Ovarian cancer treatment: The end of empiricism? open access

Open access

Abstract

The diagnosis, investigation, and management of ovarian cancer are in a state of flux—balancing ever rapid advances in our understanding of its biology with 3 decades of clinical trials. Clinical trials that started with empirically driven selections have evolved in an evidence-informed manner to gradually improve outcome. Has this improved understanding of the biology and associated calls to action led to appropriate changes in therapy? In this review, the authors discuss incorporating emerging data on biology, combinations, dose, and scheduling of new and existing agents with patient preferences in the management of women with ovarian cancer.

Table 1. Prioritization Questions in the Management of Ovarian Cancer and Current Proposed Strategies

Conclusion

The treatment of ovarian cancer is on the verge of a major change that will propel improvement in outcomes.[87] Recent developments emphasize that a multipronged approach is warranted, integrating genomics, subtype-specific maintenance therapy, and other directions that will be used alongside increasingly sensitive disease-detection tools. Better definition of treatment timing may further allow exploitation of additional benefits of surgery as the role of surgery remains central to OC treatment. Taken together, this will allow us to build on our understanding of the heterogeneity of OC to tailor treatment. Future therapeutic strategy should target genetics, microenvironment, and sequence schedule to keep cancer cells from developing resistance. To move forward, we have to take some bold steps based on biology, require objective evidence of benefit, and reflect on experience from other cancers and diseases. It is important to constantly re-evaluate data and expect that, for therapy to be considered “standard,” it has to demonstrate objective, clinically meaningful, as well as statistically significant benefit. The timing is right for a paradigm shift that will require clinicians to have the courage and confidence to not prescribe treatments without evidence of benefit. This will necessitate optimizing surgery and appropriate evidence-based recommendations for each subtype of ovarian cancer. This therapeutic direction has to be supported by excellence and precision in pathology, molecular profiling, and imaging. In equal measure, it will require open dialogue with patients and being honest about treatments that have evidence of benefit and, especially, those that do not.