Treatment of refractory and recurrent ovarian cancer

Patients with recurrent ovarian cancer can be divided into two groups: those who have recurrence more than 6 months after primary therapy with paclitaxel/platinum (ie, platinum-sensitive) and those with tumor progression or recurrence within 6 months of primary therapy (ie, platinum-resistant). In patients with platinum-sensitive tumors and good performance status, re-treatment with paclitaxel/platinum combination therapy is usually the most appropriate choice. For patients with minimum residual disease, the greatest promise for long-term disease-free survival is associated with intensive intraperitoneal therapy with combinations of cisplatin and intravenous/intraperitoneal paclitaxel. Alternatively, patients with platinum-sensitive disease can receive intravenous carboplatin or paclitaxel. Patients with platinum-resistant ovarian cancer can benefit from single-agent therapy with altretamine, topotecan, oral etoposide, ifosfamide, liposomal doxorubicin, or other standard or investigational regimens. (Of these drugs, only altretamine and topotecan are approved by the US Food and Drug Administration for persistent or recurrent ovarian cancer.) Since the response rates achieved with these drugs are similar, patient convenience, side effects, and cost may play a significant role in drug selection.