Management of relapsed ovarian cancer in routine clinical practice: a case study

In patients with recurrent ovarian cancer, there are certain situations where further surgery and/or next-line platinum-based chemotherapy is not feasible or is not the best option. Multidisciplinary teams have a key role in reviewing available options and selecting the most appropriate intervention.

A case study of relapsed ovarian cancer illustrates some of the factors that shape decision-making and shows the potential of a non-platinum-based regimen in the context of limited platinum sensitivity.

Taking into account the patient's individual circumstances, many options were discarded by the tumor board. Further surgery was not recommended as initial surgery had been suboptimal. Platinum-based regimens incorporating bevacizumab were not indicated due to exposure to bevacizumab in the first-line setting. Other platinum-based regimens were not recommended in general, due to limited platinum sensitivity (relapse <12 months after previous platinum) and unacceptable toxicity. A decision was taken to treat with trabectedin + pegylated liposomal doxorubicin (PLD), which provided 15 months of disease control. Subsequent platinum rechallenge led to a complete response.

Second-line use of trabectedin + PLD in patients with limited platinum sensitivity may restore sensitivity at next platinum.