Management of newly diagnosed or recurrent ovarian cancer

The treatment of newly diagnosed or recurrent ovarian cancer has changed significantly in recent years, with an increased number of treatment options available. Surgery and combination treatment with carboplatin and paclitaxel are the standard of care for patients with newly diagnosed disease, although the use of neoadjuvant chemotherapy is increasing. Clinical strategies have also evolved along with the understanding that ovarian cancer is not one disease but rather comprises several with different histologic and underlying genetic characteristics. The most common histologic type is high-grade serous carcinoma, which is associated with underlying DNA repair deficiencies and copy number alterations. Other, less common histologic types include endometrioid (both low- and high-grade) as well as low-grade serous, mucinous, and clear cell carcinomas. Antivascular agents (specifically bevacizumab) and poly(ADP-ribose) polymerase (PARP) inhibitors have received regulatory approval for many aspects of treatment. PARP inhibitors, which inhibit DNA repair, have shown the greatest activity in those ovarian cancers that harbor deleterious BRCA mutations, and they have also demonstrated activity in the maintenance setting after a response to and completion of platinum-based chemotherapy in patients with sensitive recurrent ovarian cancer regardless of BRCA status. Newer or experimental strategies to improve both up-front and second-line or later treatment include the addition of biologic agents to chemotherapy; the use of newer combination strategies that employ antivascular agents, PARP inhibitors, and immuno-oncology drugs; and the use of new agents such as antibody-drug conjugates.