Overcoming platinum resistance in ovarian cancer treatment: from clinical practice to emerging chemical therapies

ABSTRACT

Introduction: The objective of this review is to summarize results from clinical trials that tested cytotoxic drugs and target strategies for the treatment of platinum resistant (PR) recurrent ovarian cancer (ROC) with particular attention to Phase III and ongoing trials.

Areas covered: Since platinum free interval (PFI) represents the most important predictive factor for response to platinum re-treatment in ROC, non-platinum regimens are conventionally considered the most appropriate approaches.

Impressive progress has been made in recent decades, resulting in the identification of most effective cytotoxic agents and in the development of new target strategies.

However, the efficacy of most of these drugs for the treatment of PR disease is still limited.

Expert opinion: The most favorable benefit for the treatment of PR disease, has been described by the AURELIA trial that showed a 3.3 months increase in progression free survival (PFS) when bevacizumab was combined with non-platinum single agent chemotherapy in bevacizumab-naïve patients.

Nevertheless, the use of novel agents is associated to important costs for just little gains in survival.

Thus, in our opinion the economic evaluation, such as the incorporation of quality of life into the clinical studies is crucial for the development of future trials for PR-ROC.

KEYWORDS:

• Ovarian cancer
• platinum resistance
• target therapies
• clinical practice

Article highlights

• Historically, ovarian cancer relapses have been categorized according to platinum-free interval in platinum refractory, platinum resistant, partially platinum-sensitive and platinum sensitive disease. However, this classification has been recently criticized for different reasons. Most of clinical trials have been still designed according to the platinum-free interval.

• Platinum resistant recurrent ovarian cancer has an extremely poor prognosis with few chances of responding to further treatments.

• PLD, topotecan, paclitaxel and GEM have been shown some activity for the treatment of PR-ROC.

• The longest progression free survival benefit has been obtained through the use of one of the most effective antiangiogenic agent, bevacizumab.

• Novel therapeutic strategies, including target and immunologic approaches should be tested for the treatment of platinum resistant disease.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.