上皮性卵巢癌維持治療之檢視

Maintenance therapy for epithelial ovarian cancer

上皮性卵巢癌（Epithelial ovarian cancer，EOC）在初次治療後的復發率非常高；從歷史上來看，大約70%的手術和輔助化療反應良好的患者依舊會復發並死於這種疾病。儘管這一數字經過多年的研究以及手術技巧的精進而有所改善，但整體治愈率仍然低於50%。因此，以預防或延遲疾病復發為目標的維持療法、以及提高整體生存率的目標，一直是研究的焦點。早期使用從放射性磷、到延長輔助性化學治療、或以每月單用紫杉醇藥物治療的研究，顯示在疾病無惡化存活期（progression free survival，PFS）方面取得了令人鼓舞的改善，但令人失望的是，在整體生存時間方面並未有顯著的差異。此外，維持療法的PFS優勢伴隨著令人不安的副作用，以至於維持療法並未成為標準治療方法。使用bevacizumab和PARP（PolyADP-ribose polymerase）抑制劑進行的研究表明，在可控的副作用情況下取得了PFS優勢。然而，整體生存優勢仍不明確，因此這些方法的使用雖然給了卵巢癌治療一線希望但是仍存在爭議。此外，在復發疾病中，化療的長度和延長化療的好處尚不清楚。因此，需要進一步的試驗來評估卵巢惡性腫瘤的維持治療策略。

Epithelial ovarian cancer (EOC) has a remarkably higher rate of recurrence after operation and first-line adjuvant therapy; historically, approximately 70% of patients who have undergone surgery and received adjuvant chemotherapy with a positive clinical response will experience relapse and even mortality. Although we have seen significant improvement over the years due to advancements in surgical techniques and medical interventions, the overall cure rates still remain below 50%. Consequently, strategies for maintenance therapy aimed at preventing or delaying disease relapse and enhancing overall survival have been the focal point of extensive research. The advantages in PFS associated with maintenance therapy were accompanied by disconcerting side effects, which hindered the adoption of maintenance therapy as a standard care approach. Trials involving bevacizumab and PARP inhibitors indicated PFS benefits with manageable side-effect profiles. Nonetheless, uncertainties persist regarding overall survival advantages, leading to ongoing controversies over the utilization of these therapies. Additionally, in the context of recurrent disease, the optimal duration of chemotherapy and the benefits of prolonged chemotherapy remain unclear. Additional trials evaluating maintenance strategies for ovarian malignancies are essential.