University Hospital for Tumors, University Hospital Center Sestre milosrdnice
Abstract
Ovarian cancer is typically a disease susceptible to systemic antineoplastic treatment. Systemic antineoplastic therapy is indicated in almost all FIGO stages of ovarian cancer. In very early stage, well diff erentiated disease, benefi t gained with chemotherapy (CT) is no bigger than the 5-year survival rate per se, 90-98%, therefore CT is not indicated in these stages. Inall other stages, the systemic antineoplastic therapy is aplicable and desirable. It is based on platinum compounds, cisplatin and carboplatin, with addition of paclitaxel. For years, there was no advance in systemic chemotherapy treatment in ovarian cancer. The disease is treated as early, advanced and recurrent, and recurrent as platinum sensitive and platinum resistant disease, and this is how the drugs are being applied. Platinum basis, along with taxane partner is the basis and standard protocol, precisely carboplatinum – paclitaxel. There are also some other active agents, such as pegylated liposomal doxorubicin, topotecan etc. Beside the chemotherapy, a biological therapy holds an important spot in treating (epithelial) ovarian
cancer. Bevacizumab showed effi ciency and benefi t in platinum resistant and platinum sensitive recurrent disease, as well as in advanced, nonmetastatic and nonrecurrent disease. PARP inhibitor olaparib gained accelerated approval on the basis of significantly improved fast overall response rate and duration of response. It is yet to be shown, whether all the benefits of neoadjuvant approach, dose dense regimen, metronomic chemotherapy and intraperitoneal way of application of CT in treating ovarian cancer are being explored.Rak jajnika u načelu je bolest osjetljiva na sustavnu antineoplastičnu terapiju. Sustavno antineoplastično liječenje indicirano je u gotovo svim FIGO stadijima bolesti. U vrlo ranom, dobro diferenciranom raku jajnika, benefi t postignut kemoterapijom ne razlikuje se od 5 –godišnje stope preživljenja same po sebi, stoga kemoterapija u ovim stadijima nije indicirana. U svim drugim stadijima, sustavna antineoplastična terapija primjenjiva je i poželjna. Temeljena je na derivatima platine,
cisplatini i karboplatini, uz dodatak paklitaksela. Godinama u sustavnoj terapiji raka jajnika nije bilo napretka. Bolest se liječi kao rani, uznapredovali te rekurentni rak jajnika, a rekurentna bolest kao platina - rezistentna i platina – osjetljiva bolest i na taj način se primjenjuju i lijekovi. Platinska baza uz taksanski partner, točnije karboplatina – paklitaksel temelj su i standardni protokol liječenja. Također su aktivni i neki drugi agensi, poput pagiliranog liposomalnog doksorubicina, topotekana i sl. Osim kemoterapije, važnu ulogu ima i biološka terapija. Bevacizumab se pokazao učinkovitim i donio benefi t u liječenju rekurentnog paltina – rezistentnog, paltina – osjetljivog , kao i u liječenju uznapredovalog, nemetastatskog nerekurentnog raka jajnika. PARP inhibitor olaparib dobio je odobrenje ubrzanim postupkom na temelju značajno poboljšane brze sveukupne stope odgovora te trajanja odgovora. Ostaje za vidjeti jesu li i koliko iskorištene prepoznate prednosti neoadjuvantnog pristupa, dose dense režima primjene, metronomičke terapije te intraperitonealnog načina apliciranja terapije
