Abstract

Current and future options for sequential therapy for first and subsequent relapses in ovarian cancer were discussed in three workshops centered around a number of case studies. The participants included investigator oncologists from the USA, Europe, and Asia. For a platinum-resistant patient, topotecan or pegylated liposomal doxorubicin was considered the treatment of choice at first relapse. Since optimal tolerability with topotecan is achieved in less heavily pretreated patients, it may be best to use it earlier rather than later in the treatment schedule. For subsequent relapse within 6 months, most clinicians would use liposomal-encapsulated doxorubicin if the prior treatment had been topotecan and vice versa. Alternative agents may be considered with the aim of achieving symptom palliation rather than prolongation of survival. For late relapse after optimal debulking and treatment with carboplatin/paclitaxel, retreatment with carboplatin/paclitaxel (possibly after further surgery) was considered the best approach in platinum-sensitive patients. For first relapse after 10 months in a suboptimally debulked patient, retreatment with carboplatin/paclitaxel was also considered a viable option. Alternatively, single-agent therapy with paclitaxel, pegylated liposomal doxorubicin, or topotecan may be appropriate to prolong the platinum-free interval. For second relapse, oral etoposide was felt to be useful. Treatment for subsequent relapses included gemcitabine, docetaxel, and agents above not previously utilized. Topotecan tolerability and convenience may be improved by employing a lower dose, shorter schedule, 21-day continuous infusion or weekly dosing in relapsed/refractory disease. The progression-free interval may be extended by continuing topotecan until disease progression in patients with stable disease or by topotecan consolidation therapy in treatment responders.