All
work referenced herein relates to treatment of epithelial ovarian
carcinomas, as their treatment differs from ovarian germ cell cancers
and other rare ovarian cancers, the treatments of which are addressed
elsewhere. Fallopian tube cancers and primary peritoneal
adenocarcinomatosis are also generally treated as epithelial ovarian
cancers. The standard of care initial treatment of advanced stage
epithelial ovarian cancer is optimal debulking surgery as feasible plus
chemotherapy with a platinum plus a taxane agent. If this front-line
approach fails, as it too often the case, several FDA-approved agents
are available for salvage therapy. However, because no second-line
therapy for advanced-stage epithelial ovarian cancer is typically
curative, we prefer referral to clinical trials as logistically
feasible, even if it means referring patients outside our system. Immune
therapy has a sound theoretical basis for treating carcinomas
generally, and for treating ovarian cancer in particular. Advances in
understanding the immunopathogenic basis of ovarian cancer, and the
immunopathologic basis for prior failures of immunotherapy for it and
other carcinomas promises to afford novel treatment approaches with
potential for significant efficacy, and reduced toxicities compared with
cytotoxic agents. Thus, referral to early phase immunotherapy trials
for ovarian cancer patients that fail conventional treatment merits
consideration.
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