Malignant ascites in ovarian cancer and the role of targeted therapeutics.

Ovarian cancer (OC) is the eighth most lethal gynecological malignancy and the main cause of gynecological cancer death in industrialized countries. Malignant ascites is often found in OC, with about 10% of patients suffering from recurrent OC. Tumor cells in OC-associated malignant ascites promote disease recurrence and patient mortality is mainly associated with widespread metastasis to serosal surfaces and accompanying peritoneal effusions. Targeted therapies have recently been developed as novel therapeutic options for malignant ascites. The tri-functional anti-epithelial cell adhesion molecule and anti-cluster of differentiation 3 monoclonal antibody catumaxumab has been assessed in the therapy of malignant ascites, and proven to significantly reduce the ascitic flow rate when applied into the peritoneal cavity. The anti-angiogenic targeted agent bevacizumab has also shown good effects in the symptomatic treatment of malignant ascites, significantly prolonging the time until the next paracentesis. Vascular endothelial growth factor (VEGF) Trap, or aflibercept, is a fusion protein that inhibits VEGF-receptor binding. Aflibercept has proven to be effective in reduction of ascites, diminishing clinical symptoms of ascites and prolonging the time to next paracentesis. All three agents we review in the present article are effective in symptomatic control of ascites, leading to a rapid reduction of effusion and prolonging the time interval between paracenteses. However, no improvement in overall survival was observed in any of the clinical trials reported. We, thus, conclude that further investigations on larger patient series are needed to clarify whether the reduction of ascites by these targeted agents leads to a prolongation in tumor-related survival or not.