Treatment for Platinum-Sensitive Relapsed Ovarian Cancer After Paclitaxel-Carboplatin

Initial Assessment and Treatment Approach

The European Society for Medical Oncology recommends evaluating critical factors, including BRCA1/2 mutation status, treatment-free platinum interval, residual neurotoxicity, and prior bevacizumab exposure, before selecting treatment for platinum-sensitive relapsed ovarian cancer 1, 2, 3
The optimal next treatment is a platinum-based doublet, such as carboplatin combined with either pegylated liposomal doxorubicin, gemcitabine, or paclitaxel, plus bevacizumab, followed by PARP inhibitor maintenance if the patient achieves a response and has not been previously exposed to PARP inhibitors 1

The American Society of Clinical Oncology suggests that carboplatin-pegylated liposomal doxorubicin plus bevacizumab is the preferred regimen due to its superior safety profile with lower rates of severe and long-lasting toxicity 1, 3, 4, 5, 2
This combination showed non-inferiority in progression-free survival compared to carboplatin-paclitaxel with better tolerability, with a progression-free survival of 11.3 months versus 9.4 months (HR=0.821) 4, 5, 2
Bevacizumab continuation until symptomatic progression or next treatment line is recommended, with an ESMO-MCBS score of 3 1, 3

The National Comprehensive Cancer Network recommends olaparib for BRCA1/2-mutated patients, and niraparib or rucaparib regardless of BRCA1/2 mutation status, as maintenance therapy after response to platinum doublet, with ESMO-MCBS scores of 2 and 3, respectively 1
Continue PARP inhibitor maintenance until disease progression or next treatment line 1, 3

The European Society for Medical Oncology advises against repeating carboplatin-paclitaxel if the patient completed treatment within the past 12 months due to cumulative neurotoxicity from both agents 4, 5, 2, 6, 7
Monitor for hypersensitivity reactions, which increase significantly after multiple exposures to carboplatin, with a risk of 1-46% incidence 8, 9, 10