For more than a decade, taxane platinum-based primary therapy has been a standard of care for the adjuvant treatment of ovarian cancer in the United States. Optimizing outcomes appears to be linked not only to the quality of primary surgical cytoreduction, but also to chemotherapy delivery. Two important concepts in this regard are the degree of cytoreduction considered truly “optimal” and infusional standards such as neoadjuvant chemotherapy and intraperitoneal chemotherapy.
Studies have documented that substandard surgery translates into poorer overall survival, and data show that almost 75% of the primary surgeries for ovarian cancer performed in this country are done so without the involvement of a gynecologic oncologist. Also to be determined is whether neoadjuvant chemotherapy, in order to improve the probability of a better surgery, is harmful or beneficial to patients.
Intraperitoneal studies are now becoming well known but are labor intensive and frequently modified to be more “patient friendly.” Will these maneuvers, however, detract from the reported survival benefits, and are there other strategies which can make the infusional standard more tolerable?
Recurrent ovarian cancer is a situation filled with despair for both patients and health care providers. Many questions to optimal care remain unanswered and range from surgery to investigational agents. CME LLC has collaborated with a team of oncology specialists who have summarized recent advances that are pertinent for oncology practice, and provided a seasoned and practical perspective that may advance patient care.
CME, 2 Credits Dec 15, 2009