engleski

Recurrent ovarian cancer

Ovarian cancer is a disease with high recurrence rate, which occurs in up to 90% of cases of stage III and IV. Due to the ovarian cancer biology, multidisciplinary approach is highly recommended. According to last ESMO-ESGO consensus on ovarian cancer, there is a role for secondary cytoreductive surgery after first recurrence. Recent clinical trials show prolonged progression free survival following secondary cytoreduction, while there is no benefit for overall survival. The selection of patients for secondary cytoreduction must be meticulous because, the benefit is shown only in those patients in whom complete surgical cytoreduction is feasible. Patients with second or later recurrence can also benefit from cytoreduction, but in this scenario it should be reserved for highly specialized centres. However, chemotherapy is still the backbone for recurrent ovarian cancer treatment. The selection of chemotherapy protocol depends on multiple factors such as cancer biology, prior treatment, platinum sensitivity, toxicity, patients’ symptoms and preferences. The gold standard for recurrent ovarian cancer is still platinum based chemotherapy, but only if the prior response to platinum treatment was good (platinum sensitive disease) and there are no contraindications for its use. The addition of bevacizumab to platinum protocol prolongs the overall survival. Furthermore, maintenance therapy with PARP-inhibitors in high grade recurrent ovarian cancer showed its benefit in prolonged progression free survival, while results on overall survival impact are immature. It is interesting that the efficacy of PARP-inhibitors was expected only in BRCA mutated patients, but trial results showed benefit in all patients with high grade recurrent ovarian cancer regardless of BRCA status. On the other hand, if the platinum-based chemotherapy is not an option because of platinum insensitivity or if patient is platinum ineligible, the treatment is based on non-platinum mono- chemotherapy. Some of preferred protocols are paclitaxel, topotecan, pegylated liposomal doxorubicin or gemcitabine. Unfortunately, the objective response rates in this scenario are no more than 20% with median overall survival of 12 months. The addition of bevacizumab to mono-chemotherapy treatment results are better, with longer progression free survival, overall survival and improvement in patient reported quality of life.

Hrcak, lecture

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