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Erhaltungstherapie bei metastasierten gynäkologischen Malignomen

Maintenance therapy of metastatic gynecological tumors

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Die Erhaltungstherapie ist ein relevanter Bestandteil der Behandlung von Patientinnen mit metastasierten gynäkologischen Malignomen. Beim metastasierten Ovarialkarzinom gehört der Angiogenesehemmer (AI) Bevacizumab zur Standardtherapie in der Primär- und Rezidivsituation sowie sowohl beim platinsensiblem als auch beim platinresistentem Rezidiv. Der Multikinasehemmer Sorafenib stellt in der Kombination mit Topotecan eine zwar nicht zugelassene, aber wirksame Therapieoption bei platinresistentem Rezidiv dar. Als besonders wirkungsvoll wird der Einsatz des PARP-Inhibitors Olaparib beim platinsensiblem Rezidiv für BRCA-mutierte Patientinnen mit metastasiertem Ovarialkarzinom angesehen. Weitere, viel versprechende PARP-Inhibitoren (Rucaparib, Niraparib) sowie Kombinationen aus den AI Cediranib oder Bevacizumab und PARP-Inhibitor Olaparib werden in Studien erforscht und sind nicht zugelassen. Der AI Bevacizumab ist auch bei metastasiertem Zervixkarzinom Bestandteil der klinischen Routine, sogar mit einem signifikant positiven Einfluss auf das OS. Eine Immuntherapie mit Checkpoint-Inhibitoren (Atezolizumab, Pembrolizumab, Avelumab) bei metastasierten Ovarial- und Zervixkarzinomen ist derzeit Gegenstand intensiver klinischer Studien, die vielleicht in naher Zukunft eine neue Therapieperspektive in den metastasierten Situationen eröffnen könnte.

Abstract

Maintenance therapy is an important component in the treatment of patients with metastatic gynecological tumors. The angiogenesis inhibitor bevacizumab belongs to the standard therapy in primary and recurrent situations as well as for platinum-sensitive and platinum-resistant metastatic ovarian cancer. The multikinase inhibitor sorafenib is not licensed in combination with topotecan but is an effective therapy option for platinum-resistant recurrent ovarian cancer. Especially effective is the therapy with the PARP inhibitor olaparib in cases of platinum-sensitive recurrent ovarian cancer in patients with BRCA mutations. Other promising PARP inhibitors (rucaparib and niraparib) as well as combinations of the angiogenesis inhibitors cediranib or bevacizumab with the PARP inhibitor olaparib are not currently licensed and are the subject of clinical studies. The angiogenesis inhibitor bevacizumab is also a component of the clinical routine in cases of advanced or metastatic cervical cancer and even has a significant positive influence on overall survival. Immunotherapy with checkpoint inhibitors (atezolizumab, pembrolizumab and avelumab) is currently a subject of intensive clinical studies in cases of metastatic ovarian and cervical cancer, which could provide a new perspective on therapy in cases of metastatic disease in the near future.

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Authors and Affiliations

  1. Gynäkologie, Klinikum Bad Trissl, Bad-Trissl-Str. 73, 83080, Oberaudorf, Deutschland

    V. Aivazova-Fuchs & K. Friese

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  1. V. Aivazova-Fuchs
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  2. K. Friese
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Correspondence to V. Aivazova-Fuchs.

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V. Aivazova-Fuchs und K. Friese geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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K. Friese, Oberaudorf

M. Kiechle, München

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Aivazova-Fuchs, V., Friese, K. Erhaltungstherapie bei metastasierten gynäkologischen Malignomen. Gynäkologe 50, 320–326 (2017). https://doi.org/10.1007/s00129-017-4071-x

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  • DOI: https://doi.org/10.1007/s00129-017-4071-x

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