Over recent decades, truly impressive progress has been made in the outcome associated with the pharmacological
antineoplastic management of women with advanced
ovarian cancer. Following initial surgery, the large majority of patients with this
malignancy will receive a
chemotherapy regimen that includes a
platinum drug (
carboplatin or
cisplatin) and a
taxane (
paclitaxel or
docetaxel). Currently, objective responses are observed in approximately 60-80% of patients treated in the front-line setting, with documented improvements in overall survival compared with prior non-
platinum and
taxane programmes. Unfortunately, despite the high response rate to initial
chemotherapy, the majority of women with advanced disease will experience recurrence of the malignant process and be candidates for a variety of possible second-line therapeutic options. It is well recognized that
ovarian cancer patients who are documented to experience an initial response to
platinum-based
chemotherapy but where the disease recurs approximately 6 or more months following the completion of primary
therapy, may have another clinically meaningful response (both objective and subjective) to a second
platinum-based strategy. However, an optimal management approach in this setting remains to be defined. Furthermore, the malignant cell populations in all
ovarian cancer patients who experience an initial relapse of the disease process will eventually be resistant to the
platinum agents. In this setting, multiple drugs have been shown to be biologically active. Again, an optimal strategy to be employed in the
platinum-resistant setting has yet to be demonstrated through the conduct of evidence-based trials. Reasonable goals of
therapy in women with recurrent or resistant
ovarian cancer are to improve overall survival, reduce the severity (and delay the occurrence) of symptoms and optimize overall quality of life.