Platinum Sensitive

In patients who experienced a CR to first-line chemotherapy and have had greater than a 6-month platinum-free interval, retreatment with a platinum containing regimen is appropriate. Current National Comprehensive Cancer Network (NCCN) guidelines recommend the combination of carboplatin with either gemcitabine or paclitaxel for the treatment of platinum-sensitive recurrent ovarian cancer with a curative intent.41 However, in patients who are unable to tolerate additional combination chemotherapy regimens, carboplatin alone or any one of the second-line agents would be appropriate48 (see Table 94-2).

Platinum Resistant

Recurrent or persistent ovarian cancer after platinum-based regimens has a discouraging prognosis. Second-line agents have not been successful to date, but any active agent that has not been used during initial treatment is available to use. Singleagent chemotherapy is standardpractice for recurrent platinum-resistant ovarian cancer. Active agents include altretamine (formerly hexamethylmelamine), anastrozole, capecitabine (5-fluorouracil), cyclophosphamide, docetaxel, gemcitabine, liposomal doxorubicin, oral etoposide, vinorelbine, topotecan, or investigational agents. There are numerous ongoing investigational studies evaluating the benefit of addition of biologically targeted agents such as bevacizumab to cytotoxic agent regimens to improve outcomes in the recurrent ovarian cancer setting (see Fig. 94-3). Since the efficacy of the agents is similar, the selection of agent for treatment of recurrent platinum-resistant ovarian cancer is dependent upon residual toxicities, physician preference, and patient convenience. Table 94-3 gives a short summary of the adverse effects and monitoring parameters for chemotherapy agents commonly used for the treatment of recurrent ovarian cancer.

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