced (stage III or IV) epithelial ovarian, fallopian tubal, and peritoneal cancer", section on 'Treatment of recurrent disease'):
●Patients with a PFI of six months or longer are considered to have "platinum-sensitive" disease. The management of these patients is discussed separately. (See "Medical treatment for relapsed epithelial ovarian, fallopian tubal, or peritoneal cancer: Platinum-sensitive disease".)
●Patients with a PFI of less than six months are considered to have "platinum-resistant" disease. This includes women who experience disease progression during first-line platinum-based therapy, often referred to as having "platinum-refractory" disease. The management of these patients (collectively referred to as having platinum-resistant EOC) is discussed here.
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- OVERVIEW OF THE TREATMENT APPROACH
- First-line treatment
- Second- or later-line treatment
- SINGLE-AGENT THERAPY
- Pegylated liposomal doxorubicin
- Other agents
- SINGLE-AGENT CHEMOTHERAPY PLUS BEVACIZUMAB
- ALTERNATIVE OPTIONS
- Combination therapy
- Endocrine therapy
- Heated intraperitoneal chemotherapy
- PROLONGING THE PLATINUM-FREE INTERVAL
- SPECIAL CONSIDERATIONS
- Patients with a BRCA mutation
- Recurrence based on CA-125 only
- Malignant bowel obstruction
- Recurrent ascites
- Genome-wide tumor analysis
- In vitro chemosensitivity and resistance assays
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS