What are the recommendations for treatment of platinum-sensitive recurrent ovarian cancer?

Updated: Jan 14, 2019
  • Author: Shannon M Grabosch, MD; Chief Editor: from Memorial Sloan-Kettering - Yukio Sonoda, MD  more...
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Answer

Answer

If recurrence occurs more than 6 months after initial or subsequent complete clinical response to platinum-containing chemotherapy, the patient should be treated with one of the IV platinum-containing combination regimens below. The choice depends on factors such as pre-existing comorbidity, prior toxicities, and physician and patient preference. Regimens are as follows:

  • Carboplatin AUC 5 IV  plus  liposomal doxorubicin 30 mg/m2 IV over 30 min; every 28 d for six cycles [24] or

  • Paclitaxel 175 mg/m2 IV over 3 h plus  carboplatin AUC 5 (Calvert) IV over 1 h; every 21 d for six cycles [25] or

  • Paclitaxel 80 mg/m2 IV over 1 h weekly days 1, 8, and 15 plus  carboplatin AUC 6 IV over 1 h on day 1; every 21 days for six cycles [26]  or

  • Docetaxel 75 mg/m2 IV over 1 h plus  carboplatin AUC 5 IV over 1 h; every 21 d for six cycles [8] or

  • Gemcitabine 1000 mg/m2 IV over 30 min on days 1 and 8 plus  carboplatin AUC 4 IV over 1 h on day 1; every 21 days for 6 cycles [27, 28]

Consideration may be given to bevacizumab, in combination with carboplatin and paclitaxel [29] or with carboplatin and gemcitabine, [30] followed by bevacizumab alone, as follows:

  • Bevacizumab 7.5 mg/kg IV over 30-90 min on Day 1 plus carboplatin AUC 5-6 IV on day 1 plus paclitaxel 175 mg/m2 IV over 3 h on day 1 every 21 days for five to six cycles, followed by continued use of bevacizumab 7.5 mg/kg every 21 days for up to 12 additional cycles [29]  or

  • Bevacizumab 15 mg/kg IV over 30–90 min on day 1 plus  carboplatin IV AUC 6 on day 1 every 21 days for six cycles, followed by continued use of bevacizumab 15 mg/kg IV over 30–30-90 min every 21 days for up to 22 additional cycles

  • Bevacizumab 15 mg/kg IV on Day 1 plus  carboplatin IV AUC 4 on day 1 plus  gemcitabine 1000 mg/m2 IV on Days 1 and 8 every 21 days for six to 10 cycles, followed by continued use of bevacizumab 15 mg/kg every 21 days as a single agent until disease progression [30]

A minority of patients may be suitable candidates for secondary surgery, including those with limited disease and a long interval to recurrence from original treatment. All patients should be considered for entry into clinical trials.


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