تازه های درمانی سرطان تخمدان نقش درمان هایNeoadjuvant

Angiogenesis is an important component driving the growth of ovarian cancer. (OCEANStrial) included patients with measurable recurrent ovarian cancer after first-line and platinum-freeinterval longer than months. The addition of bevacizumab to chemotherapy increasedsignificantly the PFS (HR 0.48, 95% CI 0.38–0.60) and produced an increment in the response rateof 21% (ORR 78.5% versus 57.4%,P< 0.0001). Besides bevacizumab, additional molecularlytargeted agents, namely the inhibitors of the poly(adenosine diphosphate (ADP)-ribose)polymerases (PARPs), have been tested in EOC with promising results. BRCA mutations are foundin 5%-15% of ovarian cancer population studies. It is now recommended that patients with highgrade tumours are tested for germline BRCA mutation. In December 2014, olaparib (AZD-2281)was the first PARPi to be granted FDA approval, specifically as monotherapy for women withovarian cancer who have had at least three line of prior chemotherapy and who carry aBRCAmutaion. Patients with recurrent high-grade serous ovarian cancer and germline BRCAmutation should be offered maintenance olaparib after response to platinum-based chemotherapy.Maintenance olaparib led to improvment in PFS in patient with newly diagnosed advanced ovariancancer and BRCAm with difference in median PFS for olaparib versus placebo of approximately 3years. For women with newly diagnosed BRCAm advanced ovarian cancer maintenance olaparibshoud be considered standard treatment following platinum based chemotherapy.Recent translational data show BRCA1/2-mutated epithelial ovarian cancer has greaterimmune infiltration. It has been suggested that these cancers may have sensitivity to immunecheckpoint inhibitors targeting the PD-1/PD-L1 pathway.Immune checkpoint inhibitor combination in recurent ovarian cancer with angiogenictherapy (nivolomab with avastin) and with PARP inhibitor(olaparib with durvalumab) in phase 2study.