Recurrent ovarian cancer: How important is it to treat to disease progression?
Recurrent ovarian cancer: How important is it to treat to disease progression?
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DOI：
10.1158/1078-0432.ccr-04-0683
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发表时间：
2004-11-15
影响因子：
11.5
通讯作者：
Herzog, TJ
中科院分区：
文献类型：
--
作者：
Herzog, TJ
卵巢癌越来越被认为是一种慢性疾病，其治疗通常以使用多种连续的活性药物为特征，每种药物可能伴随也可能不伴随肿瘤反应。尽管有很大比例的患者复发并接受长期治疗，但最佳治疗时间的问题迄今尚未得到充分解决。对于在治疗中取得进展的患者，答案很简单：他们被切换到另一种活性药物，可能与以前的治疗具有不同的作用机制，理想情况下，重叠毒性有限。然而，对于保持部分反应或病情稳定的患者，答案就不那么明显和明确了。大多数肿瘤学家；相信超过6个疗程的治疗不会给患者带来任何额外的好处。有一些数据支持这种治疗策略。然而，随着新的，毒性较小的药物的出现，治疗进展应进一步探索。潜在适合延长治疗间隔的药物可能包括以下特性：无累积毒性、无交叉耐药、对生活质量的积极益处和方便的时间表。一些卵巢癌的活性药物（铂、紫杉醇、拓扑替康、脂质体阿霉素、多西他赛、吉西他滨和依托泊苷）将在已知的累积毒性、对患者生活质量的潜在不良影响以及长期治疗的潜在益处的背景下进行审查。
Ovarian cancer is increasingly recognized as a chronic disease whose treatment is often characterized by administration of multiple, sequential active agents, each of which may or may not be accompanied by a tumor response. Despite the large proportion of patients who relapse and undergo longer-term treatment, the question of optimal treatment duration has not been fully addressed to date. For patients who progress on therapy, the answer is straightforward: they are switched to another active agent, presumably having a different mechanism of action from previous therapies with, ideally, limited overlapping toxicities. However, for patients who remain in partial response or who have stable disease, the answer is less apparent and less clear. The majority of oncologists; believe that treatment beyond 6 cycles of a given therapy does not provide any additional benefit to patients. There are some data to support that treatment strategy. However, with the advent of new, less toxic agents, treatment to progression should be further explored. Agents that are potentially well suited for extended treatment intervals may include such properties as absence of cumulative toxicity, non-cross-resistance, positive benefit on quality of life, and convenient schedule. A number of active agents in ovarian cancer (platinum, paclitaxel, topotecan, liposomal doxorubicin, docetaxel, gemcitabine, and etoposide) will be reviewed in the context of what is known about cumulative toxicity, potential adverse effects on patients' quality of life, and evidence addressing the potential benefits of longer-term treatment.