Update of randomized trials in first-line treatment

Advanced-stage epithelial ovarian cancer remains a highly lethal malignancy, in spite of effective cytoreductive surgery and primary chemotherapy. Randomized phase III trials have provided the most consistent platform for the evaluation of new treatment interventions. Recently completed and ongoing international phase III studies in the primary disease setting, summarized and analyzed in the present review, have evaluated multidrug combinations, weekly scheduling, intraperitoneal delivery, neoadjuvant chemotherapy, maintenance therapy and targeting of angiogenesis. The data from these studies have supported the consideration of intraperitoneal cisplatin, dose-dense weekly scheduling of paclitaxel or neoadjuvant chemotherapy with interval cytoreductive surgery in appropriate patient populations. Contrary to this, the use of three-drug combinations or maintenance chemotherapy is not supported by phase III data. Encouraging data have emerged using antiangiogenic agents, but with questions regarding optimal dose, timing and duration. Ongoing and planned trials will evaluate the inhibition of DNA repair and tailored treatment in accordance with tumor molecular profiles.