Advanced Ovarian Carcinoma

Advanced (FIGO stage III/IV) ovarian carcinoma is only occasionally curable at first presentation and is almost always incurable at relapse. Current standard first-line therapy involves treatment with a platinum agent (cisplatin or carboplatin) in combination with a taxane (paclitaxel or docetaxel) delivered on a 3-weekly cycle for six cycles. Patients optimally cytoreduced can expect a median progression-free survival of 22 months and a median overall survival of 57 months, whereas patients with residual tumor nodules .1 cm in diameter have correspondingly poorer figures for median progression-free survival and median overall survival of 18 and 36 months, respectively. No randomized trials of other intravenous cytotoxic regimens or schedules have demonstrated better survival data in the first-line setting,
although emerging data for intraperitoneal cisplatin–paclitaxel may change that paradigm. Ongoing or planned international randomized trials will integrate novel biologic agents such as inhibitors of angiogenesis (eg, the monoclonal antibody bevacizimab) or epidermal growth factor receptor tyrosine kinase inhibitors (eg, gefitinib, erlotinib) with conventional cytotoxics. The implication is that we may have reached a plateau in outcomes from conventional cytotoxic therapy in this disease.