Ovarian cancer is a relatively infrequent
malignancy, but it is the fifth leading cause of
cancer-related mortality in American women. The initial diagnosis of
ovarian cancer is usually made when the disease is at an advanced stage. Although advanced
ovarian cancer is characteristically sensitive to initial surgical debulking followed by
platinum-based
combination chemotherapy, it is rarely cured, and even patients who achieve a complete remission ultimately go on to experience relapsed disease. When
tumor relapse occurs more than 6 months following completion of the
platinum-based treatment, patients are defined as having
platinum-sensitive disease. This roundtable includes an expert discussion of the options for treatment of patients with
platinum-sensitive
ovarian cancer. After distinguishing this form of recurrent
ovarian cancer from
platinum-resistant and
platinum-refractory disease, the therapeutic options are reviewed. Much evidence supports the benefit of secondary
cytoreductive surgery in
platinum-sensitive patients, although this strategy has not yet been established by a prospective randomized clinical trial. Further, the standard
chemotherapy regimens recommended in this setting are reviewed in the context of the clinical trials that established their efficacy. Finally, a description of emerging and
investigational treatments, including both
biologic agents and novel cytotoxic drugs, is included. Several recent and ongoing clinical trials involving these investigational agents are described. Throughout, the experts discuss the implication of these findings in the clinical setting.