New Strategies and Novel Agents Transform Ovarian Cancer Into a Chronic Condition

Maurie Markman, MD
Published: Wednesday, Mar 06, 2019
Maurie Markman, MD

Maurie Markman, MD
Approximately 20 years ago, findings from a landmark ovarian cancer study demonstrated the favorable impact associated with adding paclitaxel to cisplatin (compared with cyclophosphamide plus cisplatin) as first-line chemotherapy.1 Remarkably, other than the substitution of carboplatin for cisplatin, which improved the toxicity profile of the regimen but not its efficacy, there has been essentially no change in the primary cytotoxic management of the malignancy since that time.

The study results revealed an impressive improvement in both PFS and objective response rates when the antiangiogenic agent was added to any of 3 cytotoxic drugs. It is uniquely relevant that this was the first—and, to date, only—randomized phase III trial to reveal an improvement in survival outcome in platinum-resistant ovarian cancer.

 

Over the past several years, ovarian cancer care has been transformed by the impressive activity of PARP inhibitors in several clinical settings.5 Currently, the FDA has approved 3 PARP inhibitors for use in ovarian cancer as second-line or later maintenance therapy following a response to platinum-based therapy.

Unfortunately, we must acknowledge that the overall percentage of patients with advanced ovarian cancer who are “cured” of their malignancy—defined as those whose disease does not recur during their lifetime—has not changed substantially over the past 2 decades.

 

However, during this time, epithelial ovarian cancer has been transformed in an increasing percentage of individuals into a serious, unfortunately still likely fatal, but more chronic condition in which extended survival of satisfactory quality (as defined by an individual patient) may be measured in years. In fact, it is estimated that as many as 200,000 women in the United States are currently living with this malignancy. With these important facts in mind, it becomes even more essential that the oncology research community focus as much attention on the overall impact of antineoplastic therapy on the quality of life of the patient undergoing treatment as on the duration of survival.

References

  1. Markman. Drugs. 2008;68(6):771-789.
  2. Vergote et al. N Engl J Med. 2010;363(10):943-953.
  3. van Driel et al. N Engl J Med. 2018;378(3):230-240.
  4. Rossi et al. Oncotarget. 2017;8(7):12389-12405.
  5. Markman. Womens Health (Lond). 2018;14:1745505717750694
  6. Moore et al. N Engl J Med. 2018;379(26):2495-2505.

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