Targeted Therapies in the Management of Ovarian Cancer: A Focus on Older Patients
Targeted Therapies in the Management of Ovarian Cancer: A Focus on Older Patients
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DOI：
10.1007/s40266-017-0495-1
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发表时间：
2017-10
期刊：
影响因子：
2.8
通讯作者：
C. Lum;C. Steer
中科院分区：
文献类型：
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作者：
C. Lum;C. Steer
卵巢癌是最常见的妇科恶性肿瘤之一，也是女性癌症死亡的主要原因之一。卵巢癌的标准治疗是最大限度的减瘤手术，然后辅助铂类化疗。诊断时的中位年龄为63岁，但老年患者在临床试验中的代表性不足。从历史上看，65岁一直被用作老年人的定义;然而，这样的年龄截止值涵盖了在合并症、功能状态和认知方面高度异质的人群。新的靶向治疗正在卵巢癌的治疗中出现，最有经验的是贝伐单抗和聚（ADP-核糖）聚合酶（PARP）抑制剂。这些药物在选定的试验人群中显著改善了无进展生存期。虽然在老年女性中使用这些药物的证据有限，但似乎没有任何疗效差异的信号。使用现有数据探索了合并症的老年人中毒性增加的潜在风险。在老年卵巢癌患者中应用新的靶向治疗需要更多的证据，并且需要改善老年患者的临床试验。
Ovarian cancer is one of the most common gynaecological malignancies and one of the leading causes of cancer mortality in women. The standard of care for ovarian cancer is maximal de-bulking surgery followed by adjuvant platinum-based chemotherapy. The median age at diagnosis is 63 years, yet older patients are under-represented in clinical trials. Historically, 65 years of age has been used as a definition of elderly; however, such an age cut-off encompasses a highly heterogeneous population with regards to comorbidity, functional status, and cognition. New targeted therapies are emerging in the treatment of ovarian cancer, with the most experience being with bevacizumab and poly(ADP-ribose) polymerase (PARP) inhibitors. These agents have led to significant improvements in progression-free survival in selected trial populations. Whilst evidence for the use of these agents in older women is limited, there appears to be no signal for any difference in efficacy. The potential risk of increased toxicity in older adults with comorbidities is explored using the data available. More evidence is needed in the application of newer targeted therapies in older women with ovarian cancer, and improved accrual of older patients to clinical trials is required.