Chemotherapy of ovarian cancer.

Abstract

The classic approach to the treatment of ovarian cancer has been the combination of cytoreductive surgery followed by chemotherapy. Surgery has played an instrumental role in the overall management of the disease because of the necessity for accurate staging and because of the finding that chemotherapy is more effective in patients who have small-volume disease after initial surgery. The vast majority of patients with ovarian cancer are diagnosed with stage III disease at a time when they have intraperitoneal carcinomatosis. While surgery is effective in removing the bulk of disease in 50–80% of patients, it is not a curative modality at this stage because the vast majority of patients are left with residual cancer. Ovarian cancer has long been known to be a chemosensitive tumor. Early studies demonstrated that drugs from different classes of chemotherapeutic agents (alkylating agents, antimetabolites, DNA alkylating drugs, etc.) all had activity in ovarian cancer. In the late 1960s and early 1970s, multiple combination chemotherapy regimens were developed utilizing the principle of combining drugs with different mechanisms of activity and nonoverlapping toxicities [1]. However, the development of the platinum compounds in the 1980s changed the nature of chemotherapy for this disease. Platinum compounds (either cisplatin or carboplatin) had the highest degree of activity in ovarian cancer and became the mainstay of treatment [2]. Numerous studies subsequently demonstrated that the addition of multiple drugs to platinum was not associated with any significant improvement and the standard of care became the two-drug combination of the platinum compound plus an alkylating agent. In practical terms, most patients were treated in the United States with the combination of carboplatin and cyclophosphamide.KeywordsOvarian CancerEpithelial Ovarian CancerOvarian Cancer PatientPlatinum CompoundRecurrent Ovarian CancerThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.