劑量密集化學治療於卵巢癌治療之應用與展望

Dose-dense chemotherapy in the treatment of ovarian cancer: clinical evidence, current applications, and future perspectives

卵巢癌為婦科惡性腫瘤中預後最差者之一，傳統標準治療以腫瘤減積手術合併每三
週一次之含鉑化學治療為主。近年來，劑量密集化學治療（dose-dense chemotherapy）透過縮短給藥間隔、提升劑量密度之概念，逐漸受到臨床重視。日本JGOG 3016試驗首先證實劑量密集化療於東亞族群中可顯著改善無惡化存活期與整體存活期；然而，後續歐美多項大型隨機對照試驗（GOG0262、ICON8、MITO-7）之結果未能重現相同效益，使學界對其整體臨床價值仍存在爭議。本文系統回顧上述代表性臨床試驗，並討論族群差異、藥物代謝基因多型性及組織學亞型等可能影響療效的因素，同時探討劑量密集化療於新興標靶治療（PARP抑制劑）與免疫療法時代中的潛在定位與未來發展方向。

Ovarian cancer remains one of the most lethal gynecologic malignancies, with the standard first-line treatment consisting of cytoreductive surgery followed by platinum-based chemotherapy administered every three weeks. Dose-dense chemotherapy, which increases dose intensity by shortening the administration interval, has emerged as a potentially advantageous approach. The Japanese JGOG 3016 trial provided the first compelling evidence that dose-dense weekly paclitaxel combined with carboplatin significantly im-proves both progression-free survival (PFS) and overall survival (OS) in an east asian population. However, subsequent large-scale randomized controll-ed trials conducted in western populations―including GOG 0262, ICON8, and MITO-7―failed to replicate these survival benefits, leaving the role of dose-dense chemotherapy subject to ongoing debate. This review system-atically examines these landmark trials and discusses potential explanatory factors for the observed discrepancies, including ethnic differences in pharma-cogenomics, histological subtype distribution, and variations in supportive care. Furthermore, we explore the evolving role of dose-dense chemotherapy in the era of targeted therapies such as PARP inhibitors and immune check-point inhibitors, and identify patient subgroups that may derive the greatest benefit from this approach.