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

Yes

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

Patients with recurrent low-grade serous ovarian cancer (LGSOC) have multiple options for treatment: chemotherapy with/without bevacizumab, bevacizumab, or endocrine therapy. While all of these are viable and appropriate options, MEK inhibitors are a key treatment option that should be considered at time of first recurrence in all patients with LGSOC. Trametinib is now NCCN compendium listed for recurrent LGSOC. While MEK inhibitors have shown clear efficacy in the treatment of recurrent LGSOC, they can cause considerable toxicity, with rash, diarrhea, edema, and ocular toxicity all commonly observed. These toxicities can lead to dose interruptions and dose reductions, causing decreased dose intensity that translates into a missed opportunity for optimal response. MEK inhibitors are therefore best administered early in the disease course, at time of first relapse, when patients generally have the best performance status and are most likely to be able to tolerate continuous therapy without dose reduction.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

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Grisham, RN, et al. BRAF mutation is associated with early stage disease and improved outcome in patients with low-grade serous ovarian cancer. Cancer 2012;119(3):548554.Google 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(2):134140.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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