Treatment of advanced ovarian cancer

Chemotherapy for advanced ovarian cancer has evolved over the past 25 years from the initial use of alkylating agents such as melphalan. Combinations containing cisplatin, cyclophosphamide and doxorubicin were studied in the 1980s and showed improved median progression-free survival. The comparison of platinum-based combinations containing alkylating agents (mainly cyclophosphamide) with triple drug combinations containing anthracyclines and alkylating agents did not convincingly show superiority for the more toxic triple drug combinations. Subsequently, cisplatin plus cyclophosphamide was accepted as a new standard treatment. Carboplatin was introduced as an alternative to cisplatin in the early 1990s resulting in a reduced toxicity but similar efficacy. Taxanes were incorporated into the first-line treatment combinations in the mid-1990s, resulting in superior responses and a prolonged survival especially in patients with bulky disease. Despite this, over 50% of all these patients relapse and ultimately die of their disease. Currently, there is no worldwide accepted standard treatment for patients with platinum-refractory ovarian cancer. Topotecan, etoposide, gemcitabine and liposomal doxorubicin have been studied in this patient group and responses of up to 20% can be expected. However, response duration rarely exceeds 12 months and increased efforts are needed in this area of chemotherapy.