Ovarian cancer standard of care: are there real alternatives?

Abstract

Ovarian cancer remains a major issue for gynecological oncologists, and most patients are diagnosed when the disease is already advanced with a poor chance of survival. Debulking surgery followed by platinum-taxane chemotherapy is the current standard of care, but based on several different strategies currently under evaluation, some encouraging data have been published in the last 4 to 5 years. This review provides a state-of-the-art overview of the available alternatives to conventional treatment and the most promising new combinations. For example, neoadjuvant chemotherapy does not seem to be inferior to primary debulking. Despite its outcome improvements, intraperitoneal chemotherapy struggles for acceptance due to the heavy toxicity. Dose-dense chemotherapy, after showing an impressive efficacy in Asian populations, has not produced equal results in a European cohort, and the results of alternative platinum doublets are not superior to those of carboplatin and paclitaxel. In this setting, adherence to a maintenance therapy after first-line treatment and multiple (primarily antiangiogenic) agents appears to be effective. Although many questions, including the duration of maintenance treatment and the use of bevacizumab beyond progression, remain unanswered, new biologic agents, such as poly(ADP-ribose) polymerase (PARP) inhibitors, nintedanib, and mitogen-activated protein/extracellular signal-regulated kinase (MEK) inhibitors, have emerged as potential therapeutic options in the very near future. Based on the multiplicity of available strategies, the histological and molecular features of the tumor, in addition to patient's clinical condition and disease state, continue to gain importance in guiding treatment choices.

Figure 1.. Critical steps in epithelial ovarian cancer care.

CDDP + CTX: cisplatin and cyclophosphamide; CDDP + PAC: cisplatin and paclitaxel,; CBCDA + PAC: carboplatin and paclitaxel,; CBCDA-PAC + BEVACIZUMAB: carboplatin, paclitaxel, and bevacizumab,; TKi: tyrosin-kinase inhibitors; PARPi: poly(ADP-ribose) polymerase inhibitors; MEKi: mitogen-activated protein/extracellular signal-regulated kinase inhibitors.