Impact of new non-cytotoxics in the treatment of ovarian cancer

Over the last decade, a number of new cytotoxic chemotherapy agents have sh own evidence of antitumor activity in patients with ovarian carcinoma. Thes e agents are currently being evaluated in large multinational randomized tr ials to determine whether their addition either concurrently or sequentiall y to standard paclitaxel and carboplatin regimens will result in improved s urvival. Whether these new combinations will provide additional benefit may be uncertain; however, it is certain that additional toxicity will limit t he continued evaluation of the strategy of adding cytotoxics together. New approaches to improve the systemic therapy of ovarian cancer need to be exp lored. The next decade will see many trials of non-cytotoxics having a wide range of subcellular and extracellular targets. Many of these targets are abnormally expressed in a variety of solid tumors; thus, it is expected tha t many of these agents will be appropriate to evaluate in patients with ova rian carcinoma. Based on promising data from preclinical and early clinical studies as well as the presumed applicability of these targets to ovarian carcinoma, the inhibitors of growth factor receptors such as epidermal grow th factor receptor and inhibitors of angiogenesis are of particular interes t. Despite the interest of the investigators, the rapid evaluation of these target-specific non-cytotoxics is limited by the lack of accurate informat ion on the expression of target in ovarian tumors and the relevance of targ et expression and its modulation to this tumor type. Early clinical trials are being designed to address these concerns; however, the clinical impact of non-cytotoxic agents in epithelial ovarian carcinoma patients must await the completion of randomized evaluations in combination with standard chem otherapeutic regimens.