ABSTRACT
Epithelial carcinoma of the ovary carries a poor prognosis, as most patients are diagnosed at a relatively late stage of development of the disease. Because only a minority of ovarian cancer patients are diagnosed with localized, surgically curable disease, systemic chemotherapy is the treatment modality for the majority of patients suffering from this tumor. Cisplatin-based combination regimens are the basis for most treatment schedules in advanced ovarian cancer, resulting in a median survival of 21-30 months. In these regimens, cisplatin may be combined with cyclophosphamide and doxorubicin. Even patients who achieve a pathological complete remission (pCR) after systemic treatment will have disease recurrence after 5 years in about 70% of cases. These data show that the greater part of patients will ultimately die of their disease as the result of intrinsic or acquired resistance to chemotherapeutic drugs. This phenomenon is the major obstacle in the management of patients with advanced-stage ovarian cancer and is responsible for the poor outlook for these patients (1,2). Therefore, many studies have been directed at the improvement of treatment results. Although our understanding of cell biology and genetic changes involved in drug resistance is developing rapidly, transferral of this knowledge to the clinic is just beginning. In this chapter, we address a number of factors known to be associated with drug resistance in human ovarian cancer, and we describe options used to treat potential drug resistance in the clinic.
