Frontline Therapy in Advanced Ovarian Cancer

First-line therapeutic options for women with advanced ovarian cancer include optimal surgical cytoreduction and intraperitoneal (IP) chemotherapy, says Angeles Alvarez Secord, MD. IP chemotherapy should be considered for individuals with optimally cytoreduced disease (eg, residual disease that is less than 2 centimeters), states Robert L. Coleman, MD. However, it is difficult to formulate a good scoring algorithm that helps determine who should receive surgical intervention, notes Coleman.

IP chemotherapy can be used in patients with small volume disease, as long as they are good candidates, suggests Thomas Herzog, MD. For those who are not optimal candidates, Herzog recommends carboplatin and paclitaxel every 3 weeks. The addition bevacizumab can be discussed with patients in the frontline setting, although it is often not covered by insurance, notes Herzog.

Each of these frontline strategies varies between each of the panelists, in terms of chemotherapy dosing and administration strategies. Some of the panelists will consider IP chemotherapy for broader groups, while others prefer standard intravenous chemotherapy, points out Bradley J. Monk, MD. Additionally, the dosing schedules vary, between a weekly schedule and every 3 weeks. In general, there is a lack of agreement on an optimal frontline strategy, notes Monk.

Regardless of the strategy utilized, paclitaxel and carboplatin represent the two most important chemotherapeutic agents in this category, states James Tate Thigpen, MD, who prefers to add bevacizumab as part of the regimen. This triplet may be preferable in most cases, given the toxicities associated with IP chemotherapy, adds Thigpen.

To help resolve some of the disagreement regarding frontline treatment, the phase III GOG-252 study is currently assessing existing frontline options more thoroughly. This study is exploring bevacizumab with either IV or IP chemotherapy for patients with advanced ovarian, fallopian tube, and primary peritoneal carcinoma. Results from this investigation are expected within the next 6 months, Thigpen notes.