以往，现代医学在卵巢癌的诊疗中有三个“70%”的说法，即70%病例确诊时处于晚期，70%病例在一线治疗达到临床缓解后2年内复发，约70%的患者生存期不超过5年 。 As the number of relapses increases, the patient's treatment remission period gradually shortens, and chemotherapy sensitivity eventually turns into chemotherapy resistance, leading to the failure of final treatment.
In recent years, parp inhibitors, a new type of drug, have brought hope to the treatment of refractory tumors, especially for those with BRCA gene mutations (a genetic defect related to familial breast/ovarian cancer susceptibility, such as a well-known Hollywood actress, because of the carrying of this gene, in order to avoid the evolution of breast cancer, bilateral breast glands have been prophylactic resection). Ovarian cancer patients, whether alone or in combination with chemotherapy, whether advanced maintenance therapy or back-line rescue therapy, have shown good results.
Chinese medicine often understands the pathogenesis of ovarian cancer from the aspects of "weakness, sputum turbidity, blood stasis, cancer poison", and determines the treatment rules such as yiqi support, sputum dispersion, blood detoxification and detoxification according to the specific performance of patients, which are widely used in clinical practice.
Ovarian cancer is a highly heterogeneous class of tumors, which determines that its treatment methods cannot be uniform. Modern medicine emphasizes the determination of individualized treatment plans based on conventional pathological types and molecular typing; Chinese medicine emphasizes prescribing drugs based on the cause, mechanism and constitution of each patient, reflecting the overall view and dialectical view of "disease evidence and treatment". But the goals of the two are the same, that is, objective efficacy (tumor remission/prolongation of survival) comes first.
A recent ovarian cancer patient also gave our team a new understanding of the TCM mechanism of ovarian cancer.
This is a 62-year-old middle-aged woman who underwent radical ovarian cancer resection five years ago, and the pathology is "ovarian high-grade serous papillary cystic carcinoma", staged IIIC stage, which is locally advanced. Postoperative chemotherapy for 6 cycles, thereafter regular review and coordination with traditional Chinese medicine treatment. Unfortunately, two years ago, the patient's intra-abdominal tumor recurred, and heeded our advice and underwent tumor reduction surgery again. The surgery was successful, and after the operation, we consolidated the chemotherapy for six cycles until the end of February 2020, and then continued the Chinese medicine treatment. The patient is in good physical condition and is regularly reviewed. Everything seems normal, but both the doctor and the patient himself always maintain a sense of worry and alertness. In a situation like her, the initial operation is advanced, the degree of malignancy is high, and even after the secondary recurrence surgery, even if the standard postoperative adjuvant treatment is received, the probability of recurrence and metastasis is more than 90%, which seems to have become the "fate" of this type of tumor treatment. So, we tested her for ca125, a blood tumor marker, every two months and an imaging review every four months to monitor for signs of early tumor recurrence. In February this year, the CA125 value exceeded 10U/ml for the first time, and although it is still in the normal range, the risk factor is rising. Monthly monitoring since then can see a slow climb in the indicator, reaching 43.5 in June, and small nodular thickening of the pelvic peritoneum was also observed on abdominal CT. At this point, we have determined that her tumor recurrence in the pelvic cavity is at least a tumor biochemical recurrence. Earlier we mentioned a new drug to treat ovarian cancer, a PARP inhibitor, and in fact, when it first recurred two years ago, we suggested that she have performed peripheral blood gene monitoring, which suggests a "suspected BRCA2 pathogenic mutation", which is an indication for the use of PARP inhibitors.
So, is the next step in treatment to choose traditional platinum-containing chemotherapy or a new drug? Or conservative treatment of Chinese medicine? It is a question that both doctors and patients must seriously consider.
(To be continued)