Primary chemotherapy and maintenance therapy in epithelial ovarian cancer

Summary

PURPOSE. This overview summarizes the most prominent data on the evolution of first-line and maintenance chemotherapy in epithelial ovarian cancer. METHODS. The literature published on first-line and maintenance chemotherapy in ovarian cancer between 1970 and 2008 was identified systematically by computer-based searches in MEDLINE and the Cochrane Library. RESULTS. In suboptimally debulked and FIGO stage IV ovarian cancer patients the combination of carboplatin and a taxane given intravenously at a three-weekly interval represents the standard of care in first-line chemotherapy. On the contrary, if optimal cytoreduction with residual disease ≤1 cm was achieved during primary surgery and disease was confined to the peritoneal cavity, intraperitoneal chemotherapy should seriously be taken into consideration even at the expense of significantly increased, but manageable toxicity. A more favourable therapeutic index should be expected in IP regimens, when cisplatin will be substituted by the better tolerable carboplatin. Concerning maintenance chemotherapy in ovarian cancer, the only randomized trial showing significant effects on progression-free survival used paclitaxel as a single agent over 12 cycles given once monthly. However, that study was prematurely closed at the first interim analysis because of prominent differences in progression-free survival in favour of the study arm. Translatable effects on overall survival thus remained unevaluated. CONCLUSION. Intravenous platinum-taxane-based chemotherapy remains the first-line post-operative treatment of choice in ovarian cancer, but the option of intraperitoneal chemotherapy should be considered in appropriate patients. In ovarian cancer, maintenance chemotherapy should be performed only in controlled clinical trials.