Ovarian cancer: a focus on management of recurrent disease

Surgery and chemotherapy form the cornerstone in the treatment of ovarian cancer. The standard of care for primary ovarian cancer is platinum and taxane-based chemotherapy. Despite the favorable response characteristics, however, most women with advanced-stage ovarian cancer will relapse. Herzog and Pothuri discuss the treatment options available and highlight the issues surrounding how these patients should be managed with surgical, chemotherapy, biological targeted agents and radiation therapy. Surgery and chemotherapy form the cornerstone of the treatment for ovarian cancer. Currently, the standard of care for primary ovarian cancer is platinum and taxane-based therapy. Even among women with advanced and suboptimal disease (i.e. tumors greater than 1 cm) following surgery, the clinical efficacy of chemotherapy is noteworthy. Despite the favorable response characteristics, however, most women with advanced-stage ovarian cancer will relapse, including about 50% of women who have no evidence of disease after primary therapy. A multitude of treatment options are available at the time of recurrence, but there is no clear consensus about how these patients should be managed. Options include surgery, chemotherapy, hormones, and sometimes, radiation therapy. The sequence, combinations of treatment, and manner in which any or all of these options should be employed in an individual patient, which heretofore have not been standardized, are the subjects of ongoing clinical investigations. Key Points Unfortunately, most cases of ovarian cancer (approximately 75%) are at an advanced stage at the time of diagnosis. Administration of adjuvant chemotherapy consisting of a platinum and a taxane-based regimen remains the standard front-line treatment for advanced ovarian cancer following a maximal surgical cytoreduction. Unfortunately, tumors will recur in up to 70% of patients with advanced-stage ovarian or primary peritoneal cancer. Treatment of recurrent ovarian cancer is often decided by the interval from previous platinum treatment; those receiving treatment within 6 months and those receiving treatment after 6 months being defined as platinum-resistant and platinum-sensitive, respectively. Secondary cytoreduction might be considered in select patients with isolated masses, and a long disease-free interval of at least 12 months. Future trials are needed to establish the role of molecular-targeted compounds, sequential versus combination chemotherapy, role of assay-d