Elise C. Kohn, MD
In the past 5 years, the FDA has awarded 4 drugs 9 new indications for the treatment of advanced ovarian cancers. Although these approvals represent a welcome expansion of the therapeutic toolkit for this challenging malignancy, the arrival of new options has outpaced efforts to discover the best use for each medication.
Table. Select Phase III Randomized Trials in Ovarian Cancer (Click to Enlarge)
Until the wave of new approvals, ovarian cancer was treated almost entirely by surgery and chemotherapy and, in some subtypes, radiation. Ovarian tumors have no gain-offunction oncogenes, so they did not present any obvious point of attack for new drugs.
“Classical high-grade serous ovarian cancer, which is the most common type and the biggest killer, is a disease of genomic instability. It has dominant oncogene mutations, but none of them are important enough to tumor function to make a great target,” Kohn said. “The best treatment strategy has been increasing the genomic instability and pushing the DNA damage far enough that you kill the cell. Chemotherapy does that directly, and PARP inhibitors do it indirectly by inhibiting DNA damage repair.”Recent Drug Approvals
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