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Medical treatment for relapsed epithelial ovarian, fallopian tubal, or peritoneal cancer: Platinum-resistant disease

INTRODUCTION

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.

The initial diagnosis and management of EOC, the surgical treatment of recurrent EOC and an overview of angiogenesis inhibitors in EOC are covered separately. (See "Overview of epithelial carcinoma of the ovary, fallopian tube, and peritoneum" and "Surgery for recurrent epithelial ovarian cancer" and "First-line chemotherapy for advanced (stage III or IV) epithelial ovarian, fallopian tubal, and peritoneal cancer" and "The role of angiogenesis inhibitors in epithelial carcinoma of the ovary, fallopian tube, or peritoneum", section on 'Recurrent disease' and "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Clinical features and diagnosis".)

                

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Literature review current through: May 2013. | This topic last updated: Dec 20, 2012.
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References
Top
  1. Seewaldt VL, Greer BE, Cain JM, et al. Paclitaxel (Taxol) treatment for refractory ovarian cancer: phase II clinical trial. Am J Obstet Gynecol 1994; 170:1666.
  2. Gore ME, Levy V, Rustin G, et al. Paclitaxel (Taxol) in relapsed and refractory ovarian cancer: the UK and Eire experience. Br J Cancer 1995; 72:1016.
  3. Bruzzone M, Catsafados E, Miglietta L, et al. Salvage chemotherapy with paclitaxel in platinum-resistant advanced ovarian cancer patients. Oncology 1996; 53:349.
  4. Ezcurdia L, Jovtis SL, Mickiewicz E, et al. Paclitaxel in platinum-resistant ovarian cancer patients. Argentine Multicenter Taxol Group. Semin Oncol 1997; 24:S15.
  5. Markman M, Reichman B, Hakes T, et al. Responses to second-line cisplatin-based intraperitoneal therapy in ovarian cancer: influence of a prior response to intravenous cisplatin. J Clin Oncol 1991; 9:1801.
  6. Herrin VE, Thigpen JT. High-dose chemotherapy in ovarian carcinoma. Semin Oncol 1999; 26:99.
  7. Stiff PJ, Veum-Stone J, Lazarus HM, et al. High-dose chemotherapy and autologous stem-cell transplantation for ovarian cancer: an autologous blood and marrow transplant registry report. Ann Intern Med 2000; 133:504.
  8. Sarosy GA, Reed E. Autologous stem-cell transplantation in ovarian cancer: is more better? Ann Intern Med 2000; 133:555.
  9. Peng LH, Chen XY, Wu TX. Topotecan for ovarian cancer. Cochrane Database Syst Rev 2008; :CD005589.
  10. Gordon AN, Fleagle JT, Guthrie D, et al. Recurrent epithelial ovarian carcinoma: a randomized phase III study of pegylated liposomal doxorubicin versus topotecan. J Clin Oncol 2001; 19:3312.
  11. Gordon AN, Tonda M, Sun S, et al. Long-term survival advantage for women treated with pegylated liposomal doxorubicin compared with topotecan in a phase 3 randomized study of recurrent and refractory epithelial ovarian cancer. Gynecol Oncol 2004; 95:1.
  12. Lorusso D, Naldini A, Testa A, et al. Phase II study of pegylated liposomal doxorubicin in heavily pretreated epithelial ovarian cancer patients. May a new treatment schedule improve toxicity profile? Oncology 2004; 67:243.
  13. Rose PG, Maxson JH, Fusco N, et al. Liposomal doxorubicin in ovarian, peritoneal, and tubal carcinoma: a retrospective comparative study of single-agent dosages. Gynecol Oncol 2001; 82:323.
  14. Markman M, Kennedy A, Webster K, et al. Phase 2 trial of liposomal doxorubicin (40 mg/m(2)) in platinum/paclitaxel-refractory ovarian and fallopian tube cancers and primary carcinoma of the peritoneum. Gynecol Oncol 2000; 78:369.
  15. Gynecologic Oncology Group, Markman M, Blessing J, et al. Phase II trial of weekly paclitaxel (80 mg/m2) in platinum and paclitaxel-resistant ovarian and primary peritoneal cancers: a Gynecologic Oncology Group study. Gynecol Oncol 2006; 101:436.
  16. Verschraegen CF, Sittisomwong T, Kudelka AP, et al. Docetaxel for patients with paclitaxel-resistant Müllerian carcinoma. J Clin Oncol 2000; 18:2733.
  17. Coleman RL, Brady WE, McMeekin DS, et al. A phase II evaluation of nanoparticle, albumin-bound (nab) paclitaxel in the treatment of recurrent or persistent platinum-resistant ovarian, fallopian tube, or primary peritoneal cancer: a Gynecologic Oncology Group study. Gynecol Oncol 2011; 122:111.
  18. Rose PG, Blessing JA, Mayer AR, Homesley HD. Prolonged oral etoposide as second-line therapy for platinum-resistant and platinum-sensitive ovarian carcinoma: a Gynecologic Oncology Group study. J Clin Oncol 1998; 16:405.
  19. Sehouli J, Stengel D, Harter P, et al. Topotecan Weekly Versus Conventional 5-Day Schedule in Patients With Platinum-Resistant Ovarian Cancer: a randomized multicenter phase II trial of the North-Eastern German Society of Gynecological Oncology Ovarian Cancer Study Group. J Clin Oncol 2011; 29:242.
  20. Mutch DG, Orlando M, Goss T, et al. Randomized phase III trial of gemcitabine compared with pegylated liposomal doxorubicin in patients with platinum-resistant ovarian cancer. J Clin Oncol 2007; 25:2811.
  21. Sørensen P, Høyer M, Jakobsen A, et al. Phase II study of vinorelbine in the treatment of platinum-resistant ovarian carcinoma. Gynecol Oncol 2001; 81:58.
  22. Rothenberg ML, Liu PY, Wilczynski S, et al. Phase II trial of vinorelbine for relapsed ovarian cancer: a Southwest Oncology Group study. Gynecol Oncol 2004; 95:506.
  23. Markman M, Hakes T, Reichman B, et al. Ifosfamide and mesna in previously treated advanced epithelial ovarian cancer: activity in platinum-resistant disease. J Clin Oncol 1992; 10:243.
  24. Miller DS, Blessing JA, Krasner CN, et al. Phase II evaluation of pemetrexed in the treatment of recurrent or persistent platinum-resistant ovarian or primary peritoneal carcinoma: a study of the Gynecologic Oncology Group. J Clin Oncol 2009; 27:2686.
  25. Vergote I, Calvert H, Kania M, et al. A randomised, double-blind, phase II study of two doses of pemetrexed in the treatment of platinum-resistant, epithelial ovarian or primary peritoneal cancer. Eur J Cancer 2009; 45:1415.
  26. Lortholary A, Largillier R, Weber B, et al. Weekly paclitaxel as a single agent or in combination with carboplatin or weekly topotecan in patients with resistant ovarian cancer: the CARTAXHY randomized phase II trial from Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO). Ann Oncol 2012; 23:346.
  27. Brewer CA, Blessing JA, Nagourney RA, et al. Cisplatin plus gemcitabine in platinum-refractory ovarian or primary peritoneal cancer: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol 2006; 103:446.
  28. Pectasides D, Pectasides E, Papaxoinis G, et al. Carboplatin/gemcitabine alternating with carboplatin/pegylated liposomal doxorubicin and carboplatin/cyclophosphamide in platinum-refractory/resistant paclitaxel - pretreated ovarian carcinoma. Gynecol Oncol 2010; 118:52.
  29. Williams CJ. Tamoxifen for relapse of ovarian cancer. Cochrane Database Syst Rev 2001; :CD001034.
  30. Smyth JF, Gourley C, Walker G, et al. Antiestrogen therapy is active in selected ovarian cancer cases: the use of letrozole in estrogen receptor-positive patients. Clin Cancer Res 2007; 13:3617.
  31. Argenta PA, Thomas SG, Judson PL, et al. A phase II study of fulvestrant in the treatment of multiply-recurrent epithelial ovarian cancer. Gynecol Oncol 2009; 113:205.
  32. Cannistra SA, Matulonis UA, Penson RT, et al. Phase II study of bevacizumab in patients with platinum-resistant ovarian cancer or peritoneal serous cancer. J Clin Oncol 2007; 25:5180.
  33. McGonigle KF, Muntz HG, Vuky J, et al. Combined weekly topotecan and biweekly bevacizumab in women with platinum-resistant ovarian, peritoneal, or fallopian tube cancer: results of a phase 2 study. Cancer 2011; 117:3731.
  34. Pujade-Lauraine E, Hilpert F, Weber B, et al. AURELIA: A randomized phase III trial evaluating bevacizumab (BEV) plus chemotherapy (CT) for platinum (PT)-resistant recurrent ovarian cancer (OC). J Clin Oncol 30, 2012 (suppl; abstr LBA5002^). http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=114&abstractID=94636 (Accessed on June 20, 2012).
  35. Poveda AM, Selle F, Hilpert F, et al. Weekly paclitaxel, pegylated liposomal doxorubicin or topotecan ± bevacizumab in platinum-resistant ovarian cancer: analysis by chemotherapy cohort in the GCIG AURELIA randomised phase III trial. Ann Oncol 2012; 23:ixe17.
  36. Tanguay JS, Ansari J, Buckley L, Fernando I. Epithelial ovarian cancer: role of pegylated liposomal Doxorubicin in prolonging the platinum-free interval and cancer antigen 125 trends during treatment. Int J Gynecol Cancer 2009; 19:361.
  37. Leitao MM Jr, Hummer A, Dizon DS, et al. Platinum retreatment of platinum-resistant ovarian cancer after nonplatinum therapy. Gynecol Oncol 2003; 91:123.
  38. Hanker LC, Loibl S, Burchardi N, et al. The impact of second to sixth line therapy on survival of relapsed ovarian cancer after primary taxane/platinum-based therapy. Ann Oncol 2012; 23:2605.
  39. Tamussino KF, Lim PC, Webb MJ, et al. Gastrointestinal surgery in patients with ovarian cancer. Gynecol Oncol 2001; 80:79.
  40. Clarke-Pearson DL, Chin NO, DeLong ER, et al. Surgical management of intestinal obstruction in ovarian cancer. I. Clinical features, postoperative complications, and survival. Gynecol Oncol 1987; 26:11.
  41. Abu-Rustum NR, Barakat RR, Venkatraman E, Spriggs D. Chemotherapy and total parenteral nutrition for advanced ovarian cancer with bowel obstruction. Gynecol Oncol 1997; 64:493.
  42. Kobold S, Hegewisch-Becker S, Oechsle K, et al. Intraperitoneal VEGF inhibition using bevacizumab: a potential approach for the symptomatic treatment of malignant ascites? Oncologist 2009; 14:1242.
  43. Numnum TM, Rocconi RP, Whitworth J, Barnes MN. The use of bevacizumab to palliate symptomatic ascites in patients with refractory ovarian carcinoma. Gynecol Oncol 2006; 102:425.
  44. Hamilton CA, Maxwell GL, Chernofsky MR, et al. Intraperitoneal bevacizumab for the palliation of malignant ascites in refractory ovarian cancer. Gynecol Oncol 2008; 111:530.
  45. Ströhlein MA, Heiss MM. The trifunctional antibody catumaxomab in treatment of malignant ascites and peritoneal carcinomatosis. Future Oncol 2010; 6:1387.
  46. Gotlieb WH, Amant F, Advani S, et al. Intravenous aflibercept for treatment of recurrent symptomatic malignant ascites in patients with advanced ovarian cancer: a phase 2, randomised, double-blind, placebo-controlled study. Lancet Oncol 2012; 13:154.
  47. Bellati F, Napoletano C, Ruscito I, et al. Complete remission of ovarian cancer induced intractable malignant ascites with intraperitoneal bevacizumab. Immunological observations and a literature review. Invest New Drugs 2010; 28:887.
  48. Von Hoff DD, Stephenson JJ Jr, Rosen P, et al. Pilot study using molecular profiling of patients' tumors to find potential targets and select treatments for their refractory cancers. J Clin Oncol 2010; 28:4877.
  49. Sales E, Penson RT, Sullivan LA, et al. A snapshot of potentially personalized care: Molecular diagnostics in gynecologic cancer. J Clin Oncol 30, 2012 (suppl; abstr 5029).