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Chemotherapy Remains Cornerstone of Recurrent Ovarian Cancer Treatment

Caroline Seymour
Published: Tuesday, Apr 09, 2019

Jason A. Konner, MD

Jason A. Konner, MD

Platinum-doublet chemotherapy remains the cornerstone of treatment for patients with platinum-sensitive recurrent ovarian cancer, just as anthracycline- and taxane-based chemotherapy are mainstays for those with platinum-resistant/recurrent disease. However, the availability of bevacizumab (Avastin) warrants careful consideration in terms of which regimen to begin with, explained Jason A. Konner, MD.

“Despite all of the excitement about some of the new targeted therapies, standard chemotherapies remain the bedrock of treatment both in the first-line, adjuvant, and recurrent settings,” said Konner. “The standards of care all wrap around these platinum doublets until platinum resistant/recurrent disease develops. Then, we talk about some nonplatinum therapies.”

Although preliminary data posited mirvetuximab soravtansine (IMGN853) as one such nonplatinum therapy, the agent failed to demonstrate a statistically significant improvement in progression-free survival (PFS) versus chemotherapy in patients with platinum-resistant/recurrent disease in the phase III FORWARD I trial.

For patients with platinum-sensitive disease, commonly used agents include liposomal doxorubicin, taxane, gemcitabine, platinum, and now bevacizumab, according to data from the phase III OCEANS and GOG0213 trials.

In OCEANS,1 patients with platinum sensitivity who were randomized to receive gemcitabine combined with carboplatin plus bevacizumab followed by maintenance bevacizumab experienced a 54% reduction in the risk of disease progression or death versus chemotherapy plus placebo (HR, 0.46; 95% CI, 0.37-0.58; P <.0001). Further, in the GOG0213 trial,2 patients with platinum sensitivity who were randomized to receive bevacizumab plus paclitaxel/carboplatin chemotherapy experienced a 39% reduction in the risk of progression or death versus chemotherapy alone (HR, 0.61; P <.0001).  

Findings from the AURELIA trial3 echoed the utility of adding bevacizumab to standard chemotherapy backbones. In the phase III trial, patients with platinum-resistant/recurrent disease experienced a 62% reduction in the risk of progression or death if they received the combination of bevacizumab and investigator’s choice of chemotherapy—pegylated liposomal doxorubicin, weekly paclitaxel, or topotecan—versus chemotherapy alone (HR, 0.38; 95% CI, 0.30-0.49; <.0001).

“Right now, it's important to recognize that there are FDA maintenance strategies that involve bevacizumab or PARP inhibitors,” said Konner. “Whenever choosing a platinum doublet, you need to keep in mind not only which platinum doublet might be best for your patient, but also what maintenance strategy you might consider for that patient.”

In an interview during the 2019 OncLive® State of the Science Summit™ on Ovarian Cancer and Soft Tissue Sarcoma, Konner, a medical oncologist at Memorial Sloan Kettering Cancer, shed light on the current treatment landscape for patients with platinum-sensitive and platinum-resistant/recurrent ovarian cancer.

OncLive: What are the key takeaways from major trials in recurrent ovarian cancer?

Konner: First, we established the basis for the platinum doublets. We looked at the trials combining paclitaxel and gemcitabine with carboplatin, which showed superiority to carboplatin by itself. Furthermore, we looked at the head-to-head doublet of liposomal doxorubicin and carboplatin versus paclitaxel/carboplatin in the CALYPSO study.

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