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Ovarian cancer: a focus on management of recurrent disease

Nature Clinical Practice Oncology volume 3, pages 604–611 (2006)Cite this article

Abstract

Surgery and chemotherapy form the cornerstone of the treatment for ovarian cancer. Currently, the standard of care for primary ovarian cancer is platinum and taxane-based therapy. Even among women with advanced and suboptimal disease (i.e. tumors greater than 1 cm) following surgery, the clinical efficacy of chemotherapy is noteworthy. Despite the favorable response characteristics, however, most women with advanced-stage ovarian cancer will relapse, including about 50% of women who have no evidence of disease after primary therapy. A multitude of treatment options are available at the time of recurrence, but there is no clear consensus about how these patients should be managed. Options include surgery, chemotherapy, hormones, and sometimes, radiation therapy. The sequence, combinations of treatment, and manner in which any or all of these options should be employed in an individual patient, which heretofore have not been standardized, are the subjects of ongoing clinical investigations.

Key Points

  • Unfortunately, most cases of ovarian cancer (approximately 75%) are at an advanced stage at the time of diagnosis.

  • Administration of adjuvant chemotherapy consisting of a platinum and a taxane-based regimen remains the standard front-line treatment for advanced ovarian cancer following a maximal surgical cytoreduction.

  • Unfortunately, tumors will recur in up to 70% of patients with advanced-stage ovarian or primary peritoneal cancer.

  • Treatment of recurrent ovarian cancer is often decided by the interval from previous platinum treatment; those receiving treatment within 6 months and those receiving treatment after 6 months being defined as platinum-resistant and platinum-sensitive, respectively.

  • Secondary cytoreduction might be considered in select patients with isolated masses, and a long disease-free interval of at least 12 months.

  • Future trials are needed to establish the role of molecular-targeted compounds, sequential versus combination chemotherapy, role of assay-directed therapy and secondary cytoreduction in recurrent ovarian cancer.

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Author information

Authors and Affiliations

  1. Director of the Division of Gynecologic Oncology, and Physicians and Surgeons Alumni Professor of Clinical Obstetrics and Gynecology, at Columbia University College of Physicians and Surgeons, Herbert Irving Cancer Center, New York, USA

    Thomas J Herzog

  2. Assistant Professor in the Division of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, Herbert Irving Cancer Center, New York

    Bhavana Pothuri

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  1. Thomas J Herzog
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  2. Bhavana Pothuri
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Corresponding author

Correspondence to Thomas J Herzog.

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Competing interests

TJ Herzog declared he is a consultant for and has received research support from GlaxoSmith Kline, Orthobiotech, Sanofi Aventis and Lilly. B Pothuri declared she has no competing interests.

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Herzog, T., Pothuri, B. Ovarian cancer: a focus on management of recurrent disease. Nat Rev Clin Oncol 3, 604–611 (2006). https://doi.org/10.1038/ncponc0637

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