Recurrent or Progressive Disease

The Basics

Most patients with advanced disease (diagnosed at stage III or IV) have no disease remaining after completing surgery and chemotherapy that includes platinum (usually carboplatin or cisplatin). Unfortunately, despite initial response to treatment, many will see their disease recur.  Some women will not have their cancer eliminated by the first-line treatment.

Recurrence happens because chemotherapy may not eliminate all of the cancer cells (they are too small to be visible on a scan). Those 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 is important since it predicts the likelihood that re-treatment with platinum will be effective and influences choice of subsequent treatment.

  • platinum-sensitive recurrence occurs more than six months after ending treatment with platinum.   Re-treatment with a combination of platinum and another drug is often beneficial.
  • A platinum-resistant recurrence occurs less than six months after the last platinum treatment.   Non-platinum drugs are prescribed to treat it.
  • Platinum refractory cancer continues to grow while on treatment.  Non-platinum drugs are prescribed to treat it.

In addition to standard chemotherapy, there are new drugs in various stages of clinical development that can sometimes be better options. 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 has progressed on treatment (ie., refractory) or has come back less than 6 months after the last platinum treatment (ie., resistant).  Groups of drugs are used in combination. These drugs are listed in the National Comprehensive Cancer Network (NCCN) guidelines as standard treatment options.