The Case for Platinum-Based Chemotherapy for Patients With Platinum-Sensitive Recurrent Ovarian Cancer

At the 2024 Great Debates and Updates in Women’s Oncology meeting in New York, New York, Ying Liu, MD, MPH, Memorial Sloan Kettering Cancer Center, New York, New York, participates in a debate arguing for platinum-based chemotherapy as the optimal treatment for patients with platinum-sensitive recurrent ovarian cancer who have recurred or progressed after PARP inhibitor therapy, but highlights that choices may differ in clinical practice. 

Transcript:

Hi, my name is Ying Liu. I'm a medical oncologist at Memorial Sloan Kettering Cancer Center, where I lead our inherited UIN cancer group. And I'm a practicing oncologist in the gynecological cancer space. I'm so excited to be here at the Great Debates in Women's Oncology in New York City.

The debate that I was a part of was for patients with ovarian cancer in the platinum-sensitive setting, who have recurred or progressed on or after PARP inhibitor therapy. My side was that platinum-based chemotherapy is still the best answer. And you know, platinum-based chemotherapy is such an integral part of ovarian cancer treatment.

We actually define our treatment by its relationship with platinum because it's so effective. We discuss things like the platinum-free interval. We talk about a woman's trajectory in terms of platinum sensitivity, platinum resistance, and because of that, I think it's it still has an important role in the treatment of ovarian cancer, despite PARP inhibitors.

Now I know there are some concerns because of the overlapping mechanisms. Both platinum and PARP inhibitors affect DNA repair, and we know that platinum resistance seems to also mean PARP inhibitor resistance, so I think the concern here is that, well, does PARP inhibitor resistance mean platinum resistance? I think we don't know for sure. The clinical studies are conflicting.

There are certainly some small post-hoc exploratory analyses that are showing potentially in these patients treated with PARP inhibitors, there is a shorter time to second progression, meaning a less robust response to platinum-based chemotherapy than in placebo arms. And this was not seen in non-platinum-based chemotherapy.

But other studies have shown that overall survival is still improved, that our time to second therapy, our PFS2, our other clinical end points are still better in the PARP inhibitor arms versus the placebo arm. And we don't know these data for a lot of the frontline trials.

I think the jury is still out, but certainly more and more of our patients are receiving PARP inhibitors in the frontline. This is definitely an extremely important question. What do we do with these patients when they recur? I think right now, platinum is still a good answer. It's certainly one of the treatments that I offer my patients. 

There are a lot of promising clinical trials and Dr Simkins did a great job of describing that. In full disclosure, I voted for her side even before I gave my presentation because I do believe that we need to learn more about the mechanism here. We need to advance the field, we need novel therapies, but in reality there are very few trials currently open and so in the clinic I do use platinum-based chemotherapy.

Again, we talk about the risks and benefits but I'm definitely keeping my eye on novel therapies, definitely open to clinical trials. I think everyone should be. Thanks so much.

Source: 

Liu Y. Platinum is always best for platinum sensitive recurrent disease. Presented at Great Debates and Updates in Women’s Oncology; May 3-4, 2024; New York, NY.