Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria.
Crit Rev Oncol Hematol. 2019 Nov;143:14-19. doi: 10.1016/j.critrevonc.2019.08.002. Epub 2019 Aug 14.
Through the last three decades, the combination of paclitaxel and carboplatin remains the standard of care chemotherapy in newly diagnosed epithelial ovarian cancer (EOC). Based on a single trial, first-line maintenance therapy with angiogenesis inhibitor bevacizumab was approved in Europe and widely applied. In 2018, based on a second trial bevacizumab was approved for first-line maintenance in the United States. Despite complete remission upon chemotherapy, the majority of the patients recur. A large number of randomized trials were conducted to explore the optimal front-line therapy regimen, but neither dose-densing, nor adding of a third chemotherapy agent or intraperitoneal administration could improve overall survival (OS). Also implementation of hyperthermic intraperitoneal chemotherapy (HIPEC) or the neoadjuvant approach failed to improve OS. Recently, maintenance therapy with PARP inhibitors showed encouraging results in patients with BRCA1/2 mutation. Further trials with targeted therapies are ongoing. Here we review the achievements of front-line therapy in primary advanced EOC through the last three decades and discuss future treatment strategies.
在过去的三十年中，紫杉醇和卡铂的联合治疗仍然是新诊断的上皮性卵巢癌（EOC）的标准治疗化疗方案。基于一项单臂试验，抗血管生成抑制剂贝伐珠单抗的一线维持治疗在欧洲获得批准并广泛应用。2018 年，基于第二项试验，贝伐珠单抗在美国被批准用于一线维持治疗。尽管化疗后达到完全缓解，但大多数患者仍会复发。进行了大量的随机试验来探索最佳的一线治疗方案，但无论是剂量密集型方案、添加第三种化疗药物还是腹腔内给药，都未能改善总生存期（OS）。实施腹腔内热化疗（HIPEC）或新辅助治疗也未能改善 OS。最近，PARP 抑制剂的维持治疗在 BRCA1/2 突变患者中显示出令人鼓舞的结果。针对靶向治疗的进一步试验正在进行中。本文通过回顾过去三十年中在原发性晚期 EOC 一线治疗中的成就，讨论未来的治疗策略。
