title: Emerging treatment strategies in recurrent platinum-sensitive ovarian cancer: focus on trabectedin.
abstract: Ovarian cancer (OC) is the leading cause of death from gynecological malignancies. In spite of high response rates to the standard front-line treatment for advanced disease with cytoreductive surgical debulking, followed by platinum/taxane-based chemotherapy, most patients eventually relapse developing drug-resistant disease. Owing to the molecular heterogeneity, genetic instability and mutagenicity of OC, increases in survival might be achieved by translating recent insights at the morpho-molecular levels to individual therapeutic strategies. Several emerging treatments have been shown to be active in platinum-sensitive (PS) recurrent OC (ROC), but an optimal strategy still has not been established. Based on the recent results, it is likely that the introduction of novel non-platinum based chemotherapies and molecular targeted therapies will have a major impact on the management of ROC. Some current strategies are focused on the extension of platinum-free interval (PFI) in patients with PS, particularly in those with partially PS disease. Apparently, the PFI extension by an effective non-platinum intervention, such as trabectedin plus pegylated liposomal doxorubicin (PLD), may reduce cumulative platinum-induced toxicities leading to longer survival after the reintroduction of subsequent platinum. The introduction of novel therapies, such as the antiangiogenic monoclonal antibody bevacizumab, opens a new field of targeted therapies in this indication. In this review, we aim to outline the therapeutic potential of new emerging approaches, particularly the role of non-platinum therapy with trabectedin in combination with PLD in patients with PS ROC.
authors.affiliation: Área Clínica de Oncología Ginecológica, Fundación Instituto Valenciano de Oncología, Prof. Baguena, 19, 46009 Valencia, Spain. Electronic address: apoveda@fivo.org.
authors.forename: Andrés
authors.initials: A
authors.lastname: Poveda
authors.affiliation: Département d'Oncologie Médicale Adulte, Centre Léon Bérard, 28 rue Laennec, 69008 Lyon, France. Electronic address: isabelle.ray-coquard@lyon.unicancer.fr.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ray-Coquard
authors.affiliation: Área Clínica de Oncología Ginecológica, Fundación Instituto Valenciano de Oncología, Prof. Baguena, 19, 46009 Valencia, Spain. Electronic address: nachete54@hotmail.com.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Romero
authors.affiliation: Área Clínica de Oncología Ginecológica, Fundación Instituto Valenciano de Oncología, Prof. Baguena, 19, 46009 Valencia, Spain; Laboratorio de Biología Molecular, Fundación Instituto Valenciano de Oncología, Prof. Baguena, 19, 46009 Valencia, Spain. Electronic address: jalopez@fivo.org.
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Lopez-Guerrero
authors.affiliation: Dipartimento di Medicina e Chirurgia Interdisciplinare, Università Milano-Bicocca and Divisione di Ginecologia Oncologica Medica, Via Ripamonti, 435-20141 Milano, Italy. Electronic address: nicoletta.colombo@ieo.it.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Colombo
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D004149:Dioxoles / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D017671:Platinum Compounds / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D044005:Tetrahydroisoquinolines / Q000627:therapeutic use*; D000077606:Trabectedin
chemical_list: D018906:Antineoplastic Agents, Alkylating; D004149:Dioxoles; D017671:Platinum Compounds; D044005:Tetrahydroisoquinolines; D000077606:Trabectedin
keywords: PLD; Platinum-sensitive; Recurrent ovarian cancer; Trabectedin