{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:06:49Z","timestamp":1791936409572,"version":"4.3.4"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T00:00:00Z","timestamp":1674777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Much drug development and published analysis for epithelial ovarian cancer (EOC) focuses on early-line treatment. Full sequences of treatment from diagnosis to death and the impact of later lines of therapy are rarely studied. We describe the establishment of an international network of cancer centers configured to compare real-world treatment pathways in UK, Portugal, Germany, South Korea, France and Romania (the Ovarian Real-World International Consortium; ORWIC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>3344 patients diagnosed with EOC (2012-2018) were analysed using a common data model and hub and spoke programming approach applied to existing electronic medical records. Consistent definition of line of therapy between sites and an efficient approach to analysis within the limitations of local information governance was achieved.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median age of participants was 53-67 years old and 5-29% were ECOG &amp;gt;1. Between 62% and 84% of patients were diagnosed with late-stage disease (FIGO III-IV). Sites treating younger and fitter patients had higher rates of debulking surgery for those diagnosed at late stage than sites with older, more frail patients. At least 21% of patients treated with systemic anti-cancer therapy (SACT) had recurrent disease following second-line therapy (2L); up to 11 lines of SACT treatment were recorded for some patients. Platinum-based SACT was consistently used across sites at 1L, but choices at 2L varied, with hormone therapies commonly used in the UK and Portugal. The use (and type) of maintenance therapy following 1L also varied. Beyond 2L, there was little consensus between sites on treatment choice: trial compounds and unspecified combinations of other agents were common.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Specific treatment sequences are reported up to 4L and the establishment of this network facilitates future analysis of comparative outcomes per line of treatment with the aim of optimizing available options for patients with recurrent EOC. In particular, this real-world network can be used to assess the growing use of PARP inhibitors. The real-world optimization of advanced line treatment will be especially important for patients not usually eligible for involvement with clinical trials. The resources to enable this analysis to be implemented elsewhere are supplied and the network will seek to grow in coverage of further sites.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2023.1114435","type":"journal-article","created":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T06:52:26Z","timestamp":1674802346000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Ovarian Real-World International Consortium (ORWIC): A multicentre, real-world analysis of epithelial ovarian cancer treatment and outcomes"],"prefix":"10.3389","volume":"13","author":[{"given":"Sue","family":"Cheeseman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany","family":"Levick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Will","family":"Sopwith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayley","family":"Fenton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Ji","family":"Nam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DongKyu","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subin","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elodie","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-S\u00e9bastien","family":"Frenel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Bocquet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Kubelac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patriciu","family":"Achimas-Cadariu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catalin","family":"Vlad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Chevrier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Rouzier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthieu","family":"Carton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Savva-Bordalo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Magalh\u00e3es","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Borges","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Wolf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Becker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Niklas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Guergova-Kuras","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoff","family":"Hall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,1,27]]},"reference":[{"key":"B1","volume-title":"Ovarian cancer statistics","year":"2015"},{"key":"B2","unstructured":"Cancer today2022"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djy071","article-title":"Invasive epithelial ovarian cancer survival by histotype and disease stage","volume":"111","author":"Peres","year":"2019","journal-title":"J Natl Cancer Inst"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2016.10.019","article-title":"The histology of ovarian cancer: worldwide distribution and implications for international survival comparisons (CONCORD-2)","volume":"144","author":"Matz","year":"2017","journal-title":"Gynecol Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1136\/ijgc-2019-000983","article-title":"The world ovarian cancer coalition every woman study: identifying challenges and opportunities to improve survival and quality of life","volume":"31","author":"Reid","year":"2021","journal-title":"Int J Gynecol Cancer"},{"key":"B6","doi-asserted-by":"publisher","first-page":"m3773","DOI":"10.1136\/bmj.m3773","article-title":"Treatment of epithelial ovarian cancer","author":"Kuroki","year":"2020","journal-title":"BMJ"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00086-8","article-title":"Standard chemotherapy with or without bevacizumab for women with newly diagnosed ovarian cancer (ICON7): overall survival results of a phase 3 randomised trial","volume":"16","author":"Oza","year":"2015","journal-title":"Lancet Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1104390","article-title":"Incorporation of bevacizumab in the primary treatment of ovarian cancer","volume":"365","author":"Burger","year":"2011","journal-title":"N Engl J Med"},{"key":"B9","volume-title":"Avastin","year":"2018"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(17)30279-6","article-title":"Bevacizumab and paclitaxel\u2013carboplatin chemotherapy and secondary cytoreduction in recurrent, platinum-sensitive ovarian cancer (NRG Oncology\/Gynecologic oncology group study GOG-0213): a multicentre, open-label, randomised, phase 3 trial","volume":"18","author":"Coleman","year":"2017","journal-title":"Lancet Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.42.0505","article-title":"OCEANS: a randomized, double-blind, placebo-controlled phase III trial of chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent epithelial ovarian, primary peritoneal, or fallopian tube cancer","volume":"30","author":"Aghajanian","year":"2012","journal-title":"J Clin Oncol Off J Am Soc Clin Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2015.08.004","article-title":"Final overall survival and safety analysis of OCEANS, a phase 3 trial of chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent ovarian cancer","volume":"139","author":"Aghajanian","year":"2015","journal-title":"Gynecol Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.51.4489","article-title":"Bevacizumab combined with chemotherapy for platinum-resistant recurrent ovarian cancer: The AURELIA open-label randomized phase III trial","volume":"32","author":"Pujade-Lauraine","year":"2014","journal-title":"J Clin Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2020.06.004","article-title":"The forefront of ovarian cancer therapy: update on PARP inhibitors","volume":"31","author":"Mirza","year":"2020","journal-title":"Ann Oncol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1105535","article-title":"Olaparib maintenance therapy in platinum-sensitive relapsed ovarian cancer","volume":"366","author":"Ledermann","year":"2012","journal-title":"N Engl J Med"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(17)30469-2","article-title":"Olaparib tablets as maintenance therapy in patients with platinum-sensitive, relapsed ovarian cancer and a BRCA1\/2 mutation (SOLO2\/ENGOT-Ov21): a double-blind, randomised, placebo-controlled, phase 3 trial","volume":"18","author":"Pujade-Lauraine","year":"2017","journal-title":"Lancet Oncol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdz104","article-title":"Treatment of patients with recurrent epithelial ovarian cancer for whom platinum is still an option","volume":"30","author":"Buechel","year":"2019","journal-title":"Ann Oncol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1038\/nm.3369","article-title":"Mechanisms of resistance to therapies targeting BRCA-mutant cancers","volume":"19","author":"Lord","year":"2013","journal-title":"Nat Med"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.2217\/fon-2018-0070","article-title":"Avelumab (anti-PD-L1) in platinum-resistant\/refractory ovarian cancer: JAVELIN ovarian 200 phase III study design","volume":"14","author":"Pujade-Lauraine","year":"2018","journal-title":"Future Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-20-0056","article-title":"Combination of PARP inhibitor olaparib, and PD-L1 inhibitor durvalumab, in recurrent ovarian cancer: a proof-of-Concept phase II study","volume":"26","author":"Lampert","year":"2020","journal-title":"Clin Cancer Res"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1186\/s40064-016-2660-0","article-title":"Management of relapsed ovarian cancer: a review","volume":"5","author":"Giornelli","year":"2016","journal-title":"SpringerPlus"},{"key":"B22","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1093\/annonc\/mdz062","article-title":"ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease\u2020","volume":"30","author":"Colombo","year":"2019","journal-title":"Ann Oncol Off J Eur Soc Med Oncol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdw663","article-title":"Fifth ovarian cancer consensus conference of the gynecologic cancer InterGroup: recurrent disease","volume":"28","author":"Wilson","year":"2017","journal-title":"Ann Oncol Off J Eur Soc Med Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2103294","article-title":"Randomized trial of cytoreductive surgery for relapsed ovarian cancer","volume":"385","author":"Harter","year":"2021","journal-title":"N Engl J Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2018.36.15_suppl.5501","article-title":"A phase III randomized controlled trial of secondary surgical cytoreduction (SSC) followed by platinum-based combination chemotherapy (PBC), with or without bevacizumab (B) in platinum-sensitive, recurrent ovarian cancer (PSOC): A NRG Oncology\/Gynecologic oncology group (GOG) study","volume":"36","author":"Coleman","year":"2018","journal-title":"J Clin Oncol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-006-9058-0","article-title":"Surgery in recurrent ovarian cancer: The arbeitsgemeinschaft gynaekologische onkologie (AGO) DESKTOP OVAR trial","volume":"13","author":"Harter","year":"2006","journal-title":"Ann Surg Oncol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1186\/s13048-019-0579-0","article-title":"Maintenance therapy for recurrent epithelial ovarian cancer: current therapies and future perspectives \u2013 a review","volume":"12","author":"Gupta","year":"2019","journal-title":"J Ovarian Res"},{"key":"B28","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1002\/pds.2336","article-title":"Design considerations, architecture, and use of the mini-sentinel distributed data system","author":"Curtis","year":"2012","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"B29","unstructured":"ECOG performance status scale2022"},{"key":"B30","doi-asserted-by":"publisher","first-page":"61\u201385","DOI":"10.1002\/ijgo.13878","article-title":"Cancer of the ovary, fallopian tube, and peritoneum: 2021 update","volume":"155","author":"Berek","year":"2021","journal-title":"Int J Gynecol Obstet"},{"key":"B31","unstructured":"R: The r project for statistical computing"},{"key":"B32","unstructured":"DataBank2022"},{"key":"B33","doi-asserted-by":"publisher","first-page":"292","DOI":"10.7497\/j.issn.2095-3941.2015.0077","article-title":"Chemotherapy of ovarian cancer in elderly patients","volume":"12","author":"Troso-Sandoval","year":"2015","journal-title":"Cancer Biol Med"},{"key":"B34","article-title":"Advanced epithelial ovarian cancer in the elderly: Chemotherapy tolerance and outcome","volume":"27","author":"Efstathiou","year":"2007","journal-title":"Anticancer Res"},{"key":"B35","volume-title":"Lynparza recommended for approval in ovarian cancer","year":"2018"},{"key":"B36","unstructured":"Products|Drugs|Our Works|Minisry of food and drug safety2022"},{"key":"B37","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1097\/GCO.0000000000000423","article-title":"Endocrine therapy in ovarian cancer: where do we stand","volume":"30","author":"Paleari","year":"2018","journal-title":"Curr Opin Obstet Gynecol"},{"key":"B38","article-title":"Clinical benefit of hormonal therapy in advanced ovarian cancer","volume-title":"European Journal of Gynaecological Oncology","author":"Bei","year":"2020"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32552-2","article-title":"Epithelial ovarian cancer","volume":"393","author":"Lheureux","year":"2019","journal-title":"Lancet"},{"key":"B40","volume-title":"Lynparza","year":"2018"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.02745","article-title":"Olaparib versus nonplatinum chemotherapy in patients with platinum-sensitive relapsed ovarian cancer and a germline BRCA1\/2 mutation (SOLO3): A randomized phase III trial","volume":"38","author":"Penson","year":"2020","journal-title":"J Clin Oncol"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2020.08.2102","article-title":"ESMO recommendations on predictive biomarker testing for homologous recombination deficiency and PARP inhibitor benefit in ovarian cancer","volume":"31","author":"Miller","year":"2020","journal-title":"Ann Oncol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2021.08.1206","article-title":"764P survey on the practical implementation of BRCA gene and HRD-testing and PARP-inhibitor management in Germany: A national NOGGO\/JAGO-AGO intergroup study","author":"Baum","year":"2021","journal-title":"Ann Oncol"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30435-2","article-title":"PARP inhibitors and quality of life in ovarian cancer","volume":"19","author":"Aoki","year":"2018","journal-title":"Lancet Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2023.1114435\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T06:52:35Z","timestamp":1674802355000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2023.1114435\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,27]]},"references-count":44,"alternative-id":["10.3389\/fonc.2023.1114435"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2023.1114435","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,27]]},"article-number":"1114435"}}