[Optimal therapeutic strategies in ovarian epithelial cancer in 1997]

"Optimal" chemotherapy for advanced ovarian cancer has constantly evolved over the last 2 decades through the conduct of prospective randomized clinical trials. Because 3 such important trials have recently disclosed provocative results there are reasons to believe in the emergence of new "standard" treatment approaches for this disease towards the end of this century. 1) The Intergroup trial found a survival advantage for intraperitoneal cisplatin as compared to intravenous cisplatin following optimal debulking surgery. 2) In the EORTC-GCCG trial, which recruited patients with bulky disease at completion of primary surgery, survival was prolonged when interval debulking surgery was performed after 3 cycles of chemotherapy. 3) Paclitaxel-cisplatin was associated with a marked survival advantage in comparison with cisplatin-cyclophosphamide in the GOG trial, which enrolled suboptimally debulked patients. These trials clearly have important implications for the future management of ovarian cancer patients and from a health economy point of view: for these reasons, two of them (2 + 3) have been repeated by other groups, and results of these confirmatory trials should be available soon. There are a number of new treatment options for "Platinum-resistant" patients including docetaxel, topotecan, gemcitabine, oxaliplatin: but none of them is "optimal". An active search for new drugs in this setting remains a high priority. Finally, with the expanding knowledge of the molecular biology of cancer in general and ovarian cancer in particular, one can now start thinking of new molecular targets for treatment intervention including transmembrane tyrosine kinase growth factor receptors, matrix metalloproteinases, the vascular endothelial growth factor and so on....