Future directions.

Although uncontrolled studies and anecdotal reports of high-dose chemotherapy with marrow reconstitution appear promising, the highly selected nature of the patients and the expense of the procedures mandate that randomized, comparative trials demonstrate the superiority of this approach over standard therapy before it can be considered a valid part of the therapeutic armamentarium. Such a study is underway with very poor accrual.

Intraperitoneal administration of drug, although under study for over a decade, still has no defined role in management. In the salvage setting, it appears to have no advantage over intravenous therapy. In the setting of first-line treatment, two large randomized trials in patients with small-volume disease show small advantages but have major design problems. The final determination of the role, if any, for intraperitoneal therapy awaits the completion of the current trial comparing intravenous paclitaxel-platinum to intraperitoneal paclitaxel-platinum. If a role for intraperitoneal therapy exists, data show that it will be in only those patients with extremely small-volume disease or perhaps no residual disease; hence, its role will be a very narrow one.
Breast cancer
In conclusion, the future holds the promise of continuing advances in the management of patients with celomic epithelial carcinoma of the ovary. Although the explosion of knowledge of the basic nature of the disease holds the greatest potential for improvement, the identification of an effective screening technique, the clarification of the role of surgery in advanced disease, and the introduction of exciting new agents such as Taxol offer the promise of better treatment in the immediate future. The great promise of dose-intense regimens, still worthy of further investigation, suffers from a growing body of evidence that no advantage is obtained at least over the clinically achievable range of doses unsupported by marrow reconstitution.

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