Der Gynäkologe

, Volume 46, Issue 8, pp 541–546

Primäre Systemtherapie des Ovarialkarzinoms

  • J. Pfisterer
  • F. Hilpert
  • S. Mahner
  • P. Harter
  • A. du Bois
Leitthema
  • 236 Downloads

Zusammenfassung

Standardprimärtherapie bei Patientinnen mit fortgeschrittenem Ovarialkarzinom ist die intravenöse Chemotherapie mit Carboplatin und Paclitaxel. Bei Patientinnen im FIGO-Stadium IIIB–IV kann eine zusätzliche Gabe von Bevacizumab erwogen werden. Eine neoadjuvante, primäre Chemotherapie ohne vorherige Debulking-Operation sollte nicht durchgeführt werden. Intraperitoneale Therapieverfahren einschließlich HIPEC sollen nur im Rahmen von klinischen Studien erfolgen.

Schlüsselwörter

Chemotherapie Bevacizumab  Metastasen Angiogeneshemmung Zielgerichtete Therapien 

Primary systemic therapy of ovarian cancer

Abstract

Standard primary systemic treatment of patients with advanced ovarian cancer comprises six courses of intravenously administered carboplatin and paclitaxel. In patients with FIGO stage IIIB–IV disease, additional treatment with bevacizumab is possible. Primary, neoadjuvant treatment without prior debulking surgery should be avoided. Intraperitoneal treatments, including HIPEC, should only be given within controlled clinical trials.

Keywords

Chemotherapy Bevacizumab Metastases Angiogenesis inhibition Targeted therapy  

Literatur

  1. 1.
    AWMF (2013) S3-Leitlinie Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren. AWMF-Register-Nummer 032-035OL. Langversion 1.0Google Scholar
  2. 2.
    International Collaborative Ovarian Neoplasm (ICON) Collaborators (2003) International Collaborative Ovarian Neoplasm Trial 1: a randomized trial of adjuvant chemotherapy in women with early-stage ovarian cancer. J Natl Cancer Inst 95:125–132CrossRefGoogle Scholar
  3. 3.
    Trimbos JB, Vergote I, Bolis G et al (2003) Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma: European Organisation for Research and Treatment of Cancer-Adjuvant ChemoTherapy in Ovarian Neoplasm trial. J Natl Cancer Inst 95:113–125PubMedCrossRefGoogle Scholar
  4. 4.
    Bois A du, Lück HJ, Meier W et al (2003) A randomized clinical trial of-cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. J Natl Cancer Inst 95(17):1320–1329PubMedCrossRefGoogle Scholar
  5. 5.
    Ozols RF, Bundy BN, Greer BE et al (2003) Phase III trial of carboplatin and paclitaxel compared with-cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 21(17):3194–3200PubMedCrossRefGoogle Scholar
  6. 6.
    Lindemann K, Christensen RD, Vergote I et al (2012) First-line treatment of advanced ovarian cancer with paclitaxel/carboplatin with or without epirubicin (TEC versus TC) – a gynecologic cancer intergroup study of the NSGO, EORTC GCG and NCIC CTG. Ann Oncol 23(10):2613–2619PubMedCrossRefGoogle Scholar
  7. 7.
    Bois A du, Weber B, Rochon J et al (2006) Addition of epirubicin as a third drug to carboplatin-paclitaxel in first-line treatment of advanced ovarian cancer: a prospectively randomized gynecologic cancer intergroup trial by the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group and the Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens. J Clin Oncol 24(7):1127–1135PubMedCrossRefGoogle Scholar
  8. 8.
    Pfisterer J, Weber B, Reuss A et al (2006) Randomized phase III trial of topotecan following carboplatin and paclitaxel in first-line treatment of advanced ovarian cancer: a gynecologic cancer intergroup trial of the AGO-OVAR and GINECO. J Natl Cancer Inst 98(15):1036–1045PubMedCrossRefGoogle Scholar
  9. 9.
    Hoskins P, Vergote I, Cervantes A et al (2010) Advanced ovarian cancer: phase III randomized study of sequential-cisplatin-topotecan and carboplatin-paclitaxel vs carboplatin-paclitaxel. J Natl Cancer Inst 102(20):1547–1556PubMedCrossRefGoogle Scholar
  10. 10.
    Bois A du, Herrstedt J, Hardy-Bessard AC et al (2010) Phase III trial of carboplatin plus paclitaxel with or without gemcitabine in first-line treatment of epithelial ovarian cancer. J Clin Oncol 28(27):4162–4169PubMedCrossRefGoogle Scholar
  11. 11.
    Bookman MA, Brady MF, McGuire WP et al (2009) Evaluation of new platinum-based treatment regimens in advanced-stage ovarian cancer: a Phase III Trial of the Gynecologic Cancer Intergroup. J Clin Oncol 27(9):1419–1425PubMedCrossRefGoogle Scholar
  12. 12.
    Katsumata N, Yasuda M, Takahashi F et al (2009) Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial. Lancet 374(9698):1331–1338PubMedCrossRefGoogle Scholar
  13. 13.
    Katsumata N, Yasuda M, Isonishi S et al (2012) Long-term follow-up of a randomized trial comparing conventional paclitaxel and carboplatin with dose-dense weekly paclitaxel and carboplatin in women with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer: JGOG 3016 trial. J Clin Oncol 30(suppl; abstr 5003)Google Scholar
  14. 14.
    Burger RA, Brady MF, Bookman MA et al (2011) Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med 365(26):2473–2483PubMedCrossRefGoogle Scholar
  15. 15.
    Perren TJ, Swart AM, Pfisterer J et al (2011) A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med 365(26):2484–2496PubMedCrossRefGoogle Scholar
  16. 16.
    Monk BJ, Huang HQ, Burger RA et al (2013) Patient reported outcomes of a randomized, placebo-controlled trial of bevacizumab in the front-line treatment of ovarian cancer. Gynecol Oncol 128:573–578PubMedCrossRefGoogle Scholar
  17. 17.
    Stark D, Nankivell M, Pujade-Lauraine E et al (2013) Standard chemotherapy with or without bevacizumab in advanced ovari-an cancer: quality-of-life outcomes from the International Collaboration on Ovarian Neoplasms (ICON7) phase 3 randomised trial. Lancet Oncol 14:236–243PubMedCrossRefGoogle Scholar
  18. 18.
    Burg ME van der, Lent M van, Buyse M et al (1995) The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. Gynecological Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer. N Engl J Med 332:629–634PubMedCrossRefGoogle Scholar
  19. 19.
    Rose PG, Nerenstone S, Brady MF et al (2004) Secondary surgical cytoreduction for advanced ovarian carcinoma. N Engl J Med 351:2489–2497PubMedCrossRefGoogle Scholar
  20. 20.
    Vergote I, Tropé CG, Amant F et al (2010) Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 363:943–953PubMedCrossRefGoogle Scholar
  21. 21.
    Markman M, Bundy BN, Alberts DS et al (2001) Phase III trial of standard-dose intravenous-cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and intraperitoneal-cisplatin in small-volume stage III ovarian carcinoma: an intergroup study of the Gynecologic Oncology Group, Southwestern Oncology Group, and Eastern Cooperative Oncology Group. J Clin Oncol 19:1001–1007PubMedGoogle Scholar
  22. 22.
    Armstrong DK, Bundy B, Wenzel L et al (2006) Intraperitoneal-cisplatin and paclitaxel in ovarian cancer. N Engl J Med 354:34–43PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • J. Pfisterer
    • 1
  • F. Hilpert
    • 2
  • S. Mahner
    • 3
  • P. Harter
    • 4
  • A. du Bois
    • 4
  1. 1.Zentrum für Gynäkologische Onkologie KielKielDeutschland
  2. 2.Klinik für Gynäkologie und GeburtshilfeUniversitätsklinikum Schleswig Holstein Campus KielKielDeutschland
  3. 3.Klinik für GynäkologieUniversitätsklinikum Hamburg EppendorfHamburgDeutschland
  4. 4.Klinik für Gynäkologie und Gynäkologische OnkologieKliniken Essen MitteEssenDeutschland

Personalised recommendations