Resistance to chemotherapy in advanced ovarian cancer: mechanisms and current strategies

Although treatment for advanced epithelial ovarian cancer has improved over recent years with the introduction of taxane–platinum chemotherapy, the majority of patients will relapse, and in most the disease remains incurable. A thorough understanding of drug resistance mechanisms is needed, as this remains the largest obstacle in treating patients with recurrent disease. Multidrug resistance proteins, mismatch repair processes and alterations in the p53 pathway are examples of properties within tumour cells that may lead to drug resistance. Novel agents designed to circumvent these mechanisms (e.g. PSC 833, ONYX-015 and ADP53) are currently being investigated for ovarian cancer patients. Further improvements may result from the optimisation of existing first-line regimens with more creative schedules, perhaps involving sequential or intraperitoneal administration of existing drugs, and the incorporation of newer noncross-resistant drugs.