Recent advances in the treatment of epithelial ovarian cancer

Ovarian cancer leads to more fatalities than any other form of gynaecologic al cancer in North America and Europe. Over the last 30 years survival figu res have improved somewhat due to improvements in diagnosis, surgery and ch emotherapy. Despite these advances, the majority of patients will die from their disease, with the overall 5-year survival being just 30%. The majorit y of patients with this disease will require treatment with cytotoxic chemo therapy. It is now well established that the platinum agents (cisplatin or carboplatin) are the most important drugs to be included in first-line regi mens. More recently, randomised trials have confirmed the benefit of the ad dition of taxanes to platinum-containing regimens and the standard of care has become the combination of carboplatin and paclitaxel. Several unanswere d questions remain regarding the optimal schedule, the optimum duration of treatment, possible benefits to be gained from the addition of other drugs and whether paclitaxel the best taxane. Despite high response rates to firs t line chemotherapy, the majority of patients with advanced ovarian cancer will relapse and will be candidates for further chemotherapy, which can pal liate symptoms and improve survival even in recurrent disease. For a patien t relapsing within six months of first-line treatment, studies have shown t hat there is little point in rechallenge with the same drugs. However, for patients who have a longer treatment-free interval the response rates to re challenge with platinum is significant. A number of drugs have been shown t o have activity in platinum- and taxane-refractory disease and are approved for this and/or other applications. These include topotecan, etoposide, pe gylated liposomal doxorubicin, epirubicin, gemcitabine, altretamine, oxalip latin and vinorelbine. Anti-oestrogens such as tamoxifen have a small but s ignificant response rate. Recurrent ovarian cancer is a good setting to tes t investigational agents and compounds with promising activity including ne w platinums and taxoids, as well as a range of new compounds. Non-cytotoxic approaches that are showing promise include therapies designed to overcome drug resistance, signal transduction inhibitors, immunotherapy and gene th erapy.