How do you determine the choice of therapy for platinum resistant ovarian cancer in healthy, good performance status patients?

Platinum-resistant epithelial ovarian cancer is generally defined as relapse less than 6 months following completion of primary or the last platinum-based chemotherapy regimen. Options for therapy include conventional, commercially available drugs or potential clinical trials. If prior genetic testing and genomic profiling has not been performed, these tests are strongly recommended since they may identify common mutations--either germline or somatic--that are actionable. I would always advise patients to explore clinical trial options. These vary from one institution to another, and web sites such as clinical trials.gov may be helpful in navigating opportunities.

For conventional options, response rates generally range between 15-25%. There...

Whenever possible I will consider a clinical trial, but clinical trials are not available for many patients. When a clinical trial is not an option, treating chemotherapy resistant ovarian cancer allows one to practice the ‘art of medicine’. As clinical trials have suggested that no one agent is superior to another, agents can be chosen to best meet the patient’s needs; If the patient is traveling from a distance I will opt for a drug such as liposomal doxorubicin which can be given every 4 weeks. If the patient has significant neuropathy gemcitabine or liposomal doxorubicin can be seen considered. If the patient has had significant difficulty with low blood counts marrow sparing regimens such as bevacizumab with oral Cytoxan can be u...

In a patient with good PS 0-1 who opts for aggressive treatment one could consider the modified (outpatient) Rotterdam protocol of weekly cisplatin and oral etoposide which can yield a median PFS of 6.5 months and OS of 8.5 months. Inpatient version is no more effective.

Morgan, RD et. al "An Outpatient Dose-Intense Intravenous Cisplatin and Oral Etoposide Regimen For Treatment of Advanced Platinum-Resistant Ovarian Cancer". Int J Gynecol Cancer 218 Mar; 28 (3): pp448-52.

Van der Burg, et al. " Weekly Cisplatin and Daily Oral Etoposide is Highly Effective in Platinum Pretreated Ovarian Cancer. " Br J Cancer 2002 Jan 7; 86(1):pp19-25.