Current drug treatment guidelines for epithelial ovarian cancer.

The management of ovarian cancer is developing rapidly with the improvements in specialist multidisciplinary care. Most patients present with advanced disease and require careful surgical debulking followed by platinum-based chemotherapy. The recent introduction of paclitaxel appears to have improved the prognosis of advanced ovarian cancer by an increment that is similar in size to that seen after the introduction of cisplatin in the 1970s. Further clinical trials are required to define the optimum combination and dose of the platinum and taxane analogues, and to establish the role of the many new agents currently undergoing clinical testing. Useful chemotherapy for second-line treatment in platinum-refractory patients is now available, which, combined with more aggressive surgical management, is leading to modest improvements in survival. Improvements in supportive care have enabled increasingly intensive chemotherapy to be given safely. Bone marrow support and inhibitors of specific organ toxicities are likely to be incorporated into treatment protocols over the next decade. The impact of these treatments on patients' quality of life and the economic consequences of a more active approach to management will require careful evaluation.