20160927 - Polémicas en junta: Qué es un cáncer de ovario platino-resistente?

Se presentó una paciente con carcinoma de ovario estadío IIIC que tuvo una cirugía subóptima, se le administró 6 meses de quimioterapia basada en platino, con normalización del marcador tumoral, con buena evolución clínica, pero con persistencia de ascitis e implantes tumorales peritoneales por imágenes. En la discusión se planteó que se trataba de un carcinoma platino-resistente por un asistente a la junta. La posición de oncología clínica era que se definía la resistencia a platino si se documentaba progresión tumoral dentro de los siguientes 6 meses después de TERMINADA la quimioterapia basada en platino.

En Markman (Markman MR, The Oncologist, 2000) se establece:

"Recurrent ovarian cancer (potential platinum-sensitive) is defined as the recurrence of active disease in a patient who has achieved a documented response to initial platinum-based treatment and has been off therapy for an extended period of time. For the purposes of study design and interpretation, the Gynecologic Oncology Group (GOG) has divided “sensitive” from “resistant” disease at six months. 

Resistant ovarian cancer is defined as disease that has responded to initial chemotherapy but demonstrates recurrence within a relatively short period of time following the completion of treatment. Again, GOG has decided that patients with documented recurrence within six months of completing initial therapy should be considered “platinum-resistant.” 

Persistent ovarian cancer is the finding of residual disease in a patient who has completed, and apparently responded to, initial chemotherapy. For example, this would include a microscopic-positive second-look laparotomy in a patient who began chemotherapy with suboptimal or optimal residual disease after initial cytoreductive surgery. However, many patients begin chemotherapy in clinical complete remission after cytoreductive surgery, and persistence of small-volume disease may represent chemotherapy resistance rather than evidence of continued response, contributing to heterogeneity in this population. 

Refractory ovarian cancer occurs in patients who have failed to achieve at least a partial response to therapy. This includes patients with either stable disease or actual disease progression during primary therapy, which occurs in approximately 20% of cases. As might be expected, this group has the lowest response rate to second-line therapy."

Consideraciones similares son presentadas en el artículo más reciente de Slaughter (Slaughter K, Gynecologic Oncology (2016)).

Finalmente, en el protocolo del estudio AURELIA que estudió precisamente este grupo de pacientes, se incluyeron pacientes  con resistencia al platino (platino-resistentes) definidas como aquellas con evidencia de progresión tumoral dentro de los 6 meses siguientes a la última dosis del agente (Pujade_Lauraine, 2014).

Referencias
Markman M, Bookman MA. Second-line treatment of ovarian cancer. Oncologist. 2000;5(1):26-35.              doi:10.1634/THEONCOLOGIST.5-1-26.

Slaughter K, Holman LL, Thomas EL, et al. Primary and acquired platinum-resistance among women with high grade serous ovarian cancer. Gynecol Oncol. 2016;142(2):225-230. doi:10.1016/j.ygyno.2016.05.020.

Pujade-Lauraine E, Hilpert F, Weber B, et al. Bevacizumab combined with chemotherapy for platinum-resistant recurrent ovarian cancer: The AURELIA open-label randomized phase III trial. J Clin Oncol. 2014;32(13):1302-1308. doi:10.1200/JCO.2013.51.4489.

Participantes
Ana Milena Roldán
Mauricio Luján
Diego Morán
René Pareja
Rubén Darío Salazar
Gonzalo Ángel
Mauricio Lema