Advanced ovarian cancer: what should be the standard of care?

For many years the optimal treatment for women with advanced ovarian cancer has been surgical cytoreduction followed by intravenous platinum and taxane chemotherapy on an every three-week schedule. Recent clinical trials suggest that new treatment paradigms with different routes, dosing schedules and addition of targeted biologic therapies are replacing this old standard. In addition, new research suggests that ovarian, fallopian tube and peritoneal cancers may arise from a similar precursor, but histologic variants may require different treatment strategies. A paradigm shift has recently occurred in our understanding of the pathologic origin of ovarian, fallopian tube and peritoneal cancers Many of the high grade serous tumors of the female pelvis are now thought to arise from the fallopian tube [1-5]. These type II cancers have fairly rapid progression and account for 60-70% of epithelial ovarian cancer Type I ovarian cancers include clear cell and endometrioid cancers which are thought to arise from endometriosis and mucinous tumors which are thought to arise from benign or low malignant potential (LMP) mucinous neoplasms Even grouped together, type I cancers account for only about 30% of ovarian cancer. These tumors tend to be slower growing and more likely to present in stage I, but also may be more resistant to chemotherapy when they present in advanced stages.