Management of recurrent ovarian cancer with systemic therapy

The majority of patients with recurrent ovarian cancer receive palliative chemotherapy. Several factors have been identified as predictors of response, but the main factor related to second-line treatment response is platinum-free interval (PFI). Patients with a PFI of <6 months have a poor prognostic profile and can be described as platinum resistant, while those patients with a PFI of >6 months are described as platinum sensitive. In platinum-sensitive patients the goal is to prolong survival, whereas in platinum-resistant patients treatment can only produce palliative benefits. An alternative classification of ovarian cancer has been proposed relating to platinum-refractory disease. Patients with refractory disease are those who have progressive disease during treatment or those with a treatmentfree interval (TFI) of 4 months or less, intermediate group patients have a TFI of 4-12 months, while patients with sensitive-recurrent disease have a TFI of 12 months or more. Trial data have confirmed the superiority of platinum-based combination chemotherapy versus platinum monotherapy in platinum-sensitive patients. In patients pre-treated with paclitaxel plus carboplatin, a gemcitabine plus carboplatin combination is promising, avoiding alopecia, neurotoxicity and other toxicities, and may also benefit platinum-sensitive patients who have suffered early recurrence. Trials are currently under way for various compounds, including bevacizumab, erlotinib, pertuzumab, imatinib, enzastaurin, epothilones, topotecan and trabectedin. Clinical trials are also ongoing for combinations of molecular-targeting agents and conventional chemotherapeutics.