Current and emerging treatment options in the management of advanced ovarian cancer

ABSTRACT

Introduction: Epithelial ovarian cancer is the most lethal gynecologic malignancy. Recent advances in understanding the biology and its molecular and histological diversity have led to mechanism based therapeutic strategies such as poly-ADP-ribose polymerase inhibitors (PARP) targeting homologous recombination deficient tumor cells and anti-angiogenic therapies. Clinical trial designs in ovarian cancer have to evolve to incorporate assessment of the genomic complexity and identify predictive biomarkers to improve precision of treatment and outcome.

Areas covered: This review summarizes present-day strategies used in the management of ovarian cancer and novel promising therapeutic approaches in development. The article is based on English peer-reviewed articles located on MEDLINE and related abstracts presented at major international meetings.

Expert opinion: Two types of molecular targeted therapies, anti-angiogenics and PARP inhibitors, have been shown to be active in randomized clinical trials and approved by regulatory agencies. Management of ovarian cancer is poised to change with the continued advancement of precision medicine that is founded upon improved understanding of disease biology; separation into histologically and molecularly defined subgroups; and the incorporation of this new knowledge into early phase drug development and novel clinical trial design.

KEYWORDS:

• Angiogenesis
• epithelial ovarian cancer
• PARP inhibitors
• immunotherapy
• targeted therapies

Article highlights

• In this article, we review emerging therapeutic strategies and research directions in the management of epithelial ovarian cancer.

• Antiangiogenic strategies have demonstrated activity in several positive randomized clinical trials encompassing the disease spectrum from newly diagnosed to platinum-sensitive and platinum-resistant recurrent disease.

• PARP inhibitors represent one of the successful models of translational research and PARP inhibitors are now approved for BRCA-associated ovarian cancer.

• Predictors of response, strategies to overcome resistance, combination with other chemotherapies and targeted agents, should be investigated in future trials.

• Promising future therapies that merit evaluation in advanced ovarian cancer include immunotherapies.

• For rare ovarian cancer subsets such as clear cell, mucinous, and low grade serous ovarian cancer, improved understanding of their molecular characteristics has led to rational trial design with promising positive results.

This box summarizes key points contained in the article.

Declaration of interest

V. Rodriguez-Freixinos is supported in part by a translational research grant from the Spanish Society of Medical Oncology (SEOM) Translational Research Grant. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.