{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:08:54Z","timestamp":1792696134146,"version":"4.5.0"},"reference-count":56,"publisher":"Federacion Colombiana de Obstetricia y Ginecologia","issue":"1","license":[{"start":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T00:00:00Z","timestamp":1718323200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T00:00:00Z","timestamp":1718323200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["revista.fecolsog.org"],"crossmark-restriction":false},"short-container-title":["Rev. colomb. obstet. ginecol."],"abstract":"<jats:p>Introducci\u00f3n y objetivo: el abordaje de pacientes con c\u00e1ncer epitelial de ovario (CEO) de alto grado avanzado o metast\u00e1sico ha ido evolucionando a trav\u00e9s del tiempo con el advenimiento de nuevas terapias y estrategias multimodales. El objetivo de este consenso de expertos es generar recomendaciones nacionales para el perfilamiento y manejo del CEO de alto grado avanzado o metast\u00e1sico, definido como estadios III y IV de la clasificaci\u00f3n de la Federaci\u00f3n Internacional de Ginecolog\u00eda y Obstetricia (FIGO) al momento del diagn\u00f3stico, a partir de la revisi\u00f3n de la literatura que incluy\u00f3 gu\u00edas de pr\u00e1ctica cl\u00ednica (GPC) internacionales basadas en la evidencia.\nMateriales y m\u00e9todos: once panelistas (onc\u00f3logos y ginec\u00f3logos onc\u00f3logos) respondieron ocho preguntas sobre el perfilamiento y manejo del carcinoma epitelial de ovario avanzado o metast\u00e1sico. Los panelistas fueron escogidos por su perfil acad\u00e9mico e influencia en instituciones de salud nacionales. Para el desarrollo del consenso se utilizaron los lineamientos de la \u201cConferencia de consenso de procedimientos operativos estandarizados de ESMO\u201d. Se defini\u00f3 que el nivel de acuerdo para aceptar una recomendaci\u00f3n deb\u00eda ser \u2265 80%. El documento fue revisado por pares.\nResultados: Se hacen 8 recomendaciones generales, presentadas en cinco dominios; algunas de ellas se subdividen en recomendaciones espec\u00edficas.\nTratamiento inicial\nRecomendaci\u00f3n 1\n1.1. Como terapia inicial de elecci\u00f3n para pacientes con CEO de alto grado o metast\u00e1sico se sugiere la cirug\u00eda de citorreducci\u00f3n primaria (Cpr) completa que, idealmente, debe realizarse en centros con experiencia, seguida de terapia adyuvante.\n1.2. Se sugiere quimioterapia neoadyuvante seguida de cirug\u00eda de citorreducci\u00f3n de intervalo (Cint) en quienes sea improbable alcanzar una citorreducci\u00f3n\ncompleta en la Cpr, bien sea por enfermedad metast\u00e1sica no resecable o que presenten criterios de irresecabilidad (imagenol\u00f3gicos, laparosc\u00f3picos o por laparotom\u00eda) que hayan sido definidos por un ginec\u00f3logo onc\u00f3logo. Tambi\u00e9n en pacientes con un pobre estado funcional y comorbilidades de acuerdo con el criterio del equipo multidisciplinario (oncolog\u00eda cl\u00ednica, ginecolog\u00eda oncol\u00f3gica, radiolog\u00eda, etc.).\nRecomendaci\u00f3n 2. En pacientes con CEO de alto grado, en estadio III localmente avanzado o metast\u00e1sico, que recibieron quimioterapia neoadyuvante y alcanzaron respuesta completa o parcial (citorreducci\u00f3n con residuo tumoral &lt; 2,5 mm), se podr\u00eda evaluar el uso de la quimioterapia intraperitoneal hipert\u00e9rmica (Hyperthermic IntraPeritoneal Chemotherapy - HIPEC) como alternativa a la quimioterapia IV adyuvante est\u00e1ndar basada en platinos durante la Cint, previa discusi\u00f3n en junta multidisciplinaria, en un centro de experiencia en este tipo de pacientes.\nUso de pruebas gen\u00e9ticas\nRecomendaci\u00f3n 3. Al momento del diagn\u00f3stico, se sugiere ofrecer testeo molecular gen\u00e9tico a toda paciente con CEO de alto grado avanzado o metast\u00e1sico, independientemente de la historia familiar.\nRecomendaci\u00f3n 4. Se sugiere ofrecer asesoramiento gen\u00e9tico, por parte de personal calificado, a toda paciente con CEO de alto grado avanzado o metast\u00e1sico a quien se le ordene un testeo gen\u00e9tico.\nRecomendaci\u00f3n 5. Se sugiere que a toda paciente con CEO de alto grado avanzado o metast\u00e1sico se le realice panel germinal que incluya los genes de susceptibilidad al c\u00e1ncer de mama 1\/2 (BRCA 1\/2) y los otros genes de susceptibilidad de acuerdo con los protocolos institucionales y la disponibilidad de paneles de testeo gen\u00e9tico; si es negativo entonces se deber\u00eda realizar testeo som\u00e1tico que incluya el estatus de deficiencia de la recombinaci\u00f3n hom\u00f3loga (homologous recombination deficiency - HRD), independientemente de la historia familiar.\nTerapia adyuvante\nRecomendaci\u00f3n 6\n6.1. Se sugiere que a toda paciente con CEO estadios III\/IV avanzado o metast\u00e1sico, con estatus de desempe\u00f1o (performance score care - PSC) de 0-2 se le administre como tratamiento est\u00e1ndar quimioterapia intravenosa (IV) adyuvante dentro de las seis semanas posteriores a la Cpr. Se sugiere administrar paclitaxel\/carboplatino.\n6.2. Se sugiere utilizar quimioterapia est\u00e1ndar basada en platino m\u00e1s bevacizumab como adyuvancia en pacientes con enfermedad de alto riesgo (CEO estadios IV o III con citorreducci\u00f3n tumoral sub\u00f3ptima), continuando con bevacizumab como mantenimiento. No se recomienda el uso de bevacizumab como terapia de mantenimiento si no se incluy\u00f3 en la primera l\u00ednea de tratamiento.\nSe sugiere seguir los esquemas de los estudios Gynecologic Oncology Group Study (GOG-0218) e International Collaborative Ovarian Neoplasm (ICON7).\n6.3. Se sugiere la quimioterapia combinada IV\/intraperitoneal (IP) solo para pacientes seleccionadas, con una citorreducci\u00f3n \u00f3ptima (lesiones residuales &lt; 1 cm), en especial aquellas sin enfermedad residual (R0) y que sean evaluadas en junta multidisciplinaria. La quimioterapia combinada IV\/IP no se considera como tratamiento est\u00e1ndar.\n6.4. 6.4.1. Se sugiere utilizar inhibidores de poli(ADP-ribosa) polimerasa (PARP) tales como olaparib o niraparib como mantenimiento despu\u00e9s de recibir una primera l\u00ednea de quimioterapia en pacientes con CEO estadios III\/IV BRCA1\/2 positivo que recibieron quimioterapia basada en platino y obtuvieron respuesta completa\/respuesta parcial (RC\/RP).\n6.4.2. Se sugiere utilizar olaparib solo o en combinaci\u00f3n con bevacizumab o niraparib en pacientes con CEO estadios III\/IV BRCA1\/2 positivo que recibieron quimioterapia basada en platino m\u00e1s bevacizumab y obtuvieron RC\/RP.\n6.4.3. Se sugiere utilizar niraparib en pacientes con CEO estadio III\/IV BRCA1\/2 negativo o desconocido que recibieron quimioterapia basada en platino y obtuvieron RC\/RP.\n6.4.4. Se sugiere utilizar bevacizumab u olaparib m\u00e1s bevacizumab en pacientes con CEO estadios III\/IV BRCA1\/2 negativo o desconocido (HRD positivo) que recibieron quimioterapia basada en platino m\u00e1s bevacizumab y obtuvieron RC\/RP.\nTratamiento de la reca\u00edda de la enfermedad\nRecomendaci\u00f3n 7. Se sugiere la realizaci\u00f3n de la cirug\u00eda de citorreducci\u00f3n secundaria (Csec), seguida de quimioterapia, a pacientes seleccionadas con CEO de alto grado avanzado o metast\u00e1sico en primera reca\u00edda, platino-sensibles (intervalo libre de platinos \u2265 6 meses), puntuaci\u00f3n Arbeitsgemeinschaft Gyn\u00e4kologische Onkologie (AGO) positiva o Integrate model (I-Model) positivo (&lt; 4,7), y con una potencial resecci\u00f3n a R0, en centros con acceso a soporte quir\u00fargico y posoperatorio \u00f3ptimo.\nNota: el intervalo libre de tratamiento con platinos y la puntuaci\u00f3n AGO solo se han desarrollado como predictores positivos de resecci\u00f3n completa y no para excluir a las pacientes de la cirug\u00eda.\nRecomendaci\u00f3n 8\n8.1. Para pacientes con CEO de alto grado avanzado o metast\u00e1sico en reca\u00edda platino-sensibles se sugiere:\n\nQuimioterapia combinada basada en platino: carboplatino\/doxorrubicina liposomal o carboplatino\/paclitaxel o carboplatino\/ nab-paclitaxel o carboplatino\/docetaxel o carboplatino\/gemcitabina, por seis ciclos. Si no se tolera la terapia combinada, dar carboplatino o cisplatino solo.\nQuimioterapia combinada: carboplatino\/gemcitabina o carboplatino\/paclitaxel o carboplatino\/doxorubicina liposomal, m\u00e1s bevacizumab, seguida de bevacizumab como mantenimiento (hasta progresi\u00f3n o toxicidad).\n\n8.2. Para pacientes con CEO de alto grado avanzado o metast\u00e1sico en reca\u00edda, platino-resistentes, se sugiere:\n\nTratamiento secuencial con quimioterapia, preferiblemente con un agente \u00fanico que no sea un platino (paclitaxel semanal o doxorrubicina liposomal pegilada o docetaxel o etop\u00f3sido oral o gemcitabina o trabectidina o topotecan).\n\nEl paclitaxel semanal o la doxorrubicina liposomal pegilada o el topotecan pueden ser administrados con o sin bevacizumab.\n\nExisten otros agentes que se consideran potencialmente act ivos (capecitabina, ciclofosfamida, ifosfamida, irinotec\u00e1n, oxaliplatino, pemetrexed, vinorelbina, ciclofosfamida), que se podr\u00edan recomendar para l\u00edneas posteriores.\nLas pacientes con receptores hormonales positivos que no toleran o no tienen respuesta a los reg\u00edmenes citot\u00f3xicos pueden recibir terapia hormonal con tamoxifeno u otros agentes, incluidos los inhibidores de la aromatasa (anastrozol y letrozol) o acetato de leuprolide o acetato de megestrol.\nPacientes con PSC \u2265 3 deber\u00edan ser consideradas solo para el mejor cuidado de soporte.\n\n8.3. Terapia de mantenimiento con inhibidores PARP. Para pacientes con CEO de alto grado avanzado o metast\u00e1sico en reca\u00edda estadios III\/IV BRCA1\/2 (positivo, negativo o desconocido), que hayan recibido dos o m\u00e1s l\u00edneas de quimioterapia basada en platino y hayan alcanzado RC\/RP, se sugiere utilizar olaparib, niraparib o rucaparib. El niraparib podr\u00eda ser \u00fatil en pacientes BRCA 1\/2 +\/-\/desconocido, al igual que el rucaparib, sin embargo, este \u00faltimo no tiene a\u00fan aprobaci\u00f3n del ente regulador en Colombia.\nConclusiones: se espera que las recomendaciones emitidas en este consenso contribuyan a mejorar la atenci\u00f3n cl\u00ednica, el impacto oncol\u00f3gico y la calidad de vida de estas mujeres.<\/jats:p>","DOI":"10.18597\/rcog.4094","type":"journal-article","created":{"date-parts":[[2024,6,18]],"date-time":"2024-06-18T11:00:36Z","timestamp":1718708436000},"update-policy":"https:\/\/doi.org\/10.18597\/crossmark","source":"Crossref","is-referenced-by-count":7,"title":["Consenso de expertos basado en la evidencia: perfilamiento y manejo del carcinoma epitelial de ovario de alto grado avanzado","Expert consensus: Profiling and management of advanced or metastatic epithelial ovarian cancer"],"prefix":"10.18597","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2119-9840","authenticated-orcid":false,"given":"Marc E","family":"Pierre","sequence":"first","affiliation":[{"name":"Centro de tratamiento e investigaci\u00f3n sobre el C\u00e1ncer Luis Carlos Sarmiento (CTIC), Bogot\u00e1, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8106-9741","authenticated-orcid":false,"given":"Ray","family":"Manneh","sequence":"additional","affiliation":[{"name":"Sociedad de Oncolog\u00eda y Hematolog\u00eda del Cesar, Valledupar, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0258-5888","authenticated-orcid":false,"given":"Abraham","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Centro hospitalario Serena del Mar, Cartagena, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5472-4093","authenticated-orcid":false,"given":"Juliana","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Santaf\u00e9 de Bogot\u00e1, Bogot\u00e1, Colombia. Departamento de obstetricia y ginecolog\u00eda Universidad Nacional de Colombia, Bogot\u00e1, Colombia. Instituto Nacional de Cancerolog\u00eda, Bogot\u00e1, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8634-6261","authenticated-orcid":false,"given":"Ang\u00e9lica V","family":"Fletcher","sequence":"additional","affiliation":[{"name":"Centro de Investigaciones Oncol\u00f3gicas Cl\u00ednica San Diego (CIOSAD), Bogot\u00e1, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9928-811X","authenticated-orcid":false,"given":"Heydi M","family":"Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Valle de Lili, Cali, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2138-5144","authenticated-orcid":false,"given":"Oscar M","family":"Ni\u00f1o","sequence":"additional","affiliation":[{"name":"Hospital San Ignacio, Bogot\u00e1, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4376-4583","authenticated-orcid":false,"given":"Diego A","family":"G\u00f3mez","sequence":"additional","affiliation":[{"name":"Hospital Internacional de Colombia, Bucaramanga, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2258-6546","authenticated-orcid":false,"given":"Daniel","family":"Sanabria","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Santaf\u00e9 de Bogot\u00e1, Bogot\u00e1, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1859-5906","authenticated-orcid":false,"given":"Fernando","family":"Contreras","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Cancerolog\u00eda, Bogot\u00e1, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2363-7373","authenticated-orcid":false,"given":"Jos\u00e9 R","family":"Pieschac\u00f3n","sequence":"additional","affiliation":[{"name":"Evidentias SAS, Bogot\u00e1, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3672-4820","authenticated-orcid":false,"given":"Pedro H","family":"Calder\u00f3n","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Cancerolog\u00eda, Bogot\u00e1, Colombia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"7913","published-online":{"date-parts":[[2024,6,14]]},"reference":[{"key":"98687","unstructured":"The Global Cancer Observatory. 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