Improving outcome in the first-line management of advanced ovarian cancer

ABSTRACTCarboplatin plus paclitaxel is the standard first-line chemotherapy for ovarian carcinoma. Primary debulking surgery is likely to remain the standard of care for advanced disease until results from the EORTC trial on neoadjuvant chemotherapy are available. A number of methods of improving chemotherapy treatment have been investigated. However, few trials have been conducted and insufficient data collated to date to support intraperitoneal (IP) delivery as standard first-line chemotherapy, in part due to concerns over potential toxicity. There is an unmet need for an appropriate IP trial (preferentially with carboplatin) for comparison with intravenous carboplatin and paclitaxel. Triplet or sequential doublet combinations have similarly not yet shown any advantage over standard doublet therapy. There is also insufficient evidence to date that maintenance therapy following standard chemotherapy improves overall survival. However, it is hoped that current trials examining tyrosine kinase inhibitors, vascular endothelial growth factor inhibitors and other multitargeted biological agents will yield promising options for concomitant use with firstline chemotherapy or as maintenance therapy.