Emons Julius, Gocke Julia, Schulmeyer Carla, Stübs Frederik Alexander, Krückel Annika, Amann Niklas, Beckmann Matthias W, Hörner Manuel, Pöschke Patrik
Department of Gynecology and Obstetrics, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Comprehensive Cancer Center Erlangen, Erlangen, Germany.
Geburtshilfe Frauenheilkd. 2025 Jun 30;85(7):736-745. doi: 10.1055/a-2622-0684. eCollection 2025 Jul.
There have been major changes in the understanding of gynecologic malignancies in recent years, leading to new therapy options and subsequently to greater responsibilities for every professional treating those patients. The most significant therapeutic advances were achieved with checkpoint inhibitors (CPI), especially for endometrial and cervical cancer. In ovarian cancer the dominant and most important new substances are poly (ADP-ribose) polymerase inhibitors (PARPi). This review aims to summarize the latest studies and developments in the therapeutic landscape of endometrial, ovarian, and cervical cancer. The treatment of advanced endometrial cancer has changed significantly with the introduction of CPI such as dostarlimab (RUBY trial), durvalumab (DUO-E trial) and pembrolizumab (Keynote-868 trial). For ovarian cancer PARPi have shown substantial PFS benefits in key approval trials, including PRIMA for niraparib, PAOLA for olaparib, and ATHENA-MONO for rucaparib. These findings have established PARPi as the standard of care in maintenance therapy. Overall survival (OS) data for PRIMA and PAOLA are now available and are analyzed and placed into context in this article. Furthermore, mirvetuximab soravtansine is the first antibody-drug conjugate (ADC) approved in Germany for platinum-resistant ovarian cancer for patients with folate receptor alpha expression. The Keynote-A18 and BEATcc trials have opened new options for the utilization of immuno-oncology in cervical cancer treatment. Along with new therapeutic options, new biomarkers have also become part of daily clinical practice as predictive and prognostic factors as well as forming the basis for targeted personalized medicine. The use of CPI is revolutionizing the treatment of all gynecologic cancers and offers significant benefits for progression-free survival (PFS) and OS in most therapy regimens. With the increased use of ADCs, this is not the end of these developments. Therapy algorithms from a certified German oncology center are developed and presented in this article.
近年来，人们对妇科恶性肿瘤的认识发生了重大变化，催生了新的治疗方案，进而使每位治疗这些患者的专业人员承担了更大的责任。免疫检查点抑制剂（CPI）取得了最显著的治疗进展，尤其是在子宫内膜癌和宫颈癌治疗方面。在卵巢癌治疗中，占主导地位且最重要的新型药物是聚（ADP - 核糖）聚合酶抑制剂（PARPi）。本综述旨在总结子宫内膜癌、卵巢癌和宫颈癌治疗领域的最新研究与进展。随着多斯塔利单抗（RUBY试验）、度伐利尤单抗（DUO - E试验）和帕博利珠单抗（Keynote - 868试验）等CPI的引入，晚期子宫内膜癌的治疗发生了显著变化。对于卵巢癌，PARPi在关键的获批试验中显示出显著的无进展生存期（PFS）获益，包括尼拉帕利的PRIMA试验、奥拉帕利的PAOLA试验以及鲁卡帕利的ATHENA - MONO试验。这些研究结果已确立PARPi作为维持治疗的标准疗法。PRIMA和PAOLA试验的总生存期（OS）数据现已可得，本文将对其进行分析并置于相应背景中。此外，mirvetuximab soravtansine是德国首个获批用于治疗叶酸受体α表达阳性的铂耐药卵巢癌患者的抗体药物偶联物（ADC）。Keynote - A18和BEATcc试验为免疫肿瘤学在宫颈癌治疗中的应用开辟了新途径。随着新的治疗方案出现，新的生物标志物也已成为日常临床实践的一部分，作为预测和预后因素，并构成靶向个性化医疗的基础。CPI的应用正在彻底改变所有妇科癌症的治疗方式，在大多数治疗方案中为无进展生存期（PFS）和总生存期（OS）带来显著益处。随着ADC应用的增加，这些进展并未就此停止。本文编制并展示了来自一家德国认证肿瘤中心的治疗算法。
