Frontline Therapy Options for Ovarian Cancer Based on Platinum Sensitivity

Dana Chase, MD, a gynecological oncologist with Arizona Oncology, discusses frontline therapy options for patients with advanced ovarian cancer.

According to Chase, if a patient recurs within 6 months of her last platinum therapy, they are considered platinum resistant. If occurrence is this close to the last platinum-based therapy, they patient can be enrolled in a clinical trial or the standard of care therapy is used, which consists of using a nonplatinum-based chemotherapy with bevacizumab (Avastin).

If patients recur over 6 months since the last platinum therapy, they are considered platinum-sensitive, according to Chase. If this is the case, the patient may receive another platinum doublet. If the patient remains in remission after their last platinum-based therapy, they will receive either bevacizumab maintenance or PARP inhibitor maintenance. 

0:08 | Currently, if a patient recurs within 6 months of her last platinum, they're given this title of platinum resistant. When a patient has recurred close to her last platinum, we usually either go for a clinical trial, there's a lot of clinical trials available for the platinum-resistance setting, or we do standard of care treatment, which is usually a nonplatinum-based chemotherapy with bevacizumab. The choice of that nonplatinum single-agent treatment is dependent upon the patient's toxicities that she accumulated with her last platinum therapy. Sometimes that will determine what nonplatinum agent you decide to give for the platinum resistance setting.

1:01 |If the patient recurred over 6 months from her last platinum, she's considered platinum-sensitive, and that patient may be exposed to another platinum doublet. That platinum doublet could be platinum with a taxane or platinum with another agent, and bevacizumab may be incorporating with that regimen versus doing some other form of maintenance after the platinum is complete.

1:36| Right now, patients in the first line setting who go into remission when done with their platinum treatment, most are going to get either bevacizumab maintenance, or PARP inhibitor maintenance. Unfortunately, we just don't have a way to predict who's going to do well. So even though you give PARP inhibitor maintenance, or you give bevacizumab maintenance, or you just watch and wait, we don't really know how to say who's going to recur or have progression within 6 months versus 6 to 12 versus.