What are the next treatment options for a patient with ovarian cancer who has progressed during adjuvant treatment with carboplatin (Carboplatin), paclitaxel (Paclitaxel), and bevacizumab (Bevacizumab)?

From the Guidelines

For a patient with ovarian cancer who has progressed during adjuvant treatment with carboplatin, paclitaxel, and bevacizumab, the next treatment options should focus on platinum-resistant disease, with a recommended approach being a non-platinum single-agent therapy or a platinum-based doublet with bevacizumab if the patient is considered platinum-sensitive. The patient's treatment history and current disease status should be assessed to determine the best course of action, considering factors such as histotype, BRCA1/2-mut status, number of prior lines of treatment, exposure and response to prior treatment, and the patient's general condition and preferences 1. Given the progression during adjuvant treatment with carboplatin, paclitaxel, and bevacizumab, it is essential to evaluate the patient's potential for surgical cytoreduction if the disease has relapsed more than 6 months after the last platinum administration 1. Some key considerations for the next treatment steps include:

• Non-platinum single-agent therapies such as pegylated liposomal doxorubicin, weekly paclitaxel, gemcitabine, or topotecan may be suitable options 1.
• Platinum-based doublets with bevacizumab could be considered for patients who have previously responded to platinum without early symptomatic relapse 1.
• PARP inhibitors like olaparib, niraparib, or rucaparib may be considered if the patient has a BRCA mutation or homologous recombination deficiency, with specific FDA-approved indications for each agent 1.
• The choice between these agents should be guided by the patient's performance status, comorbidities, toxicity profile, and patient preference, with treatments generally continued until disease progression or unacceptable toxicity. It is crucial to prioritize the patient's quality of life and consider integrating palliative care early in the treatment pathway, especially for patients not candidates to receive platinum 1.

From the Research

Next Treatment Options for Ovarian Cancer

• For patients with ovarian cancer who have progressed during adjuvant treatment with carboplatin, paclitaxel, and bevacizumab, the next treatment options may include:
  • Pegylated liposomal doxorubicin and carboplatin, as shown in a study 2 that demonstrated superiority in progression-free survival and a better therapeutic index compared to standard carboplatin and paclitaxel
  • Bevacizumab in combination with chemotherapy, as explored in a study 3 that found improved median overall survival in patients with platinum-sensitive recurrent ovarian cancer
• The choice of next treatment option may depend on various factors, including:
  • The patient's performance status and overall health
  • The stage and extent of the disease
  • The presence of any residual disease after primary surgery
  • The patient's previous response to treatment and any adverse effects experienced
• Other studies have investigated the use of bevacizumab in combination with paclitaxel and carboplatin in different settings, including:
  • Advanced and recurrent endometrial carcinoma 4
  • Neoadjuvant treatment in cervical cancer 5
  • First-line treatment of advanced ovarian cancer 6
• These studies provide evidence for the efficacy and safety of bevacizumab in combination with chemotherapy in various gynecological cancers, and may inform treatment decisions for patients with ovarian cancer who have progressed during adjuvant treatment.