Neoadjuvante Chemotherapie beim Ovarialkarzinom – ein sinnvolles Vorgehen?

Zusammenfassung

Neoadjuvante Therapien werden in der Onkologie eingesetzt, um durch Tumorverkleinerung operationstechnische Vorteile zu erlangen. Darüber hinaus kann die Bewertung des Therapieansprechens hilfreiche Hinweise auf den weiteren Verlauf der Erkrankung liefern. Das epitheliale Ovarialkarzinom erscheint aufgrund seiner frühen und ausgedehnten peritonealen Metastasierung, seiner Chemosensitivität und aufgrund der prognostischen Bedeutung des verbleibenden postoperativen Tumorrests für ein neoadjuvantes Therapiekonzept besonders geeignet. Seit vielen Jahren ist die neoadjuvante Chemotherapie beim Ovarialkarzinom umstritten, ohne dass größere kontrollierte Studien zu diesem Thema durchgeführt wurden. Die Ergebnisse mehrerer Phase-II-Studien, u. a. einer deutschen Multicenter-Phase-II-Studie (PRIMOVAR), und die einer ersten großen Phase-III-Studie (EORTC 55971) liegen jetzt vor: Eine frühe Beurteilbarkeit des Ansprechens, eine geringere perioperative Morbidität und Mortalität bei den neoadjuvant therapierten Patientinnen und nahezu identische Raten an progressionsfreiem Überleben und Gesamtüberleben im Vergleich zur Standardtherapie werden die Diskussion um diese Therapieform neu beleben.

Abstract

Neoadjuvant therapies are usually applied to obtain a better surgical outcome by down-staging the tumor. Moreover, evaluating the response can predict disease progression. Epithelial ovarian cancer appears particularly suitable for neoadjuvant chemotherapy due to its chemosensitivity, early and extensive intraperitoneal dissemination and the prognostic significance of the amount of residual disease after cytoreductive surgery. Allthough large controlled studies are lacking, the use of neoadjuvant chemotherapy in ovarian cancer has been controversially discussed for many years. The results of several phase II studies including a German multi-center phase II study (PRIMOVAR) and the results of a first large phase III study (EORTC 55971) are now available: early evaluation of the response to treatment, lower rates of perioperative morbidity and mortality for patients treated with neoadjuvant therapies and almost identical rates of progression-free and overall survival compared to the standard therapy will revive the discussion on the benefits of neoadjuvant treatment.

Schlüsselwörter

Ovarialkarzinom - neoadjuvante Chemotherapie

Key words

ovarian cancer - neoadjuvant chemotherapy

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