Este protocolo aborda a mujeres con carcinoma de trompa de Falopio avanzado (estadio FIGO III o IV) que tienen una alta probabilidad de lograr una reducción quirúrgica óptima y no presentan riesgo perioperatorio elevado — candidatas adecuadas para la cirugía citorreductora como primer paso en el tratamiento.
El tratamiento de primera línea para esta población consiste en cirugía citorreductora primaria seguida de quimioterapia con doble régimen de platino, con agentes adicionales considerados para pacientes elegibles según el estadio de la enfermedad y el perfil molecular.
Para la enfermedad recurrente sensible al platino, el enfoque se centra en un régimen de combinación basado en platino junto con un agente dirigido adicional, con terapia de mantenimiento como opción en pacientes que responden. El régimen completo, los criterios de elegibilidad y la secuenciación se detallan en el protocolo completo.
DOI: 10.1200/JOP.18.00662
National Comprehensive Cancer Network recommends that any woman with suspected epithelial ovarian cancer be evaluated by a gynecologic oncologist, because optimal surgical debulking by a skilled physician is central to the initial management of patients with advanced, stage III or IV disease.
ASCO states that although primary cytoreductive surgery is preferred for patients with a high likelihood of achieving optimal debulking, women with high perioperative risk or a low likelihood of achieving optimal cytoreduction should receive neoadjuvant chemotherapy followed by possible interval surgery.
To date, bevacizumab has been FDA approved for the following uses in epithelial ovarian cancer: in combination with carboplatin plus paclitaxel, followed by bevacizumab single agent for stage III or IV disease after initial surgical resection; in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan for platinum-resistant recurrent epithelial ovarian cancer after no more than two prior chemotherapy regimens; and in combination with carboplatin plus paclitaxel or carboplatin plus gemcitabine, followed by bevacizumab single agent, for platinum-sensitive recurrent epithelial ovarian cancer.
All three drugs are approved for maintenance treatment of recurrence of epithelial ovarian cancer in patients with at least a partial response to platinum-based therapy.
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