Second-line and subsequent therapy for ovarian carcinoma.

Ovarian carcinoma continues to be the leading cause of death among gynecologic malignancies. Paclitaxel and platinum chemotherapy is still the treatment of choice after primary debulking surgery. Salvage chemotherapy with several single agents has only modest activity and does not prolong survival of patients with relapsed ovarian carcinoma. An intense search has been made for novel approaches to treatment of ovarian cancer, and several new treatments, such as immunotherapy and gene therapy, show promise. Newer combination chemotherapy regimens and molecularly targeted therapy need to be developed. High-dose chemotherapy with autologous stem-cell transplantation appears to benefit selected groups of patients and is still investigational. Whole abdominal radiotherapy for relapsed microscopic disease should be studied in prospective randomized trials. Women with advanced ovarian carcinoma should continue to be encouraged to participate in well-designed clinical trials.