Part II: chemotherapy for epithelial ovarian cancer-treatment of recurrent disease.

For women with advanced ovarian cancer, rates of response to first-line chemotherapy are high but most patients have relapses and become candidates for further chemotherapy. Chemotherapy for recurrence can palliate symptoms, and there is some evidence that it can also improve survival in this clinical situation. Patients who relapse quickly after first-line therapy should not be given the same drugs as were used initially. However, for patients who have longer intervals from treatment to relapse, the rates of response to a rechallenge with platinum are clinically significant. Several cytotoxic drugs have shown activity in patients whose disease has relapsed after therapy with platinum and a taxane; these drugs include topotecan, etoposide, pegylated liposomal doxorubicin, epirubicin, gemcitabine, altretamine, oxali platin, and vinorelbine. Recurrent ovarian cancer is also an important setting in which to test investigational agents with promising activity, such as new platinum compounds, new taxanes, and other cytotoxic agents, as well as non-cytotoxic compounds with novel mechanisms of action.