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Current Oncology Reports
Published in: Current Oncology Reports 6/2020

Open Access 01-06-2020 | Ovarian Cancer | Gynecologic Cancers (NS Reed, Section Editor)

First-Line Management of Advanced High-Grade Serous Ovarian Cancer

Authors: Reem D. Mahmood, Robert D. Morgan, Richard J. Edmondson, Andrew R. Clamp, Gordon C. Jayson

Published in: Current Oncology Reports | Issue 6/2020

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Abstract

Purpose of Review

Epithelial ovarian cancer is a disease that encompasses a number of histologically and molecularly distinct entities; the most prevalent subtype being high-grade serous (HGS) carcinoma. Standard first-line treatment of advanced HGS carcinoma includes cytoreductive surgery plus intravenous paclitaxel/platinum-based chemotherapy. Despite excellent responses to initial treatment, the majority of patients develop recurrent disease within 3 years. The introduction of the vascular endothelial growth factor (VEGF) inhibitor, bevacizumab, and poly(ADP-ribose) polymerase (PARP) inhibitors into first-line management has changed the outlook for this lethal disease. In this review, we summarise the most recent clinical trials that determine current primary therapy of advanced HGS carcinoma and the ongoing trials that aim to change management in the future.

Recent Findings

Recent phase III clinical trials have shown that delayed primary surgery after completing neo-adjuvant chemotherapy is non-inferior to immediate primary surgery, but could provide a survival benefit in FIGO (International Federation of Gynecology and Obstetrics) stage IV disease. The use of weekly intravenous chemotherapy regimens has not been proven to be more effective than standard 3-weekly regimens in Western patient populations, and the use of intraperitoneal chemotherapy remains controversial in the first-line setting. In contrast, newer systemic anti-cancer therapies targeting angiogenesis and/or HR-deficient tumours have been successfully incorporated into front-line therapeutic regimens to treat HGS carcinoma. Recent results from randomised trials investigating the use of PARP inhibitors as monotherapy and in combination with the anti-angiogenic agent, bevacizumab, have demonstrated highly impressive efficacy when combined with traditional first-line multi-modality therapy.

Summary

Management of HGS carcinoma is evolving, but further work is still required to optimise and integrate tumour and plasma biomarkers to exploit the potential of these highly efficacious targeted agents.
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Metadata
Title
First-Line Management of Advanced High-Grade Serous Ovarian Cancer
Authors
Reem D. Mahmood
Robert D. Morgan
Richard J. Edmondson
Andrew R. Clamp
Gordon C. Jayson
Publication date
01-06-2020
Publisher
Springer US
Published in
Current Oncology Reports / Issue 6/2020
Print ISSN: 1523-3790
Electronic ISSN: 1534-6269
DOI
https://doi.org/10.1007/s11912-020-00933-8

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