PRO: Therapy for a Patient with Platinum-Resistant/Refractory Recurrent Ovarian Carcinoma Should Be Selected Based on the Result of an In Vitro Chemoresistance Assay

Abstract

General Debate Background Ovarian cancers are the second most frequent group of invasive malignancies of the female genital tract (an estimated 21,650 new cases in 2008); however, the lack of an effective early diagnostic test for ovarian cancer results in ovarian cancers accounting for more deaths than the other 2 major gynecologic cancers combined (an estimated 15,520 deaths in 2008).1 Stage distribution at diagnosis explains the lethality of ovarian cancer because 75%-80% of cases present as stage 111-IV (advanced) disease and require systemic therapy as the mainstay of treatment. Although the success rate with initial systemic therapy has improved, the majority of patients will exhibit recurrent or persistent disease during the course of their disease and will require management beyond initial therapy. There are 4 distinct patient populations with newly diagnosed disease: large-volume residual advanced disease, small-volume residual advanced disease, high-risk limited disease, and low-risk limited disease. The recurrent disease population will come from these 4 groups. Patients with large-volume residual advanced disease (2 1 residual neoplastic masses > 2 centimeters in diameter) have a probability of recurrence at 10 years that ranges from 80% to 90%. Those with small-volume residual advanced disease (no residual masses > 2 centimeters in diameter) exhibit a recurrence rate at 10 years of 60% to 70%. Patients with limited disease at high risk for recurrence (1 of the following high-risk features: grade 2 or 3 disease, disease on the surface of the ovary, disease outside the ovary, positive peritoneal cytology, or the presence of ascites) have a probability of recurrence by 10 years of 20%-25%, whereas those at low risk for recurrence (none of the high-risk features) exhibit a probability of recurrence of only 10% by 10 years. If the relative frequencies of each