[First line chemotherapy for advanced ovarian cancer in 2000: standards and questions]

Ovarian cancer is wellknown to be chemosensitive since more than thirty years. However, long term results of this disease remain low. That's why standard first line chemotherapy is evolving to attempt to increase disease free survival and overall survival. Before cisplatin, standard chemotherapy was an alkylant used alone, mainly melphalan. With cisplatin disponibility, cisplatin based chemotherapy like cisplatin-cyclophosphamide with or without doxorubicin (CP or CAP) is used. Carboplatin can replace cisplatin because theses two platinum compounds have the same tumoral efficacy. Carboplatin is less toxic and its administration is more easy; so carboplatin with cyclophosphamide is actually the standard combination for elderly patients. Paclitaxel-cisplatin or carboplatin became the new actual standard combination. However, questions are asked concerning first-line chemotherapy for advanced ovarian cancer. Some of them are resolved like optimal number of cycles (6 in average), intensity-dose of cisplatin (25 mg/m2/week or 75 mg/m2 every 3 weeks) or for carboplatin (300 mg/m2 every 3 weeks or dose calculation according to AUC of 5 to 7.5 mg/ml x min). Another questions are ongoing like the place of anthracyclins or new drugs in front-line, the use of intra-peritoneal way for cisplatin and the role of intensive chemotherapy or immunotherapy as consolidation.