Journal Article

Latest research and treatment of advanced-stage epithelial ovarian cancer

Herzog, Thomas J., Sood, Anil K., Coleman, Robert L., Monk, Bradley J.

2013

Overview

Late-stage distribution and bulky intraperitioneal disease are the hallmarks of ovarian cancer presentation, which is managed primarily by surgical resection and chemotherapy. However, advances in surgical resection objectives, alternative chemotherapy administration schedules, and novel therapeutics based on increasing knowledge of disease biology are making strides to improve outcomes. This Review covers all elements of the definition, treatment, and biology of ovarian cancer. The natural history of ovarian cancer continues to be characterized by late-stage presentation, metastatic bulky disease burden and stagnant mortality statistics, despite prolific drug development. Robust clinical investigation, particularly with modifications to primary treatment surgical goals and adjuvant therapy are increasing median progression-free survival and overall survival, although the cure rates have been affected only modestly. Maintenance therapy holds promise, but studies have yet to identify an agent and/or strategy that can affect survival. Recurrent disease is largely an incurable state; however, current intervention with selected surgery, combination and targeted therapy and investigational protocols are impacting progression-free survival. Ovarian cancer is a diverse and genomically complex disease, which commands global attention. Rational investigation must balance the high rate of discovery with lagging clinical investigation and limited patient resources. Nevertheless, growth in our armamentarium offers unprecedented opportunities for patients suffering with this disease. This Review presents and reviews the contemporary management of the disease spectrum termed epithelial 'ovarian' cancer and describes the direction and early results of clinical investigation. Key Points Ovarian cancer continues to be characterized by late-stage presentation and bulky intraperitoneal disease burden at presentation Surgery and chemotherapy are the mainstays of primary therapy; 'optimal' surgical cytoreduction is being re-defined as resection of all macroscopic disease Advances in adjuvant chemotherapy have leveraged intraperitoneal administration, dose-dense paclitaxel and the addition of biological agents predominately targeting angiogenesis Maintenance therapy is a promising strategy as a primary or subsequent adjuvant approach, but as yet is not been proven to increase overall survival Recurrence therapy has improved post-progression outcomes, although cures are elusive Closely tied to a wider understanding of the underlying biology of ovarian cancer, drug development is increasingly focused on specific new targets in the hope of optimizing the therapeutic index

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 692/699/67/1059/602 / 692/699/67/1517/1709 / 692/700/565/545/546 / Biomedical Research / Carcinoma, Ovarian Epithelial / Care and treatment / Causes of / Combined Modality Therapy / Diagnosis / Female / Humans / Medicine / Medicine & Public Health / Neoplasms, Glandular and Epithelial - secondary / Neoplasms, Glandular and Epithelial - therapy / Oncology / Ovarian cancer / Ovarian Neoplasms - secondary / Ovarian Neoplasms - therapy / Patient outcomes / review-article