Low-grade serous ovarian cancer

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Note: this page has regimens which are specific to low-grade serous ovarian cancer (LGSOC). Please see the main ovarian cancer page for other chemotherapy regimens.
7 regimens on this page
9 variants on this page
=Guidelines=
Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.
==NCCN==
*NCCN does not currently have guidelines at this granular level; please see NCCN Guidelines - Ovarian Cancer, Including Fallopian Tube Cancer and Primary Peritoneal Cancer.
=Relapsed or recurrent disease=
==Letrozole monotherapy==
===Regimen===
Study 	Dates of enrollment	Evidence 	Comparator	Comparative Efficacy
Gershenson et al. 2022 (LOGS)	2014-2018 	Phase 3 (C)	Trametinib	Shorter PFSMedian PFS: 7.2 vs 13 mo(HR 2.08, 95% CI 1.56-2.78)
====Endocrine therapy====
*Letrozole (Femara) 2.5 mg PO once per day on days 1 to 28
28-day cycles
===References===
#LOGS: Gershenson DM, Miller A, Brady WE, Paul J, Carty K, Rodgers W, Millan D, Coleman RL, Moore KN, Banerjee S, Connolly K, Secord AA, O'Malley DM, Dorigo O, Gaillard S, Gabra H, Slomovitz B, Hanjani P, Farley J, Churchman M, Ewing A, Hollis RL, Herrington CS, Huang HQ, Wenzel L, Gourley C. Trametinib versus standard of care in patients with recurrent low-grade serous ovarian cancer (GOG 281/LOGS): an international, randomised, open-label, multicentre, phase 2/3 trial. Lancet. 2022 Feb 5;399(10324):541-553. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors EuroPMC NCT02101788
==Paclitaxel monotherapy==
===Regimen===
Study 	Dates of enrollment	Evidence 	Comparator 	Comparative Efficacy
Monk et al. 2020 (MILO) 	2013-2016 	Phase 3 (C)	Binimetinib	Did not meet primary endpoint of PFSMedian PFS: 10.6 vs 9.1 mo(HR 0.83, 95% CI 0.54-1.27)
Gershenson et al. 2022 (LOGS)	2014-2018 	Phase 3 (C)	Trametinib 	Shorter PFSMedian PFS: 7.2 vs 13 mo(HR 2.08, 95% CI 1.56-2.78)
====Chemotherapy====
*Paclitaxel (Taxol) 80 mg/m2 IV over 60 minutes once per day on days 1, 8, 15
28-day cycles
===References===
# MILO: Monk BJ, Grisham RN, Banerjee S, Kalbacher E, Mirza MR, Romero I, Vuylsteke P, Coleman RL, Hilpert F, Oza AM, Westermann A, Oehler MK, Pignata S, Aghajanian C, Colombo N, Drill E, Cibula D, Moore KN, Christy-Bittel J, Del Campo JM, Berger R, Marth C, Sehouli J, O'Malley DM, Churruca C, Boyd AP, Kristensen G, Clamp A, Ray-Coquard I, Vergote I. 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 Nov 10;38(32):3753-3762. Epub 2020 Aug 21. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article EuroPMC NCT01849874
#LOGS: Gershenson DM, Miller A, Brady WE, Paul J, Carty K, Rodgers W, Millan D, Coleman RL, Moore KN, Banerjee S, Connolly K, Secord AA, O'Malley DM, Dorigo O, Gaillard S, Gabra H, Slomovitz B, Hanjani P, Farley J, Churchman M, Ewing A, Hollis RL, Herrington CS, Huang HQ, Wenzel L, Gourley C. Trametinib versus standard of care in patients with recurrent low-grade serous ovarian cancer (GOG 281/LOGS): an international, randomised, open-label, multicentre, phase 2/3 trial. Lancet. 2022 Feb 5;399(10324):541-553. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors EuroPMC NCT02101788
==Pegylated liposomal doxorubicin monotherapy==
===Regimen variant #1, 40 mg/m2===
Study 	Dates of enrollment	Evidence 	Comparator 	Comparative Efficacy
Monk et al. 2020 (MILO) 	2013-2016 	Phase 3 (C)	Binimetinib	Did not meet primary endpoint of PFSMedian PFS: 10.6 vs 9.1 mo(HR 0.83, 95% CI 0.54-1.27)
Gershenson et al. 2022 (LOGS)	2014-2018 	Phase 3 (C)	Trametinib 	Shorter PFSMedian PFS: 7.2 vs 13 mo(HR 2.08, 95% CI 1.56-2.78)
Note: this is the lower bound of dosing in LOGS.
====Chemotherapy====
*Pegylated liposomal doxorubicin (Doxil) 40 mg/m2 IV over 60 minutes once on day 1
28-day cycles
===Regimen variant #2, 50 mg/m2===
Study 	Dates of enrollment	Evidence 	Comparator	Comparative Efficacy
Gershenson et al. 2022 (LOGS)	2014-2018 	Phase 3 (C)	Trametinib	Shorter PFSMedian PFS: 7.2 vs 13 mo(HR 2.08, 95% CI 1.56-2.78)
Note: this is the upper bound of dosing in LOGS.
====Chemotherapy====
*Pegylated liposomal doxorubicin (Doxil) 50 mg/m2 IV over 60 minutes once on day 1
28-day cycles
===References===
# MILO: Monk BJ, Grisham RN, Banerjee S, Kalbacher E, Mirza MR, Romero I, Vuylsteke P, Coleman RL, Hilpert F, Oza AM, Westermann A, Oehler MK, Pignata S, Aghajanian C, Colombo N, Drill E, Cibula D, Moore KN, Christy-Bittel J, Del Campo JM, Berger R, Marth C, Sehouli J, O'Malley DM, Churruca C, Boyd AP, Kristensen G, Clamp A, Ray-Coquard I, Vergote I. 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 Nov 10;38(32):3753-3762. Epub 2020 Aug 21. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article EuroPMC NCT01849874
#LOGS: Gershenson DM, Miller A, Brady WE, Paul J, Carty K, Rodgers W, Millan D, Coleman RL, Moore KN, Banerjee S, Connolly K, Secord AA, O'Malley DM, Dorigo O, Gaillard S, Gabra H, Slomovitz B, Hanjani P, Farley J, Churchman M, Ewing A, Hollis RL, Herrington CS, Huang HQ, Wenzel L, Gourley C. Trametinib versus standard of care in patients with recurrent low-grade serous ovarian cancer (GOG 281/LOGS): an international, randomised, open-label, multicentre, phase 2/3 trial. Lancet. 2022 Feb 5;399(10324):541-553. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors EuroPMC NCT02101788
==Selumetinib monotherapy==
===Regimen===
Study 	Dates of enrollment	Evidence
Farley et al. 2013 (GOG-0239)	2007-2009 	Phase 2
====Targeted therapy====
*Selumetinib (Koselugo) 50 mg PO twice per day on days 1 to 28
28-day cycles
===References===
# GOG-0239: Farley J, Brady WE, Vathipadiekal V, Lankes HA, Coleman R, Morgan MA, Mannel R, Yamada SD, Mutch D, Rodgers WH, Birrer M, Gershenson DM. 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 Feb;14(2):134-40. Epub 2012 Dec 21. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors EuroPMC NCT00551070
==Tamoxifen monotherapy==
===Regimen===
Study 	Dates of enrollment	Evidence 	Comparator	Comparative Efficacy
Gershenson et al. 2022 (LOGS)	2014-2018 	Phase 3 (C)	Trametinib	Shorter PFSMedian PFS: 7.2 vs 13 mo(HR 2.08, 95% CI 1.56-2.78)
====Endocrine therapy====
*Tamoxifen (Nolvadex) 20 mg PO twice per day
Continued indefinitely
===References===
#LOGS: Gershenson DM, Miller A, Brady WE, Paul J, Carty K, Rodgers W, Millan D, Coleman RL, Moore KN, Banerjee S, Connolly K, Secord AA, O'Malley DM, Dorigo O, Gaillard S, Gabra H, Slomovitz B, Hanjani P, Farley J, Churchman M, Ewing A, Hollis RL, Herrington CS, Huang HQ, Wenzel L, Gourley C. Trametinib versus standard of care in patients with recurrent low-grade serous ovarian cancer (GOG 281/LOGS): an international, randomised, open-label, multicentre, phase 2/3 trial. Lancet. 2022 Feb 5;399(10324):541-553. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors EuroPMC NCT02101788
==Topotecan monotherapy==
===Regimen variant #1, 5 days per cycle===
Study 	Dates of enrollment	Evidence 	Comparator 	Comparative Efficacy
Monk et al. 2020 (MILO)	2013-2016 	Phase 3 (C)	Binimetinib	Did not meet primary endpoint of PFSMedian PFS: 10.6 vs 9.1 mo(HR 0.83, 95% CI 0.54-1.27)
====Chemotherapy====
*Topotecan (Hycamtin) 1.25 mg/m2 IV over 30 minutes once per day on days 1 to 5
21-day cycles
===Regimen variant #2, 3 weeks out of 4===
Study 	Dates of enrollment	Evidence 	Comparator	Comparative Efficacy
Gershenson et al. 2022 (LOGS)	2014-2018 	Phase 3 (C)	Trametinib	Shorter PFSMedian PFS: 7.2 vs 13 mo(HR 2.08, 95% CI 1.56-2.78)
====Chemotherapy====
*Topotecan (Hycamtin) 4 mg/m2 IV over 30 minutes once per day on days 1, 8, 15
28-day cycles
===References===
# MILO: Monk BJ, Grisham RN, Banerjee S, Kalbacher E, Mirza MR, Romero I, Vuylsteke P, Coleman RL, Hilpert F, Oza AM, Westermann A, Oehler MK, Pignata S, Aghajanian C, Colombo N, Drill E, Cibula D, Moore KN, Christy-Bittel J, Del Campo JM, Berger R, Marth C, Sehouli J, O'Malley DM, Churruca C, Boyd AP, Kristensen G, Clamp A, Ray-Coquard I, Vergote I. 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 Nov 10;38(32):3753-3762. Epub 2020 Aug 21. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article EuroPMC NCT01849874
#LOGS: Gershenson DM, Miller A, Brady WE, Paul J, Carty K, Rodgers W, Millan D, Coleman RL, Moore KN, Banerjee S, Connolly K, Secord AA, O'Malley DM, Dorigo O, Gaillard S, Gabra H, Slomovitz B, Hanjani P, Farley J, Churchman M, Ewing A, Hollis RL, Herrington CS, Huang HQ, Wenzel L, Gourley C. Trametinib versus standard of care in patients with recurrent low-grade serous ovarian cancer (GOG 281/LOGS): an international, randomised, open-label, multicentre, phase 2/3 trial. Lancet. 2022 Feb 5;399(10324):541-553. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors EuroPMC NCT02101788
==Trametinib monotherapy==
===Regimen===
Study 	Dates of enrollment	Evidence 	Comparator 	Comparative Efficacy
Gershenson et al. 2022 (LOGS)	2014-2018 	Phase 3 (E-switch-ooc)	Investigator's choice of:1a. Paclitaxel1b. Topotecan1c. PLD1d. Letrozole1e. Tamoxifen	Longer PFS (primary endpoint)Median PFS: 13 vs 7.2 mo(HR 0.48, 95% CI 0.36-0.64)
====Targeted therapy====
*Trametinib (Mekinist) 2 mg PO once per day
Continued indefinitely
===References===
#LOGS: Gershenson DM, Miller A, Brady WE, Paul J, Carty K, Rodgers W, Millan D, Coleman RL, Moore KN, Banerjee S, Connolly K, Secord AA, O'Malley DM, Dorigo O, Gaillard S, Gabra H, Slomovitz B, Hanjani P, Farley J, Churchman M, Ewing A, Hollis RL, Herrington CS, Huang HQ, Wenzel L, Gourley C. Trametinib versus standard of care in patients with recurrent low-grade serous ovarian cancer (GOG 281/LOGS): an international, randomised, open-label, multicentre, phase 2/3 trial. Lancet. 2022 Feb 5;399(10324):541-553. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors EuroPMC NCT02101788
Category:Low-grade serous ovarian cancer regimens
Category:Histology-specific pages
Category:Gynecologic cancers