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

Parkin et al. CA Cancer J Clin. 2005;55: 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

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. 2006;33(suppl 6):S3-S11; Aletti et al. Mayo Clinic Proc. 2007;82: Advanced Ovarian Cancer: Therapeutic Approach

Recurrent Ovarian Cancer (ROC): Magnitude of the Problem

Patterns of Recurrence

Secondary Cytoreductive Surgery Retrospective Studies: Residual Tumor

Prognostic Factors for Survival After Secondary Debulking Surgery (Hauspy and Covens, Curr Opinion Oncology 2007)

Patient/disease factors – heterogeneous disease Prior complete debulking or initial FIGO I/II Ascites > 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. 2002;7(suppl 5): – DEKSTOP II IGCS Bangkok Challenges in the Management of Recurrent Ovarian Cancer (I)

Patient/disease factors – heterogeneous disease Prior complete debulking or initial FIGO I/II Ascites > 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. 2002;7(suppl 5): – IGCS Bangkok Challenges in the Management of Recurrent Ovarian Cancer (I) DESKTOP II

E. Pujade-Lauraine et al. Outcome by Treatment-Free Interval (TFI) 393 Pr >18 Response rate (%) Survival (days) TFI (mos) 60 Response rate Progression- free survival Overall survival

Gadducci et al. Anticancer Res. 2001;21: Recurrent Ovarian Cancer: Population Characteristics Initial Response to Platinum Treatment-free Interval Platinum sensitiveYes> 12 mo Platinum-partially sensitiveYes6-12 mo Platinum-resistantYes< 6 mo Platinum-refractoryNoN/A

Bookman. The Oncologist. 1999;4: Common Treatment Approaches to ROC

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. 2000;5(suppl 1): ROC: Therapeutic Goals

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