Over the last decade, a number of new cytotoxic
chemotherapy agents have shown evidence of antitumor activity in patients with ovarian
carcinoma. These agents are currently being evaluated in large multinational randomized trials to determine whether their addition either concurrently or sequentially to standard
paclitaxel and
carboplatin regimens will result in improved survival. Whether these new combinations will provide additional benefit may be uncertain; however, it is certain that additional toxicity will limit the continued evaluation of the strategy of adding cytotoxics together. New approaches to improve the systemic
therapy of
ovarian cancer need to be explored. The next decade will see many trials of non-cytotoxics having a wide range of subcellular and extracellular targets. Many of these targets are abnormally expressed in a variety of solid
tumors; thus, it is expected that many of these agents will be appropriate to evaluate in patients with ovarian
carcinoma. Based on promising data from preclinical and early clinical studies as well as the presumed applicability of these targets to ovarian
carcinoma, the inhibitors of
growth factor receptors such as
epidermal growth factor receptor and inhibitors of angiogenesis are of particular interest. Despite the interest of the investigators, the rapid evaluation of these target-specific non-cytotoxics is limited by the lack of accurate information on the expression of target in ovarian
tumors and the relevance of target expression and its modulation to this
tumor type. Early clinical trials are being designed to address these concerns; however, the clinical impact of non-
cytotoxic agents in
epithelial ovarian carcinoma patients must await the completion of randomized evaluations in combination with standard chemotherapeutic regimens.