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- Title
Therapeutic novelties in epithelial ovarian cancer.
- Authors
Stănculeanu, Dana Lucia
- Abstract
Epithelial ovarian cancer accounts for 90% of all ovarian tumors. Over the past decade, as a result of the improvement of each therapeutic stratagem in the multidisciplinary treatment, the survival of advanced stage patients has increased. Integrating clinical trials and translational research into clinical practice led to an increase in survival in advanced stages from 12 months in 1980 (GOG 3) to more than 120 months in the 21st century. Surgical treatment, R0 cytoreduction, has prognostic value, and lymphadenectomy according to the LION study does not appear to be necessary in patients with R0 and N0 clinical, which has changed medical practice in locoregional advanced disease. Adjuvant medical treatment is standardized, and chemotherapy with paclitaxel and platinum salts plus/minus bevacizumab in maintenance remains the standard of care. In the last years, the somatic genetic signature BRCA-like has an important role in establishing the therapeutic pathway. The most important oncology societies (ASCO, NCCN, SGO) recommend that women diagnosed with ovarian cancer be tested for BRCA-like regardless of family history. The classification of high grade ovarian cancer patients in three subgroups (wild BRCA, BRCA-like and BRCA mutant) allows the redefinition of treatment based on these biomarkers. The ARIEL 2 study defined using the NGS technique a category of patients with HRD (homologous recombination deficiency). Currently, FDA and EMA approved three categories of PARP inhibitor molecules: niraparib (NOVA study) - maintenance treatment in relapsed patients and resumed chemotherapy after platinum salt therapy; rucaparib (ARIEL 2 and ARIEL 3 studies) in monotherapy in platinum-sensitive patients with two or more treatment lines, who could no longer receive platinum-based chemotherapy, and olaparib (Study 19, Solo2) as maintenance treatment in patients with complete or partial response to platinum-based chemotherapy. The therapeutic decision to use in the maintenance sequence PARP inhibitors therapy or bevacizumab, both active and approved molecules in the treatment of ovarian cancer, is a reality. The sequence of these treatments is complicated. HRR mutations have a predictive role for the PARP inhibitor response, whereas for bevacizumab they have only prognostic value. The role of immunotherapy and treatment combinations is the subject of numerous clinical trials and remains to be defined, with promising results.
- Subjects
OVARIAN epithelial cancer; LYMPHADENECTOMY; PACLITAXEL; CANCER treatment
- Publication
Oncolog-Hematolog, 2018, Issue 43, p48
- ISSN
2066-8716
- Publication type
Article