title: Trials with impact on clinical management: first line.
abstract: BACKGROUND
  Advanced-stage epithelial ovarian cancer is generally managed with cytoreductive surgery and chemotherapy consisting of carboplatin and paclitaxel. Although initially responsive, most tumors recur and demonstrate progressive chemotherapy resistance. During the last 20 years, many thousands of women have participated in international front-line phase 3 trials that have contributed to our understanding of ovarian cancer biology and helped to define optimal treatment strategies. Emerging data from these trials need to be interpreted within an evolving paradigm of cancer biology, disease management, and availability of clinical resources.
  
  
  METHODS
  Survey of recent phase 3 trials and emerging principles of ovarian tumor biology.
  
  
  RESULTS
  There is no evidence that adding a third cytotoxic agent improves clinical outcomes. However, weekly dose-dense scheduling of paclitaxel appears superior to standard dosing.
  
  
  CONCLUSIONS
  Primary therapy with carboplatin and paclitaxel remains a well-tolerated standard regimen, including the option of weekly paclitaxel dosing. Data are awaited from completed trials incorporating bevacizumab. Emerging biological paradigms will contribute to individualized treatment options in the future.
authors: Arizona Cancer Center, 1515 N Campbell Avenue, Tucson, AZ 85724-5024, USA. mbookman@azcc.arizona.edu
authors: Michael A
authors: MA
authors: Bookman
mesh_terms: D017326:Clinical Trials, Phase III as Topic / Q000379:methods* / Q000592:standards; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D017410:Practice Guidelines as Topic / Q000592:standards