6. First-line Therapy –
Standard Treatment Options
Platinum + Taxane Chemotherapy
(Carboplatin + Paclitaxel)
Surgery with maximum
cytoreduction effort <1cm residual
disease
7. Monitoring Ovarian Cancer Patients Following First Line
Treatment
*The combination of carboplatin and paclitaxel given every 3weeks
remains the standard first line chemotherapy for ovarian cancer.
8.
9.
10. Current option in platinum sensitive
ovarian cancer
* Cancer ovary
* Platinum sensitive
* Current option
16. Treatment of Recurrent Cancer
• Timing of Recurrence
• Platinum Resistance vs Platinum Sensitivity
• Prior Chemotherapy Treatments
• Goal is Quality of Life and Longevity
• Treatment Options
• Chemotherapy
• Surgery (selective cases)
• New Treatment Options such as biologic
therapies
17.
18. Definitions of Disease State
Recurrent Ovarian Cancer
Asymptomatic
Biochemical
Measurable Disease
22. When patients relapse following first-line treatment, cure is generally
not possible.
If patients are asymptomatic:
-quality of life should be maintained
-OVO5 trial questions early intervention in asymptomatic patients
If patients symptomatic:
-quality of life needs to be improve
* Depends to a certain extent on the scenario of relapsed disease:
-Local, operable recurrence, surgery+/- chemotherapyshould be
considered and very occasionally radiotherapy (e.g. depending on
site,comorbidities
-Early treatment is warranted if significant extent of disease on
CT, rapidly increasing disease volume, impending organ dysfunction
23. The main recognized factors improving the likelihood
of optimal secondary cytoreduction and possibly
contributing to prolong patients survival are :
1-the absence of ascites
2-good performance status
3- and the complete debulking during primary surgery
(AGO score)
24. AGO-OVAR DESKTOP III (Protocol AGO - OVAR OP.4)
A randomized trial evaluating cytoreductive surgery
in patients with platinum-sensitive recurrent ovarian cancer
Strata:
Platinum-free-interval
6-12 vs > 12 months
1st line platinum
based chx: yes vs no
R
A
N
D
O
M
Cytoreductive
surgery
platinum-based
chemotherapy*
recommended
* Recommended platinum-based chemotherapy regimens:
- carboplatin/paclitaxel
-
carboplatin/gemcitabine
-
carboplatin/pegliposomal doxorubicin
-
or other platinum combinations in prospective trials
no surgery
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40. •Prior treatment with Bev.
• More than one prior line in platinum-sensitive
disease and more than 2 in resistant.
• contraindications to BEV: uncontroled HTA,
renal or cardiac function impairment, recent
history of bleeding, thrombosis, wound healing
trouble, bowel/bladder wall involvement
41.
42.
43.
44.
45. PARP
Poly ADP-ribose polymerase (DNA Repair Enzyme)
• Healthy cells undergo replication. Cancer cells replicate quickly and
often.
– Sometimes there are breaks or mistakes in the duplication of the
DNA to form new cells.
– Healthy cells are able to activate a couple of different DNA repair
pathways. One of these pathways is regulated by a PARP enzyme.
• When there a defect in the BRCA 1 or 2 gene (gene mutation)
– The ”other” DNA repair pathways doesn’t work.
– DNA repair pathways is dependent on PARP enzyme to repair the
DNA.
– If the PARP action is blocked (by a PARP Inhibitor) then the PARP
pathways is also will not function. There is no “back-up” repair
system.
– If the DNA can’t repair itself, it can’t replicate—leading to cell
death and replication is stopped.
46.
47. • Blocks a the PARP-associated DNA Repair Pathway
– Particularly effective when there is a BRCA mutation
• Oral drug
• Well tolerated
– Common Side Effects
• Nausea, fatigue, vomiting, diarrhea, affects take and digestion
• Bone Marrow Suppression (increased risk infection, bleeding)
• Rare serious toxicity leukemia, lung inflammation
