婦科惡性腫瘤生物標記導向治療

Biomarker-Driven and Targeted Approaches or for the Management of Gynecological Malignancies

婦科惡性腫瘤的治療策略，正經歷從傳統組織病理學分類，轉向分子生物特徵導向的重大變革。隨著次世代定序與免疫組織化學染色技術的普及，精準醫療已成為處置核心。本文旨在回顧具臨床影響力的生物標記及其應用策略。針對子宮頸癌，探討PD-L1表現，及KEYNOTE-826試驗中的免疫治療效益。在卵巢癌方面，分析BRCA突變與同源重組修復缺失（homologous recombination deficiency，HRD），在PARP抑制劑維持治療上的長期存活數據。關於子宮內膜癌，詳述TCGA四大分子分型對應的預後意義，與免疫治療的療效差異。此外，亦解析HER2、FRα與TROP2之抗體藥物複合體（antibody-drug conjugate，ADC）在復發難治病例中的跨癌種應用。透過整合這些生物標記，臨床醫師能精確預測療效，落實個人化醫療，文末將探討台灣在檢測普及度與健保給付上之挑戰與展望。

The therapeutic strategy for gynecologic malignancies is undergoing a major paradigm shift from traditional histopathological classification to biomarker-driven approaches. With the widespread adoption of next-generation sequencing (NGS) and immunohistochemistry (IHC), precision medicine has become the core of clinical management. This article aims to review clinically impactful biomarkers and their application strategies. Regarding cervical cancer, we explore PD-L1 expression and the immunotherapy benefits demonstrated in the KEYNOTE-826 trial. In ovarian cancer, we analyze BRCA mutations and homologous recombination deficiency (HRD) regarding long-term survival data in PARP inhibitor maintenance therapy. For endometrial cancer, we detail the prognostic significance of the four TCGA molecular subtypes and the differential efficacy of immunotherapy. Furthermore, we analyze the cross-tumor application of antibody-drug conjugates (ADCs) targeting HER2, FRα, and TROP2 in recurrent and refractory cases. By integrating these biomarkers, clinicians can accurately predict treatment responses and implement personalized medicine. Finally, we discuss the challenges and prospects regarding testing accessibility and health insurance reimbursement in Taiwan.