Current challenges and future directions in the management of ovarian cancer: Proceedings of the first global workshop on ovarian cancer

Epithelial ovarian cancer is the leading cause of death from gynecologic malignancies in the United States. Although the prevalence of ovarian cancer when compared with other neoplasms is low, with an estimated 21,550 new cases in 2009, the majority of patients are diagnosed at an advanced stage of disease, with projected 5-year relative survival rates of 31%. Early detection is a clinically relevant goal for the optimal management of patients with ovarian cancer. Attempts to develop valuable screening strategies and incorporate preventive measures are ongoing. Frontline management of ovarian cancer involves primary cytoreductive surgery followed by platinum-based combination chemotherapy and up to 80% of women with advanced disease achieve an objective response and 10%-20% are cured with this regimen; nevertheless, disease recurrence is inevitable in most patients. Multiple strategies including the inclusion of effective targeted therapies upfront and the incorporation of maintenance regimens are being investigated to improve frontline response rates. Currently, the choice of treatment in recurrent ovarian cancer is based on the disease-free interval from completion of frst-line platinum-based therapy; several platinum and non-platinum agents are used in the recurrent setting with equivalent effcacy outcomes. The roles of targeted therapies, secondary cytoreductive surgery, and rising cancer antigen 125 levels in the treatment of recurrent disease are being delineated. Clearly, there is a need to identify novel agents and personalized strategies that will improve clinical outcomes in this disease. It is likely that a better understanding of the molecular changes in the pathogenesis of ovarian cancer will pave the way for more effective therapeutic options. This summary highlights current challenges in the management of ovarian cancer and outlines expert perspectives, key questions, and future directions.