Pros and cons for systemic therapy in recurrent ovarian cancer

Due to the high recurrence rates of ovarian carcinoma, the treatment of recurrent disease is currently one of the most challenging topics in the clinical setting. Ovarian cancer patients who do not respond to initial chemotherapy or who relapse after achieving a response are generally incurable. Treatment goals after failure of first-line treatment for ovarian cancer include: (a) controlling or preventing disease-related symptoms, (b) maintaining quality of life by choosing an effective treatment with low toxicity potential, and (c) prolonging progression-free survival. In contrast to the adjuvant situation in which prospective randomized phase III trials have established the current standard, only a few randomized trials are available for patients with recurrent disease. In addition, a series of agents has been shown to have clinical activity in recurrent ovarian cancer, including topotecan, pegylated liposomal doxorubicin, gemcitabine and oral etoposide. It has also been demonstrated that re-treatment with a platinum drug and taxane has been associated with a significant clinical activity in patients with "sensitive" (treatment-free interval >6 months) recurrent disease. The role of antihormonal therapy is still unclear. These possible treatments for recurrent ovarian cancer require prospective randomized trials comparing efficacy, toxicity and quality of life.