Do all patients with recurrent ovarian cancer need systemic therapy?. (3rd December 2019) - Friedlander, Michael L.
Abstract : The scientific organizing committee of the 12th International Symposium on Advanced Ovarian Cancer: Optimal Therapy. Update proposed the question regarding whether all patients with recurrent ovarian cancer (ROC) need systemic therapy. This article has addressed this question and focused on the clinical scenarios in which the benefits of systemic therapy in patients with ROC are limited, including the frail elderly and patients with multiple medical comorbidities, as well as a subset of patients with platinum‐resistant ovarian cancer who have a particularly poor prognosis with a short survival. The challenges of identifying and selecting which patients are unlikely to benefit from systemic therapy were addressed. The benefit of systemic therapy also can be questioned in specific histological subtypes of ROC such as low‐grade serous cancers as well as clear cell and mucinous cancers in view of low response rates. Finally, the contentious question regarding the timing of chemotherapy in asymptomatic patients with CA 125 disease progression after response to first‐line chemotherapy was addressed and an argument made challenging the current treatment paradigm. Clearly, not all patients with ROC need or should be offered systemic therapy, and ultimately the recommendations need to be based on evidence and communicated in a clear and sensitive manner to patients and their families. Abstract : There is complex interplay between patient‐associated and tumor‐associated factors that impacts the likelihood of a response to systemic therapies and prognosis in patients with advanced ovarian cancer. These factors should be considered to help avoid futile treatment, particularly in the final weeks of life.