González-Martín A
Medical Oncology Service, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Int J Gynecol Cancer. 2005 Nov-Dec;15 Suppl 3:241-6. doi: 10.1111/j.1525-1438.2005.00436.x.
Recurrent ovarian carcinoma is normally an incurable disease situation in which chemotherapy is the usual treatment for palliation. The probability of response to chemotherapy depends on the time from last chemotherapy and the previous response observed. The issue of combination chemotherapy versus monotherapy is a clinically relevant dilemma for medical and gynecologic oncologist involved in the treatment of recurrent patients. In those patients with platinum-resistant relapse, combination chemotherapy has been associated with higher toxicity without a clear clinical benefit in randomized clinical trials. Therefore, a less toxic sequential monotherapy approach should be the choice for resistant patients. On the other hand, two large randomized clinical trials have proved the superiority of a platinum-based doublet over platinum monotherapy in platinum-sensitive recurrent patients. The ICON-4/AGO-OVAR 2.2 trial demonstrated that the combination of paclitaxel-carboplatin (or cisplatin) is likely to provide a survival benefit compared with carboplatin monotherapy. This benefit was more clear in patients with a treatment free-interval >12 months. Moreover, the AGO-OVAR 2.5 trial, with the cooperation of NCIC CTG and EORTC GCG, has confirmed the advantage in response rate and progression free survival of the doublet carboplatin-gemcitabine compared to carboplatin.
复发性卵巢癌通常是一种无法治愈的疾病状况，化疗是常用的姑息治疗方法。对化疗产生反应的概率取决于距上次化疗的时间以及之前观察到的反应情况。对于参与复发性患者治疗的医学和妇科肿瘤学家而言，联合化疗与单一疗法的问题是一个具有临床相关性的两难困境。在那些铂耐药复发的患者中，在随机临床试验中，联合化疗的毒性更高，但并无明确的临床益处。因此，毒性较小的序贯单一疗法应是耐药患者的选择。另一方面，两项大型随机临床试验已证明，在铂敏感的复发性患者中，铂类双联疗法优于铂单一疗法。ICON - 4/AGO - OVAR 2.2试验表明，与卡铂单一疗法相比，紫杉醇 - 卡铂（或顺铂）联合使用可能带来生存益处。这种益处在无治疗间隔大于12个月的患者中更为明显。此外，由NCIC CTG和EORTC GCG合作开展的AGO - OVAR 2.5试验已证实，与卡铂相比，卡铂 - 吉西他滨双联疗法在缓解率和无进展生存期方面具有优势。
