1. Introduction Ignace Vergote, MD Department of Obstetrics and Gynaecology Gynaecologic Oncology Catholic University of Leuven Leuven, Belgium

2. Parkin et al. CA Cancer J Clin. 2005;55:74-108. Background: Ovarian Cancer Globally, 6th most common cause of cancer in women (GLOBOCAN 2002 estimates: ~ 204,000 new cases; 125,000 deaths) Vast majority (~ 75%) of patients present with advanced disease Recent treatment advances have led to gains in 5-y survival rates Treatment requires multimodality approach

3. Surgery and carboplatin-paclitaxel iv are the cornerstones of first-line therapy 80%-85% respond to first-line therapy Newer regimens including molecular targeted therapy are under investigation Most patients develop disease recurrence within 2 years of diagnosis Long-term remission dependent upon surgical/chemotherapy approach Several agents active in the second-line setting, resulting in improved progression-free and overall survival Ozols R. Semin Oncol. 2006;33(suppl 6):S3-S11; Aletti et al. Mayo Clinic Proc. 2007;82:751-770. Advanced Ovarian Cancer: Therapeutic Approach

4. Recurrent Ovarian Cancer (ROC): Magnitude of the Problem

5. Patterns of Recurrence

6. Secondary Cytoreductive Surgery Retrospective Studies: Residual Tumor

7. Prognostic Factors for Survival After Secondary Debulking Surgery (Hauspy and Covens, Curr Opinion Oncology 2007)

8. Patient/disease factors – heterogeneous disease Prior complete debulking or initial FIGO I/II Ascites > 500ml Performance status ECOG 0 Age Presence/absence of symptoms Platin-based chemotherapy Parenchymal involvement Relapse-free vs treatment-free interval (TFI) Armstrong D. The Oncologist. 2002;7(suppl 5):20-28. – DEKSTOP II IGCS Bangkok Challenges in the Management of Recurrent Ovarian Cancer (I)

9. Patient/disease factors – heterogeneous disease Prior complete debulking or initial FIGO I/II Ascites > 500ml Performance status ECOG 0 Age Presence/absence of symptoms Platin-based chemotherapy Parenchymal involvement Relapse-free vs treatment-free interval (TFI) Armstrong D. The Oncologist. 2002;7(suppl 5):20-28. – IGCS Bangkok Challenges in the Management of Recurrent Ovarian Cancer (I) DESKTOP II

10. E. Pujade-Lauraine et al. Outcome by Treatment-Free Interval (TFI) 393 Pr0-33-66-99-1212-18>18 Response rate (%) Survival (days) 100 80 60 40 20 0 1000 800 600 400 200 0 TFI (mos) 60 Response rate Progression- free survival Overall survival 33 9 90 174 339 217 957

11. Gadducci et al. Anticancer Res. 2001;21:3525-3533. Recurrent Ovarian Cancer: Population Characteristics Initial Response to Platinum Treatment-free Interval Platinum sensitiveYes> 12 mo Platinum-partially sensitiveYes6-12 mo Platinum-resistantYes< 6 mo Platinum-refractoryNoN/A

12. Bookman. The Oncologist. 1999;4:87-94. Common Treatment Approaches to ROC

13. Cure Survival prolongation Achievement of durable objective response Improvement in cancer-related symptoms Maintenance of quality of life (tend to correlate with response rate) Delayed time to (symptomatic) disease progression Markman and Bookman. The Oncologist. 2000;5(suppl 1):26-35. ROC: Therapeutic Goals

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