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    First-Line management of advanced high-grade serous ovarian cancer

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    Authors
    Mahmood, Reem D
    Morgan, Robert David
    Edmondson, RJ
    Clamp, Andrew R
    Jayson, Gordon C
    Affiliation
    Department of Medical Oncology, Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK.
    Issue Date
    2020
    
    Metadata
    Show full item record
    Abstract
    Purpose of review: Epithelial ovarian cancer is a disease that encompasses a number of histologically and molecularly distinct entities; the most prevalent subtype being high-grade serous (HGS) carcinoma. Standard first-line treatment of advanced HGS carcinoma includes cytoreductive surgery plus intravenous paclitaxel/platinum-based chemotherapy. Despite excellent responses to initial treatment, the majority of patients develop recurrent disease within 3 years. The introduction of the vascular endothelial growth factor (VEGF) inhibitor, bevacizumab, and poly(ADP-ribose) polymerase (PARP) inhibitors into first-line management has changed the outlook for this lethal disease. In this review, we summarise the most recent clinical trials that determine current primary therapy of advanced HGS carcinoma and the ongoing trials that aim to change management in the future. Recent findings: Recent phase III clinical trials have shown that delayed primary surgery after completing neo-adjuvant chemotherapy is non-inferior to immediate primary surgery, but could provide a survival benefit in FIGO (International Federation of Gynecology and Obstetrics) stage IV disease. The use of weekly intravenous chemotherapy regimens has not been proven to be more effective than standard 3-weekly regimens in Western patient populations, and the use of intraperitoneal chemotherapy remains controversial in the first-line setting. In contrast, newer systemic anti-cancer therapies targeting angiogenesis and/or HR-deficient tumours have been successfully incorporated into front-line therapeutic regimens to treat HGS carcinoma. Recent results from randomised trials investigating the use of PARP inhibitors as monotherapy and in combination with the anti-angiogenic agent, bevacizumab, have demonstrated highly impressive efficacy when combined with traditional first-line multi-modality therapy. Management of HGS carcinoma is evolving, but further work is still required to optimise and integrate tumour and plasma biomarkers to exploit the potential of these highly efficacious targeted agents. Keywords: Bevacizumab; Cytoreductive surgery; Intra-peritoneal chemotherapy; Ovarian cancer; PARP inhibitors.
    Citation
    Mahmood RD, Morgan RD, Edmondson RJ, Clamp AR, Jayson GC. First-Line Management of Advanced High-Grade Serous Ovarian Cancer. Curr Oncol Rep. 2020;22(6):64.
    Journal
    Current Oncology Reports
    URI
    http://hdl.handle.net/10541/623068
    DOI
    10.1007/s11912-020-00933-8
    PubMed ID
    32494876
    Additional Links
    https://dx.doi.org/10.1007/s11912-020-00933-8
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1007/s11912-020-00933-8
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