Over the past two years, doctors have beefed up their chemo- therapy arsenal against ovarian cancer from two drugs to about 10.
Yet the truth remains: Survival rates are only 20 percent to 25 percent for those with advanced disease.
Since 1971, as deaths from cervical cancer plummeted by 50 percent, ovarian cancer deaths rose by 50 percent, in part because there are still no routine screening tests. Most ovarian cancer is found only after it has spread. But for those who are diagnosed early, the cure rate is 90 percent.
Treatment starts with "debulking" surgery to remove as much cancer as possible. Often, microscopic cancer cells remain, so chemotherapy is next. Here's what's new on that front:
Topotecan, gemcitabine and vinelrelbine are the latest of about 10 drugs doctors now have to fight the disease, providing options for women who can't tolerate one or another drug. Cisplatinum has been around 15 years; Taxol about four. Carboplatinum, a newer platinum drug, has fewer side effects.
Chemo delivered directly into the abdomen, or intraperitoneally, allows doctors to give a stronger dose with less toxic effects on the rest of the body. If a surgical look after chemo shows no cancer, patients may get a shorter round of chemo to prevent recurrence.
Doctors can also target cancer cells by "clustering" older drugs in liposomes, the microscopic fatty sacs in cells.
* Stem cell replacement: Doctors are working on zapping cells with chemo, a process in which they inject growth-factor material, harvest early white blood cells from the bone marrow, multiply them in labs, then return them to the patient -- after a patient has had a second chemo treatment. Patients who benefit most are those with small-volume disease after surgery.
* Anti-angiogenesis: Drugs are being used and developed to cut off blood supplies to the cancers.