Future directions in the chemotherapy of ovarian cancer

Clinical research in the treatment of epithelial ovarian cancer has entered a new phase. A pivotal Gynecologic Oncology Group study demonstrated that paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) plus cisplatin was superior to the previous standard therapy of cyclophosphamide plus cisplatin. Confirmatory trials in Europe have either been completed or are nearing an interim analysis. However, many questions still remain regarding what constitutes optimum chemotherapy in ovarian cancer. Clinical trials are addressing issues regarding the optimum use of paclitaxel, including dose, schedule, and duration of therapy. Several clinical trials throughout the world are comparing cisplatin plus paclitaxel versus a combination of carboplatin plus paclitaxel. In addition, the role of high-dose chemotherapy in ovarian cancer is being studied in important clinical trials in previously untreated patients or in patients who have had a response to initial therapy. These trials of high-dose chemotherapy with hematologic support will define the role, if any, of dose intensity either as part of initial therapy or as part of consolidation. A recent study has also demonstrated that chemotherapy with intraperitoneal cisplatin was superior to intravenous cisplatin in patients with optimal stage III ovarian cancer. However, additional confirmatory trials are needed to define the role of intraperitoneal therapy when combined with paclitaxel. A series of new agents have been identified with substantial activity in recurrent ovarian cancer, including topotecan, oral etoposide, gemcitabine, vinorelbine, and encapsulated doxorubicin. Future clinical trials will be addressing the incorporation of these agents into the up-front treatment of patients with advanced ovarian cancer.