Future directions in the treatment of ovarian cancer.

Standard chemotherapy for previously untreated patients with advanced ovarian cancer consists of the combination of a taxane and a platinum compound. While the majority of patients respond to therapy, median time to progression is less than 2 years. Patients with recurrent disease frequently respond to second-line treatments, but the impact on survival remains uncertain. Consequently, new treatment approaches are needed. Based on the results of phase II trials that demonstrated activity in previously treated patients with ovarian cancer, new combination regimens are being tested in which drugs such as gemcitabine, topotecan, or encapsulated doxorubicin are added to or sequenced with carboplatin plus paclitaxel. In addition, new platinum and taxane analogs are also under clinical development. Biological approaches to the treatment of patients with ovarian cancer are also in clinical development and include drugs that interfere with angiogenesis, matrix metalloproteinases, and signal transduction pathways. These drugs are currently being tested in previously treated patients with recurrent ovarian cancer. However, ultimately there may be a new paradigm of treatment in which patients receive combination chemotherapy together with a biologic agent for six cycles of treatment and, at that point, the chemotherapy is stopped and patients continue with chronic maintenance biologic therapy. Semin Oncol 29 (suppl 1):32-42. Copyright 2002 by W.B. Saunders Company.