What are the significant outcomes of treatments for stage 4 (four) ovarian cancer?

From the Guidelines

The standard first-line treatment for stage 4 ovarian cancer should combine cytoreductive surgery with platinum-based chemotherapy, typically paclitaxel (175 mg/m²) plus carboplatin (AUC 5-6) administered every 3 weeks for 6 cycles, as this regimen has been consistently shown to improve progression-free survival and overall survival 1.

Treatment Options

• The combination of paclitaxel and carboplatin is the most widely used and effective first-line treatment for stage 4 ovarian cancer, with a significant improvement in progression-free survival and overall survival compared to other regimens 1.
• For patients who develop an allergy to or do not tolerate paclitaxel, alternative regimens such as docetaxel-carboplatin or pegylated liposomal doxorubicin (PLD)-carboplatin can be considered, based on two randomized clinical trials that showed similar efficacy 1.
• Bevacizumab, an anti-angiogenic agent, has also demonstrated benefit when added to chemotherapy and continued as maintenance, particularly in patients with advanced ovarian cancer and poor prognostic features such as stage IV or suboptimal debulking 1.

Chemotherapy Regimens

• The recommended intravenous regimens include paclitaxel plus carboplatin, docetaxel plus carboplatin, and dose-dense paclitaxel plus carboplatin, all of which have been shown to be effective in the treatment of stage 4 ovarian cancer 1.
• Intraperitoneal chemotherapy, which involves the administration of chemotherapy directly into the peritoneal cavity, has also been shown to be effective in patients with stage III, optimally debulked disease, and may be considered as an alternative to intravenous chemotherapy 1.

Treatment Selection

• Treatment selection should be individualized based on genetic testing results, previous treatment response, and patient-specific factors, such as performance status and comorbidities 1.
• The choice of treatment regimen should also take into account the potential side effects and toxicity of each regimen, as well as the patient's preferences and values.

From the FDA Drug Label

The ORR was higher in patients who received bevacizumab with chemotherapy [45% (95% CI: 39,52)] compared to patients who received chemotherapy alone [34% (95% CI: 28,40)] The HR for OS with bevacizumab with cisplatin and paclitaxel as compared to cisplatin and paclitaxel alone was 0.72 (95% CI: 0.51,1.02) The addition of bevacizumab to chemotherapy demonstrated a statistically significant improvement in investigator-assessed PFS Gemcitabine Injection is a nucleoside metabolic inhibitor indicated: in combination with carboplatin, for the treatment of advanced ovarian cancer that has relapsed at least 6 months after completion of platinum-based therapy

Studies with significant outcomes on stage 4 ovarian cancer treatments include:

• Bevacizumab with chemotherapy showing a higher overall response rate (ORR) and improved progression-free survival (PFS) compared to chemotherapy alone 2
• Bevacizumab with cisplatin and paclitaxel showing a hazard ratio (HR) for overall survival (OS) of 0.72 (95% CI: 0.51,1.02) compared to cisplatin and paclitaxel alone 2
• Gemcitabine in combination with carboplatin for the treatment of advanced ovarian cancer that has relapsed at least 6 months after completion of platinum-based therapy 3

From the Research

Stage 4 Ovarian Cancer Treatments with Significant Outcomes

• The study 4 compared the efficacy and safety of weekly carboplatin and paclitaxel (PC-W) with the standard three-weekly schedule (PC-3W) in first-line treatment of ovarian cancer, and found that PC-W demonstrated improved survival and a better safety profile.
• Another study 5 discussed the current status and future directions of first-line and maintenance therapy for ovarian cancer, highlighting the potential of anti-angiogenic therapy, such as bevacizumab, in improving progression-free survival.
• A review 6 discussed the results of randomized trials investigating alternative first-line treatment strategies for ovarian cancer, including intraperitoneal chemotherapy and alternative doublets and triplet regimens.

Carboplatin and Paclitaxel Combination Chemotherapy

• The carboplatin/paclitaxel doublet remains the chemotherapy backbone for the initial treatment of ovarian cancer, with carboplatin's dose-limiting toxicity being thrombocytopenia 7.
• A phase IV study 8 explored the clinical and biological prognostic factors for advanced ovarian cancer patients receiving first-line treatment with carboplatin, paclitaxel, and bevacizumab, and found that performance status, stage, and residual disease after primary surgery were significant predictors of progression-free and overall survival.

Bevacizumab in Combination with Carboplatin and Paclitaxel

• The study 8 found that the combination of bevacizumab, carboplatin, and paclitaxel in the first-line treatment of advanced ovarian cancer patients resulted in a median progression-free survival of 20.8 months and a median overall survival of 41.1 months.
• The efficacy and safety of bevacizumab in combination with carboplatin and paclitaxel were comparable to previous data, with no unexpected safety signal reported 8.