Ovarian cancer: Current status and strategies for improving therapeutic outcomes

Abstract

Of all the gynecologic tumors, ovarian cancer (OC) is known to be the deadliest. Advanced-stages of OC are linked with high morbidity and low survival rates despite the immense amount of research in the field. Shortage of promising screening tools for early-stage detection is one of the major challenges linked with the poor survival rate for patients with OC. In OC, therapeutic management is used with multidisciplinary approaches that includes debulking surgery, chemotherapy, and (rarely) radiotherapy. Recently, there is an increasing interest in using immunomodulation for treating OC. Relapse rates are high in this malignancy and averages around every 2-years. Further treatments after the relapse are more intense, increasing the toxicity, resistance to chemotherapy drugs, and financial burden to patients with poor quality-of-life. A procedure that has been studied to help reduce the morbidity rate involves pre-sensitizing cancer cells with standard therapy in order to produce optimal results with minimum dosage. Utilizing such an approach, platinum-based agents are effective due to their increased response to platinum-based chemotherapy in relapsed cases. These chemo-drugs also help address the issue of drug resistance. After conducting an extensive search with available literature and the resources for clinical trials, information is precisely documented on current research, biomarkers, options for treatment and clinical trials. Several schemes for enhancing the therapeutic responses for OC are discussed systematically in this review with an attempt in summarizing the recent developments in this exciting field of translational/clinical research.

Keywords: biomarkers; clinical trials; ovarian cancer; ovarian cancer screening.

Figure 1

Association of Sp transcription factors in anti‐cancer activity. Small molecules like tolfenamic acid (TA), Mithramycin A are shown to inhibit specificity protein (Sp) family of transcription factors and will result in increased apoptosis of cancer cells

Figure 2

Dug resistance mechanisms: A schematic representation of proteins involved in drug resistance mechanism of commonly used chemotherapeutic agents for ovarian cancer chemotherapy. The classical multiple drug resistance produced by ABC transporters and non‐ABC transporters are illustrated

Figure 3

Emerging immunotherapies for ovarian cancer. A schematic representation with the details on cancer vaccines, dendritic cell vaccines, adoptive T‐cell transfer, immunostimulatory cytokines are some of the techniques explained in this review

Figure 4

Current strategies for improving therapeutic response. Effective Targeted therapy, Usage of PARP inhibitors, combination therapy, immunotherapy, and usage of chemosensitizers are some of the future strategies for improved therapeutic responses for ovarian cancer treatment