The Doctors of the Therapeutic Clinic of the Faculty of Medicine of the National and Kapodistrian University of Athens (EKPA) summarise all the latest data on the effectiveness of new treatments against ovarian cancer
About 1.1% of women will be diagnosed with ovarian cancer at some point in their lives. Fortunately, mortality has decreased by 2.8% each year in recent years. More specifically, survival has lengthened considerably in recent years since the 5-year survival of just 35% in the previous decade now concerns over 50% of patients.
The doctors of the Therapeutic Clinic (Alexandra Hospital) of the School of Medicine of EKPA Thanos Dimopoulos (former Chancellor of EKPA, Professor of Oncology - Hematology), Dr. Maria Kaparelou (Pathologist - Oncologist) and Angeliki Andrikopoulou summarise the latest data.
The treatment of ovarian cancer in the early stages is surgery with total hysterectomy after appendages, exploration of the whole abdomen, epiplexy, lymphadenectomy and cytological examination of ascitic fluid. In most cases after surgery, adjuvant treatment with a combination of paclitaxel and carboplatin is indicated.
However, if the disease cannot be excluded entirely at the outset, platinum-based induction chemotherapy and second-line surgery are now possible with similar overall survival results as shown by studies (CHORUStrial, EORTC 55971). Therefore, stage III-IV patients who cannot achieve maximal cytoreduction during primary surgery undergo three cycles of induction platinum-based chemotherapy followed by interval debulking.
Now, a modern technique used during surgery is the HIPEC (Hyperthermic Intraperitoneal Chemotherapy) technique to sterilise the abdomen from peritoneal implants not visible to the naked eye. In this technique, a chemotherapeutic drug is administered to the abdomen at high temperatures (42-43 degrees Celsius) for a duration of 30-90 minutes after all macroscopically visible diseases have previously been removed. This technique is performed by properly trained surgeons and in specialised centres.
Based on the guidelines, HIPEC is indicated in patients who have received induction chemotherapy and are undergoing intermediate cytoreduction (IDS), while its role in second surgery at first relapse is also being investigated.
New therapeutic developments are the treatment with inhibitors of PARP proteins that have maximum benefit in patients with BRCA gene mutations and with a deficiency in the DNA damage repair system, homologous recombination (HR).
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It is now known that one in two women with ovarian cancer have homologous recombination deficiency, while one in four women will carry a mutation in the BRCA 1/2 genes, either inherited or acquired.
After completion of first-line platinum-based chemotherapy, maintenance therapy with the PARP inhibitors Niraparib and Olaparib is indicated in patients with advanced ( FIGO stage III and IV) high-grade epithelial ovarian cancer. Based on the PAOLA -1 study, maintenance therapy with Olaparib in combination with antiangiogenic therapy with bevacizumab is approved as maintenance therapy after first-line treatment in patients with HomologousRecombinationDeficiency either as a result of a BRCA1/2 mutation or as a result of genomic instability.
In patients with BRCA1/2 mutation, Olaparib maintenance therapy is approved as monotherapy after completion of first-line platinum-based therapy based on the SOLO-1 study.
Niraparib maintenance therapy is approved in all FIGO stage III/IV patients regardless of homologous recombination deficiency based on the PRIMA study showing benefit in the overall population. Finally, a new development in ovarian cancer is a new drug, mirvetuximab soravtansine, an antibody-drug conjugate (ADC) that targets a receptor on the surface of cancer cells. This drug targets the folic acid receptor α (Folatereceptoralpha, FR α), which is evaluated with a special test approved by the FDA.
Based on Study 0417, mirvetuximab soravtansine received accelerated approval in patients with platinum-resistant relapsed disease and positive expression of the FR α receptor. The response rate in these patients was 31.7%, while the average duration of response was 6.9 months.
These results were also confirmed by the MIRASOL study, which showed a benefit both in terms of disease progression-free time and overall survival in these patients compared to chemotherapy.
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