Primary chemotherapy of epithelial ovarian carcinoma

This review provides a perspective on primary chemotherapeutic approaches in epithelial ovarian cancer. Chemotherapy is not recommended in grade 1 or 2 stage I-a or b. In other early-stage cases, postoperative melphalan or intraperitoneal radioactive phosphorus remain standard of care, even though these treatments have not been shown in a randomized fashion to be superior to no further treatment. The role of platinum-based chemotherapy in the same subgroup is currently under study. Despite the introduction of cisplatin, leading to significantly improved response rates, responses have usually been brief in stage III and IV cases with only a modest impact on overall survival and little improvement in long-term survival. Systemic intensification with cisplatin has been difficult secondary to more toxicity and with no consistent improvement in survival. Intraperitoneal chemotherapy is being evaluated as a component of initial management. Recently a new drug, Taxol, has been introduced; although it has not been a cure-all, Taxol will presumably become part of the primary chemotherapy of ovarian cancer in the 1990s. Issues of optimal dosing and combinations with Taxol are being addressed. The combination of Taxol and cisplatin appears promising.