Recurrent ovarian cancer 8 months after induction and bevacizumab consolidation: rationale for using trabectedin + pegylated liposomal doxorubicin in second line

Objectives: Ovarian cancer patients with relapse 6–12 months after last platinum treatment, who have received bevacizumab consolidation and are not BRCA mutant, represent a considerable therapeutic challenge. Methods: By means of illustrative case study, this review evaluates various treatment strategies for use at first relapse in an ovarian cancer patient with limited sensitivity to platinum. Results: Clinical parameters predictive of complete resection in secondary cytoreductive surgery include an Eastern Cooperative Oncology Group performance status of 0, no residual disease after first surgery, and <500 mL of ascites. Options for systemic therapy include platinum-based therapies, non-platinum combinations, and non-platinum single agents. The patient’s circumstances suggested that the non-platinum combination of trabectedin + pegylated liposomal doxorubicin (PLD) would be most appropriate. Trabectedin + PLD may enhance response to the next platinum cycle and thus prolong survival although this hypothesis requires confirmation. At minimum, trabectedin + PLD provides additional time for patients to recover from previous platinum toxicity while receiving an effective treatment. Conclusion: In recurrent ovarian cancer patients with expected suboptimal response to platinum, trabectedin + PLD may offer an active alternative, which differs from the first-line schedule, and may enhance the efficacy of subsequent platinum rechallenge