“Current Chemotherapy of Ovarian Cancer
Optimal primary chemotherapy of advanced ovarian cancer has not substantially changed over the last few years, in spite of the extensive evaluation of new cytotoxic agents and diverse treatment strategies. The rapid development of drug resistance remains a major clinical challenge for the majority of patients
While the combination of carboplatin and paclitaxel remains a well-tolerated and effective standard treatment for newly diagnosed ovarian cancer, there is continued interest in the discovery of new targets, as well as new approaches for inhibiting old targets
When patients undergo complete surgical clearance and have a tumor that is limited to the ovary with the finding of clear cell histology, cure would be expected in the vast majority of cases. In contrast, early-stage serous tumors are often high-grade and have a greater risk of recurrence and are perhaps more likely to benefit from adjuvant chemotherapy.
The dominant pattern of chemotherapy resistance observed in ovarian cancer is related to platinum compounds (cisplatin and carboplatin). Currently, there are no compounds with the ability to specifically target platinum-resistant tumors in the clinical setting.
The integration of emerging biologic principles with the development of molecular-targeted reagents is starting to achieve meaningful results, especially with regard to inhibition of angiogenesis and interference with PARP-mediated DNA repair. This single-agent treatment strategy is well tolerated and effective in a proportion of women with BRCA1/2 mutations. However, inheritable germ-line mutations only account for perhaps 5% of all ovarian cancers”.
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