A New Standard for Low-Grade Serous Cancer of the Ovary?

Maurie Markman, MD


June 29, 2017

Hello. This is Dr Maurie Markman from Cancer Treatment Centers of America in Philadelphia. I want to briefly discuss a very interesting paper that appeared in the April 2017 issue of Journal of Clinical Oncology, entitled "Hormonal Maintenance Therapy for Women With Low-Grade Serous Cancer of the Ovary or Peritoneum."[1]

This is an uncommon clinical situation. The vast majority of epithelial ovarian cancers are high-grade cancers; however, low-grade cancers do occur and we really don't have a good treatment paradigm following surgical cytoreduction. For the past 40-plus years, the standard of care has been the same therapy used for high-grade cancers, yet it remains unclear what the role or benefits of platinum-based chemotherapy are in this clinical setting. One of the reasons that this is difficult is because it's been recognized that the objective response rate in this setting to platinum is relatively low and, very importantly, overall prognosis is relatively good compared with high-grade cancers.

Remembering that this is a relatively uncommon situation and that randomized controlled trials are very difficult, what else might one consider after the use of platinum to optimize the care of women in this clinical setting?

This paper from David Gershenson, MD, and the group at the MD Anderson Cancer Center retrospectively looked at patients in that institution from 1981 to 2013 with stage II to stage IV low-grade serous carcinoma of the ovary with at least 2 years of follow-up. Very importantly, the question raised was: Following completion of chemotherapy, [what are the outcomes in patients receiving routine observation versus maintenance] oral hormonal therapy?

This group showed that the use of oral hormonal therapy—again recognizing that this was a retrospect review of a nonrandomized experience—was associated with a substantial improvement in overall survival in both the population that had no evidence of the disease at the completion of that primary surgery and in women who had evidence of disease following the completion of the surgical procedure.

This is a very important paper. I would argue that this changes the standard of care in this clinical setting because oral hormonal therapy is recognized to be well tolerated, and randomized trials in this setting are extremely difficult, if not impossible. I would also add that the large majority of these tumors are actually estrogen receptor–positive and progesterone receptor–positive, which makes a very strong rationale for this particular therapeutic strategy.

I encourage any of you who treat women with low-grade serous carcinomas of the ovary to read this important paper in the Journal of Clinical Oncology and to seriously consider the use of oral hormonal therapy for maintenance in the management of this rare clinical entity.

I thank you for your attention and I encourage you to read this important paper.


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