Chemotherapy for ovarian cancer: current concepts

Ovarian cancer is the most common gynecologic cancer and has the highest case-fatality rate of all gynecologic malignancies: over one-half of all women diagnosed with ovarian cancer die of their disease. Chemotherapy for epithelial ovarian carcinoma has evolved rapidly during the last 15 years. Demonstrations that combination chemotherapy was superior to single-agent therapy began to improve outcome among women with this disease. By 1990, the advent of the platinum compounds had improved response rate, and the new standard of care combined platinum with alkylating agents. Recently, more significant progress has been made with utilization of the taxanes, which demonstrate not only improved response rates, but significantly prolonged survival as well. The most current clinical trials have established that taxane/platinum combination chemotherapy should be the standard of care for epithelial ovarian cancer. Recent and ongoing studies also address such issues as relative efficacy of different doses of taxanes and platinum, length of infusion for the taxanes, and interchangeability of the platinum compounds. This broad overview of the development of current standards of treatment also will address unresolved issues in this field, including intraperitoneal administration of chemotherapy and dose intensification.