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Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 125-126

Treatment pattern of ovarian cancer in Southeast Asia

Department of Medical Oncology, Tata Memorial Hospital; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India

Date of Submission30-Dec-2019
Date of Acceptance30-Dec-2019
Date of Web Publication24-Feb-2020

Correspondence Address:
Priti Agarwal
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra; Homi Bhabha National Institute (HBNI), Mumbai
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CRST.CRST_124_19

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How to cite this article:
Agarwal P. Treatment pattern of ovarian cancer in Southeast Asia. Cancer Res Stat Treat 2020;3:125-6

How to cite this URL:
Agarwal P. Treatment pattern of ovarian cancer in Southeast Asia. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Sep 23];3:125-6. Available from: http://www.crstonline.com/text.asp?2020/3/1/125/279082

I read with great interest the article and the accompanying editorial on the practice of ovarian cancer in SAARC countries.[1],[2] I agree with the comment in the editorial that only 30% of participants answered and that too mainly medical oncologists, and hence, this study remains biased. Furthermore, most of the participants were from India and Nepal, while other countries of SAARC were underrepresented or not represented.

Systemic lymphadenectomy in early-stage ovarian cancer and the removal of enlarged lymph nodes in advanced lymph nodes remains standard.[3] However, it is surprising to see nonadherence to the same in this review, as was very nicely highlighted.

As per the MRC and EORTC trials, both upfront cytoreduction and secondary cytoreduction after giving neoadjuvant chemotherapy give equivalent results in terms of survival; however, perioperative mortality and chances of R0 resection are better with neoadjuvant chemotherapy.[4],[5],[6],[7] Two large studies from India by Maheshwari et al. and by Rajanbabu et al. highlighted the similar fact. Hence, a uniform practice should be adopted based on these studies to have the best outcomes.

There is no comment regarding the dose schedule of chemotherapy regimens practiced. As we have seen in the survey by Sapkota S et al., nearly 10% of participants used a dose-dense schedule.[1] It is worthwhile to note that the standard chemotherapy schedule remains three-weekly paclitaxel and carboplatin as highlighted by GOG 262, MITO7, and ICON8 trials.[8],[9],[10] Moreover, the weekly regimen is not less toxic; rather, it has more adverse events in terms of anemia and neuropathy; although less neutropenia as was seen in the GOG 262 trial.

The use of heated intraperitoneal chemotherapy (HIPEC) in SAARC countries is not highlighted in the present article. Although the article by Van Driel et al. showed benefit in terms of progression-free survival (PFS) and overall survival (OS) with HIPEC which was administered after neoadjuvant chemotherapy in secondary cytoreductive surgery, however, the study by Lin SD et al. did not show benefit of HIPEC which was done in patients who underwent primary cytoreduction.[11],[12],[13] It would be rather interesting to find out what are the HIPEC practices in SAARC nations, its tolerance and its benefit.

Bevacizumab is an antiangiogenic agent that improves PFS when given with chemotherapy as demonstrated by the GOG 218 study; however, there was no OS advantage[14] The use of bevacizumab in developing countries remains challenging mainly due to its cost.

Although as per the NCCN guidelines, BRCA testing should be done in all patients with high grade serous ovarian cancer,[15] it is interesting to see that nearly 40% of participants did BRCA mutation analysis despite the resource-constrained setting of SAARC nations.

Use of poly ADP ribose polymerase inhibitors in both frontline or in the relapsed setting as maintenance is found to have improved PFS mainly in HRD-deficient and BRCA-mutated patients.[16],[17],[18],[19] Hence, the applicability of BRCA/HRD testing[20] without the use of PARP remains questionable in cases when PARP inhibitors remain unaffordable.

Hence overall, the article and editorial nicely summarized the recent trials regarding the management of ovarian cancer. They also highlight the need of having a uniform guideline to be developed for SAARC countries keeping in mind their needs and resources.

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There are no conflicts of interest.

  References Top

Sapkota S, Abhyankar A, Dessai S. Ovarian cancer practice survey from the South Asian Association for Regional Cooperation (SAARC) Nations. Cancer Res Stat Treat 2019;2:158-62.  Back to cited text no. 1
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2. Kaur S, Singh R. Patterns of care for ovarian cancer. Cancer Res Stat Treat 2019;2:217-20.  Back to cited text no. 2
Harter P, Sehouli J, Lorusso D, Reuss A, Vergote I, Marth C, et al. A randomized trial of lymphadenectomy in patients with advanced ovarian neoplasms. N Engl J Med 2019;380:822-32.  Back to cited text no. 3
Vergote I, Tropé CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 2010;363:943-53.  Back to cited text no. 4
Vergote I, Tropé CG, Amant F, Ehlen T, Reed NS, Casado A, et al. Neoadjuvant chemotherapy is the better treatment option in some patients with stage IIIc to IV ovarian cancer. J Clin Oncol 2011;29:4076-8.  Back to cited text no. 5
Kehoe S, Hook J, Nankivell M, Jayson GC, Kitchener H, Lopes T, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): An open-label, randomised, controlled, non-inferiority trial. Lancet 2015;386:249-57.  Back to cited text no. 6
Makar AP, Tropé CG, Tummers P, Denys H, Vandecasteele K. Advanced ovarian cancer: Primary or interval debulking? Five categories of patients in view of the results of randomized trials and tumor biology: Primary debulking surgery and interval debulking surgery for advanced ovarian cancer. Oncologist 2016;21:745-54.  Back to cited text no. 7
Chan JK, Brady MF, Penson RT, Huang H, Birrer MJ, Walker JL, et al. Weekly vs. every-3-week paclitaxel and carboplatin for ovarian cancer [Internet]. New England J Med 2016;374:738-48.  Back to cited text no. 8
Pignata S, Scambia G, Katsaros D, Gallo C, Pujade-Lauraine E, De Placido S, et al. Carboplatin plus paclitaxel once a week versus every 3 weeks in patients with advanced ovarian cancer (MITO-7): A randomised, multicentre, open-label, phase 3 trial. Lancet Oncol 2014;15:396-405.  Back to cited text no. 9
Clamp AR, James EC, McNeish IA, Dean A, Kim J-W, O'Donnell DM, et al. Weekly dose-dense chemotherapy in first-line epithelial ovarian, fallopian tube, or primary peritoneal carcinoma treatment (ICON8): primary progression free survival analysis results from a GCIG phase 3 randomised controlled trial [Internet]. The Lancet 2019; 394:2084-95.  Back to cited text no. 10
van Driel WJ, Koole SN, Sikorska K, van Leeuwen JHS, Schreuder HWR, Hermans RHM, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer [Internet]. New England J Med 2018;378:230-40.  Back to cited text no. 11
Bae JH, Lee JM, Ryu KS, Lee YS, Park YG, Hur SY, et al. Treatment of ovarian cancer with paclitaxel- or carboplatin-based intraperitoneal hyperthermic chemotherapy during secondary surgery. Gynecol Oncol 2007;106:193-200.  Back to cited text no. 12
Lin SD, Soucisse ML, Lansom J, Morris DL. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a patient with peritoneal carcinomatosis from a pancreatic cystadenocarcinoma: A case report. Int J Surg Case Rep 2019;63:48-52.  Back to cited text no. 13
Oza AM, Cook AD, Pfisterer J, Embleton A, Ledermann JA, Pujade-Lauraine E, et al. Standard chemotherapy with or without bevacizumab for women with newly diagnosed ovarian cancer (ICON7): Overall survival results of a phase 3 randomised trial. Lancet Oncol 2015;16:928-36.  Back to cited text no. 14
Daly MB, Pilarski R, Berry M, Buys SS, Farmer M, Friedman S, et al. NCCN guidelines insights: Genetic/Familial high-risk assessment: Breast and ovarian, version 2.2017. J Natl Compr Canc Netw 2017;15:9-20.  Back to cited text no. 15
Moore KN, DiSilvestro P, Lowe ES, Garnett S, Pujade-Lauraine E. SOLO1 and SOLO2: Randomized phase III trials of olaparib in patients (pts) with ovarian cancer and a BRCA1/2 mutation (BRCAm). J Clin Orthod 2014;32:TPS5616.  Back to cited text no. 16
Moore K, Colombo N, Scambia G, Kim BG, Oaknin A, Friedlander M, et al. Maintenance olaparib in patients with newly diagnosed advanced ovarian cancer. N Engl J Med 2018;379:2495-505.  Back to cited text no. 17
Friedlander M, Gebski V, Gibbs E, Davies L, Bloomfield R, Hilpert F, et al. Health-related quality of life and patient-centred outcomes with olaparib maintenance after chemotherapy in patients with platinum-sensitive, relapsed ovarian cancer and a BRCA1/2 mutation (SOLO2/ENGOT ov-21): A placebo-controlled, phase 3 randomised trial. Lancet Oncol 2018;19:1126-34.  Back to cited text no. 18
Pujade-Lauraine E, Ledermann JA, Selle F, Gebski V, Penson RT, Oza AM, et al. Olaparib tablets as maintenance therapy in patients with platinum-sensitive, relapsed ovarian cancer and a BRCA1/2 mutation (SOLO2/ENGOT-ov21): A double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Oncol 2017;18:1274-84.  Back to cited text no. 19
Chheda P, Pande S, Dama T, Vinarkar S, Chanekar M, Limaye S, et al. Spectrum of Germline BRCA1/2 mutations in hereditary breast and ovarian cancer syndrome in Indian population: A central reference laboratory experience. Cancer Res Stat Treat 2019;3:32-41.  Back to cited text no. 20


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