Oleh Admin Kalbe Medical pada March 16, 2017 08:00

Terapi Hormon Pemeliharaan pada Pasien Karsinoma Ovarium atau Peritoneum Serous Derajat Rendah

Karsinoma ovarium atau peritoneum serous derajat rendah (low grade serous carcinoma/LGSC) merupakan subtipe histologi yang jarang dijumpai, yang tampaknya berasal dari tumor serous dengan potensi maligna rendah. Laporan terkini dari Arbeitsgemeinschaft Gynaekologische Onkologie menyebutkan bahwa LGSC tidak responsif terhadap kemoterapi seperti yang ditemukan pada high-grade serous carcinoma (HGSC). Temuan ini mempercepat pencarian terapi alternatif yang efektif termasuk terapi hormon dan terapi target.

Peneliti mengatakan bahwa LGSC tidak mutlak resisten terhadap kemoterapi berbasis platinum, hal ini terlihat dari pemberian kemoterapi platinum plus taxane pada pasien dengan LGSC stadium II-IV newly diagnosed setelah bedah sitoreduktif primer. Kombinasi kemoterapi platinum plus taxane diberikan selama 6-8 siklus. Karena masih kurangnya data uji klinik prospektif, ada yang meninggalkan kemoterapi pasca-operasi dan beralih pada terapi hormon.

Gershenson dan rekan-rekan melakukan studi untuk melihat outcome yang dikaitkan dengan terapi hormon pemeliharaan dibandingkan dengan observasi rutin setelah bedah sitoreduktif primer dan kemoterapi berbasis platinum pada pasien karsinoma ovarium atau peritoneum serous derajat rendah stadium II-IV. Kriteria lainnya untuk pasien adalah pada pemantauan ≥ 2 tahun, pasien tidak mengalami rekurensi dan pasien mendapat informasi klinis adekuat.

Dalam studi ini, antara tahun 1981 dan 2013 terdapat 203 pasien yang dilakukan observasi rutin (n= 133) dan mendapat terapi hormon pemeliharaan (n= 70) di MD Anderson Cancer Center. Sebagian besar pasien adalah orang kulit putih, dengan LGSC, dan stadium III. Hasil median follow up secara keseluruhan adalah 70,8 bulan. Pasien yang mendapat terapi hormon pemeliharaan memiliki risiko progresivitas penyakit yang lebih rendah dibandingkan pasien yang dilakukan observasi rutin (HR 0,44; 95% CI 0,31 s/d 0,64; p < 0,001). Pasien mendapat terapi hormon pemeliharaan letrozole (54,3%), anastrozole (2,9%), tamoxifen (28,6%), leuprolide acetate (7,1%), leuprolide acetate dengan letrozole (2,9%), leuprolide acetate dengan tamoxifen (2,9%), depot medroxyprogesterone acetate (1,4%). Durasi median terapi hormon pemeliharaan adalah 33,3 bulan.

Kesimpulan dari studi ini adalah pasien dengan karsinoma serous derajat rendah stadium II-IV yang mendapat terapi hormon pemeliharaan setelah terapi primer memiliki PFS yang lebih panjang secara bermakna dibandingkan pasien yang dilakukan observasi rutin. Temuan ini memerlukan penelitian lebih lanjut dengan uji klinik prospektif. (HLI)

Image : Ilustrasi
Referensi:
1.Gershenson DM, Bodurka DC, Coleman RL, Lu KH, Malpica A, Sun CC. Hormonal maintenance therapy for women with low-grade serous cancer of the ovary or peritoneum. J Clin Oncol. 2017 doi: 10.1200/JCO.2016.71.0632.
2.Hoffman J. Hormonal maintenance may improve PFS in low-grade ovarian cancer. Cancer Therapy Advisor [Internet]. 2017 Feb 22 [cited 2017 March 10]. Available from: http://www.cancertherapyadvisor.com/gynecologic-cancer/ovarian-cancer-hormonal-maintenance-improves-survival-pfs/article/639654/
3.Kaldawy A, Segev Y, Lavie O, Auslender R, Sopik V, Narod SA. Low-grade serous ovarian cancer: A review. Gynecol Oncol. 2016 doi: 10.1016/j.ygyno.2016.08.320.

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