In 2012, an estimated 239,000 women were diagnosed with ovarian cancer worldwide, and 152,000 women died of the disease1. These data suggest that almost 65% of all women with ovarian cancer will succumb to the disease — fatality rates are even higher for women who are diagnosed at an advanced disease stage. Indeed, one often hears nowadays that the prognosis of patients with advanced-stage serous ovarian cancer is dismal, but to accept this statement as fact is to overlook the 20% of patients who defy our expectations and survive for 10 years or more, most of whom are effectively cured2. Who are these women, and what can we learn from their experience? More importantly, can we use our knowledge to achieve better than a 20% 10-year survival rate? Although the two canonical types of drugs we use to treat ovarian cancer — taxane and platinum-based chemotherapeutic agents — have not been replaced in the past 20 years, debate continues regarding the optimum timing of treatment (neoadjuvant versus adjuvant) and the best route of administration (intravenous versus intraperitoneal). In this Perspectives article, I address the questions posed above, based on the available efficacy data for the various treatment approaches used in patients with advanced-stage ovarian cancer. I argue that — in my opinion, and supported by published evidence — the ideal therapy for women with this disease should comprise optimal debulking surgery and adjuvant intraperitoneal chemotherapy; using this approach, the current cure rate of 20% could be substantially improved, and we might achieve a cure rate closer to 50%.
20-01-2016 | Ovarian cancer | Article
Can advanced-stage ovarian cancer be cured?
Abstract
Approximately 20% of women with advanced-stage ovarian cancer survive beyond 12 years after treatment and are effectively cured. Initial therapy for ovarian cancer comprises surgery and chemotherapy, and is given with the goal of eradicating as many cancer cells as possible. Indeed, the three phases of therapy are as follows: debulking surgery to remove as much of the cancer as possible, preferably to a state of no visible residual disease; chemotherapy to eradicate any microscopic disease that remains present after surgery; and second-line or maintenance therapy, which is given to delay disease progression among patients with tumour recurrence. If no cancer cells remain after initial therapy is completed, a cure is expected. By contrast, if residual cancer cells are present after initial treatment, then disease recurrence is likely. Thus, the probability of cure is contingent on the combination of surgery and chemotherapy effectively eliminating all cancer cells. In this Perspectives article, I present the case that the probability of achieving a cancer-free state is maximized through a combination of maximal debulking surgery and intraperitoneal chemotherapy. I discuss the evidence indicating that by taking this approach, cures could be achieved in up to 50% of women with advanced-stage ovarian cancer.
Nat Rev Clin Oncol 2016;13: 255–261. doi:10.1038/nrclinonc.2015.224
Subject terms: Chemotherapy • Outcomes research • Ovarian cancer • Surgical oncology