Achievements and unmet needs in the management of advanced ovarian cancer
Achievements and unmet needs in the management of advanced ovarian cancer
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DOI：
10.1016/j.ygyno.2009.11.033
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发表时间：
2010-05-01
影响因子：
4.7
通讯作者：
Conte, Pier Franco
中科院分区：
文献类型：
--
作者：
Guarneri, Valentina;Piacentini, Federico;Conte, Pier Franco
卵巢癌是第二大常见妇科恶性肿瘤，是欧洲和美国妇科癌症相关死亡的主要原因。事实上，大多数病例被诊断为晚期，治愈的机会有限。晚期卵巢癌的最佳治疗包括组织病理学诊断、准确的手术分期、减体积手术和铂基化疗。由于耐受性和活性，卡铂和紫杉醇的联合治疗通常被认为是标准方案。腹腔化疗具有较好的疗效，但由于其耐受性和依从性较差，其使用仍存在争议。不幸的是，尽管它具有化疗敏感性，但大多数卵巢癌患者，包括那些对一线化疗完全有效的患者，都会复发并最终死亡。在改善患者预后的策略中，维持治疗未能在临床试验中显示出一致的益处。挽救二线治疗通常是基于铂敏感性疾病患者铂的再挑战。铂耐药/难治患者可能受益于阿霉素或拓扑替康脂质体。其他活性细胞毒素包括多西他赛、吉西他滨、依托泊苷和长春瑞滨，以及仍在开发中的艾替龙衍生物，如帕匹龙。在靶向药物中，抗血管生成药物贝伐单抗似乎非常有前景，并且正在积极研究与一线化疗联合使用。最近，在brca突变肿瘤患者中使用聚adp核糖聚合酶（PARP）抑制剂获得了有趣的结果。(C) 2009爱思唯尔公司版权所有。
Ovarian cancer is the second most common gynaecological malignancy, and represents the leading cause of gynecologic cancer-related death in Europe and United States. The majority of the cases are in fact diagnosed in advanced stage, with limited chance to be cured.Optimal management of advanced ovarian cancer includes histopathological diagnosis, accurate surgical staging, debulking surgery and platinum-based chemotherapy. The combination of carboplatin and paclitaxel is commonly recognised as the standard regimen because of tolerability and activity. Intraperitoneal chemotherapy provides superior efficacy results, but its use is still controversial because of poor tolerability and compliance. Unfortunately, despite its chemosensitivity, the majority of ovarian cancer patients, including those who achieve a complete response to first-line chemotherapy, will relapse and eventually die. Among the strategies to improve patient outcome, maintenance therapy has failed to show a consistent benefit across clinical trials. Salvage second-line therapy is generally based on rechallenge with platinum in patients with platinum sensitive disease. Patients with platinum resistant/refractory might benefit from liposomal doxorubicin or topotecan. Other active cytotoxics include docetaxel, gemcitabine, etoposide and vinorelbine as well as epothilone derivatives such as patupilone which is still in development. Among targeted agents, the antiangiogenic agent bevacizumab seems extremely promising and is actively investigated in combination with first-line chemotherapy. More recently, interesting results have been obtained with the inhibitors of poly-ADP-ribose polymerase (PARP) in patients with BRCA-mutated tumors. (C) 2009 Elsevier Inc. All rights reserved.