a GINECO/TMRO Network , Centre Léon Bérard & Université Claude Bernard , Lyon , France.
Expert Rev Anticancer Ther. 2018 Oct;18(sup1):9-11. doi: 10.1080/14737140.2018.1515630.
In patients with recurrent ovarian cancer, there are certain situations where further surgery and/or next-line platinum-based chemotherapy is not feasible or is not the best option. Multidisciplinary teams have a key role in reviewing available options and selecting the most appropriate intervention.
A case study of relapsed ovarian cancer illustrates some of the factors that shape decision-making and shows the potential of a non-platinum-based regimen in the context of limited platinum sensitivity.
Taking into account the patient's individual circumstances, many options were discarded by the tumor board. Further surgery was not recommended as initial surgery had been suboptimal. Platinum-based regimens incorporating bevacizumab were not indicated due to exposure to bevacizumab in the first-line setting. Other platinum-based regimens were not recommended in general, due to limited platinum sensitivity (relapse <12 months after previous platinum) and unacceptable toxicity. A decision was taken to treat with trabectedin + pegylated liposomal doxorubicin (PLD), which provided 15 months of disease control. Subsequent platinum rechallenge led to a complete response.
Second-line use of trabectedin + PLD in patients with limited platinum sensitivity may restore sensitivity at next platinum.
在复发性卵巢癌患者中，存在某些情况下进一步手术和/或下一线铂类化疗不可行或不是最佳选择的情况。多学科团队在审查可用选择并选择最合适的干预措施方面发挥着关键作用。
复发性卵巢癌的病例研究说明了影响决策的一些因素，并展示了在铂类敏感性有限的情况下非铂类方案的潜力。
考虑到患者的个体情况，肿瘤委员会排除了许多选择。不建议进一步手术，因为初始手术不理想。由于一线治疗中已使用贝伐珠单抗，因此不推荐使用包含贝伐珠单抗的铂类方案。一般不推荐其他铂类方案，因为铂类敏感性有限（复发距上次铂类治疗<12 个月）和不可接受的毒性。决定使用 trabectedin + 聚乙二醇化脂质体多柔比星（PLD）治疗，该方案提供了 15 个月的疾病控制。随后的铂类再挑战导致完全缓解。
在铂类敏感性有限的患者中二线使用 trabectedin + PLD 可能在下一次铂类治疗时恢复敏感性。
