Unresolved issues in the chemotherapeutic management of gynecologic malignancies

Despite substantial documented progress in the chemotherapeutic management of women with gynecologic malignancies, a number of highly clinically relevant issues remain unresolved. In ovarian cancer, questions asked by practicing oncologists, patients, and their families include the role of maintenance chemotherapy in routine management of the disease, determining which patients with early stage disease do not require cytotoxic therapy, defining the most appropriate management paradigm for both recurrent and resistant cancer, determining which taxane to combine with carboplatin in the first-line regimen, and developing an optimal intraperitoneal primary chemotherapy regimen for small-volume residual advanced disease. In endometrial cancer, important issues include defining first-line chemotherapy for metastatic or recurrent disease and mixed mesodermal endometrial cancer, and determining whether there is a role for adjuvant cytotoxic chemotherapy in the setting of high-risk early stage cancer. Finally, in cervical cancer, there is a critical need to determine the most appropriate treatment strategy for metastatic cancer, as well as to find an effective second-line treatment option for platinum-resistant disease. It is reasonable to anticipate that future clinical trials will answer these and other unresolved issues, just as past well-designed studies have resulted in major improvements in both the survival and quality of life of women with this group of malignancies.