3.0 Introduction 
3.1 Overall status of treatment of ovarian cancer 
There are approximately 19,000 new cases of and 12,000 deaths from ovarian 
cancer each year (1). Mortality from ovarian cancer accounts for 6% of cancer deaths 
in females, and approximately 50% of gynecological malignancies (1). Ovarian 
cancer is staged into four catogories: Stage 1 - growth limited to ovaries, 
Stage II - growth involving one or more ovaries with pelvic extension, Stage III - tumor 
extending outside the pelvis and/or retroperitoneal or inguinal node involvement, and 
Stage IV - distant metastasis outside the peritoneal cavity. The first three stages can 
be divided into three substages of more progressive disease (a-b-c). 
Patient survival can be evaluated based on the stage of the disease at 
diagnosis. Higher stage disease correlates with a worse prognosis. Treatment of 
ovarian cancer is based on the stage of the disease. Higher stage disease is treated 
with a more aggressive course of chemotherapy. Stage I disease can be treated with 
either surgery or surgery and chemotherapy. Stage II, III, and IV patients are initially 
surgically debulked of tumor before receiving chemotherapy and/or radiation therapy. 
The treatment is based on the ability to surgically remove the tumor and the location of 
the remaining tumor. The ckug of choice to treat ovarian tumors is cisplatin. Patients in 
may be treated with intraperitoneal chemotherapy. Therefore, the technology allowing 
the insertion of fluid into the peritoneal cavity for treatment of ovarian cancer is 
established (1). 
Ovarian cancer patient survival is: Stage 1 - 80-100%, Stage II to Stage Ilia - 
30-40%, Stage II lb - 20%, and Stage II Ic to IV - 5-10%. Ovarian cancer patient 
prognosis can also be estimated by either: 1) size of largest tumor lesion at the time 
of diagnosis, or 2) diameter of the largest remaining metastatic lesion after surgical 
reduction. Patients presenting with a >10 cm tumor mass exhibited a 0% three year 
survival and a 9 month mean survival (2). Patients with a >1.5 cm tumor mass post- 
surgical reduction exhibited a 0% three year survival with a 6 month mean survival (2) 
In addition, patients who relapse only have a 10-20% response to second line therapy 
which has not been shown to prolong patient survival (3). 
The CA 125 marker has been useful in determining microscopic disease 
recurrence if the patient presented with a positive titer which decreased with treatment 
CA 125 is a cell surface glycoprotein found on ovarian tumor cells. In a patient with 
ovarian cancer, a CA 125 titer of >35 lU/ml is almost always associated with disease 
A negative titer is a poor indicator for lack of disease (4). The rising or falling of the CA 
125 titer can be used to follow the success or failure of treatment. Thus, persistently 
elevated titers during treatment usually indicates treatment failure (4). 
Recombinant DNA Research Volume 15 
