Update on Gynecologic Oncology Group (GOG) trials in ovarian cancer.

The Gynecologic Oncology Group (GOG) has conducted a series of randomized trials in advanced ovarian cancer patients, both with early-stage disease (FIGO stages I and II) and advanced-stage disease (FIGO stages III and IV). In patients with early-stage disease, the current standard of therapy is three cycles of paclitaxel and carboplatin-based combination chemotherapy. In patients with advanced-stage ovarian cancer, the GOG standard is six cycles of the same regimen. The GOG has also performed prospective randomized trials of consolidation and maintenance therapy with intraperitoneal (IP) radioisotomes and additional cycles of paclitaxel, respectively. Neither of these modalities has shown improvement in survival. In addition, the GOG has performed randomized trials of IP chemotherapy, and while it has been demonstrated that the regimens that included IP cisplatin led to improved outcomes, the toxicity of this approach has precluded widespread acceptance of this modality. Currently, the GOG is performing additional pilot studies to evaluate less toxic IP regimens. The GOG has also been at the forefront of developing new combination chemotherapy regimens based on the activity of second-line agents, such as topotecan, gemcitabine, and encapsulated doxorubicin. The GOG is also exploring molecular-targeted therapies in phase II trials with the goal of ultimately incorporating biological therapies in newly diagnosed patients with advanced disease.