Advanced ovarian cancer

Abstract

State-of-the-art treatment for advanced ovarian cancer requires a multimodality approach. Aggressive surgical debulking with the goal of optimal cytoreduction is the initial step. After primary cytoreductive surgery, standard treatment for patients with stage III and IV disease is systemic combination chemotherapy consisting of six cycles of paclitaxel and carboplatin. Approximately 70% of patients enter a clinical remission with this approach, yet less than 30% remain disease free. Options following primary therapy include observation or second surgical assessment if no clinical evidence of disease is present. Novel strategies for consolidation are needed. Second-look surgery can be performed safely and effectively laparoscopically, and this is the most accurate means of identifying patients who appear to be clinically free of disease but actually harbor persistent cancer. Although this procedure is an extremely accurate means of identifying these patients, women who have pathologically negative second-look surgery are still at risk for relapse. Patients can receive additional treatment following second-look surgical assessment via the intraperitoneal route if they are pathologically negative or if they have microscopic or small volume disease. Alternatively, additional systemic chemotherapy can be given with non-cross-resistant systemic agents, but no current standard approach for consolidation therapy exists for patients following the completion of primary treatment. Unfortunately, most patients relapse. Multiple agents with similar activity in phase II trials are available to treat patients with advanced recurrent disease. Combination therapy in this setting has not been shown to have significantly superior progression-free or overall survival compared with single agents. The selection of treatment for patients with recurrent disease is currently based on a determination of the treatment-free interval since last treatment, as well as the route, schedule, and expected side effects of the agent.

Targeting cancer cells by using an antireceptor antibody-photosensitizer fusion protein

“…For instance, i.p. chemotherapy versus conventional systemic chemotherapy is currently considered an option for patients with stage III ovarian cancer (32). It is performed during or after so-called ''second-look'' laparoscopic surgery in patients who appear to be clinically free of disease after primary cytoreductive surgery but who actually harbor persistent cancer.…”

Glyceraldehyde-3-Phosphate Dehydrogenase Binds to the AU-Rich 3′ Untranslated Region of Colony-Stimulating Factor–1 (CSF-1) Messenger RNA in Human Ovarian Cancer Cells: Possible Role in CSF-1 Posttranscriptional Regulation and Tumor Phenotype

“…Epithelial ovarian cancers are usually characterized by an advanced stage of tumor invasion into the lymphatic channels and in widespread peritoneal metastases (1)(2)(3). Although progress has been made in the diagnosis of this disease, there has been no significant improvement in the 10-year survival of the patients and the molecular basis for epithelial ovarian cancer (EOC) remains largely unknown.…”

A phase II trial of capecitabine (Xeloda®) in recurrent ovarian cancer

“…In these indications, capecitabine in combination with other cytotoxic agents, including docetaxel, oxaliplatin and irinotecan, has demonstrated high activity and an acceptable safety profile (Kerr et al, 2002;O'Shaughnessy et al, 2002;Sastre et al, 2002). Although combination regimens have yet to demonstrate benefits in efficacy compared with single-agent therapy in randomised trials of patients with relapsed ovarian cancer (Chi and Sabbatini, 2000), this should not automatically preclude trials investigating new combinations that may achieve an acceptable balance of efficacy and tolerability. Indeed, the highest response rates in phase II studies of platinum-resistant disease can be seen using dose-dense combination regimens (Meyer et al, 2001;van der Burg et al, 2002).…”