Although significant improvements in standard therapy for ovarian carcinoma have been made over the past decade, current treatment is limited by the development of resistance to cytotoxic chemotherapy, and most women ultimately die of the disease. New knowledge of the biology of ovarian cancer has led to the identification of potential molecular targets that are differentially expressed in normal cells versus cancer cells, and advances in pharmacology have led to the development of novel agents that work differently from traditional cytotoxic chemotherapy by exploiting these targets. Many of these agents are being evaluated in clinical trials. This article discusses molecular targets that are important in ovarian carcinoma, including angiogenesis, tyrosine kinases, mitogen-activated protein kinases, and phosphatidylinositol-like kinases such as mammalian target of rapamycin, and the proteosome. This article reviews novel non-cytotoxic agents that target these pathways and are currently being evaluated in ovarian carcinoma treatment.
Lainie Martin and Russell J. Schilder
Robert J. Morgan Jr., Ronald D. Alvarez, Deborah K. Armstrong, Barry Boston, Robert A. Burger, Lee-may Chen, Larry Copeland, Marta Ann Crispens, David Gershenson, Heidi J. Gray, Perry W. Grigsby, Ardeshir Hakam, Laura J. Havrilesky, Carolyn Johnston, Shashikant Lele, Ursula A. Matulonis, David M. O'Malley, Richard T. Penson, Steven W. Remmenga, Paul Sabbatini, Russell J. Schilder, Julian C. Schink, Nelson Teng, and Theresa L. Werner
Robert J. Morgan, Ronald D. Alvarez, Deborah K. Armstrong, Robert A. Burger, Mariana Castells, Lee-may Chen, Larry Copeland, Marta Ann Crispens, David Gershenson, Heidi Gray, Ardeshir Hakam, Laura J. Havrilesky, Carolyn Johnston, Shashikant Lele, Lainie Martin, Ursula A. Matulonis, David M. O’Malley, Richard T. Penson, Steven W. Remmenga, Paul Sabbatini, Joseph T. Santoso, Russell J. Schilder, Julian Schink, Nelson Teng, Theresa L. Werner, Miranda Hughes, and Mary A. Dwyer
These NCCN Guidelines Insights focus on the major updates for the 2012 NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Ovarian Cancer by describing how and why the new recommendations were made. The 6 update topics were selected based on recent important updates in the guidelines and on debate among panel members about recent clinical trials, and include: 1) screening, 2) diagnostic tests for assessing pelvic masses, 3) primary treatment using neoadjuvant chemotherapy, 4) primary adjuvant treatment using bevacizumab in combination with chemotherapy, 5) therapy for recurrent disease, and 6) management of drug/hypersensitivity reactions. These NCCN Guidelines Insights also discuss why some recommendations were not made (eg, panel members did not feel the new data warranted changing the guideline). See “Updates” in the NCCN Guidelines for Ovarian Cancer for a complete list of all the recent revisions.