First-line systemic treatment of ovarian cancer: a critical review of available evidence and expectations for future directions

Abstract

Purpose of review: Epithelial ovarian cancer (EOC) is a prevalent gynecologic malignancy whose prognosis in most cases remains poor despite advances in therapy. In this article, we critically review the available clinical evidence for the choice of first-line chemotherapy in EOC and discuss promising therapeutic strategies.

Recent findings: In the last 25 years, first-line chemotherapy regimens and the indication of systemic treatment for early-stage disease have been better established. Significant progress has been made in the treatment of advanced EOC with the optimization of the carboplatin plus paclitaxel regimen and the use of intraperitoneal chemotherapy for selected patients. Targeted therapies may be approved for EOC in the near future and this would bring more specific treatments and improve outcomes for patients. Validated biomolecular signatures to better define prognosis and to predict response to therapeutic agents are still lacking.

Summary: The standard first-line chemotherapy in EOC is based on the doublet carboplatin plus paclitaxel. It may be possible to improve the efficacy of treatment by means of a more intensive dose-dense regimen or by the intraperitoneal delivery of chemotherapy. Significant improvements in the treatment of EOC are expected from the development of antiangiogenic and other targeted agents and from better patient selection.