PDF(Pubmed)
Abstract：
Ovarian cancer is the most lethal gynecologic cancer. The high grade serous epithelial (HGSE) subtype is the most aggressive and it often presents at advanced stages, while screening programs have not proven beneficial. Management of the advanced stages (FIGO III and IV), which constitute the majority of diagnoses, usually consists of platinum-based chemotherapy and cytoreductive surgery (primary or interval) followed by maintenance therapy. Currently, the standard-of-care for advanced newly diagnosed HGSE ovarian cancer, as per international medical societies, starts with upfront cytoreductive surgery, followed by platinum-based chemotherapy (mostly carboplatin and paclitaxel) and/or anti-angiogenic agent bevacizumab, then maintenance therapy with a poly(ADP-ribose) polymerase (PARP) inhibitor with/without/or bevacizumab (continued). PARP inhibitor use depends on the patient\'s genetic signature, mainly the breast cancer gene (BRCA) mutation and the homologous recombination deficiency (HRD) status. Therefore, genetic testing is recommended at diagnosis to inform treatment and prognosis. In line with the evolving standard-of-care for ovarian cancer, a panel of experts in treating advanced ovarian cancer convened to lay down practical recommendations on the management of advanced ovarian cancer in Lebanon; since the currently applicable guidelines by the Lebanese Ministry of Public Health for cancer treatment have not been updated yet to reflect the treatment paradigm shift brought upon by the development and approval of PARP inhibitors. The current work reviews the leading clinical trials on PARP inhibitors (as maintenance for newly diagnosed advanced and platinum-sensitive relapsed ovarian cancer), presents international recommendations, and proposes treatment algorithms for optimal local practice.
摘要：
卵巢癌是最致命的妇科癌症。高级别浆液性上皮（HGSE）亚型是最具侵略性的，它通常出现在晚期，虽然筛查计划还没有被证明是有益的。高级阶段的管理(FIGOIII和IV)，构成大多数诊断，通常包括铂类化疗和细胞减灭术(原发或间期),然后进行维持治疗.目前,晚期新诊断的HGSE卵巢癌的护理标准，根据国际医学协会，从前期的细胞减灭术开始，其次是铂类化疗（主要是卡铂和紫杉醇）和/或抗血管生成药物贝伐单抗，然后用聚(ADP-核糖)聚合酶(PARP)抑制剂加/不加/不加贝伐单抗维持治疗(续).PARP抑制剂的使用取决于患者的遗传特征，主要表现为乳腺癌基因(BRCA)突变和同源重组缺陷(HRD)状态。因此,建议在诊断时进行基因检测，以告知治疗和预后。根据不断发展的卵巢癌护理标准，一个治疗晚期卵巢癌的专家小组召开会议，就黎巴嫩晚期卵巢癌的治疗提出切实可行的建议；因为黎巴嫩公共卫生部目前适用的癌症治疗指南尚未更新，以反映PARP抑制剂的开发和批准带来的治疗模式转变。目前的工作回顾了PARP抑制剂（作为新诊断的晚期和铂敏感的复发性卵巢癌的维持）的主要临床试验，提出国际建议，并提出了最优局部实践的治疗算法。
