Medscape: Bevacizumab Benefits Patients With Recurrent Ovarian Cancer (bevacizumab plus carboplatin and gemcitabine followed by bevacizumab)

Bevacizumab Benefits Patients With Recurrent Ovarian Cancer

paywalled: PET/CT scanning guided intensity-modulated radiotherapy in treatment of recurrent ovarian cancer.

PET/CT scanning guided intensity-modulated radi... [Eur J Radiol. 2012] - PubMed - NCBI

Abstract

OBJECTIVE:

This study was undertaken to evaluate the clinical contribution of positron emission tomography using (18)F-fluorodeoxyglucose and integrated computer tomography (FDG-PET/CT) guided intensity-modulated radiotherapy (IMRT) for treatment of recurrent ovarian cancer.

MATERIALS AND METHODS:

Fifty-eight patients with recurrent ovarian cancer from 2003 to 2008 were retrospectively studied. In these patients, 28 received PET/CT guided IMRT (PET/CT-IMRT group), and 30 received CT guided IMRT (CT-IMRT group). Treatment plans, tumor response, toxicities and survival were evaluated.

RESULTS:

Changes in GTV delineation were found in 10 (35.7%) patients based on PET-CT information compared with CT data, due to the incorporation of additional lymph node metastases and extension of the metastasis tumor. PET/CT guided IMRT improved tumor response compared to CT-IMRT group (CR: 64.3% vs. 46.7%, P=0.021; PR: 25.0% vs. 13.3%, P=0.036). The 3-year overall survival was significantly higher in the PET-CT/IMRT group than control (34.1% vs. 13.2%, P=0.014).

CONCLUSIONS:

PET/CT guided IMRT in recurrent ovarian cancer patients improved the delineation of GTV and reduce the likelihood of geographic misses and therefore improve the clinical outcome.

open access: Nature Reviews: Key Advances in Medicine - Ovarian Cancer/Markman page 15-16

Key Advances in Medicine (book)


Nature Reviews Clinical Oncology  (page 15)S11 ovarian cancer | Mutations and non-inferiority analyses show a way forward Maurie Markman      (page 15-16)






Highly clinically relevant ovarian cancer clinical research in 2011 focused on an increased understanding of the biology of the malignancy, limitations of strategies for early detection and screening, and the provocative reports of alternative primary and second-line management strategies.

"Although there were a number of very interesting
preliminary reports of therapeutic
advances in ovarian cancer in 2011 (for
example, bevacizumab in the first-line and
second-line management of the malignancy,
and olaparib  (Blogger's Note: links to Olaparib (parp inhibitor) - Cancer Research UK)  as maintenance therapy for
high-grade serous cancers), as of the writing
of this commentary these studies have not
appeared in the peer-reviewed oncology literature......."

Key advances
■■ There are currently no evidence-based
data supporting the clinical utility of any
ovarian cancer screening strategy in
non‑high-risk populations1
■■ Provocative data suggest there may be a
clinically meaningful difference between
the presence of a BRCA1 or a BRCA2
mutation in influencing outcome in ovarian
cancer6
■■ Under specific circumstances (for example,
neuropathy) it might be reasonable to
substitute pegylated liposomal doxorubicin
for paclitaxel in the front-line chemotherapy
management of ovarian cancer7

Markman, M. Nat. Rev. Clin. Oncol. 9, 69–70 (2012); published online 20 December 2011; doi:10.1038/nrclinonc.2011.200

                                   ~~~~~~~~~~~~~
"The articles included in Nature Reviews Key Advances in
Medicine were originally published in the February 2012
issues of the eight clinical Nature Reviews journals. The journals’
editors commissioned international experts to write a short
essay highlighting up to five key papers that made the biggest
contribution to their field in 2011."

press release: The Clearity Foundation - Molecular profiling reveals differences between primary and recurrent ovarian cancers

Analysis of tumor specimens uncovers changes in biomarker expression that may have implications for therapy selection for women with recurrent ovarian cancer

 "These results demonstrate the dynamic genetic changes in ovarian cancers between diagnosis and recurrence. While the expression of these and other candidate response biomarkers should be evaluated in larger studies to better understand the clinical utility of profiling recurrent tumor specimens, this report highlights our urgent need to individualize our treatment approaches in order to improve ovarian cancer survival," says Dr. Karlan, Director of the Cedars-Sinai Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute and a renowned expert in the field of gynecologic oncology.

".....Ovarian cancers are very different from patient to patient, which means they are likely to respond differently to FDA-approved and investigational drugs. By identifying the alterations in each tumor's information pathways, molecular profiling enables the individualization of a patient's treatment by matching those tumor alterations with one or more drugs. The Clearity Foundation has developed a process for generating this personalized diagnostic information using commercially-available molecular profiling technologies and then analyzing the results using its Diane Barton Database."

 

 

full free access: Targeted treatment of recurrent platinum-resistant ovarian cancer: current and emerging therapies

abstract: HIPEC (hyperthermic intraoperative intraperitoneal chemotherapy) in recurrent ovarian cancer patients: Morbidity-related treatment and long-term analysis of clinical outcome.

Evaluating New Regimens in Recurrent Ovarian Cancer: How Much Evidence Is Good Enough? -- Cannistra 28 (19): 3101 -- Journal of Clinical Oncology

Note: speaks about PFS vs OS (progression free survival; overall survival); PLD and Trabectedin (Yondelis) study (Monk); ICON4 and more

It's a choice to move forward: women's perceptions about treatment decision making in recurrent ovarian cancer

Abstract
OBJECTIVE: This research explores the treatment decision-making (TDM) experiences of women with recurrent ovarian cancer (ROC) with regard to treatment options; their understanding of risks and benefits of various treatment options; the decision-making role they want for themselves and for their oncologist; and the social context of the consultation as it pertains to the decision.
METHODS: We conducted semi-structured interviews with 26 women at the time of first recurrence. Through inductive data analysis key themes were identified.
RESULTS: Many women describe self-identifying the cancer recurrence fairly quickly due to new symptoms. Many feel that the goal for treating their recurrence is to control versus cure the cancer. They describe the subsequent process of diagnosis and TDM for ROC as quick and straightforward with all women accepting the oncologists' treatment recommendation. They feel that the type and number of treatment options are limited. They have a strong desire for physician continuity in their care. Participants feel that their doctor's recommendations as well as their previous experience with ovarian cancer are strong factors influencing their current TDM process.
CONCLUSIONS: Shared decision making is based on a simultaneous participation of both the physician and patient in TDM. When faced with ROC, women feel that their doctor's recommendation and their past experience with treatment and TDM are prominent factors influencing the current TDM process.

Trabectedin Plus Pegylated Liposomal Doxorubicin in Recurrent Ovarian Cancer. (multinational study)

Note: Trabectedin is also known as Yondelis PURPOSE The objective of this study was to compare the efficacy and safety of trabectedin plus pegylated liposomal doxorubicin (PLD) with that of PLD alone in women with recurrent ovarian cancer after failure of first-line, platinum-based chemotherapy CONCLUSION When combined with PLD, trabectedin improves PFS and ORR over PLD alone with acceptable tolerance in the second-line treatment of recurrent ovarian cancer.

Impact of a chemoresponse assay on treatment costs for recurrent ovarian cancer

Incidence and management of bevacizumab-associated gastrointestinal perforations in patients with recurrent ovarian carcinoma

Association of pegylated liposomal doxorubicin and ifosfamide in early recurrent ovarian cancer patients: A Multicenter Phase II Trial

Conclusion

The combination of PLD and continuous IFO is a feasible and efficient treatment in patients with relapsed ovarian cancer, especially with TFI between 6 and 12 months. This regimen may represent an alternative to platinum reintroduction and should be evaluated in a randomized trial.