Treatment of Platinum Resistant Ovarian Cancer

A relatively large number of antineoplastic agents have demonstrated activity in platinum-resistant ovarian cancer25 (see Box 9-5). To date, there is no evidence for the superiority of any specific single agent over another drug in this setting based on the results of data from phase III randomized controlled trials.

How should therapy in resistant disease be selected if data from phase III trials are not available to guide the choice of treatment? As previously noted, a number of relevant factors can be suggested that may help in the selection of treatment (see Box 9-3). In addition, it is likely that an individual ovarian cancer patient will be treated with several of these drugs during the course of her illness.29 Thus, the question of selection may in reality be one of "when" a particular drug will be delivered rather than "if" it will be administered.

Of critical relevance to the management of the patients in this frequently chronic disease setting is the often delicate balance between improving existing (or delaying the development of) cancer-related symptoms while at the same time not producing toxic effects that may negate potentially beneficial effects of the therapeutic regimen.30 For those who challenge the concept that treatment in this advanced setting has any impact on survival, evidence-based data now exist to refute this perspective (at least for the overall population of patients in this clinical setting).22

No discussion of the treatment of platinum-resistant ovarian cancer would be complete without mention of the potentially important role of radiation therapy in individual patient management. Radiation is particularly useful in patients with relatively isolated pelvic progression in whom pain is the major symptom and in whom it is possible to define radiation portals that will not require exposure of substantial volume of bowel. While it is appropriate to note that this strategy may have a negative impact on the ability to administer myelosuppressive chemotherapy in the future, in the setting of platinum-resistant disease it is unlikely that this factor will be of substantial clinical consequence.

Finally, it is important to acknowledge that at some poorly defined point in the care of almost all patients with platinum-resistant ovarian cancer, the issue of continuation of antineoplastic therapy versus a focus on symptom management or palliative/hospice care becomes a relevant discussion for the oncologist to have with the patient and her family.

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