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Immunologic Approaches to Ovarian Cancer Treatment

Paul Sabbatini, Kunle Odunsi

From the Medical Gynecologic Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York; and Division of Gynecologic Oncology, Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY

Address reprint requests to Paul Sabbatini, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, H906, New York, NY 10021; e-mail: sabbatip{at}mskcc.org

The clinical course of ovarian cancer is often marked by periods of relapse and remission until chemotherapy resistance develops. Patients in remission with minimal disease burdens are ideally suited for the evaluation of immune-based strategies. The role of immune surveillance in improving outcome has been supported by the correlation of increased survival with the presence or absence of tumor-infiltrating lymphocytes in a given patient. Major obstacles to the development of successful immune strategies include the identification of tumor-restricted immunogenic targets, generation of a sufficient immune response to cause tumor rejection, and approaches to overcome evasion of immune attack. As optimal strategies are being developed, many questions remain. Some of the questions are as follows: What is the best antigen form (eg, peptides, proteins, or tumor lysates)? What are the appropriate adjuvants? Are monovalent or multivalent vaccines likely to be more effective? What is the optimal frequency and duration of vaccination? How should antigen-specific responses be monitored? How should the anticancer response be maintained? In this review, we will explore representative examples of immune strategies under investigation for patients with ovarian carcinoma that illustrate many of these issues. We will review ongoing phase III studies for patients in first clinical remission. Basic principles generic to all these immunotherapeutic approaches will be discussed in the hopes of yielding the most promising results as the field continues to evolve.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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