Latest research and treatment of advanced-stage epithelial ovarian cancer

Abstract

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.

Figure 1

Typical peritoneal distribution of primary ovarian cancer

Figure 2

Mutation profile of several genes represented against different ovarian cancer histologies. TP53 mutations are frequent in high-grade, but not low-grade serous tumours, where BRAF and KRAS mutations are more common. Mutations in the PI3K pathway (PTEN, PIK3CA) are more common in clear cell and endometrioid tumours. RAS mutations are frequently identified in mucinous ovarian cancers. (Modified from Kuo, et al, ref. 74)