Biologic therapy in the management of refractory ovarian cancer

The success of platinum-based chemotherapy in the initial management of advanced-stage ovarian cancer has been challenged by the emergence of drug-resistant tumors in the majority of patients. Even taxol, which can achieve clinical responses in one-third of patients with platinum-resistant tumors, may fail to substantially alter long-term survival for many patients with refractory disease. Thus, there continues to be a need for alternative therapeutic strategies. Specific roles for primary or adjunctive biologic therapy in the management of refractory ovarian cancer have not yet been defined. For example, a variety of conjugated monoclonal antibodies have been evaluated for over 10 years, but have not yet been shown to be effective with acceptable levels of host toxicity. The closest candidate for standardized biologic therapy is intraperitoneal interferon for treatment of microscopic residual disease. Adjunctive hematopoietic colony stimulating factors are widely used with taxol to achieve greater dose intensity and cumulative drug delivery, although they have not yet been shown to improve response or survival. Appreciation of the complex pathways regulated by growth factors and cytokines will provide a more challenging framework for continued development of biological therapeutics in the future.