Bulletin du cancer
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Ovarian cancers are the leading cause of death from gynaecological malignancies in Western countries. Despite optimal treatment combining surgery and chemotherapy, relapse is observed in the majority of patients. This review aims to present the results of trials having evaluated new drugs in ovarian cancers. ⋯ PARP and mTOR inhibitors may also represent a significant therapeutic improvement. It remains to confirm the interest of these new approaches by assessing the benefit on overall survival. The goal remains to individualize and to tailor the drugs to the tumour biology, in order to provide personalized treatment to each patient.
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Hyperthermic intraperitoneal chemotherapy (HIPEC) represents a new treatment strategy aimed to improve outcome of patients with advanced ovarian cancer. Based on theoretical and experimental basis, HIPEC should stand as an effective treatment for ovarian cancer. ⋯ Before this technique can be routinely used, some controversial aspects have to be defined: which drug is the best to deliver and at what temperature, is it necessary to use mono- or poly-chemotherapy regimens, which is the time-point for HIPEC in the natural history of ovarian cancer: at front-line therapy, at interval debulking following initial neo-adjuvant chemotherapy, at consolidation following front-line therapy, or at the time of recurrence. Nevertheless, we must not forget that the most important issue in ovarian cancer prognosis is maximal cytoreductive surgery, with no residual disease at completion of initial surgery.
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Intraperitoneal chemotherapy is a very attractive therapeutic alternative in the treatment of advanced ovarian carcinoma, due to its intraperitoneal spreading. Pharmacokinetic rational was described 30 years ago: a drug administered within the peritoneal cavity diffuse through the peritoneum towards the plasmatic compartment, depending on both its molecular weight and its lipid solubility. A slow output of the drug from the peritoneal cavity and a high plasma clearance are associated with a great pharmacokinetic advantage, illustrated by the area under the concentration time curve ratio. ⋯ The peripheral penetration being however limited to the first cellular layers, this way of delivery is interesting only for small residual disease. The most active drugs in the treatment of ovarian cancer, paclitaxel and platinum agents, are particularly convenient for this way of administration. The most optimal administration modality still remains to be defined and the development of the targeted therapies still opens new perspectives.