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Advances in ovarian cancer treatment in 2020
Advances in ovarian cancer treatment in 2020. In 2020, these new advances in ovarian cancer treatment! From gynecological “cancer king” to chronic disease. Ovarian cancer is the second largest malignant tumor in gynecology. The previous treatment was only chemotherapy, but now there are more treatment options.
Ovarian cancer is the second largest gynecological malignant tumor, and its fatality rate ranks first among gynecological tumors. Once upon a time, chemotherapy was the only treatment option for patients with ovarian cancer.
However, in recent years, patients with ovarian cancer have ushered in more and more new treatment options. Today, we have sorted out some new developments in the field of ovarian cancer treatment in 2020 for you.
▌Ovarian cancer: the number one killer of gynecological tumors
Approximately 70% of ovarian cancers are already at an advanced stage when they are diagnosed. Due to atypical early symptoms, such as abdominal distension, abdominal pain, frequent urination, and feeling of fullness, it is easy to be confused with some benign diseases.
Ovarian cancer risk factors include: family history of ovarian cancer, BRCA gene abnormalities, advanced age (about half of ovarian cancer patients are women over 63 years old), endometriosis, infertility, and difficulty in pregnancy.
Ovarian cancer can be diagnosed by transvaginal ultrasound and CA-125 detection, and finally diagnosed by pathological biopsy under the guidance of surgery or ultrasound/CT.
The four most common types of ovarian cancer are: serous carcinoma (52%), clear cell carcinoma (6%), mucinous carcinoma (6%) and endometrioid carcinoma (10%). The prognosis of ovarian cancer can be estimated based on grade and stage. The 5-year survival rate for stage I ovarian cancer is over 90%, stage II is 70%, stage III is 39%, and stage IV is only 17%.
▌What are the new advances in the treatment of ovarian cancer?
The standard treatment for ovarian cancer is surgery and chemotherapy, especially platinum-based chemotherapy, which is the standard first-line treatment.
Ovarian cancer is usually very sensitive to chemotherapy, but it is easy to recur. Cancer that recurs more than 6 months after treatment is defined as “platinum sensitive”, and cancer that recurs less than 6 months after the end of treatment is defined as “platinum resistant”. Even for platinum-sensitive patients, the more recurrences and the shorter the recurrence interval, the higher the recurrence rate.
In 2020, the NCCN guidelines updated the recommended chemotherapy regimens, recommending different stages and histological types of tumors according to their grades, which are divided into preferred regimens, other recommended regimens and options for specific situations. For example, paclitaxel combined with carboplatin, with or without bevacizumab is the first choice for stage II-IV high-grade serous carcinoma, G2/3 endometrioid carcinoma, clear cell carcinoma and carcinosarcoma.
In recent years, due to changes in dosing schedules and methods of administration, the effectiveness of chemotherapy drugs has also increased, including peritoneal chemotherapy and intravenous chemotherapy.
In terms of surgical treatment, initial surgery combined with platinum-containing chemotherapy and first-line maintenance treatment is becoming a new mode of initial treatment for new ovarian cancer.
The 2020 ASCO annual meeting announced two clinical studies on the treatment of platinum-sensitive recurrent ovarian cancer with secondary cytoreductive surgery. The results show that compared with chemotherapy alone, secondary cytoreductive surgery combined with chemotherapy can significantly improve the progression-free survival of patients. Sub-reduction surgery to achieve R0 resection can improve the overall survival of patients. Therefore, platinum-sensitive recurrent ovarian cancer has a better prognosis than platinum-resistant recurrent ovarian cancer. Second surgery should be considered first; for platinum-resistant recurrence or R0 resection, direct chemotherapy should be selected.
Two types of targeted drugs have been included in the standard treatment regimen for ovarian cancer: the anti-angiogenic drug bevacizumab and PARP inhibitors (such as olaparib, niraparib, and rucapari).
In 2020, the NCCN guidelines recommend the use of niraparib or olaparib for first-line maintenance treatment based on whether the first-line chemotherapy contains bevacizumab and whether the tumor has BRCA mutations, and the detection of HRD status is the first to suggest PARP inhibitor therapy Of the benefits. The US FDA has also approved PARP inhibitors for the first-line maintenance treatment of ovarian cancer patients.
First-line maintenance therapy with bevacizumab and PARP inhibitors has opened a new model of initial treatment for ovarian cancer. The popularization of BRCA and HRD testing can make the first-line maintenance treatment of PARP inhibitors more accurate.
For platinum-sensitive recurrent ovarian cancer patients, maintenance therapy with PARP inhibitors after platinum-containing chemotherapy has been widely accepted. Two clinical studies announced at the 2020 ASCO Annual Meeting and 2020 ESMO Annual Meeting showed that PARP inhibitor maintenance treatment significantly prolonged the survival of patients with BRCA germline mutation platinum-sensitive recurrent ovarian cancer, allowing ovarian cancer patients to see “cured” Dawn. Of course, drug tolerance must also be considered.
In addition, for patients with multiple recurrences of ovarian cancer, the use of targeted drugs for chemotherapy is an option. NCCN guidelines recommend bevacizumab, PARP inhibitors, or pezopanib for the subsequent treatment of platinum-sensitive recurrent ovarian cancer.
Multi-targeted drug combination therapy with different mechanisms, or targeted therapy combined with other therapies, is a major direction for chemotherapy. A clinical study published at the 2020 ASCO annual meeting showed that niraparib combined with bevacizumab significantly prolonged progression-free survival and reduced the risk of recurrence compared with monotherapy.
Overall, the new progress in ovarian cancer treatment this year is mainly reflected in surgery and targeted therapy, but there has been no significant breakthrough in immunotherapy.
▌What new therapies are worth looking forward to?
Although bevacizumab and PARP inhibitors have changed the treatment pattern of ovarian cancer, they still cannot cure advanced ovarian cancer. More effective new therapies are needed, especially for patients with platinum-resistant or platinum-refractory ovarian cancer, and no Patients with BRCA mutations.
This year, some promising therapies are undergoing clinical trials, including:
- Cancer vaccine: eg, DPX-Survivac;
- Antibody conjugate (ADC): eg, Mirvetuximab Soravtansine;
- Targeted therapy: such as ATR inhibitor AZD6738, Wee1 inhibitor Adavosertib and anti-DLL4/vascular endothelial growth factor bispecific antibody Navicixizumab;
- Protein therapy: eg, AVB-S6-500;
- Gene therapy: eg Ofranergene Oobadenovec;
- Immunotherapy: such as PD-L1 monoclonal antibody MEDI4736.
With the development of precision medicine, ovarian cancer is changing from a “terminal disease” to a chronic disease. We look forward to more new advances in the field of ovarian cancer treatment in 2021, which will benefit more patients with ovarian cancer.
(source:chinanet, reference only)