CON: Therapy for a Patient with Platinum–Resistant/Refractory Ovarian Cancer Should Not Be Selected Based on Results of an In Vitro Extreme Drug Sensitivity/Resistance Assay

Abstract

Introduction Ovarian cancer remains an important health problem for women in the United States. It is estimated that there will be 21,650 cases of invasive ovarian cancer resulting in 15,520 deaths in 2008.1 Ovarian cancer has the highest case-fatality rate of all gynecologic cancers, and it is the most common cause of death from cancers of the female genital track.1-3 The high case-fatality rate results from the frequent diagnosis of epithelial ovarian cancer at an advanced stage: 75% of all cases are diagnosed as stage I11 or W, in which the disease has spread throughout the abdomen.l,3,4 Patients with advanced-stage disease have a 5-year survival of only 29%. Epithelial ovarian cancer is initially a very chemoresponsive tumor with response rates of approximately 80%.1-5 Unfortunately 5 75% of patients with advanced-stage disease will develop recurrent disease, which rapidly acquires chemoresistance, leading to death from the disease.2.3 The best strategy for selection of second-line chemotherapy after relapse in chemoresistant ovarian cancer has yet to be l l l y elucidated. Most commonly, patients are treated with a series of secondand third-line drugs that have been demonstrated to produce a modest response rate in this patient population. The precise selection of drug usually depends on a number of factors, including previous therapies, toxicities, patient wishes, and physician bias. Over the past 20 years, in vitro drug assays have been proposed as a solution to the accurate selection of a chemotherapeutic agent for patients with cancer. This article will address whether this is a rational approach to this selected platinum-rehctory/resistant population.Gl3