OBJECTIVES: Globally, ovarian cancer (OC) patients, especially epithelial OC patients are prone to relapse and recurrence, sometimes, due to chemoresistance-induced treatment failure. The objectives of this study are to describe the relapse and recurrence rates, and to identify the factors leading to chemoresistance in patients with OC in United States.

METHODS: A targeted literature review was conducted, involving a thorough search in PubMed, Cochrane and Embase databases. The English language studies published between January 2015-December 2019 were identified for the target population. Outcomes considered were relapse (end of Platinum Free Interval-PFI), recurrence, treatment failure, and chemoresistance.

RESULTS: Twenty-one publications were in sync with the objectives. The median age of patients ranged from 47.5-66 years across studies, and most patients were in the advanced stage of OC (Stage-III: 50-84%; Stage-IV: 4-16%). The median for follow-up and time to recurrence ranged from 25-49.6 months and 10-13.5 months respectively while 22.2-80% patients had recurrence. Patients receiving chemotherapy and hormonal therapy had 22.2% recurrence while those treated with primary debulking surgery and platinum combination chemotherapy had recurrence rates above 50%. The hazard ratio for platinum combination chemotherapy versus non-platinum-based chemotherapy for PFI was 0.54-0.75 and time to treatment failure ranged from 4.1-14.8 months, decreasing as the patients moved from first to fourth line chemotherapy. The median progression free survival and overall survival varied between 15-17.8 months and 14.4 (chemotherapy only)-68 (surgery and chemotherapy) months, respectively.

The different yet major drivers of chemoresistance were adipocytes secreting arachidonic acid, overexpression of pancreatic adenocarcinoma upregulated factor, proinflammatory M1 macrophage activated NFκΒ, and intra-tumor and molecular heterogeneity.

CONCLUSIONS: The literature underscores that chemoresistance plays a role in the high relapse and recurrence rates that follow surgery and chemotherapy. Further research is necessary to treat chemoresistance and thus decrease relapses and recurrences in OC.