High-dose chemotherapy of ovarian cancer followed by bone marrow transplantation or peripheral blood stem cell support

Ovarian cancer is a chemosensitive neoplasm. Unfortunately, only 5% of patients with the advanced disease can survive 5 years. It is a well-known paradigm that an intensive chemotherapy should overcome platinum resistance. Whether the intensive chemotherapy for ovarian cancer could be translated into a longer survival is a central goal of studies but still remains unclear. A number of early clinical trials have been performed. All data that have been gained so far are not strong enough to accept a high-dose chemotherapy as a widely used modality for ovarian cancer therapy. Therefore, I have reviewed results of the most valuable clinical trials in either adjuvant or salvage therapy, and ones carried out in the neoadjuvant setting. The latter is a novel field in the therapy of ovarian cancer mostly as a semi-high-dose chemotherapy used in the neoadjuvant setting. This therapy potentially offers a 70% overall response rate in patients with advanced non-operable ovarian cancer. I have looked through the mechanisms of resistance of ovarian cancer against cytotoxic agents. The most important antineoplastic agents seem to be platinum analogs and taxanes. Having discussed the high-dose chemotherapy, I have shown issues that need to be explained and are associated with malignant contamination of autologous stem cells infused to patients. However, there are no data on effects of the contamination on results for high-dose chemotherapy followed by autologous bone marrow transplantation or peripheral stem cell support in ovarian cancer patients. The new directions to combat ovarian cancer are based upon the target therapy which in turn could be used only when examining the biology of human ovarian cancer.