Western Regional Blog – BC, YK, AB, NWT and Nunavut
“TAKE-HOME MESSAGE Authors of this review critique the historical definition of “platinum-resistant” ovarian cancer (PROC) as innately flawed, as it was based on now outdated methods to detect recurrence. The review explores the heterogeneity and complexity inherent to disease comprising PROC, suggesting improvements to interpretation of PROC clinical trial data. Discussion of potential refinements of the PROC definition include recommendations to avoid broad labeling of PROC as
“platinum-sensitive” or “platinum-resistant.” Outcomes seen in PROC are poor and response rates to chemotherapy are low across all PROC histological subtypes, yet each histotype may display multiple genotypes and phenotypes, often with distinct genetic and epigenetic alterations. Recommendations for improvement include clinicians more carefully noting the time from last platinum therapy to recurrence in order to better categorize patients in clinical trials and their various histotypes. BRCA status and other relevant genomic information should also be recorded.”
Review · March 04, 2014
“Platinum resistant” ovarian cancer was historically defined as disease recurrence within 6months of completion of first-line platinum-based chemotherapy, although this is now more broadly applied to also include patients progressing within 6months after multiple lines of chemotherapy. However, this definition ignores the heterogeneity and complexity of the spectrum of diseases that comprise
“platinum resistant ovarian cancer” (PROC) and is innately flawed as it was initially derived using methods of detection of recurrence that would now be regarded as outdated. The outcome of patients with PROC is generally poor, with low response rates to further chemotherapy and a median survival of less than 12months, but this is unpredictable and can be quite variable from study to study. This review outlines the complexity of PROC, examines how this impacts on the interpretation of the results of clinical trials, and explores how the definition may be improved. We also briefly describe the mechanisms of platinum resistance, the results of clinical trials to date as well as treatment options for patients with PROC and highlight the need for better methods of assessing clinical benefit in this poor prognostic sub group of patients.