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Câncer de ovário resistente à platina ou refratário a platina: progressão durante o...

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IDRF-OVARIAN-TRANSFORMATION-PROGRESSION
TipoSinal de alerta
Estadoreviewed 2026-04-27 | pending_clinical_signoff
DoençasDIS-OVARIAN
FontesSRC-ESMO-OVARIAN-2024 SRC-NCCN-OVARIAN-2025

Origem da bandeira vermelha

DefiniçãoPlatinum-resistant or platinum-refractory ovarian cancer: progression during platinum-based therapy (refractory) or relapse <6 months from last platinum dose (resistant). Routes from platinum-doublet rechallenge to non-platinum single-agent (PLD, weekly paclitaxel, topotecan, gemcitabine) ± bevacizumab (AURELIA), or to mirvetuximab-soravtansine if FRα-high.
Direcção clínicaintensificar
Categoriatransformação-progressão
Algoritmo de deslocamentosALGO-OVARIAN-ADVANCED-1L

Lógica de Desencadeamento

{
  "any_of": [
    {
      "finding": "ovarian_platinum_refractory",
      "value": true
    },
    {
      "finding": "ovarian_platinum_resistant",
      "value": true
    },
    {
      "all_of": [
        {
          "finding": "post_platinum_response",
          "value": "stable_or_progressive"
        },
        {
          "comparator": "<",
          "finding": "months_since_last_platinum",
          "threshold": 6
        }
      ]
    },
    {
      "finding": "progression_on_platinum",
      "value": true
    }
  ],
  "type": "composite"
}

Notas

Platinum-resistant ovarian (PROC) is a defining transition point — prognosis worsens markedly (median OS ~12 mo). Sequential single- agent non-platinum chemo: PLD or weekly paclitaxel are preferred backbones; AURELIA (bevacizumab + chemo) improved PFS (HR 0.48) and is the standard if not bev-exposed and no contraindication. Mirvetuximab-soravtansine (MIRASOL) for FRα-high (≥75% by IHC PS2+) PROC: ORR 42% vs chemo 16%, OS benefit confirmed. PARPi at platinum- resistance generally not recommended (low ORR). Direction "intensify" — operationally re-routes plan generation to PROC algorithm rather than 1L choice. CA-125 + imaging confirmation per GCIG criteria.

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Algoritmos

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