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State of the science: Contemporary front-line treatment of advanced ovarian cancer

  • Emily Hinchcliff
    Affiliations
    Division of Gynecologic Oncology, Department of Ob/Gyn, Northwestern University Feinberg School of Medicine, Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, United States of America
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  • Shannon N. Westin
    Affiliations
    Dept. of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX 77030, United States of America
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  • Thomas J. Herzog
    Correspondence
    Corresponding author at: Dept. of Ob/Gyn, University of Cincinnati Cancer Center, University of Cincinnati, Medical Sciences Bldg. Suite 2005H, ML0662, 231 Albert Sabin Way, Cincinnati, OH 45267-0662, United States of America.
    Affiliations
    University of Cincinnati Cancer Center & University of Cincinnati Dept. Of Ob/Gyn, Cincinnati, OH 45267, United States of America
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      The ovarian cancer treatment landscape has transformed dramatically in the front-line setting in the past several years. A quarter of a century ago, platinum/taxane adjuvant chemotherapy was established as the new standard of care [
      • McGuire W.P.
      • Hoskins W.J.
      • Brady M.F.
      • Kucera P.R.
      • Partridge E.E.
      • Look K.Y.
      • Clarke-Pearson D.L.
      • Davidson M.
      Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer.
      ]. Various additions to and adaptations of this backbone were studied including intraperitoneal (IP) chemotherapy, substitution of taxanes with other novel chemotherapeutics, dose-dense administration, and adding novel biologics including bevacizumab to platinum/taxane. Only addition of bevacizumab, both with chemotherapy followed by maintenance therapy, emerged as a prevalent standard of care, despite supportive phase III data for other strategies. Both IP and dose-dense strategies were challenged by more recent data that did not confirm the value of these interventions, especially if bevacizumab was utilized. Advances in molecular biologics have led to targeted maintenance strategies including PARP inhibition that have significantly altered the treatment landscape for ovarian cancer.
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