symposium articles
Optimal primary therapy of ovarian cancer

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ABSTRACT

Background

Epithelial ovarian cancer continues to have the highest case–fatality ratio of all gynecologic cancers, in spite of ongoing advances in risk-assessment, genomics, tumor biology, cytoreductive surgery, chemotherapy, and molecular-targeted interventions. Primary treatment options for advanced-stage disease not only should reflect current best standards, but also need to be tailored for individual patients, with consideration of local resources.

Methods

Formulation of recommendations for optimal primary therapy based on a selective review of data from completed randomized trials, analysis of ongoing trials, and integration with current tumor biology, within the context of individualized clinical care. Recommendations were presented for discussion during an international meeting of experts in ovarian cancer treatment.

Results

Key recommendations include full adjuvant therapy for early-stage high-grade serous cancer; tailored utilization of neoadjuvant chemotherapy based on patient comorbidities, extent of disease, and likelihood of achieving optimal surgical cytoreduction; preferred utilization of carboplatin with weekly paclitaxel as primary therapy; consideration of intraperitoneal cisplatin-based therapy in appropriate patients; avoidance of maintenance chemotherapy; lack of necessity for bevacizumab during primary chemotherapy and primary maintenance; acknowledgement of research opportunities and priorities.

Conclusions

Integrated multidisciplinary care, including cytoreductive surgery and platinum-based chemotherapy, remain central to the optimal management of women with advanced-stage ovarian cancer. However, even with recent technical advances, the impact on disease-related mortality is limited, and more attention will be focused on the early integration of research, particularly with neoadjuvant chemotherapy and interval cytoreductive surgery.

Keywords

ovarian cancer
neoadjuvant
cytoreductive surgery
intraperitoneal

Cited by (0)

*

Dr Poveda has reported no conflicts of interest.

**

Professor Vermorken has reported that he has presented data on trabectedin for PharmaMar for which he has received an honorarium.

***

Dr Cervantes has acted as a consultant or advisor to Amgen, Astra Zeneca, Sanofi-Aventis, Merck Serono, MSD, Genentech, and Roche.