Nikolaidi Adamantia, Fountzilas Elena, Fostira Florentia, Psyrri Amanda, Gogas Helen, Papadimitriou Christos
Oncology Department, Private General Maternity, Gynecological and Pediatric Clinic "MITERA" Hospital, Athens, Greece.
Second Department of Medical Oncology, Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece.
Front Oncol. 2022 Jul 26;12:820128. doi: 10.3389/fonc.2022.820128. eCollection 2022.
Ovarian cancer remains the leading cause of death from gynecological cancer. Survival is significantly related to the stage of the disease at diagnosis. Of quite importance is primary cytoreductive surgery, having as a goal to remove all visible tumor tissue, and is the standard primary treatment in combination with platinum-based chemotherapy for patients with advanced ovarian carcinoma. Neo-adjuvant chemotherapy (NACT) has been implemented mostly in treating advanced disease, with studies performed having numerous limitations. Data extrapolated from these studies have not shown inferiority survival of NACT, compared to primary debulking surgery. The role of NACT is of particular interest because of the intrinsic mechanisms that are involved in the process, which can be proven as therapeutic approaches with enormous potential. NACT increases immune infiltration and programmed death ligand-1 (PDL-1) expression, induces local immune activation, and can potentiate the immunogenicity of immune-exclude high grade serous ovarian tumors, while the combination of NACT with bevacizumab, PARP inhibitors or immunotherapy remains to be evaluated. This article summarizes all available data on studies implementing NACT in the treatment of ovarian cancer, focusing on clinical outcomes and study limitations. High mortality rates observed among ovarian cancer patients necessitates the identification of more effective treatments, along with biomarkers that will aid treatment individualization.
卵巢癌仍然是妇科癌症死亡的主要原因。生存率与诊断时疾病的分期显著相关。至关重要的是初次肿瘤细胞减灭术，其目标是切除所有可见的肿瘤组织，并且是晚期卵巢癌患者铂类化疗联合的标准初始治疗方法。新辅助化疗（NACT）主要用于治疗晚期疾病，但所开展的研究存在诸多局限性。从这些研究推断的数据并未显示NACT的生存率低于初次肿瘤细胞减灭术。由于该过程涉及的内在机制，NACT的作用尤其令人关注，这些机制可被证明具有巨大潜力的治疗方法。NACT增加免疫浸润和程序性死亡配体-1（PDL-1）表达，诱导局部免疫激活，并可增强免疫排除型高级别浆液性卵巢肿瘤的免疫原性，而NACT与贝伐单抗、PARP抑制剂或免疫疗法的联合应用仍有待评估。本文总结了关于在卵巢癌治疗中实施NACT的所有现有研究数据，重点关注临床结果和研究局限性。卵巢癌患者中观察到的高死亡率需要确定更有效的治疗方法以及有助于治疗个体化的生物标志物。
