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Introduction

Introduction. Ignace Vergote, MD Department of Obstetrics and Gynaecology Gynaecologic Oncology Catholic University of Leuven Leuven, Belgium. Background: Ovarian Cancer. Globally, 6th most common cause of cancer in women (GLOBOCAN 2002 estimates: ~ 204,000 new cases; 125,000 deaths).

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Introduction

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  1. Introduction Ignace Vergote, MD Department of Obstetrics and Gynaecology Gynaecologic Oncology Catholic University of Leuven Leuven, Belgium

  2. Background: Ovarian Cancer Globally, 6th most common cause of cancer in women (GLOBOCAN 2002 estimates: ~ 204,000 new cases; 125,000 deaths) Vast majority (~ 75%) of patients present with advanced disease Recent treatment advances have led to gains in 5-y survival rates Treatment requires multimodality approach Parkin et al. CA Cancer J Clin. 2005;55:74-108.

  3. Advanced Ovarian Cancer: Therapeutic Approach • Surgery and carboplatin-paclitaxel iv are the cornerstones of first-line therapy • 80%-85% respond to first-line therapy • Newer regimens including molecular targeted therapy are under investigation • Most patients develop disease recurrence within 2 years of diagnosis • Long-term remission dependent upon surgical/chemotherapy approach • Several agents active in the second-linesetting, resulting in improved progression-free and overall survival Ozols R. Semin Oncol. 2006;33(suppl 6):S3-S11; Aletti et al. Mayo Clinic Proc. 2007;82:751-770.

  4. Recurrent Ovarian Cancer (ROC): Magnitude of the Problem

  5. Patterns of Recurrence

  6. Secondary Cytoreductive Surgery Retrospective Studies: Residual Tumor

  7. PrognosticFactors for SurvivalAfterSecondaryDebulkingSurgery(Hauspy and Covens, Curr Opinion Oncology 2007)

  8. Challenges in the Management of Recurrent Ovarian Cancer (I) Patient/disease factors – heterogeneous disease • Prior complete debulking or initial FIGO I/II • Ascites > 500ml • Performance status ECOG 0 • Age • Presence/absence of symptoms • Platin-based chemotherapy • Parenchymal involvement • Relapse-free vs treatment-free interval (TFI) Armstrong D. The Oncologist. 2002;7(suppl 5):20-28. – DEKSTOP II IGCS Bangkok

  9. Challenges in the Management of Recurrent Ovarian Cancer (I) Patient/disease factors – heterogeneous disease • Prior complete debulking or initial FIGO I/II • Ascites > 500ml • Performance status ECOG 0 • Age • Presence/absence of symptoms • Platin-based chemotherapy • Parenchymal involvement • Relapse-free vs treatment-free interval (TFI) DESKTOP II Armstrong D. The Oncologist. 2002;7(suppl 5):20-28. – IGCS Bangkok

  10. Outcome by Treatment-Free Interval (TFI) 1000 800 600 400 200 0 100 80 60 40 20 0 Response rate (%) 957 Overall survival 60 Survival (days) Response rate 393 217 33 339 Progression-free survival 174 9 90 Pr 0-3 3-6 6-9 9-12 12-18 >18 TFI (mos) E. Pujade-Lauraine et al.

  11. Recurrent Ovarian Cancer: Population Characteristics Gadducci et al. Anticancer Res. 2001;21:3525-3533.

  12. Common Treatment Approaches to ROC Bookman. The Oncologist. 1999;4:87-94.

  13. ROC: Therapeutic Goals • Cure • Survival prolongation • Achievement of durable objective response • Improvement in cancer-related symptoms • Maintenance of quality of life (tend to correlate with response rate) • Delayed time to (symptomatic) disease progression Markman and Bookman. The Oncologist. 2000;5(suppl 1):26-35.

  14. REMINDER Please complete the evaluation form and return to the hostesses

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