< Approaching Recurrent Ovarian Cancer

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Approaching Recurrent Ovarian Cancer

Panelists: Bradley J. Monk, MD, FACS, FACOG, University of Arizona, Creighton University, & Arizona Oncology Practice of US Oncology; Ursula Matulonis, MD, Dana-Farber Cancer Institute; David OMalley, MD, The Ohio State University; Matthew Powell, MD, Washington University; Shannon N. Westin, MD, MPH, MD Anderson Cancer Center
Published: Thursday, Apr 26, 2018



Transcript: 

Bradley J. Monk, MD, FACS, FACOG: I’d like to transition now to recurrent ovarian cancer. Unfortunately, almost 75% to 80% of patients with advanced ovarian cancer recur. When they recur, they unfortunately ultimately succumb to their disease. The fortunate scenario today is that they have multiple options. Patients are living longer and longer. If it hasn’t dawned on you, the prevalence of ovarian cancer is 10 times the incidence. The incidence of ovarian cancer is about 20,000 patients, but 10 times as many patients—200,000 patients—in the United States are living with recurrent ovarian cancer, and, quite frankly, they are battling it. Matt, what are the factors that determine how to treat recurrent ovarian cancer? What are the key factors?

Matthew Powell, MD: I wish I knew the answer to that question. I can tell you the factors that I use. Whether they’re the right ones or not is really the question. Certainly, we want to make sure we know whether it is a low-grade tumor or high-grade tumor and how long has it been since...

Bradley J. Monk, MD, FACS, FACOG: Histologic subtype.

Matthew Powell, MD: Or histologic subtype.

Bradley J. Monk, MD, FACS, FACOG: Platinum-free interval.

Matthew Powell, MD: Platinum-free interval—and so, big biomarkers and what side effects have they had.

Bradley J. Monk, MD, FACS, FACOG: Molecular signature.

Matthew Powell, MD: Molecular signature. We want to know about HRD. We certainly don’t want to neglect looking for MSI or mismatch repair deficiency, although it’s rare. Our endometrioid subtype might be one that we would want to be looking in. Then we’d want to think about side effects from prior therapy and then, goals of care. Do they want to travel? Maybe they don’t want to lose their hair or they have a wedding coming up...? There are a lot of things that factor into these decisions that we make.

Bradley J. Monk, MD, FACS, FACOG: Histologic subtype, platinum-free interval, molecular signature, number of lines of therapy, preexisting toxicities, and the goal of treatment. That’s 6 things. I love it. Thank you.
In the old days, Dave, we used to talk about platinum-resistant and platinum-sensitive recurrent ovarian cancer. He didn’t even mention that. Is that still a valid concept?

David O’Malley, MD: Those terms are still used, and we need some guidelines.

Bradley J. Monk, MD, FACS, FACOG: So, define them.

David O’Malley, MD: We used to talk about 6 months of treatment-free interval or platinum-free interval, but that’s been modified, as we’re using maintenance z up front. We still use the time from the last platinum drug as guidance for this random 6-month range, but really, 3 to 12 is probably better. That will probably be modified in the future, as we have more and more maintenance therapies.

Transcript Edited for Clarity 

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Transcript: 

Bradley J. Monk, MD, FACS, FACOG: I’d like to transition now to recurrent ovarian cancer. Unfortunately, almost 75% to 80% of patients with advanced ovarian cancer recur. When they recur, they unfortunately ultimately succumb to their disease. The fortunate scenario today is that they have multiple options. Patients are living longer and longer. If it hasn’t dawned on you, the prevalence of ovarian cancer is 10 times the incidence. The incidence of ovarian cancer is about 20,000 patients, but 10 times as many patients—200,000 patients—in the United States are living with recurrent ovarian cancer, and, quite frankly, they are battling it. Matt, what are the factors that determine how to treat recurrent ovarian cancer? What are the key factors?

Matthew Powell, MD: I wish I knew the answer to that question. I can tell you the factors that I use. Whether they’re the right ones or not is really the question. Certainly, we want to make sure we know whether it is a low-grade tumor or high-grade tumor and how long has it been since...

Bradley J. Monk, MD, FACS, FACOG: Histologic subtype.

Matthew Powell, MD: Or histologic subtype.

Bradley J. Monk, MD, FACS, FACOG: Platinum-free interval.

Matthew Powell, MD: Platinum-free interval—and so, big biomarkers and what side effects have they had.

Bradley J. Monk, MD, FACS, FACOG: Molecular signature.

Matthew Powell, MD: Molecular signature. We want to know about HRD. We certainly don’t want to neglect looking for MSI or mismatch repair deficiency, although it’s rare. Our endometrioid subtype might be one that we would want to be looking in. Then we’d want to think about side effects from prior therapy and then, goals of care. Do they want to travel? Maybe they don’t want to lose their hair or they have a wedding coming up...? There are a lot of things that factor into these decisions that we make.

Bradley J. Monk, MD, FACS, FACOG: Histologic subtype, platinum-free interval, molecular signature, number of lines of therapy, preexisting toxicities, and the goal of treatment. That’s 6 things. I love it. Thank you.
In the old days, Dave, we used to talk about platinum-resistant and platinum-sensitive recurrent ovarian cancer. He didn’t even mention that. Is that still a valid concept?

David O’Malley, MD: Those terms are still used, and we need some guidelines.

Bradley J. Monk, MD, FACS, FACOG: So, define them.

David O’Malley, MD: We used to talk about 6 months of treatment-free interval or platinum-free interval, but that’s been modified, as we’re using maintenance z up front. We still use the time from the last platinum drug as guidance for this random 6-month range, but really, 3 to 12 is probably better. That will probably be modified in the future, as we have more and more maintenance therapies.

Transcript Edited for Clarity 
View Conference Coverage
Online CME Activities
TitleExpiration DateCME Credits
Oncology Best Practice™: Expert Perspectives to Incorporate Evidence on PARP Inhibitors into Practice and Optimize the Medical Management of Ovarian CancerOct 31, 20181.0
Community Practice Connections™: Precision Medicine for Community Oncologists: Assessing the Role of Tumor-Testing Technologies in Cancer CareNov 30, 20181.0
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