Prognosis and Therapy of Ovarian Cancer, Part 3: Follow up care, recurrence and screening, the full round circle.

Abstract

Background: Ovarian cancer (OC) accounts for the most cancer deaths in women worldwide, despite it being the 8th most common one. Almost two thirds or OC cases present in advanced stages (III/IV) and will require maintenance therapy lasting for up to 36 months in some patients. Despite the introduction of innovative treatments, OC recurs in about 80% of cases in advanced stage disease. Management of recurrent OC is based on multiple factors and includes either surgery, in suitable candidates, followed by chemotherapy or systemic treatment alone. Due to its heavy physical, psychological and economic burden, reducing mortality of OC through prevention and early diagnosis is of utmost importance.

Summary: Prolonged maintenance treatment period in advanced OC led to a more complex follow up care, which will start during active treatment and hence include management of therapy side effects. Intensifying follow up through routine measurements of serum CA-125 and the consequent early induction of treatment in asymptomatic relapsed patients failed to improve overall survival compared to symptom oriented follow up. In recurrent OC patients with a long treatment free interval, good performance status, low ascitic fluid volume and completely operable tumor in the first diagnosis were found to benefit form a secondary cytoreductive surgery. Several drug classes were heavily tested in recurrent OC, antibody drug conjugates (ADCs) have been showing some promising results in platinum resistant recurrent OC. Studies investigating Immunotherapy on the other hand have been much less encouraging. Despite achieving a stage shift toward early-stage detection in some trials, large, well-designed studies have so far failed to develop an effective ovarian cancer screening program that reduces mortality.

Key messages: Managing long-term treatment side effects has become an indispensable part of follow up care in OC. Symptom oriented follow up with tumor marker measurement and imaging reserved for symptomatic patients is the standard of care. Allocating the right therapy plan in patients with recurrent OC, to secondary cytoreductive surgery versus systemic treatment will significantly impact progression free (PFS) and OS. To date there is no effective screening program for prevention and early detection of OC.