Nayl B, Cabrespine-Faugeras A, Maliki Ym, Bay J-O
Centre Jean-Perrin, Département de médecin oncologique, 58 Rue Montalembert, 63011 Clermont-Ferrand, France.
Bull Cancer. 2009 Dec;96(12):1225-32. doi: 10.1684/bdc.2009.1004.
For several years, research for treatment of advanced ovarian cancer in first line or in relapse was made on the basis of two concepts. The first one is to improve the response rate by increasing the dose of chemotherapy delivered by high dose chemotherapy consolidation. The second concept is the development of an immunological antitumoral effect following allogeneic hematopoietic stem cells transplantation (HSC). The autologous HSC transplantation is required to first concept because of medullar toxicities induced by high dose chemotherapy. This therapeutic was widely studied in first line of advanced ovarian cancer. The recent phases III demonstrate an increase of the toxicity without efficacy improvement compared with the standard doses of chemotherapy. In relapse, the response rate is improved but an important toxicity is observed with low response duration. Evaluation of high dose of topotecan in association with the carboplatine is currently on going. Allogeneic HSC transplantation presents a potential interest because of immunogeneic control against tumour. However, the direct proof of immunotherapy efficacy on OC in a clinical study is still missing, toxicities should not be disregarded.
数年来，针对晚期卵巢癌一线治疗或复发治疗的研究基于两个概念展开。第一个概念是通过高剂量化疗巩固增加化疗剂量来提高缓解率。第二个概念是异基因造血干细胞移植（HSC）后产生免疫抗肿瘤效应。由于高剂量化疗会引起骨髓毒性，自体HSC移植是第一个概念所必需的。这种治疗方法在晚期卵巢癌一线治疗中得到了广泛研究。最近的III期试验表明，与标准化疗剂量相比，毒性增加但疗效并未改善。在复发时，缓解率有所提高，但观察到重要毒性且缓解持续时间较短。目前正在评估高剂量拓扑替康联合卡铂的疗效。异基因HSC移植因其对肿瘤的免疫原性控制而具有潜在意义。然而，临床研究中免疫疗法对卵巢癌疗效的直接证据仍然缺失，毒性也不容忽视。
