Madariaga Ainhoa, Rustin Gordon J S, Buckanovich Ronald J, Trent Jonathan C, Oza Amit M
1 Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
2 Mount Vernon Hospital, Northwood, UK.
Am Soc Clin Oncol Educ Book. 2019 Jan;39:e152-e166. doi: 10.1200/EDBK_238755. Epub 2019 May 17.
Epithelial ovarian cancer has a very high rate of relapse after primary therapy; historically approximately 70% of patients with a complete clinical response to surgery and adjuvant chemotherapy will relapse and die of the disease. Although this number has slowly improved, cure rates remain less than 50%. As such, maintenance therapy with the aim of preventing or delaying disease relapse and the goal of improving overall survival has been the subject of intense study. Numerous earlier studies with agents ranging from radioactive phosphorus to extended frontline therapy or to monthly taxol administration demonstrated encouraging improvements in progression-free survival (PFS) only to find, disappointingly, no benefit in overall survival. In addition, the PFS advantage of maintenance therapy was associated with disconcerting side effects such that maintenance therapy was not adapted as standard of care. Studies with bevacizumab and PARP inhibitors have demonstrated a PFS advantage with a manageable side-effect profile. However, an overall survival advantage remains unclear, and the use of these approaches thus remains controversial. Furthermore, in recurrent disease, the length of chemotherapy and benefits of extended chemotherapy is unclear. Thus, additional trials assessing maintenance strategies in ovarian and other gynecologic malignancies are needed.
上皮性卵巢癌在初始治疗后复发率非常高；从历史上看，大约70%对手术和辅助化疗有完全临床反应的患者会复发并死于该疾病。尽管这一数字已在缓慢改善，但治愈率仍低于50%。因此，旨在预防或延迟疾病复发以及提高总生存率的维持治疗一直是深入研究的主题。许多早期研究使用了从放射性磷到延长一线治疗或每月给予紫杉醇等药物，结果仅显示无进展生存期（PFS）有令人鼓舞的改善，但令人失望的是，总生存率并无益处。此外，维持治疗的PFS优势与令人不安的副作用相关，以至于维持治疗未被采纳为标准治疗方案。使用贝伐单抗和PARP抑制剂的研究已证明PFS有优势且副作用可控。然而，总生存优势仍不明确，因此这些方法的使用仍存在争议。此外，在复发性疾病中，化疗的时长以及延长化疗的益处尚不清楚。因此，需要进行更多试验来评估卵巢癌及其他妇科恶性肿瘤的维持治疗策略。
