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晚期卵巢癌:一线治疗、复发性疾病及新型药物的临床进展

Advanced ovarian cancer: a clinical update on first-line treatment, recurrent disease, and new agents.

作者信息

Ozols Robert F

机构信息

Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.

出版信息

J Natl Compr Canc Netw. 2004 Sep;2 Suppl 2:S60-73.

Abstract

Platinum-based therapy plays an integral role in the first-line treatment of advanced ovarian cancer as well as in the recurrent disease setting. In advanced disease, the standard of care in the United States is maximal surgical cytoreduction followed by paclitaxel/carboplatin chemotherapy. Results from the Gynecologic Oncology Group COG 158 trial show that paclitaxel/carboplatin is at least as effective as paclitaxel/cisplatin and is better tolerated and easier to administer. Three randomized phase III trials suggest that intraperitoneal chemotherapy may provide superior progression-free or overall survival relative to systemic chemotherapy, but at the price of increased toxicity. Results from COG 178 showed that prolonged maintenance paclitaxel therapy improved progression-free survival of patients with clinical complete responses to first-line chemotherapy. The ongoing COG 182 protocol for advanced ovarian cancer is comparing 8 cycles of paclitaxel/carboplatin with 4 experimental combinations incorporating topotecan, gemcitabine, or encapsulated doxorubicin. Currently, no randomized GOG trial evaluates maintenance or intraperitoneal therapy for advanced disease. With recurrent disease, a treatment-free interval of more than 6 months is an important predictor of platinum sensitivity. In this setting, carboplatin has been the cornerstone of treatment. Recent results from the International Collaborative Ovarian Neoplasm ICON 4 trial indicate that paclitaxel/carboplatin may offer superior efficacy to single-agent carboplatin. Additional randomized comparisons of carboplatin versus other carboplatin combinations are in progress. Finally, a variety of new cytotoxic and biologic agents are being evaluated in recurrent disease, either as single agents or in combination with standard chemotherapy.

摘要

铂类疗法在晚期卵巢癌的一线治疗以及复发性疾病治疗中发挥着不可或缺的作用。在晚期疾病中,美国的标准治疗方案是最大限度的手术细胞减灭术,随后进行紫杉醇/卡铂化疗。妇科肿瘤学组(Gynecologic Oncology Group,GOG)COG 158试验结果表明,紫杉醇/卡铂至少与紫杉醇/顺铂疗效相当,且耐受性更好、给药更方便。三项随机III期试验表明,与全身化疗相比,腹腔化疗可能提供更好的无进展生存期或总生存期,但代价是毒性增加。COG 178结果显示,延长维持性紫杉醇治疗可改善对一线化疗临床完全缓解患者的无进展生存期。正在进行的针对晚期卵巢癌的COG 182方案正在比较8个周期的紫杉醇/卡铂与4种包含拓扑替康、吉西他滨或脂质体阿霉素的实验性联合方案。目前,尚无GOG随机试验评估晚期疾病的维持治疗或腹腔治疗。对于复发性疾病,无治疗间隔超过6个月是铂敏感性的重要预测指标。在这种情况下,卡铂一直是治疗的基石。国际卵巢癌协作组(International Collaborative Ovarian Neoplasm,ICON)ICON 4试验的最新结果表明,紫杉醇/卡铂可能比单药卡铂疗效更好。卡铂与其他卡铂联合方案的其他随机比较正在进行中。最后,多种新的细胞毒性和生物制剂正在复发性疾病中进行评估,要么作为单药,要么与标准化疗联合使用。

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