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Debate 7B - Is MEK Inhibitor Therapy the Best Treatment Recommendation for Low-Grade Serous Ovarian Cancer Patients at First Relapse?

No

from Section III - Ovarian Cancer

Published online by Cambridge University Press:  20 July 2023

Dennis S. Chi
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York
Nisha Lakhi
Affiliation:
Richmond University Medical Center, Staten Island
Nicoletta Colombo
Affiliation:
University of Milan-Bicocca
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Summary

The choice of therapy for first relapse of low-grade serous carcinoma – the focus of this debate – is based on several key factors, including type of primary therapy, efficacy and side effects of standard regimens, availability of clinical trials, and patient preferences. Three clinical trials have provided evidence that MEK inhibitors possess promising activity against recurrent disease. However, they are associated with potentially significant side effects. There are several options for treatment of relapse, including chemotherapy, endocrine therapies, bevacizumab, and targeted agents. However, there is no standard for sequencing of these drugs. My preference is for a clinical trial at first relapse. Off protocol, for women who have not previously received an aromatase inhibitor, this is my recommendation for first relapse. For those who have previously received an aromatase inhibitor, based on the findings in the MILO trial and the therapeutic index of MEK inhibitors, pegylated liposomal doxorubicin is my preference at first relapse.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Slomovitz, B, et al. Low-grade serous ovarian cancer: state of the science. Gynecol Oncol 2020;156:715725.CrossRefGoogle ScholarPubMed
Farley, J, et al. Selumetinib in women with recurrent low-grade serous carcinoma of the ovary or peritoneum: an open-label single-arm, phase 2 study. Lancet Oncol 2013;14:134140.CrossRefGoogle ScholarPubMed
Monk, BJ, et al. MILO/ENGOT-ov11: binimetinib versus physician’s choice chemotherapy in recurrent or persistent low-grade serous carcinomas of the ovary, fallopian tube, or primary peritoneum. J Clin Oncol 2020;38(32):37533762.CrossRefGoogle ScholarPubMed
Gershenson, DM, et al. A randomized phase II/III study to assess the efficacy of trametinib in patients with recurrent or progressive low-grade serous ovarian or peritoneal cancer. Ann Oncol 2019;30(Suppl. 5):v851v934.CrossRefGoogle Scholar

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