Second-Line Chemotherapy for Platinum- and Taxane-Resistant Epithelial Ovarian Cancer: Pegylated Liposomal Doxorubicin (PLD), Irinotecan, and Combination Therapies at Lower Doses

Epithelial ovarian cancer is sensitive to chemotherapy and approximately 75% of patients achieve complete clinical remission after the initial treatment. However, most develop a recurrence which results in death after a chronic course. Therefore, most patients are candidates for second-line chemotherapy, including approximately 20% among of these patients with platinumand taxane-resistant disease. Patients with platinum-and taxaneresistant disease have poor outcomes, and most would like to prolong their survival with relieved symptoms and the best possible quality of life (QOL). The effects of several drugs which are being used for these purposes are similar, but it is usually difficult to relieve recurrent disease with one drug. Monotherapy has been generally chosen for having the most favorable toxicity profile in patients with platinumand taxane-resistant disease. However, it is not clear whether this strategy is optimal with the various novel anticancer drugs and targeted agents under development. In this article, pegylated liposomal doxorubicin (PLD), which is used worldwide, and irinotecan, the predominant agent in Japan for the treatment of platinumand taxane-resistant ovarian cancer, are evaluated for their effects and toxicity in monotherapy and in combination at lower doses with other drugs.