Prognosis After 3 or More Lines of Therapy in Ovarian Cancer

Amina Ahmed, MD:The great news about ovarian cancer is patients are living longer with this disease. There are over 200,000 with active ovarian cancer currently in the United States. And so compared with 15 years ago, the life expectancy, the median overall survival is much better. The prognosis is really tied to if somebody becomes platinum resistant. Because we know that response rates to drugs, chemotherapy specifically, are less when somebody becomes platinum resistant. Patients like these can have multiple lines of treatment, and we typically do try to exhaust multiple drugs for patients, obviously, to increase their longevity.

Currently, this patient has had 3-plus lines in her treatment. This is very common. Patients can have many more lines of treatment in their lives. Obviously, to increase their longevity, we would exhaust as many drugs that they could see without morbidity.

When patients become platinum resistant, their response rates are much less than somebody who is platinum sensitive. Platinum resistance is if somebody has recurrent disease less than 6 months after seeing a platinum agent. And so we try to keep patients platinum sensitive potentially as long as they can. I don’t know that we know how to do that, but we think that maintenance treatments can help us keep patients platinum eligible.

Response rates to chemotherapy decrease when somebody becomes platinum resistant, and if patients stop responding to treatments, then obviously their survival is shortened as well.

This is all really tied to whether or not patients are platinum resistant or platinum sensitive and subsequent responses to treatment.

Transcript edited for clarity.

Case: A 56-Year-Old Female With Recurrent Ovarian Cancer

• 56-year-old female diagnosed with stage IV ovarian cancer (2016)
  • Weight: 105-lb, height: 5’6”, BMI of 16.9
  • Pathology: high-grade serous carcinoma, epithelial ovarian cancer
  • CA-125: 475 U/mL
  • CT with contrast of the pelvis, abdomen, and chest revealed a 3.5-cm mass in the right ovary and peritoneal carcinomatosis
  • Patient underwent suboptimal debulking surgery; residual disease 1.5 cm
  • Received IV/IP carboplatin/paclitaxel (6 cycles); achieved complete response
• 1 year later (2017) symptoms returned; CA-125, 265 U/mL; ECOG: 1
  • Received carboplatin/paclitaxel (6 cycles) and bevacizumab; achieved good partial response; CA-125, 45 U/mL; continued on bevacizumab maintenance
• 8 months following second-line therapy (2018), again presented with symptoms; CA-125, 550 U/mL; ECOG: 0
  • Received carboplatin/gemcitabine (6 cycles); CA-125, 54 U/mL; achieved complete response
• Currently:
  • CA-125, 585 U/mL
  • CT shows 2.7 cm right lower lobe lung mass
  • ECOG: 0