Latest research and treatment of advanced-stage epithelial ovarian cancer

Abstract

The natural history of ovarian cancer continues to be characterized by late-stage presentation, metastatic bulky disease burden and stagnant mortality statistics despite prolific drug development. Robust clinical investigation, particularly with modifications to primary treatment surgical goals and adjuvant therapy are increasing median progression-free and overall survival, although the cure rates have only modestly been affected. Maintenance therapy holds promise, but studies have yet to identify an agent and/or strategy that can affect survival. Recurrent disease is largely an incurable state; however, current intervention with selected surgery, combination and targeted therapy and investigational protocols are impacting progression-free survival. Ovarian cancer is a diverse and genomically complex disease, which commands global attention. Rational investigation must balance the high rate of discovery with lagging clinical investigation and limited patient resources. Nevertheless, armamentarium growth offers unprecedented opportunities for patients suffering with this disease. This Review presents and reviews the contemporary management of the disease spectrum termed epithelial ‘ovarian’ cancer and introduces the direction and early results of clinical investigation.

Final results of a phase 3 study of trebananib plus weekly paclitaxel in recurrent ovarian cancer (TRINOVA-1): Long-term survival, impact of ascites, and progression-free survival-2

“…The tumor microenvironment and, specifically, tumor angiogenesis, is involved in ovarian cancer development, progression, and metastasis [4]. Angiogenesis is controlled by growth factors, including the vascular endothelial growth factor (VEGF) pathway and angiopoietin-Tie2 receptor axis.…”

<em>In vitro</em> Enrichment of Ovarian Cancer Tumor-initiating Cells

“…Primary treatment usually comprises maximal cytoreductive surgery and subsequent platinum based therapy, although there is some evidence to suggest neoadjuvant therapy might be beneficial in some cases 1 . The majority of patients respond favorably to primary treatment, but unfortunately half will relapse within 18 months 2 .…”

GES en cáncer de ovario epitelial: un avance sanitario necesario pero no exento de riesgos y dificultades futuras

“…Alternativamente, para aquellos casos en que la condición clínica de la paciente no lo permite, está disponible la opción de iniciar tratamiento con quimioterapia neoadyuvante seguido de cirugía de intervalo (3)(4)(5)(6). En ambos escenarios, se trata de un tratamiento de alta complejidad que demanda recursos humanos, económicos y de infraestructura que para países emergentes o en vías de desarrollo no siempre es posible ofrecer o en la práctica conlleva acceso restringido.…”

“…En dicha cirugía el objetivo es alcanzar el menor residuo tumoral posible, es decir la citoreducción óptima, a fin de reducir la carga tumoral con la cual posteriormente deba lidiar la quimioterapia. La definición de citoreducción ha evolucionado en el tiempo hasta alcanzar niveles de residuo menor de 1 cm o residuo microscópico (4,5). Tal límite de lo óptimo, ha demandado por parte de los ginecólogos oncólogos un incremento de sus destrezas quirúrgicas a fin de poder realizar cirugía ultraradical (9).…”

“…Además de usar el esquema basado en carboplatino más paclitaxel, existen variaciones en su forma y vía de administración dependiendo de la condición que la enfermedad y la paciente tienen al momento de decidir su uso (3)(4)(5)(6). En aquellas pacientes que se logra la citoreducción óptima, idealmente a nivel microscópico, la mejor opción es el uso de quimioterapia endovenosa e intraperitoneal (4-6).…”