Salvage therapy in epithelial ovarian cancer

Treatment of patients with ovarian cancer who have tailed to respond to primary therapy, who have persistent disease after this therapy, or who develop recurrent disease at variable times following primary therapy present three different challenges to the treating physician. In only the rarest of circumstances are any of these patients curable so that clinicians must be mindful of the therapeutic index of therapy to a greater extent than in primary therapy when cure may still be possible. There are many treatments available and some will prolong both quality and quantity of life. Conversely, application of inappropriate therapy in some patients may diminish both. Selection of the correct therapy requires an in-depth knowledge of the disease process and understanding of the value and toxicities of the agents, and a truthful dialogue with the patient who must assist the treating physician in the best salvage approach.