Epithelial ovarian cancer: Evolution of management in the era of precision medicine

Abstract

Ovarian cancer is the second most common cause of gynecologic cancer death in women around the world. The outcomes are complicated, because the disease is often diagnosed late and composed of several subtypes with distinct biological and molecular properties (even within the same histological subtype), and there is inconsistency in availability of and access to treatment. Upfront treatment largely relies on debulking surgery to no residual disease and platinum‐based chemotherapy, with the addition of antiangiogenic agents in patients who have suboptimally debulked and stage IV disease. Major improvement in maintenance therapy has been seen by incorporating inhibitors against poly (ADP‐ribose) polymerase (PARP) molecules involved in the DNA damage‐repair process, which have been approved in a recurrent setting and recently in a first‐line setting among women with BRCA1/BRCA2 mutations. In recognizing the challenges facing the treatment of ovarian cancer, current investigations are enlaced with deep molecular and cellular profiling. To improve survival in this aggressive disease, access to appropriate evidence‐based care is requisite. In concert, realizing individualized precision medicine will require prioritizing clinical trials of innovative treatments and refining predictive biomarkers that will enable selection of patients who would benefit from chemotherapy, targeted agents, or immunotherapy. Together, a coordinated and structured approach will accelerate significant clinical and academic advancements in ovarian cancer and meaningfully change the paradigm of care.

Ovarian Cancer, Cancer Stem Cells and Current Treatment Strategies: A Potential Role of Magmas in the Current Treatment Methods

“…In the last 30 years, a five-year survival rate of all cancers has improved by 20% [124]. However, the 5 year survival rates for OC patients has changed very little for that period even in socially, economically and technologically advanced countries like United States and Canada, and remains at~40% compared to 85% for breast cancer patients [125]. Worldwide 239,000 new cases of OC are diagnosed each year and 152,000 deaths occur making OC the seventh common cancer and the eighth common cause of cancer-related death in women [124,125].…”

“…However, the 5 year survival rates for OC patients has changed very little for that period even in socially, economically and technologically advanced countries like United States and Canada, and remains at~40% compared to 85% for breast cancer patients [125]. Worldwide 239,000 new cases of OC are diagnosed each year and 152,000 deaths occur making OC the seventh common cancer and the eighth common cause of cancer-related death in women [124,125]. Although 90% of early-stage disease has a survival rate of >10 years, the majority of women diagnosed with stage III/IV disease die of the recurrent disease within 5 years [126].…”

“…Sequential clinical trials have indicated that the best survival outcome for OC patients can be achieved if there is no residual disease (R0) after surgical resection of the tumour [132]. Post-surgery standard practice takes into account histology, stage, genomic profile and the extent of residual disease [125]. Most OC patients respond favorably to the initial choice of platinum and/or taxane therapy but recurrence will occur within few months [133].…”

Tanshinone I attenuates the malignant biological properties of ovarian cancer by inducing apoptosis and autophagy via the inactivation of PI3K/AKT/mTOR pathway

“…Because ovarian cancer is often diagnosed late and composed of several subtypes with distinct biological and molecular properties, and there is inconsistency in availability of and access to treatment. Upfront treatment largely relies on debulking surgery and platinum‐based chemotherapy, with the addition of anti‐angiogenic agents in patients . Despite much progress for the treatment of ovarian cancer in recent years, an important problem in tumour therapy with compounds is the development of drug resistance and side effects .…”

“…Upfront treatment largely relies on debulking surgery and platinum-based chemotherapy, with the addition of anti-angiogenic agents in patients. 4 Despite much progress for the treatment of ovarian cancer in recent years, an important problem in tumour therapy with compounds is the development of drug resistance and side effects. 5,6 Most established compounds suffer from insufficient specificity towards tumour cells.…”