How have treatments changed for recurrent ovarian cancer over the last 5 years?

Recent advances in treating newly diagnosed, advanced ovarian cancer have focused on better surgery, namely, by gynecologic oncologists attempting to achieve compete resection. When complete resection is not feasible, neoadjuvant chemotherapy has become common, with surgery then being performed after 3 cycles. Chemotherapy has also changed. In a single Japanese study, dose-dense weekly paclitaxel (80 mg weekly without a break) combined with every-3-week carboplatin prolonged progression-free survival (PFS) and overall survival (OS). Another advancement in first-line treatment is adding bevacizumab. This appears to be most effective in those with large-volume residual disease after debulking and in stage IV patients where survival may be improved by about 8 months.

CASE 1: Epithelial Ovarian Cancer

Sarah W. is a 62-year-old Caucasian woman who works as a travel agent.

In June of 2013, the patient presented with bloating and abdominal distension. Prior medical history is notable for nulliparity, and medication-controlled hypertension.

• Physical exam revealed palpable, fixed nodular 10-cm pelvic mass with abdominal ascites, and patient’s CA-125 level was 895 U/mL
• She underwent total abdominal hysterectomy, bilateral salpingo oophorectomy, omentectomy, low anterior resection with anastomosis and complete cytoreduction of all gross metastatic disease. There was no gross residual disease. Stage was FIGO 3C epithelial ovarian cancer
• Patient was negative forBRCA1or2mutation
• She received 6 IV q3-week cycles of paclitaxel/carboplatin
• Her symptoms resolved and CA-125 levels decreased to 9 U/mL; she remained disease free for approximately 18 months

In December of 2014, the patient presents for her 6-month evaluation with rising CA-125 level, mild abdominal distension and fatigue, and inability to work.

• CT scanning reveals metastatic involvement of liver surface, an isolated splenic lesion, and a small amount of ascites
• She was retreated with carboplatin/paclitaxel
• Patient showed improvement in symptoms and performance status (ECOG 0) after 3 cycles of therapy