XXXX : progress and continuing controversies in management.

@entity43 @entity1 @entity632 @entity902 @entity5 @entity3003 @entity900 @entity1311 @entity136 @entity1205 @entity2359
@entity43 is the most lethal of the gynaecological @entity5 , affecting approximately 1 in 75 @entity1 in the developed world. In most cases (>75%), the disease is disseminated beyond the ovary at diagnosis. For @entity1 with @entity5 , many clinicians agree that standard treatment should comprise six cycles of @entity1311 - @entity3003 . Randomised trials over the past 10 years have indicated the superiority of @entity1311 -based treatment and that @entity3003 is equivalent to @entity900 , but better tolerated. A recent trial has suggested that @entity1205 may be a better option than @entity1311 , with reduced @entity2359 and comparable efficacy. Overall treatment results remain unsatisfactory, since the median survival for these @entity1 is 2-3 years. Future progress may be made by addressing the following issues: Would sequential regimes be more effective? Intriguing results from two large randomised trials (ICON-3 and GOG-132) indicate that single agent @entity902 might well be incorporated into such regimes. Additionally, a range of other agents could be tested as part of first-line regimes, having demonstrated activity in relapsed @entity1 ; these include topotecan, @entity136 and liposomal @entity632 . Newer agents, such as cell signalling inhibitors have shown potential as single agents, but may be particularly effective in combination with current drugs. Real progress can be expected when a better understanding is achieved of the mechanisms underlying clinical drug resistance in @entity43 , and a close laboratory-clinical interaction is crucial.
