First-line treatment regimens and the role of consolidation therapy in advanced ovarian cancer.

Current first-line management for advanced ovarian cancer consists of cytoreductive surgery followed by chemotherapy, usually with a platinum/taxane combination. Although this approach has been shown to achieve overall response rates of 70-80% in clinical trials, the majority of patients relapse. A number of different approaches have been investigated to improve the efficacy of therapy, including the introduction of newer agents, such as topotecan, into chemotherapy regimens and the use of consolidation therapy. Encouraging results have been obtained in clinical trials of topotecan administered using a variety of different approaches, including replacement regimens, triplet regimens, and sequential doublet regimens. Other treatment modalities have included the use of drug resistance modifiers and intraperitoneal delivery of treatment. A variety of approaches to consolidation therapy have also been investigated, including radiotherapy, cytotoxic therapy, and intraperitoneal therapy. The use of topotecan has also shown promise in this setting, although further data from large, controlled trials are required. In summary, while good response rates are obtained using current first-line treatments, the high relapse rate indicates the need to develop more effective and durable treatment regimens including new agents with, perhaps, an increased emphasis on maintaining remission through the use of consolidation therapy.