Ignace Vergote, MD

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Introduction

• Ignace Vergote, MD
• Department of Obstetrics and Gynaecology
  Gynaecologic Oncology Catholic University of
  Leuven
• Leuven, Belgium

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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. 20055574-108.

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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-line setting,
  resulting in improved progression-free and
  overall survival

• Ozols R. Semin Oncol. 200633(suppl 6)S3-S11
  Aletti et al. Mayo Clinic Proc. 200782751-770.

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Recurrent Ovarian Cancer (ROC) Magnitude of the
Problem
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Patterns of Recurrence
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Secondary Cytoreductive Surgery Retrospective
Studies Residual Tumor
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Prognostic Factors for Survival After Secondary
Debulking Surgery (Hauspy and Covens, Curr
Opinion Oncology 2007)
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Challenges in the Management of Recurrent Ovarian
Cancer (I)

• Patient/disease factors heterogeneous disease
• Prior complete debulking or initial FIGO I/II
• Ascites gt 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. 20027(suppl
  5)20-28.
• DEKSTOP II IGCS Bangkok

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Challenges in the Management of Recurrent Ovarian
Cancer (I)

• Patient/disease factors heterogeneous disease
• Prior complete debulking or initial FIGO I/II
• Ascites gt 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. 20027(suppl
  5)20-28.
• IGCS Bangkok

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Outcome by Treatment-Free Interval (TFI)

• E. Pujade-Lauraine et al.

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Recurrent Ovarian Cancer Population
Characteristics

• Gadducci et al. Anticancer Res.
  2001213525-3533.

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Common Treatment Approaches to ROC

• Bookman. The Oncologist. 1999487-94.

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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. 20005(suppl
  1)26-35.

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