From the Guidelines
For patients with ovarian cancer who progress after carboplatin and paclitaxel therapy, the next treatment of choice typically depends on the platinum-free interval, with platinum-based combinations or single-agent therapies being considered based on platinum sensitivity and other factors such as BRCA mutation status and prior treatments. When considering the next line of treatment for ovarian cancer that has progressed after carboplatin and paclitaxel, several factors come into play, including the platinum-free interval, the patient's prior response to platinum-based therapy, BRCA mutation status, and overall performance status 1.
Key Considerations
- Platinum-free interval: If the recurrence occurs more than 6 months after completing platinum-based therapy, the disease is considered platinum-sensitive, and retreatment with a platinum-based combination is often recommended.
- Platinum resistance: For disease that recurs within 6 months of completing platinum-based therapy, single-agent therapy with agents like pegylated liposomal doxorubicin, topotecan, gemcitabine, or weekly paclitaxel is generally preferred.
- BRCA mutation status: For patients with BRCA mutations or homologous recombination deficiency, PARP inhibitors like olaparib, niraparib, or rucaparib are valuable options.
- Bevacizumab: This agent may be added to chemotherapy in either platinum-sensitive or platinum-resistant scenarios if not previously used.
Treatment Options
- Platinum-based combinations: Carboplatin with gemcitabine, liposomal doxorubicin, or another agent for platinum-sensitive disease.
- Single-agent therapies: Pegylated liposomal doxorubicin, topotecan, gemcitabine, or weekly paclitaxel for platinum-resistant disease.
- PARP inhibitors: Olaparib, niraparib, or rucaparib for patients with BRCA mutations or homologous recombination deficiency.
- Bevacizumab combinations: With chemotherapy for patients without prior exposure to bevacizumab. The most recent and highest quality evidence supports a personalized approach to treatment selection, taking into account the patient's specific disease characteristics, prior treatments, and overall health status 1.
From the Research
Treatment Options for Ovarian Cancer After Progression on Carboplatin and Paclitaxel
- The next treatment of choice for ovarian cancer after progression on carboplatin and paclitaxel may include pegylated liposomal doxorubicin (PLD) and carboplatin, as this combination has shown superiority in progression-free survival compared to carboplatin and paclitaxel in patients with platinum-sensitive relapsed/recurrent ovarian cancer 2.
- Another option could be topotecan plus carboplatin, although a randomized phase III trial found that this combination did not improve progression-free survival or overall survival compared to standard platinum-based combinations in platinum-sensitive recurrent ovarian cancer 3.
- The combination of carboplatin and PLD has also been evaluated as a first-line treatment for patients with ovarian cancer, and while it was not superior to carboplatin and paclitaxel, it could be considered an alternative due to its different toxicity profile 4.
- In elderly patients (≥70 years), the combination of carboplatin and PLD may be a better option due to its lower toxicity profile, particularly with regards to neuropathy and alopecia, compared to carboplatin and paclitaxel 5.
Key Considerations
- The choice of treatment should be based on the individual patient's characteristics, including their performance status, age, and previous treatment history.
- The toxicity profile of each treatment option should be carefully considered, as some combinations may be more suitable for certain patients due to their side effect profiles.
- Further research is needed to determine the optimal treatment strategy for patients with ovarian cancer who progress after carboplatin and paclitaxel, and to identify biomarkers that can predict response to different treatments 2, 6, 3, 4, 5.