Wilczyński Jacek R, Wilczyński Miłosz, Paradowska Edyta
Department of Gynecological Surgery and Gynecological Oncology, Medical University of Lodz, Lodz, Poland.
Department of Gynecological, Endoscopic and Oncological Surgery, Polish Mother's Health Center-Research Institute, Lodz, Poland.
Front Oncol. 2023 Jun 28;13:1201497. doi: 10.3389/fonc.2023.1201497. eCollection 2023.
Ovarian cancer, especially high-grade serous type, is the most lethal gynecological malignancy. The lack of screening programs and the scarcity of symptomatology result in the late diagnosis in about 75% of affected women. Despite very demanding and aggressive surgical treatment, multiple-line chemotherapy regimens and both approved and clinically tested targeted therapies, the overall survival of patients is still unsatisfactory and disappointing. Research studies have recently brought some more understanding of the molecular diversity of the ovarian cancer, its unique intraperitoneal biology, the role of cancer stem cells, and the complexity of tumor microenvironment. There is a growing body of evidence that individualization of the treatment adjusted to the molecular and biochemical signature of the tumor as well as to the medical status of the patient should replace or supplement the foregoing therapy. In this review, we have proposed the principles of the novel regimen of the therapy that we called the "DEPHENCE" system, and we have extensively discussed the results of the studies focused on the ovarian cancer stem cells, other components of cancer metastatic niche, and, finally, clinical trials targeting these two environments. Through this, we have tried to present the evolving landscape of treatment options and put flesh on the experimental approach to attack the high-grade serous ovarian cancer multidirectionally, corresponding to the "DEPHENCE" system postulates.
卵巢癌,尤其是高级别浆液性癌,是最致命的妇科恶性肿瘤。由于缺乏筛查项目且症状不明显,约75%的患病女性被诊断时已处于晚期。尽管采取了要求极高且积极的手术治疗、多线化疗方案以及已获批和正在进行临床试验的靶向治疗,但患者的总体生存率仍不尽人意且令人失望。最近的研究对卵巢癌的分子多样性、其独特的腹腔内生物学特性、癌症干细胞的作用以及肿瘤微环境的复杂性有了更多了解。越来越多的证据表明,根据肿瘤的分子和生化特征以及患者的医疗状况进行个体化治疗应取代或补充上述治疗方法。在这篇综述中,我们提出了一种名为“DEPHENCE”系统的新型治疗方案原则,并广泛讨论了针对卵巢癌干细胞、癌症转移微环境的其他成分以及最终针对这两种环境的临床试验的研究结果。通过这样做,我们试图展现不断演变的治疗选择格局,并充实以多方向攻击高级别浆液性卵巢癌的实验方法,这与“DEPHENCE”系统的假设相对应。
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