Future options for first-line therapy of advanced ovarian cancer

Abstract

The current standard of treatment for patients with advanced ovarian cancer has been established in light of the results from various clinical trials. After debulking surgery, a combination of carboplatin and paclitaxel is considered to be the best treatment option in terms of survival and quality of life. However, since most patients on this chemotherapy modality will experience relapse, several studies have explored, and continue to do so, various modifications and alternatives to standard therapy in order to attain improved efficacy. Various modifications of dose, schedule, or route of standard regimens have shown no benefit, apart from intraperitoneal therapy, which has produced mixed results and would benefit from a definitive trial. Studies of maintenance/consolidation therapy have been mainly negative, although a small number of trials have produced enough positive data to prompt two new studies powered to detect survival benefits. Various phase II trials have investigated "targeted therapies," but until now no positive results have been recorded. Translational studies are needed to identify patients who will benefit from such specific treatment strategies. The current most evaluated modification of standard therapy is the addition of a third non-cross-resistant drug to carboplatin and paclitaxel. Data for the addition of anthracyclines have either been negative (epirubicin) or not yet analyzed (pegylated liposomal doxorubicin), while evaluable data are shortly expected for the addition of topotecan. Data on the addition of gemcitabine are eagerly awaited from two phase III trials.

Statins induce apoptosis in ovarian cancer cells through activation of JNK and enhancement of Bim expression

“…These drugs as well as paclitaxel, a taxane compound, are classiWed as anti-microtubular agents. Other agents, including hexamethylmelamine, topotecan, and pegylated liposomal doxorubicin, are used as second-line chemotherapy [4,5]. However, patients with recurrent ovarian cancer usually develop resistance to these drugs.…”

Liquid biopsy in ovarian cancer: recent advances on circulating tumor cells and circulating tumor DNA

“…Epithelial ovarian cancer is the main type, characterized by histological and molecular heterogeneity and is considered as a highly aggressive neoplasia. It is often diagnosed at an advanced stage and little progress has been achieved in standard chemotherapy treatment and overall survival (OS) during the last 3 decades [2]. Primary disease is treated with surgical removal of the tumor, followed by standard adjuvant chemotherapy, a combination of platinum and taxane-based treatment [3,4].…”

Neoadjuvant chemotherapy in advanced ovarian cancer: latest results and place in therapy

“…Due to inadequate screening tools and a lack of early clinical symptoms, approximately 70% of women with EOC are diagnosed with advanced stage of disease, which is associated with high morbidity and mortality [Cannistra, 2004;Heintz et al 2006;Jemal et al 2010]. Currently, standard primary therapy for patients with advanced EOC is primary debulking surgery (PDS) aiming to remove all visible tumor tissue, followed by adjuvant chemotherapy (ACT) with paclitaxel and carboplatin Du Bois and Pfisterer, 2005;Pignata et al 2011]. Despite treatment with this strategy, the majority of these patients develop a relapse within the first 5 years after initial diagnosis and only 20-25% of cases are cured.…”