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Abstract
Ovarian cancer affects more than 200,000 women each year around the world. Most women are not diagnosed until the disease has already metastasized from the ovaries with a resultant poor prognosis. Ovarian cancer is associated with an overall 5 year survival of little more than 50%. The mainstay of front-line therapy is cytoreductive surgery followed by chemotherapy. Traditionally, this has been by the intravenous route only but there is more interest in the delivery of intraperitoneal chemotherapy utilizing the pharmaco-therapeutic advantage of the peritoneal barrier. Despite three large, randomized clinical trials comparing intravenous with intraperitoneal chemotherapy showing improved outcomes for those receiving at least part of their chemotherapy by the intraperitoneal route.Cisplatin has been the most active drug for the treatment of ovarian cancer for the last 4 decades and the prognosis for women with ovarian cancer can be defined by the tumor response to cisplatin. Those whose tumors are innately platinum-resistant at the time of initial treatment have a very poor prognosis. Although the majority of patients with ovarian cancer respond to front-line platinum combination chemotherapy the majority will develop disease that becomes resistant to cisplatin and will ultimately succumb to the disease.Improving the efficacy of cisplatin could have a major impact in the fight against this disease. Arsenite is an exciting agent that not only has inherent single-agent tumoricidal activity against ovarian cancer cell lines but also multiple biochemical interactions that may enhance the cytotoxicity of cisplatin including inhibition of deoxyribose nucleic acid (DNA) repair. In vitro studies suggest that arsenite may enhance the activity of cisplatin in other cell types. Arsenic trioxide is already used clinically to treat acute promyelocytic leukemia demonstrating its safety profile. Further research in ovarian cancer is warranted to define its possible role in this disease.
Highlights
Improving the efficacy of cisplatin could have a major impact in the fight against this disease
Journal of Ovarian Research 2009, 2:2 http://www.ovarianresearch.com/content/2/1/2 been made in the treatment of Epithelial ovarian cancer (EOC), the enigma remains that a disease which is highly sensitive to chemotherapy compared to many other types of cancer is associated with an overall 5 year survival of just over 50% [3,4,5,6]
Cytoreductive Surgery The management of advanced EOC has evolved over the last 30 years to become a combination of initial cytoreductive surgery (CRS) followed by chemotherapy
Summary
Despite modern standard therapy overall survival in women with ovarian cancer remains relatively poor. The most active chemotherapeutic agent remains cisplatin but ironically most patients whilst initially responding to cisplatin die with platinum-resistant disease. Arsenic is a promising agent for helping overcome platinum resistance. In addition to inherent tumoricidal activity it has multiple biochemical interactions that may enhance cisplatin cytotoxicity. Further research into this agent is needed
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