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Erschienen in: Die Gynäkologie 3/2022

15.02.2022 | Ovarialkarzinom | Leitthema

Systemische Therapie und zielgerichtete Erhaltungstherapie in der Primärsituation beim high- und low-grade Ovarialkarzinom

verfasst von: Prof. Dr. Eugen Ruckhäberle, Prof. Dr. Tanja Fehm

Erschienen in: Die Gynäkologie | Ausgabe 3/2022

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Zusammenfassung

Die Therapie des low-grade und des high-grade Ovarialkarzinoms hat sich in den vergangenen Jahrzehnten grundlegend geändert. Die fundamentalen Therapiesäulen sind die multiviszerale Operation mit dem Ziel der makroskopischen Komplettresektion sowie, ab dem Stadium FIGO(Fédération Internationale de Gynécologie et d’Obstétrique)-Stadium I C, die platinhaltige Chemotherapie. In den fortgeschrittenen Stadien sowohl des low-grade als auch des high-grade serösen Ovarialkarzinoms hat sich inzwischen in der Primärtherapie die Kombination aus Carboplatin und Paclitaxel als langjähriger Standard etabliert. Noch nicht abschließend beantwortet ist die Frage nach der Wertigkeit der neoadjuvanten Chemotherapie beim primären Ovarialkarzinom. Sie wird von der abgeschlossenen TRUST(Trial of Radical Upfront Surgical Therapy)-Studie hoffentlich final geklärt. Während bei den quantitativ deutlich seltener auftretenden low-grade Karzinomen der Wert einer Erhaltungstherapie noch nicht endgültig evaluiert wurde, gilt die Erhaltungstherapie bei den fortgeschrittenen high-grade Karzinomen als gesetzt. Je nach HRD(„homologous recombination deficiency“)-Status und der Frage der Möglichkeit einer Bevacizumabtherapie stehen als Optionen heute die alleinige Therapie mit Bevacizumab bzw. Niraparib (PARP[„poly adenosine diphosphate-ribose polymerase“]-Inhibitor) oder die Kombinationstherapie aus Olaprib (PARP-Inhibitor) und Bevacizumab zur Verfügung. In den kommenden Jahren werden weitere Kombinationen aus PARP- und Immuncheckpointinhibitoren oder PARP-Inhibitoren, Bevacizumab und endokriner Therapie in großen Studien untersucht.
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Metadaten
Titel
Systemische Therapie und zielgerichtete Erhaltungstherapie in der Primärsituation beim high- und low-grade Ovarialkarzinom
verfasst von
Prof. Dr. Eugen Ruckhäberle
Prof. Dr. Tanja Fehm
Publikationsdatum
15.02.2022
Verlag
Springer Medizin
Erschienen in
Die Gynäkologie / Ausgabe 3/2022
Print ISSN: 2731-7102
Elektronische ISSN: 2731-7110
DOI
https://doi.org/10.1007/s00129-022-04907-8

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