From the Guidelines
The recommended first-line treatment for metastatic ovarian cancer in the abdominal area is a combination of cytoreductive surgery followed by platinum-based chemotherapy, specifically carboplatin (AUC 5-6) plus paclitaxel (175 mg/m² over 3 hours) administered intravenously every 3 weeks for 6 cycles, as supported by the most recent and highest quality study 1.
Treatment Overview
The treatment approach for metastatic ovarian cancer involves a multimodal strategy, including:
- Cytoreductive surgery to remove as much of the tumor as possible
- Platinum-based chemotherapy to kill rapidly dividing cancer cells
- Maintenance therapy with a PARP inhibitor, such as olaparib or niraparib, for patients with BRCA mutations or homologous recombination deficiency
- Bevacizumab may be added to the chemotherapy regimen and continued as maintenance therapy in high-risk patients
Chemotherapy Regimen
The standard chemotherapy regimen consists of:
- Carboplatin (AUC 5-6)
- Paclitaxel (175 mg/m² over 3 hours)
- Administered intravenously every 3 weeks for 6 cycles
Maintenance Therapy
For patients with BRCA mutations or homologous recombination deficiency, maintenance therapy with a PARP inhibitor is recommended, such as:
- Olaparib (300 mg twice daily)
- Niraparib (300 mg once daily)
Bevacizumab
Bevacizumab (15 mg/kg every 3 weeks) may be added to the chemotherapy regimen and continued as maintenance therapy in high-risk patients, as supported by studies such as 1.
Neoadjuvant Chemotherapy
In cases where optimal surgical debulking cannot be achieved initially, neoadjuvant chemotherapy may be given first, followed by interval debulking surgery and then additional chemotherapy cycles, as discussed in 1 and 1.
This approach is supported by the most recent and highest quality study 1, which provides the basis for the recommended treatment strategy.
From the FDA Drug Label
The safety and efficacy of paclitaxel followed by cisplatin in patients with advanced ovarian cancer and no prior chemotherapy were evaluated in 2, Phase 3 multicenter, randomized, controlled trials In both studies, patients treated with paclitaxel in combination with cisplatin had significantly higher response rate, longer to progression, and longer survival time compared with standard therapy Carboplatin injection is indicated for the initial treatment of advanced ovarian carcinoma in established combination with other approved chemotherapeutic agents.
The recommended first-line treatment for metastatic ovarian cancer in the abdominal area is paclitaxel in combination with cisplatin or carboplatin in combination with other approved chemotherapeutic agents, such as cyclophosphamide 2 3.
- Paclitaxel and cisplatin have shown significantly higher response rates, longer progression-free survival, and longer overall survival compared to standard therapy.
- Carboplatin and cyclophosphamide is another established combination regimen for the initial treatment of advanced ovarian carcinoma.
From the Research
Treatment Options for Metastatic Ovarian Cancer
- The recommended first-line treatment for metastatic ovarian cancer in the abdominal area is a combination of carboplatin and paclitaxel chemotherapy 4, 5, 6, 7.
- Carboplatin and paclitaxel can be administered every 3 weeks (PC-3W) or weekly (PC-W), with the weekly schedule showing improved survival and reduced toxicity in some studies 4.
- The standard regimen of carboplatin and paclitaxel every 3 weeks (PC-3W) is still widely used, but the weekly schedule (PC-W) may be a viable alternative, especially for elderly or frail patients 4, 7.
- Other treatment options, such as carboplatin and pegylated liposomal doxorubicin, have shown similar efficacy to carboplatin and paclitaxel, but with different toxicity profiles 5.
- The use of bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor, and poly(ADP-ribose) polymerase (PARP) inhibitors, has been shown to improve outcomes in advanced high-grade serous ovarian cancer, and may be incorporated into first-line treatment regimens 8.
Chemotherapy Regimens
- PC-3W: carboplatin and paclitaxel every 3 weeks 4, 5, 6, 7
- PC-W: weekly carboplatin and paclitaxel 4, 7
- Carboplatin and pegylated liposomal doxorubicin: an alternative regimen with similar efficacy to PC-3W, but with different toxicity 5