Challenges for chemotherapy in ovarian cancer

Background: Ovarian cancer is treated with surgery followed by combination chemotherapy with paclitaxel plus carboplatin. In an effort to improve outcomes, clinical trials are evaluating the following strategies: maintenance therapy; intraperitoneal drug administration; new combinations; novel cytotoxics; combination chemotherapy for recurrent disease; and molecular-targeted therapies. Patients and methods: Clinical trials evaluating the above strategies are being performed in ovarian cancer in patients with: (1) previously untreated advanced ovarian cancer; (2) platinum-sensitive recurrent disease; and (3) platinum-resistant recurrent disease. Results: Combination chemotherapy regimens are superior to single-agent therapy in recurrent ovarian cancer. Molecular-targeted therapy has produced objective responses in previously treated patients. Maintenance therapy of any type has not been shown to prolong survival. Intraperitoneal therapy has resulted in improved survival with considerable toxicity in patients with small-volume stage III disease. Conclusions: Numerous novel clinical strategies are being evaluated in ovarian cancers that have the potential to improve outcomes compared to standard therapy.