TY - JOUR
T1 - Therapeutic options following second-line platinum-based chemotherapy in patients with recurrent ovarian cancer
T2 - Comparison of active surveillance and maintenance treatment
AU - Ray-Coquard, Isabelle
AU - Mirza, Mansoor Raza
AU - Pignata, Sandro
AU - Walther, Axel
AU - Romero, Ignacio
AU - du Bois, Andreas
N1 - Funding Information:
The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: I. Ray-Coquard has served on advisory boards for Clovis Oncology, AstraZeneca, Genmab/Seattle Genetics, ImmunoGen, PharmaMar, Roche, and Tesaro and received support for travel or accommodation from AstraZeneca, GSK and Roche. M.R. Mirza has received fees for serving on advisory boards from Clovis Oncology, AstraZeneca, and Tesaro/GSK and speaker fees from AstraZeneca, Roche, and Tesaro/GSK. S. Pignata has received honoraria from Clovis Oncology, AstraZeneca, Incyte, MSD, PharmaMar, Pfizer, and Roche and research funding from AstraZeneca, MSD, Pfizer, and Roche. A. Walther has served on advisory boards for AstraZeneca, Roche, and Tesaro and received support for travel or accommodation from AstraZeneca and Tesaro. I. Romero has served on advisory boards for Clovis Oncology, AstraZeneca, PharmaMar, Roche, and Tesaro and received support for travel or accommodation from AstraZeneca, GSK, PharmaMar and Roche. A du Bois has served on advisory boards for Clovis Oncology, AstraZeneca, Genmab/Seattle Genetics, MSD, Pfizer, PharmaMar, Roche, and Tesaro/GSK.
Funding Information:
Medical writing and editorial support funded by Clovis Oncology were provided by Jeremy Kennard, PhD, Nathan Yardley, PhD, and Frederique H. Evans, MBS, of Ashfield Healthcare Communications.
Publisher Copyright:
© 2020 The Authors
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/11
Y1 - 2020/11
N2 - Most women with advanced ovarian cancer respond to initial treatment, consisting of surgical resection and ≈6 cycles of platinum-based chemotherapy. However, disease recurrence occurs in most patients, and subsequent therapies become necessary. Historically, close monitoring following treatment (active surveillance) was the only available option, as continued maintenance chemotherapy treatment led to increased toxicity without providing any meaningful clinical benefit. Recently, targeted therapy with the angiogenesis inhibitor bevacizumab and the poly(ADP-ribose) polymerase (PARP) inhibitors olaparib, niraparib, and rucaparib have demonstrated significant clinical benefits as maintenance treatment for recurrent disease. Despite consensus guidelines recommending their use, maintenance treatments are currently underutilized. Here, we review evidence from pivotal clinical trials of approved second-line maintenance treatments demonstrating efficacy in terms of progression-free survival and postprogression efficacy outcomes for patients with recurrent ovarian cancer. Adverse events frequently associated with bevacizumab include hypertension, proteinuria, and non-central nervous system bleeding, whereas PARP inhibitors are associated with nausea, vomiting, fatigue, and anemia. Patient-centered outcomes analyses show that PARP inhibitors provide significant benefits to patient health status, even when accounting for the toxicities associated with treatment. Many factors influence the selection of second-line maintenance treatment for patients with recurrent ovarian cancer, including the maintenance treatment received in the first-line setting. Overall, targeted maintenance treatment represents a new standard of care for patients with ovarian cancer, and we recommend that maintenance treatment should be offered to all eligible patients with recurrent ovarian cancer.
AB - Most women with advanced ovarian cancer respond to initial treatment, consisting of surgical resection and ≈6 cycles of platinum-based chemotherapy. However, disease recurrence occurs in most patients, and subsequent therapies become necessary. Historically, close monitoring following treatment (active surveillance) was the only available option, as continued maintenance chemotherapy treatment led to increased toxicity without providing any meaningful clinical benefit. Recently, targeted therapy with the angiogenesis inhibitor bevacizumab and the poly(ADP-ribose) polymerase (PARP) inhibitors olaparib, niraparib, and rucaparib have demonstrated significant clinical benefits as maintenance treatment for recurrent disease. Despite consensus guidelines recommending their use, maintenance treatments are currently underutilized. Here, we review evidence from pivotal clinical trials of approved second-line maintenance treatments demonstrating efficacy in terms of progression-free survival and postprogression efficacy outcomes for patients with recurrent ovarian cancer. Adverse events frequently associated with bevacizumab include hypertension, proteinuria, and non-central nervous system bleeding, whereas PARP inhibitors are associated with nausea, vomiting, fatigue, and anemia. Patient-centered outcomes analyses show that PARP inhibitors provide significant benefits to patient health status, even when accounting for the toxicities associated with treatment. Many factors influence the selection of second-line maintenance treatment for patients with recurrent ovarian cancer, including the maintenance treatment received in the first-line setting. Overall, targeted maintenance treatment represents a new standard of care for patients with ovarian cancer, and we recommend that maintenance treatment should be offered to all eligible patients with recurrent ovarian cancer.
KW - Active surveillance
KW - Efficacy
KW - Maintenance treatment
KW - Postprogression
KW - Quality of life
KW - Safety
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U2 - 10.1016/j.ctrv.2020.102107
DO - 10.1016/j.ctrv.2020.102107
M3 - Review article
C2 - 33099187
AN - SCOPUS:85093671598
VL - 90
JO - Cancer Treatment Reviews
JF - Cancer Treatment Reviews
SN - 0305-7372
M1 - 102107
ER -