First line therapy: have we made any improvement?

Abstract

The incidence of epithelial ovarian cancer varies throughout the world (Fig. 1), with higher frequencies in Europe, North America, and Australia, and lower frequencies in much of Asia, Central America, South America, and North Africa [1]. The epidemiologic factors responsible for this variability remain to be defined. However, regardless of where it occurs, ovarian cancer is associated with the highest case-fatality ratio among the gynaecologic cancers, reflecting a propensity for early peritoneal dissemination, and advanced-stage disease at clinical diagnosis. Approximately 80% of advanced-stage tumours demonstrate high-grade serous histology, and these tumours can arise from the distal (fimbriated) fallopian tube, peritoneal cavity, or surface epithelium of the ovary. While high-grade serous tumours can also arise from the endometrium, these tumours have a somewhat different biology, and are generally managed as endometrial cancer, and are not included in clinical trials of ovarian cancer. As such, most of our current