Therapie des epithelialen Ovarialkarzinomrezidivs

Zusammenfassung

Das epitheliale Ovarialkarzinom ist die häufigste Todesursache bei gynäkologischen Tumoren. Bei den meisten Patientinnen mit fortgeschrittenem Ovarialkarzinom tritt ein Rezidiv nach der Erstlinientherapie auf, sodass weitere Therapielinien erforderlich sind. Die Wahl der Therapie unterliegt verschiedenen Kriterien wie Tumorbiologie, Allgemeinzustand der Patientin (ECOG), Toxizität, vorherige Chemotherapie und das Ansprechen hierauf. Das sogenannte platinfreie bzw. therapiefreie Intervall definiert hierbei das potenzielle erneute Ansprechen auf eine platinhaltige Therapie. Haben die Patientinnen ein Spätrezidiv, d. h. > 6 Monate nach Ende der letzten Platintherapie (ehemals platinsensibel), so sind sie in der Regel geeignet für eine erneute platinhaltige Kombinationstherapie. Patientinnen, die nicht für eine platinhaltige Chemotherapie (CTX) infrage kommen, werden mit einem platinfreien Regime behandelt wie z. B. Paclitaxel weekly, pegyliertes liposomales Doxorubicin (PLD), Gemcitabin oder Topotecan. Die Patientinnengruppe, die für eine platinhaltige Therapie infrage kämen, aber z. B. aufgrund einer unkontrollierbaren Hypersensitivitätsreaktion kein Carboplatin mehr erhalten kann, würde für eine Therapie aus Trabectedin und PLD infrage kommen. Die Rezidivoperation wurde bisher kontrovers diskutiert, ist aber durch neue Erkenntnisse aus der DESKTOP-III-Studie der AGO-Studiengruppe wieder ins Licht des Interesses gerückt, insbesondere bei Patientinnen mit platinfreiem Intervall > 6 Monate und positivem AGO-Score. Zudem haben Angiogeneseinhibitoren wie Bevacizumab und die PARP-Inhibitoren Olaparib, Niraparib und Rucaparib ihre Wirksamkeit in der Rezidivsituation in klinischen Studien bewiesen. Diese Medikamente haben die aktuelle Behandlungspraxis nachhaltig verändert und das Spektrum der Therapien erweitert. Dabei muss zwischen einer reinen Erhaltungstherapie nach Beendigung der CTX, einer kontinuierlichen Erhaltungstherapie während der CTX und einem therapeutischen Einsatz dieser Substanzen unterschieden werden. Die PARP-Inhibitoren Niraparib, Olaparib und Rucaparib sind bereits von der FDA und der EMA zugelassen. Eine vorliegende BRCA-Mutation stellt dabei einen prädiktiven Faktor für ein besseres Ansprechen auf PARP-Inhibitoren dar.

Schlüsselwörter

Ovarialkarzinomrezidiv - ROC - Rezidivoperation - PARP-Inhibitor - Antiangiogenese

Publikationsverlauf

Eingereicht: 06. Juli 2020

Angenommen nach Revision: 26. Oktober 2020

Artikel online veröffentlicht:
03. Dezember 2020

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