Recurrent or Progressive Disease

The Basics

Most patients with advanced disease (diagnosed at stage III or IV) initially respond to platinum-based chemotherapy. If the tumor does not respond, the cancer is considered refractory. Unfortunately, 75 to 80 percent of women who respond to that first treatment will eventually see their disease recur.

Chemotherapy may not eliminate all of the cancer cells (they are too small to be visible on a scan). Any remaining cells are either resistant to the initial treatment or are not growing during treatment. Only growing cells can be killed by chemotherapy. Those cancer cells For Kids With Cancer, Focusing on Quality of Lifecan continue to divide and ultimately form new tumors, which can happen months or years after treatment.

Therapeutic choices after recurrence are complex. Many factors, such as how much time has passed since treatment with platinum and which drugs were given after that, come into play.

Platinum status influences subsequent treatment. 

If recurrence occurs more than six months after ending treatment, it is considered platinum-sensitive and re-treatment with a combination of platinum and another drug is often beneficial. If the recurrence occurs less than six months later, the disease is considered platinum-resistant and non-platinum drugs are prescribed to treat it.

New drugs in various stages of clinical development can sometimes be better options than standard chemotherapies. Some of these have clinical results available.

There are many approved and investigational drugs (agents in clinical trials) from which to choose. This is where understanding the genomic changes in a tumor can make an enormous difference. Some of these mutations can have a direct bearing on which treatments will be the most appropriate for a patient’s unique cancer. Information from a Tumor Blueprint can be helpful in making these decisions.

 

Treatments for Platinum-Sensitive Recurrence

These tables list the drugs most commonly used to treat cancer that has come back more than six months after the last platinum treatment. Groups of drugs are used in combination.  These drugs are listed in the National Comprehensive Cancer Network (NCCN) guidelines as standard treatment options.

Treatments for Platinum-Resistant or Refractory Recurrence

These tables list the drugs most commonly used for treating cancer that has progressed on treatment or has come back less than 6 months after the last platinum treatment.  Groups of drugs are used in combination. These drugs are listed in the National Comprehensive Cancer Network (NCCN) guidelines as standard treatment options.