Published online Sep 26, 2014. doi: 10.4252/wjsc.v6.i4.441
Revised: July 22, 2014
Accepted: August 30, 2014
Published online: September 26, 2014
Despite significant effort and research funds, epithelial ovarian cancer remains a very deadly disease. There are no effective screening methods that discover early stage disease; the majority of patients are diagnosed with advanced disease. Treatment modalities consist primarily of radical debulking surgery followed by taxane and platinum-based chemotherapy. Newer therapies including limited targeted agents and intraperitoneal delivery of chemotherapeutic drugs have improved disease-free intervals, but failed to yield long-lasting cures in most patients. Chemotherapeutic resistance, particularly in the recurrent setting, plagues the disease. Targeting the pathways and mechanisms behind the development of chemoresistance in ovarian cancer could lead to significant improvement in patient outcomes. In many malignancies, including blood and other solid tumors, there is a subgroup of tumor cells, separate from the bulk population, called cancer stem cells (CSCs). These CSCs are thought to be the cause of metastasis, recurrence and resistance. However, to date, ovarian CSCs have been difficult to identify, isolate, and target. It is felt by many investigators that finding a putative ovarian CSC and a chemotherapeutic agent to target it could be the key to a cure for this deadly disease. This review will focus on recent advances in this arena and discuss some of the controversies surrounding the concept.
Core tip: Ovarian cancer stem cells (CSCs) are difficult to isolate, identify, and target. However, they are often thought to be the source of development of chemoresistance. Finding a therapeutic target in ovarian CSCs and identifying the mechanisms associated with the development of chemoresistance may lead to a long-lasting cure for patients with epithelial ovarian cancer.