The Michener/Belinson article
deals not so much with what is
new in the treatment of ovarian
cancer, but with the changing management
paradigm. The authors
correctly point out that one cannot
expect to offer curative options in
ovarian cancer patients who recur.
Consequently, in planning therapy,
the focus should be on the ability to
provide a lifelong strategy to control
the disease through maintenance therapy.
After first-line chemotherapy,
complete responders have reasonably
long remissions in the absence of any
intervening therapies, but this is not
likely to be the case with recurrent
disease. In fact, Markman et al have
stressed that remissions following
treatment for recurrence are never
longer than the preceding ones.
The majority of patients with ovarian cancer, especially those who
present with stages IIIC and IV, will relapse soon after completion of
platinum-based induction treatment. It is imperative to find ways to improve
and/or enhance the efficacy of induction and to prolong the duration
of the first remission. The epidermal growth factor receptor (EGFR)
family has been exploited, and currently, three agents that directly target
this group of receptors are in use in the treatment of colorectal,
non–small-cell lung and breast cancers. EGFR and HER2/neu are
overexpressed in a significant percentage of epithelial ovarian cancers.
Thus, it would be reasonable to explore directly targeted therapy
in ovarian cancer. Numerous investigational trials involving a variety
of EGFR inhibitors in ovarian cancer are ongoing. Our institution has
an active phase II clinical study that seeks to define the role of erlotinib
(Tarceva) in potentiating first-line chemotherapy, and to determine
whether the drug offers a significant contribution as maintenance
therapy. It is hoped that data from these and other studies will help
investigators to understand more clearly the biology of ovarian cancer
and to delineate the role of EGFR inhibitors in the management of
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