Sensitivity and resistance to treatment in the primary management of epithelial ovarian cancer

Ovarian carcinoma is the most lethal gynaecologic malignancy. Despite wide initial sensibility to chemotherapy especially to platinum-based regimens, the vast majority of patients with advanced stages of the disease develop recurrences and subsequent resistance to treatments. Ovarian cancer is actually considered as a heterogeneous disease at the clinical, histological and molecular level. In this review, the mechanisms of intrinsic sensitivity or resistance to treatment, especially to platinum-based chemotherapy are considered with particular reference to the significance of tumour heterogeneity. The molecular features involved in acquired resistance are reviewed and the current-hypotheses are discussed. In particular, potential disruptions of the DNA reparation pathways are highlighted. (C) 2013 Elsevier Ireland Ltd. All rights reserved.