The Changing Landscape of Therapeutic Strategies for Recurrent Ovarian Cancer

Klaus H Baumann; Uwe Wagner; Andreas du Bois


Future Oncol. 2012;8(9):1135-1147. 

In This Article


The therapeutic landscape in recurrent ovarian cancer is characterized by well-established strategies, a number of concepts still lacking confirmation in prospective randomized trials and numerous agents including targeted therapeutics emerging from the transition of basic research to clinical trials bearing the potential to influence this permanently changing landscape (Figure 2). Treatment decision-making in recurrent ovarian cancer is based on readily available information such as personal, clinical and pathological criteria. Investigational parameters arising from chemosensitivity testing and from molecular and proteomic characterization are still limited to clinical trials and further research is required to transfer these methods to finally achieve solid and reliable predictive therapeutic response criteria for the individual patient. Local treatment, as well as conventional and newer systemic treatment modalities, has to be considered for the individual treatment situation. Sequence and combination of different strategies may have a beneficial impact on the course of disease (Figure 2). Chemotherapy will remain the backbone of systemic therapy in recurrent ovarian cancer. The important data derived from Phase III trials in primary and recurrent ovarian cancer establishing the efficacy of bevacizumab in combination with chemotherapy and for maintenance therapy already had a high impact on clinical practice (Table 1). Additional antiangiogenic agents are currently under investigation. PARP inhibitors, a variety of signal transduction inhibitors, antibodies and peptibodies aiming at different targets, and drug-targeting agents will enter clinical trial. The identification of predictive molecular markers may help to identify the right patient for the right trial and drug. Clinical trials will provide evidence of multimodal therapeutic potential, concept of treatment beyond progression, as well as the initiation and tailoring of therapeutic measures in the palliative setting.

Figure 2.

Therapeutic options and network.
Gene expression arrays and proteome analyses are supposed to guide future tumor classification and treatment decisions. Combination, simultaneous or sequential treatment modalities and agents; (re)-sensitizing and maintenance therapy; and treatment beyond progression represent important aspects for basic, translational and clinical research in recurrent ovarian cancer. '?' indicates raised and/or contentious issues.
HIPEC: Hyperthermic intraperitoneal chemotherapy.