Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
J Gynecol Oncol. 2018 Mar;29(2):e31. doi: 10.3802/jgo.2018.29.e31.
In 2017, 10 topics were selected as major clinical research advances in gynecologic oncology. For cervical cancer, efficacy and safety analysis results of a 9-valent human papillomavirus (HPV) vaccine and long-term impact of reduced dose of quadrivalent vaccine were updated. Brief introduction of KEYNOTE trials of pembrolizumab, a monoclonal antibody that blocks the interaction between programmed death (PD)-1 and its ligands, PD-L1 and PD-L2, followed. Tailored surveillance programs for gynecologic cancer related with Lynch syndrome and update on sentinel lymph node mapping were reviewed for uterine corpus cancer. For ovarian cancer, 5 topics were selected including poly(ADP-ribose) polymerases inhibitors and immunotherapy. The other potential practice changers covered in this review were lymphadenectomy in advanced disease, secondary cytoreductive surgery in recurrent disease, weekly dose-dense regimen for first-line chemotherapy, incorporation of bevacizumab maintenance in platinum-sensitive recurrent disease, and effect of platinum-free interval prolongation. Conflicting opinions of academic societies on periodic pelvic examination were introduced in conjunction with relevant literature review. For the field of radiation oncology, results of 2 big trials, The Postoperative Radiation Therapy in Endometrial Carcinoma-3 and Gynecologic Oncology Group-258, for endometrial cancer and recent advance in high-dose-rate brachytherapy for cervical cancer were reported. Topics for breast cancer covered adjuvant capecitabine after preoperative chemotherapy, adjuvant pertuzumab and trastuzumab in early human epidermal growth factor receptor 2-positive disease, olaparib for metastatic cancer in patients with a germline BRCA mutation, 20-year risks of recurrence after stopping endocrine therapy at 5 years, and contemporary hormonal contraception and the risk of breast cancer.
2017 年,10 个主题被选为妇科肿瘤学的主要临床研究进展。在宫颈癌方面,九价人乳头瘤病毒(HPV)疫苗的疗效和安全性分析结果以及四价疫苗减少剂量的长期影响得到了更新。简要介绍了 pembrolizumab 的 KEYNOTE 试验,这是一种阻断程序性死亡(PD)-1与其配体 PD-L1 和 PD-L2 之间相互作用的单克隆抗体。对与 Lynch 综合征相关的妇科癌症的定制监测计划和子宫体癌的前哨淋巴结绘图更新进行了回顾。在卵巢癌方面,选择了 5 个主题,包括聚(ADP-核糖)聚合酶抑制剂和免疫疗法。该综述涵盖的其他潜在实践改变因素包括晚期疾病的淋巴结切除术、复发性疾病的二次细胞减灭术、一线化疗的每周剂量密集方案、贝伐单抗维持治疗在铂类敏感复发性疾病中的应用以及无铂间期延长的效果。结合相关文献回顾,介绍了学术团体对定期盆腔检查的不同意见。在放射肿瘤学领域,报道了两项大型试验——子宫内膜癌术后放疗-3 和妇科肿瘤学组-258 的结果,这两个试验针对子宫内膜癌,以及宫颈癌高剂量率近距离放射治疗的最新进展。乳腺癌涵盖的主题包括术前化疗后的辅助卡培他滨、早期人表皮生长因子受体 2 阳性疾病中的辅助培妥珠单抗和曲妥珠单抗、用于有胚系 BRCA 突变的转移性癌症的奥拉帕利、停止 5 年后内分泌治疗后 20 年的复发风险以及当代激素避孕与乳腺癌风险。