First line chemotherapy for advanced ovarian cancer in 2000: standards andquestions

Ovarian cancer is wellknown to be chemosensitive since more than thirty yea rs. However, long term results of this disease remain low. That's why stand ard first line chemotherapy is evolving to attempt to increase disease free survival and overall survival. Before cisplatin, standard chemotherapy was an alkylant used alone mainly melphalan. With cisplatin disponibility, cis platin based chemotherapy like cisplatin-cyclophosphamide with or without d oxorubicin (CP or CAP) is used. Carboplatin can replace cisplatin because t heses two platinum compound have the same tumoral efficacy. Carboplatin is less toxic and its administration is more easy; so carboplatin with cycloph osphamide is actually the standard combination for elderly patients. Paclit axel-cisplatin or carboplatin became the new actual standard combination. H owever questions are asked concerning first-line chemotherapy for advanced ovarian cancer. Some of them are resolved like optimal number of cycles (6 in average), intensity-dose of cisplatin (25 mg/m(2)/week or 75 mg/w(2) eve ry 3 weeks) or for carboplatin (300 mg/m(2) every 3 weeks or dose calculati on according to AUC of 5 to 7.5 mg/ml x min). Another questions ave ongoing like the place of anthracyclins or new drugs in front-line, the use of int ra-peritoneal way for cisplatin and the role of intensive chemotherapy or i mmunotherapy as consolidation.