Multiple Choice Questions

1. There is no rationale for delivering more than three different chemotherapy regimens in ovarian cancer as the chances of producing serious side effects beyond this number of regimens far outweighs the opportunity for clinical benefit
   
2. The overall “duration of survival” following initial disease progression in ovarian cancer now frequently exceeds the time from diagnosis to the date of initial progression
   
3. There are no oral agents with known activity in ovarian cancer currently available for routine clinical use
   
4. None of the above

Increasingly, patients with ovarian cancer are able to experience extended survival (including prolonged survival after initial progression following front-line platinum–taxane chemotherapy) due to the activity of multiple active anti-neoplastic agents in this malignancy. There are no reasonable arbitrary limits on the number of chemotherapy regimens that may be employed, assuming care is taken to minimize the risk of excessive and sustained toxicity. Several oral anti-neoplastic agents (e.g., tamoxifen, etoposide, and altretamine) are utilized in routine clinical practice in the management of ovarian cancer.

1. Activating mutations in epidermal growth factor receptor
   
2. Her2 overexpression
   
3. BRAF mutations
   
4. None of the above

There are currently no molecular or genomic markers of known clinical relevance in the treatment of ovarian cancer. Provocative data have suggested the utility of PARP inhibitors in ovarian cancer patients with BRCA1 and BRCA2 mutations, but there are unfortunately currently no such anti-neoplastic agents available for routine clinical use.

1. Any benefit of surgery may result from selection bias associated with the patient population chosen to undergo such surgery (e.g., superior performance status and fewer comorbidities)
   
2. Any benefit of surgery may result from similar biological factors that influence the ability to successfully surgically cytoreduce the cancer and that determine the growth, spread, and development of drug resistance
   
3. Both A and B
   
4. Neither A nor B

Both of the issues of “selection bias” and “similar biological factors” are critical factors in any discussion of the relevance of retrospective analyses in defining the utility of secondary cytoreduction in ovarian cancer. As a result of the compounding influence of these factors, only the conduct of a well-designed randomized phase III trial can resolve the issue.