上皮性卵巢癌(EOC)是一种复杂的疾病,具有不同的组织学亚型,which,根据疾病进展的侵袭性和病程,最近被广泛归类为I型(低级浆液,子宫内膜样,透明细胞,和粘液)和II型(高级浆液,高级别子宫内膜样,和未分化癌)类别。尽管在发病机制上存在实质性差异,遗传学,预后,和治疗反应,EOC的临床诊断和治疗在不同亚型之间仍然相似.膨化手术联合以铂-紫杉醇为基础的化疗可作为高级别浆液性卵巢癌(HGSOC)的初始治疗,最普遍的,对于其他亚型,但大多数患者表现出内在或获得性耐药性,并在短时间内复发。靶向治疗,如抗血管生成素(例如,贝伐单抗)和PARP抑制剂(用于BRCA突变的癌症),提供一些成功,但是治疗抵抗,通过各种机制,提出了重大挑战。这一全面的章节深入研究了应对这些挑战的新兴战略,突出显示异常miRNA等因素,新陈代谢,凋亡逃避,癌症干细胞,和自噬,在EOC的抵抗和疾病复发中起关键作用。除了标准治疗,这项研究的重点扩展到替代靶向药物,包括免疫疗法,如检查点抑制剂,CAR-T细胞,和疫苗,以及靶向EOC关键致癌途径的抑制剂。此外,本章包括疾病分类,诊断,阻力途径,标准治疗,以及各种新兴方法的临床数据,并倡导针对个体亚型和抵抗机制量身定制的细微差别和个性化方法,旨在提高整个EOC亚型的治疗结果。
Epithelial ovarian cancer (EOC) is a complex disease with diverse histological subtypes, which, based on the aggressiveness and course of disease progression, have recently been broadly grouped into type I (low-grade serous, endometrioid, clear cell, and mucinous) and type II (high-grade serous, high-grade endometrioid, and undifferentiated carcinomas) categories. Despite substantial differences in pathogenesis, genetics, prognosis, and treatment response, clinical diagnosis and management of EOC remain similar across the subtypes. Debulking surgery combined with platinum-taxol-based chemotherapy serves as the initial treatment for High Grade Serous Ovarian Carcinoma (HGSOC), the most prevalent one, and for other subtypes, but most patients exhibit intrinsic or acquired resistance and recur in short duration. Targeted therapies, such as anti-angiogenics (e.g., bevacizumab) and PARP inhibitors (for BRCA-mutated cancers), offer some success, but therapy resistance, through various mechanisms, poses a significant challenge. This comprehensive chapter delves into emerging strategies to address these challenges, highlighting factors like aberrant miRNAs, metabolism, apoptosis evasion, cancer stem cells, and autophagy, which play pivotal roles in mediating resistance and disease relapse in EOC. Beyond standard treatments, the focus of this study extends to alternate targeted agents, including immunotherapies like checkpoint inhibitors, CAR T cells, and vaccines, as well as inhibitors targeting key oncogenic pathways in EOC. Additionally, this chapter covers disease classification, diagnosis, resistance pathways, standard treatments, and clinical data on various emerging approaches, and advocates for a nuanced and personalized approach tailored to individual subtypes and resistance mechanisms, aiming to enhance therapeutic outcomes across the spectrum of EOC subtypes.