Ovarian cancer remains the number one gynecologic killer in the Western world. However, there has been significant progress in understanding the genetics of ovarian cancer and in development of more effective therapies. The current optimum approach to therapy consists of cytoreductive surgery followed by combination chemotherapy. Clinical trials have established that carboplatin plus a taxane (usually paclitaxel) can be considered to be the treatment of choice for most patients with advanced disease. Most patients will achieve a clinical complete remission with such a combination. However, the median time to progression is less than 2 years, and for patients with optimal stage III disease, median survival will be approximately 5 years. Clinical trials are currently evaluating new combination chemotherapy regimens and the role of maintenance therapy in improving time to progression and overall survival. There has been a great deal of progress in understanding the genetics of epithelial ovarian cancer. The relationship between mutations in BRCA1 and BRCA2 genes and inherited predisposition to ovarian cancer has been of major clinical importance. While 90% of ovarian cancer cases are still considered to be sporadic, identification of the molecular events associated with hereditary ovarian cancer will lead to an increased understanding of the pathogenesis of sporadic disease as well since the two diseases share many clinical features. Development of high throughput screening methodology, such as CDNA microarray analysis, will lead to identification of additional genes which are important in the development of ovarian cancer, and will help define new targets for therapy and prevention as well as potential new biomarkers for early detection. The next generation of clinical trials will be focused on evaluating chemotherapy together with new molecular therapies, such as signal transduction inhibitors, anti-angiogenesis agents, and inhibitors of matrix metalloproteinases.
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