Neoadjuvant combined systemic chemotherapy in the treatment of advanced epithelial ovarian cancer: clinical experience
DOI:
https://doi.org/10.15574/HW.2025.6(186).94100Keywords:
ovarian cancer, serous adenocarcinoma, neoadjuvant, chemotherapy, surgery, anti-VEGF therapy, cytoreduction, tumor markersAbstract
Ovarian cancer ranks second or third among the most common gynecologic malignancies in many countries and is associated with a high mortality rate. The main method of treating this pathology is a combination of cytoreductive surgery and systemic chemotherapy, which is administered in either the neoadjuvant or adjuvant setting depending on the specific clinical situation. In cases of tumor unresectability, carcinomatosis, or the presence of concomitant diseases, neoadjuvant chemotherapy is increasingly used, with the aim of increasing the likelihood of complete tumor resection during cytoreductive surgery. Attempts to identify subgroups of patients who are likely to benefit from neoadjuvant chemotherapy remain the subject of active scientific research.
Aim - to describe and analyze the results of combined neoadjuvant chemotherapy with aflibercept in the treatment of advanced epithelial ovarian cancer to increase doctors' awareness of this pathology.
Clinical case. A clinical case is presented involving the treatment of a 65-year-old patient with poorly differentiated serous ovarian adenocarcinoma, peritoneal dissemination, ascites, and high tumor burden (FIGO IIIC, pT3N0M0) (PCI 31). A distinctive feature of this case was the administration of six cycles of neoadjuvant combination systemic chemotherapy, which made it possible to achieve a marked partial response, followed by complete cytoreductive surgery and positive dynamics of tumor markers CA-125, HE4, and ROMA. The role of aflibercept in the treatment of epithelial ovarian carcinoma is also discussed.
Conclusions. Epithelial ovarian cancer is one of the most common pathologies in terms of incidence and mortality in modern gynecologic oncology practice. Approximately 75% of cases are diagnosed at advanced stages of the disease, when the possibility of complete resectability is debatable.
In cases of tumor unresectability and/or the inability to achieve complete cytoreduction, a promising approach is to supplement standard neoadjuvant chemotherapy with an angiogenesis inhibitor (aflibercept), which can increase the likelihood of complete resection of the neoplasm during cytoreductive surgery, accompanied by a positive trend in tumor markers.
Written informed consent for treatment and publication of this case was obtained from the patient.
No conflict of interests was declared by the authors.
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