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Le TN, Harvey RE, Kim CK, Brown J, Coleman RL, Smith JA. A retrospective evaluation of activity of gemcitabine/platinum regimens in the treatment of recurrent ovarian cancer. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2017; 4:16. [PMID: 29158911 PMCID: PMC5684736 DOI: 10.1186/s40661-017-0053-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/12/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND While many of these agents have been compared in prospective clinical trials, the gemcitabine/platinumbased regimens have not been compared in a prospective, randomized clinical trial. While bothgemcitabine/carboplatin and gemcitabine/cisplatin have a similar ORR in separate clinical trials, the tworegimens have never been directly been compared. With overlapping dose-limiting toxicity of thrombocytopenia, the gemcitabine/carboplatin regimen has been challenging to employ in the clinical setting in previously treated ovarian cancer patients and is often associated with treatment delays and/or dose reductions. Gemcitabine/cisplatin can also be a challenge due to its dose limiting neuropathy and renal toxicity, especially in previously treated patients. In the absence of any prospective, head to head comparison this retrospective study was embarked upon to compare the response rate and toxicity profiles of gemcitabine/cisplatin verses gemcitabine/carboplatin for the treatment of platinum-sensitive verses platinum-resistant recurrent ovarian cancer. METHODS This was a retrospective chart review study that identified patients that had received either gemcitabine/cisplatin or gemcitabine/carboplatin for treatment of recurrent ovarian cancer and compared documented hematological and non-hematological toxicity and response based on RECIST (v1.1). Data was evaluated based upon platinum sensitivity/resistance as well. RESULTS A total of 93 patients were identified that had received a gemcitabine/platinum regimen with 48 with recurrent ovarian cancer that were included in the study. There were 21 patients in the gemcitabine/cisplatin arm and 27 patients identified in the gemcitabine/carboplatin arm. Objective response rate (ORR) was greater in platinum-sensitive patients that received gemcitabine/carboplatin compared to gemcitabine/cisplatin (8 (67%) vs 2 (25%), p < 0.05). Conversely, ORR was greater in platinum-resistant patients treated with gemcitabine/cisplatin (4 (57%) vs 1 (25%), NS). Mean time to progression was greater in gemcitabine/cisplatin patients (7.2 vs 5.1 months, p < 0.03). Patients treated with gemcitabine/carboplatin discontinued due to toxicity at a greater rate (8 (33%) vs 5 (24%)). Specifically gemcitabine/carboplatin had a greater incidence (85%) of grade 2 or greater leukopenia, thrombocytopenia, and neutropenia compared to gemcitabine/cisplatin (19%) However, there was no significant difference in dose reductions, treatment delays, or granulocyte-colony stimulating factor (G-CSF) administration between regimens. CONCLUSIONS Gemcitabine/cisplatin appears to have greater efficacy in platinum-resistant patients, while gemcitabine/carboplatin seems to have greater efficacy in platinum-sensitive patients. Overall, gemcitabine/carboplatin was associated with a greater incidence of myelosuppression and discontinuation due to toxicity. Similar to findings in endometrial cancer, gemcitabine/cisplatin may have benefit specifically in platinum-resistant ovarian cancer.
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Affiliation(s)
- Tran N. Le
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UTHealth McGovern Medical School, 6431 Fannin Street, Rm. 3.152, Houston, TX 77030 USA
| | | | - Christine K. Kim
- University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Jubilee Brown
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC USA
| | | | - Judith A. Smith
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UTHealth McGovern Medical School, 6431 Fannin Street, Rm. 3.152, Houston, TX 77030 USA
- UTHealth-Memorial Hermann Cancer Center-TMC, Houston, TX USA
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152
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Tarumi Y, Mori T, Matsushima H, Kokabu T, Tsuchiya H, Kitawaki J. Long-term survival with bevacizumab in heavily pretreated and platinum-resistant mucinous ovarian cancer: A case report. J Obstet Gynaecol Res 2017; 44:347-351. [DOI: 10.1111/jog.13496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 08/12/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Yosuke Tarumi
- Department of Obstetrics and Gynecology, Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
- Department of Obstetrics and Gynecology; Nantan General Hospital; Kyoto Japan
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Hiroshi Matsushima
- Department of Obstetrics and Gynecology, Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Tetsuya Kokabu
- Department of Obstetrics and Gynecology, Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Hiroshi Tsuchiya
- Department of Obstetrics and Gynecology; Nantan General Hospital; Kyoto Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
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153
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Jiang R, Xu Y, Wang P, Cheng X, Shi T, Zang R. Can 9q34.2 rs633862 polymorphism predict survival in epithelial ovarian cancer? PeerJ 2017; 5:e3946. [PMID: 29109911 PMCID: PMC5671115 DOI: 10.7717/peerj.3946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/30/2017] [Indexed: 11/24/2022] Open
Abstract
Objective Our previous genome-wide association study (GWAS) identified that the ABO rs633862 variant in chromosome 9q34.2 was associated with the risk of epithelial ovarian cancer (EOC) in Chinese Han women. The aim of the present study was to evaluate its prognostic effect on EOC. Methods A total of 669 EOC patients were enrolled for the genotyping of rs633862 variant in 9q34.2. We used Kaplan–Meier survival curves, univariate and multivariate Cox proportional hazard models to evaluate the association of rs633862 with overall survival (OS) in EOC patients. Results We found that rs633862 variant AG/GG genotypes were significantly associated with a longer OS by using univariate Cox proportional hazards regression analysis, compared with the rs633862 AA genotype (HR = 0.69, 95% CI [0.49–0.98], p = 0.035), albeit with a boardline significance in the multivariate analysis. Similar findings were observed in the subgroup of high-grade serous ovarian carcinoma. Further expression quantitative trait loci (eQTL) analysis indicated that the rs633862 AA genotype was associated with an increased level of ABO mRNA expression (p = 1.8 × 10−11). Conclusions Supplementary to the previous GWAS, our study provides additional evidence on the prognostic value of the 9q34.2 rs633862 variant in EOC patients, and this variant may function by regulating the ABO mRNA expression.
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Affiliation(s)
- Rong Jiang
- Ovarian Cancer Program, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuan Xu
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Pan Wang
- Ovarian Cancer Program, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xi Cheng
- Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Tingyan Shi
- Ovarian Cancer Program, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China.,Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Rongyu Zang
- Ovarian Cancer Program, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China.,Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
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154
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Tai YH, Tai YJ, Hsu HC, Lee SP, Chen YY, Chiang YC, Chen YL, Chen CA, Cheng WF. Risk Factors of Hypersensitivity to Carboplatin in Patients with Gynecologic Malignancies. Front Pharmacol 2017; 8:800. [PMID: 29163180 PMCID: PMC5681487 DOI: 10.3389/fphar.2017.00800] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/23/2017] [Indexed: 11/17/2022] Open
Abstract
We evaluated the prevalence of and risk factors for hypersensitivity reactions related to carboplatin, which is commonly used to treat gynecological malignancies. All women with pathologically documented ovarian, fallopian tube, or primary peritoneal cancer treated with carboplatin alone or a carboplatin-based combination chemotherapy regimen at a single hospital between January 2006 and December 2013 were retrospectively recruited. We analyzed the incidence, characteristics, risk factors, management, and outcomes of carboplatin-related hypersensitivity reactions among these patients. Among 735 eligible women, 75 (10.2%) experienced a total of 215 carboplatin-related hypersensitivity reaction events. The annual incidence of carboplatin-related hypersensitivity reactions gradually increased from 0.88% in 2006 to 5.42% in 2013. The incidence of carboplatin-related hypersensitivity was higher in patients with advanced stage disease (P < 0.001, Kruskal-Wallis test), serous and mixed histological types (P = 0.003, Kruskal-Wallis test), malignant ascites (P = 0.009, chi-square test), and history of other drug allergy (P < 0.001, chi-square test). Compared to women without hypersensitivity reactions, women who experienced hypersensitivity reactions had a significantly greater median cycle number (12 vs. 6, P < 0.001, independent sample t-test) and dose (6,816 vs. 3,844 mg, P < 0.001, independent sample t-test). The cumulative incidence of carboplatin-related hypersensitivity reactions dramatically increased with >8 cycles or dose >3,500 mg. Therefore, disease severity, histological type, malignant ascites, past drug allergies, and cumulative carboplatin dose are risk factors for carboplatin-related hypersensitivity reactions. Such reactions could potentially be reduced or prevented by slowing the infusion rate and using a desensitization protocol involving anti-allergy medications.
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Affiliation(s)
- Yu-Hsiao Tai
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Jou Tai
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Heng-Cheng Hsu
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Shu-Ping Lee
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yun-Yuan Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Taiwan Blood Services Foundation, Taipei, Taiwan
| | - Ying-Cheng Chiang
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Li Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chi-An Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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155
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Corrado G, Salutari V, Palluzzi E, Distefano MG, Scambia G, Ferrandina G. Optimizing treatment in recurrent epithelial ovarian cancer. Expert Rev Anticancer Ther 2017; 17:1147-1158. [DOI: 10.1080/14737140.2017.1398088] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Giacomo Corrado
- Department of Health of Woman and Child, Gynecologic Oncology Unit, Catholic University of Sacred Heart, Rome, Italy
| | - Vanda Salutari
- Department of Health of Woman and Child, Gynecologic Oncology Unit, Catholic University of Sacred Heart, Rome, Italy
| | - Eleonora Palluzzi
- Department of Health of Woman and Child, Gynecologic Oncology Unit, Catholic University of Sacred Heart, Rome, Italy
| | - Maria Grazia Distefano
- Department of Health of Woman and Child, Gynecologic Oncology Unit, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Department of Health of Woman and Child, Gynecologic Oncology Unit, Catholic University of Sacred Heart, Rome, Italy
| | - Gabriella Ferrandina
- Department of Health of Woman and Child, Gynecologic Oncology Unit, Catholic University of Sacred Heart, Rome, Italy
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156
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The Pharmacological Costs of Second-Line Treatments for Recurrent Ovarian Cancer. Int J Gynecol Cancer 2017; 27:1872-1876. [DOI: 10.1097/igc.0000000000001106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IntroductionIn ovarian cancer, it is uncertain which chemotherapy regimen is more clinically effective and cost-effective for the treatment of recurrence; therefore, it might be interesting to make a balance between the cost of the drugs administered and the difference in progression-free survival (PFS) and overall survival (OS).MethodsThe present evaluation was restricted to pivotal phase 3 randomized controlled trials. We calculated the pharmacological costs necessary to get the benefit in PFS and OS. The costs of drugs are at the pharmacy of our hospital and are expressed in Euros (€). We have subsequently applied the European Society for Medical Oncology Magnitude of Clinical Benefit Scale.ResultsOur study evaluated 3 phase 3 randomized controlled trials, including 2004 patients. The most relevant increase of costs was associated with the combination chemotherapy including trabectedin, with the highest costs for month of PFS gained (15,836 €) and for month of OS gained (7198 €), but it substantially differs considering the data of partially platinum-sensitive populations (platinum-free interval of 6–12 months), with 3959 € for month of OS gained.ConclusionsThe addition of trabectedin to pegylated liposomal doxorubicin for the treatment of recurrent ovarian cancer can lead to an increase of pharmacological costs. Differently, considering OS in patients with platinum-free interval of 6 to 12 months, there is a halving of pharmacological costs with the addition of trabectedin to pegylated liposomal doxorubicin. These costs are in line with the spending suggested as sustainable (thresholds of <$61,500 per life-year gained).
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157
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González-Martín A. Update on relapsed ovarian cancer treatment: from new consensus to daily clinical practice. Future Oncol 2017; 13:3-9. [PMID: 29020819 DOI: 10.2217/fon-2017-0316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The outcome of the 5th Ovarian Cancer Consensus Conference (OCCC) held in November 2015 in Tokyo, Japan, was the development of new and revised consensus statements to guide clinical investigations in ovarian cancer. The OCCC statements may also have direct application to daily clinical practice. This review examines the consensus statements for recurrent ovarian cancer and their impact on treatment paradigms. Importantly, patients are no longer to be categorized by the platinum-free interval (with its arbitrary 6-month cut-off points) but according to the question: 'is platinum still an option for the patient?' Another important change since the 4th OCCC in 2010 is the inclusion of BRCA mutation status when defining patient subgroups for entry into clinical trials.
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158
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Loizzi V, Del Vecchio V, Gargano G, De Liso M, Kardashi A, Naglieri E, Resta L, Cicinelli E, Cormio G. Biological Pathways Involved in Tumor Angiogenesis and Bevacizumab Based Anti-Angiogenic Therapy with Special References to Ovarian Cancer. Int J Mol Sci 2017; 18:ijms18091967. [PMID: 28906427 PMCID: PMC5618616 DOI: 10.3390/ijms18091967] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/16/2017] [Accepted: 09/08/2017] [Indexed: 12/14/2022] Open
Abstract
The creation of new blood vessels from existing ones, which is a mechanism called “angiogenesis”, is essential in cancer to supply cancerous growth. Moreover, the development and the progression of the tumor and its metastases are the result of an efficient vascular response. Cancer cells release and activate different angiogenic growth factors and their receptors in the tumor microenvironment to promote the angiogenic process. The most important pro-angiogenic factor is the “Vascular Endothelial Growth Factor” (VEGF) because of its mitogen activity on vascular endothelium. Bevacizumab is a monoclonal antibody that obstructs the binding of circulating vascular endothelial growth factor to its receptors and has been approved for the treatment of primary and recurrent ovarian cancer but also for many other solid tumors.
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Affiliation(s)
- Vera Loizzi
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy.
| | - Vittoria Del Vecchio
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy.
| | - Giulio Gargano
- Gynecologic Oncology Unit, IRCCS, Istituto Tumori Giovanni Paolo II, 70142 Bari, Italy.
| | - Maria De Liso
- Gynecologic Oncology Unit, IRCCS, Istituto Tumori Giovanni Paolo II, 70142 Bari, Italy.
| | - Anila Kardashi
- Gynecologic Oncology Unit, IRCCS, Istituto Tumori Giovanni Paolo II, 70142 Bari, Italy.
| | - Emanuele Naglieri
- Gynecologic Oncology Unit, IRCCS, Istituto Tumori Giovanni Paolo II, 70142 Bari, Italy.
| | - Leonardo Resta
- Department of Pathology, University of Bari, 70121 Bari, Italy.
| | - Ettore Cicinelli
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy.
| | - Gennaro Cormio
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy.
- Gynecologic Oncology Unit, IRCCS, Istituto Tumori Giovanni Paolo II, 70142 Bari, Italy.
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159
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Herzog TJ, Monk BJ. Bringing new medicines to women with epithelial ovarian cancer: what is the unmet medical need? GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2017; 4:13. [PMID: 28904804 PMCID: PMC5590167 DOI: 10.1186/s40661-017-0050-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/25/2017] [Indexed: 11/10/2022]
Abstract
Background Therapy for advanced epithelial ovarian cancer (OC) includes first line platinum/taxane-containing chemotherapy and re-treatment with platinum-containing regimens for disease recurrence in patients likely to respond again. Single-agent, non-platinum, cytotoxic agents are commonly used to treat patients resistant to platinum retreatment, but these agents are associated with dose-limiting toxicities and response rates below 20%. Main body Recent advances have led to novel targeted treatments for recurrent OC that offer opportunities to improve response rates and prolong progression-free intervals. However, they also add complexity to the process of selecting treatment for individual patients at different stages of the disease process. Advanced and recurrent OC is rarely cured. Multiple lines of platinum combinations, and nonplatinum chemotherapeutics eventually fail to achieve clinical benefit, thus other active and tolerable systemic therapies are needed. Consequently, the US Food and Drug Administration has created a mechanism for “accelerated approval” of new medicines in situations of high unmet medical need. Conclusion We review the clinical implications of recent key clinical studies in these settings and outline the path forward for study design and approval of novel therapeutics to treat recurrent OC.
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Affiliation(s)
- Thomas J Herzog
- University of Cincinnati Cancer Institute, University of Cincinnati, Medical Sciences Bldg, Suite 2005H, ML0662, 231 Albert Sabin Way, Cincinnati, OH 45267-0662 USA
| | - Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine and Creighton University School of Medicine at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013 USA
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160
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Herzog TJ, Ison G, Alvarez RD, Balasubramaniam S, Armstrong DK, Beaver JA, Ellis A, Tang S, Ford P, McKee A, Gershenson DM, Kim G, Monk BJ, Pazdur R, Coleman RL. FDA ovarian cancer clinical trial endpoints workshop: A Society of Gynecologic Oncology White Paper. Gynecol Oncol 2017; 147:3-10. [PMID: 28844539 DOI: 10.1016/j.ygyno.2017.08.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/05/2017] [Accepted: 08/08/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Thomas J Herzog
- University of Cincinnati Cancer Institute, Dept. of Ob/Gyn, University of Cincinnati, United States
| | - Gwynn Ison
- Office of Hematology Oncology Products, OND, CDER, FDA, United States
| | - Ronald D Alvarez
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | | | - Julia A Beaver
- Office of Hematology Oncology Products, OND, CDER, FDA, United States
| | - Annie Ellis
- Ovarian Cancer Survivor, White Plains, New York
| | - Shenghui Tang
- Division of Biometrics V, OB, OTS, CDER, FDA, United States
| | - Peg Ford
- Ovarian Cancer Alliance of San Diego, United States
| | - Amy McKee
- Office of Hematology Oncology Products, OND, CDER, FDA, United States
| | | | - Geoffrey Kim
- Office of Hematology Oncology Products, OND, CDER, FDA, United States
| | | | | | - Robert L Coleman
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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161
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Janowitz T, Williams EH, Marshall A, Ainsworth N, Thomas PB, Sammut SJ, Shepherd S, White J, Mark PB, Lynch AG, Jodrell DI, Tavaré S, Earl H. New Model for Estimating Glomerular Filtration Rate in Patients With Cancer. J Clin Oncol 2017; 35:2798-2805. [PMID: 28686534 PMCID: PMC5562175 DOI: 10.1200/jco.2017.72.7578] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The glomerular filtration rate (GFR) is essential for carboplatin chemotherapy dosing; however, the best method to estimate GFR in patients with cancer is unknown. We identify the most accurate and least biased method. Methods We obtained data on age, sex, height, weight, serum creatinine concentrations, and results for GFR from chromium-51 (51Cr) EDTA excretion measurements (51Cr-EDTA GFR) from white patients ≥ 18 years of age with histologically confirmed cancer diagnoses at the Cambridge University Hospital NHS Trust, United Kingdom. We developed a new multivariable linear model for GFR using statistical regression analysis. 51Cr-EDTA GFR was compared with the estimated GFR (eGFR) from seven published models and our new model, using the statistics root-mean-squared-error (RMSE) and median residual and on an internal and external validation data set. We performed a comparison of carboplatin dosing accuracy on the basis of an absolute percentage error > 20%. Results Between August 2006 and January 2013, data from 2,471 patients were obtained. The new model improved the eGFR accuracy (RMSE, 15.00 mL/min; 95% CI, 14.12 to 16.00 mL/min) compared with all published models. Body surface area (BSA)-adjusted chronic kidney disease epidemiology (CKD-EPI) was the most accurate published model for eGFR (RMSE, 16.30 mL/min; 95% CI, 15.34 to 17.38 mL/min) for the internal validation set. Importantly, the new model reduced the fraction of patients with a carboplatin dose absolute percentage error > 20% to 14.17% in contrast to 18.62% for the BSA-adjusted CKD-EPI and 25.51% for the Cockcroft-Gault formula. The results were externally validated. Conclusion In a large data set from patients with cancer, BSA-adjusted CKD-EPI is the most accurate published model to predict GFR. The new model improves this estimation and may present a new standard of care.
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Affiliation(s)
- Tobias Janowitz
- Tobias Janowitz, Edward H. Williams, Stephen J. Sammut, Andy G. Lynch, Duncan I. Jodrell, Simon Tavaré, and Helena Earl, Cancer Research UK Cambridge Institute, Tobias Janowitz, Peter B. Thomas, and Duncan I. Jodrell, University of Cambridge, Addenbrooke’s Hospital, Cambridge; Andrea Marshall, University of Warwick, Coventry; Nicola Ainsworth, Queen Elizabeth Hospital, King’s Lynn; Scott Shepherd, Royal Marsden Hospital, London; Jeff White, NHS Greater Glasgow and Clyde; and Patrick B. Mark, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Edward H. Williams
- Tobias Janowitz, Edward H. Williams, Stephen J. Sammut, Andy G. Lynch, Duncan I. Jodrell, Simon Tavaré, and Helena Earl, Cancer Research UK Cambridge Institute, Tobias Janowitz, Peter B. Thomas, and Duncan I. Jodrell, University of Cambridge, Addenbrooke’s Hospital, Cambridge; Andrea Marshall, University of Warwick, Coventry; Nicola Ainsworth, Queen Elizabeth Hospital, King’s Lynn; Scott Shepherd, Royal Marsden Hospital, London; Jeff White, NHS Greater Glasgow and Clyde; and Patrick B. Mark, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Andrea Marshall
- Tobias Janowitz, Edward H. Williams, Stephen J. Sammut, Andy G. Lynch, Duncan I. Jodrell, Simon Tavaré, and Helena Earl, Cancer Research UK Cambridge Institute, Tobias Janowitz, Peter B. Thomas, and Duncan I. Jodrell, University of Cambridge, Addenbrooke’s Hospital, Cambridge; Andrea Marshall, University of Warwick, Coventry; Nicola Ainsworth, Queen Elizabeth Hospital, King’s Lynn; Scott Shepherd, Royal Marsden Hospital, London; Jeff White, NHS Greater Glasgow and Clyde; and Patrick B. Mark, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Nicola Ainsworth
- Tobias Janowitz, Edward H. Williams, Stephen J. Sammut, Andy G. Lynch, Duncan I. Jodrell, Simon Tavaré, and Helena Earl, Cancer Research UK Cambridge Institute, Tobias Janowitz, Peter B. Thomas, and Duncan I. Jodrell, University of Cambridge, Addenbrooke’s Hospital, Cambridge; Andrea Marshall, University of Warwick, Coventry; Nicola Ainsworth, Queen Elizabeth Hospital, King’s Lynn; Scott Shepherd, Royal Marsden Hospital, London; Jeff White, NHS Greater Glasgow and Clyde; and Patrick B. Mark, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Peter B. Thomas
- Tobias Janowitz, Edward H. Williams, Stephen J. Sammut, Andy G. Lynch, Duncan I. Jodrell, Simon Tavaré, and Helena Earl, Cancer Research UK Cambridge Institute, Tobias Janowitz, Peter B. Thomas, and Duncan I. Jodrell, University of Cambridge, Addenbrooke’s Hospital, Cambridge; Andrea Marshall, University of Warwick, Coventry; Nicola Ainsworth, Queen Elizabeth Hospital, King’s Lynn; Scott Shepherd, Royal Marsden Hospital, London; Jeff White, NHS Greater Glasgow and Clyde; and Patrick B. Mark, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Stephen J. Sammut
- Tobias Janowitz, Edward H. Williams, Stephen J. Sammut, Andy G. Lynch, Duncan I. Jodrell, Simon Tavaré, and Helena Earl, Cancer Research UK Cambridge Institute, Tobias Janowitz, Peter B. Thomas, and Duncan I. Jodrell, University of Cambridge, Addenbrooke’s Hospital, Cambridge; Andrea Marshall, University of Warwick, Coventry; Nicola Ainsworth, Queen Elizabeth Hospital, King’s Lynn; Scott Shepherd, Royal Marsden Hospital, London; Jeff White, NHS Greater Glasgow and Clyde; and Patrick B. Mark, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Scott Shepherd
- Tobias Janowitz, Edward H. Williams, Stephen J. Sammut, Andy G. Lynch, Duncan I. Jodrell, Simon Tavaré, and Helena Earl, Cancer Research UK Cambridge Institute, Tobias Janowitz, Peter B. Thomas, and Duncan I. Jodrell, University of Cambridge, Addenbrooke’s Hospital, Cambridge; Andrea Marshall, University of Warwick, Coventry; Nicola Ainsworth, Queen Elizabeth Hospital, King’s Lynn; Scott Shepherd, Royal Marsden Hospital, London; Jeff White, NHS Greater Glasgow and Clyde; and Patrick B. Mark, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jeff White
- Tobias Janowitz, Edward H. Williams, Stephen J. Sammut, Andy G. Lynch, Duncan I. Jodrell, Simon Tavaré, and Helena Earl, Cancer Research UK Cambridge Institute, Tobias Janowitz, Peter B. Thomas, and Duncan I. Jodrell, University of Cambridge, Addenbrooke’s Hospital, Cambridge; Andrea Marshall, University of Warwick, Coventry; Nicola Ainsworth, Queen Elizabeth Hospital, King’s Lynn; Scott Shepherd, Royal Marsden Hospital, London; Jeff White, NHS Greater Glasgow and Clyde; and Patrick B. Mark, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Patrick B. Mark
- Tobias Janowitz, Edward H. Williams, Stephen J. Sammut, Andy G. Lynch, Duncan I. Jodrell, Simon Tavaré, and Helena Earl, Cancer Research UK Cambridge Institute, Tobias Janowitz, Peter B. Thomas, and Duncan I. Jodrell, University of Cambridge, Addenbrooke’s Hospital, Cambridge; Andrea Marshall, University of Warwick, Coventry; Nicola Ainsworth, Queen Elizabeth Hospital, King’s Lynn; Scott Shepherd, Royal Marsden Hospital, London; Jeff White, NHS Greater Glasgow and Clyde; and Patrick B. Mark, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Andy G. Lynch
- Tobias Janowitz, Edward H. Williams, Stephen J. Sammut, Andy G. Lynch, Duncan I. Jodrell, Simon Tavaré, and Helena Earl, Cancer Research UK Cambridge Institute, Tobias Janowitz, Peter B. Thomas, and Duncan I. Jodrell, University of Cambridge, Addenbrooke’s Hospital, Cambridge; Andrea Marshall, University of Warwick, Coventry; Nicola Ainsworth, Queen Elizabeth Hospital, King’s Lynn; Scott Shepherd, Royal Marsden Hospital, London; Jeff White, NHS Greater Glasgow and Clyde; and Patrick B. Mark, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Duncan I. Jodrell
- Tobias Janowitz, Edward H. Williams, Stephen J. Sammut, Andy G. Lynch, Duncan I. Jodrell, Simon Tavaré, and Helena Earl, Cancer Research UK Cambridge Institute, Tobias Janowitz, Peter B. Thomas, and Duncan I. Jodrell, University of Cambridge, Addenbrooke’s Hospital, Cambridge; Andrea Marshall, University of Warwick, Coventry; Nicola Ainsworth, Queen Elizabeth Hospital, King’s Lynn; Scott Shepherd, Royal Marsden Hospital, London; Jeff White, NHS Greater Glasgow and Clyde; and Patrick B. Mark, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Simon Tavaré
- Tobias Janowitz, Edward H. Williams, Stephen J. Sammut, Andy G. Lynch, Duncan I. Jodrell, Simon Tavaré, and Helena Earl, Cancer Research UK Cambridge Institute, Tobias Janowitz, Peter B. Thomas, and Duncan I. Jodrell, University of Cambridge, Addenbrooke’s Hospital, Cambridge; Andrea Marshall, University of Warwick, Coventry; Nicola Ainsworth, Queen Elizabeth Hospital, King’s Lynn; Scott Shepherd, Royal Marsden Hospital, London; Jeff White, NHS Greater Glasgow and Clyde; and Patrick B. Mark, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Helena Earl
- Tobias Janowitz, Edward H. Williams, Stephen J. Sammut, Andy G. Lynch, Duncan I. Jodrell, Simon Tavaré, and Helena Earl, Cancer Research UK Cambridge Institute, Tobias Janowitz, Peter B. Thomas, and Duncan I. Jodrell, University of Cambridge, Addenbrooke’s Hospital, Cambridge; Andrea Marshall, University of Warwick, Coventry; Nicola Ainsworth, Queen Elizabeth Hospital, King’s Lynn; Scott Shepherd, Royal Marsden Hospital, London; Jeff White, NHS Greater Glasgow and Clyde; and Patrick B. Mark, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
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Tomao F, D'Incalci M, Biagioli E, Peccatori FA, Colombo N. Restoring platinum sensitivity in recurrent ovarian cancer by extending the platinum-free interval: Myth or reality? Cancer 2017; 123:3450-3459. [PMID: 28678350 DOI: 10.1002/cncr.30830] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/11/2017] [Accepted: 05/19/2017] [Indexed: 11/08/2022]
Abstract
The platinum-free interval is the most important predictive factor of a response to subsequent lines of chemotherapy and the most important prognostic factor for progression-free and overall survival in patients with recurrent epithelial ovarian cancer. A nonplatinum regimen is generally considered the most appropriate approach when the disease recurs very early after the end of chemotherapy, whereas platinum-based chemotherapy is usually adopted when the platinum-free interval exceeds 12 months. However, the therapeutic management of patients with intermediate sensitivity (ie, when the relapse occurs between 6 and 12 months) remains debatable. Preclinical and clinical data suggest that the extension of platinum-free interval (using a nonplatinum-based regimen) might restore platinum sensitivity, thus allowing survival improvement. The objective of this review was to critically analyze preclinical and clinical evidences supporting this hypothesis. Cancer 2017;123:3450-9. © 2017 American Cancer Society.
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Affiliation(s)
- Federica Tomao
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University, Rome, Italy
| | - Maurizio D'Incalci
- Department of Oncology, Mario Negri Institute for Pharmacological Research, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS), Milan, Italy
| | - Elena Biagioli
- Department of Oncology, Mario Negri Institute for Pharmacological Research, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS), Milan, Italy
| | - Fedro A Peccatori
- Fertility and Procreation Unit, European Institute of Oncology, Institute for Treatment and Research (IRCCS), Milan, Italy
| | - Nicoletta Colombo
- Department of Gynecologic Oncology, European Institute of Oncology, Institute for Treatment and Research (IRCCS), Milan, Italy.,Department of Surgical Sciences, University of Milan Bicocca, Milan, Italy
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Lakdawalla DN, Shafrin J, Hou N, Peneva D, Vine S, Park J, Zhang J, Brookmeyer R, Figlin RA. Predicting Real-World Effectiveness of Cancer Therapies Using Overall Survival and Progression-Free Survival from Clinical Trials: Empirical Evidence for the ASCO Value Framework. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:866-875. [PMID: 28712615 DOI: 10.1016/j.jval.2017.04.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 03/23/2017] [Accepted: 04/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To measure the relationship between randomized controlled trial (RCT) efficacy and real-world effectiveness for oncology treatments as well as how this relationship varies depending on an RCT's use of surrogate versus overall survival (OS) endpoints. METHODS We abstracted treatment efficacy measures from 21 phase III RCTs reporting OS and either progression-free survival or time to progression endpoints in breast, colorectal, lung, ovarian, and pancreatic cancers. For these treatments, we estimated real-world OS as the mortality hazard ratio (RW MHR) among patients meeting RCT inclusion criteria in Surveillance and Epidemiology End Results-Medicare data. The primary outcome variable was real-world OS observed in the Surveillance and Epidemiology End Results-Medicare data. We used a Cox proportional hazard regression model to calibrate the differences between RW MHR and the hazard ratios on the basis of RCTs using either OS (RCT MHR) or progression-free survival/time to progression surrogate (RCT surrogate hazard ratio [SHR]) endpoints. RESULTS Treatment arm therapies reduced mortality in RCTs relative to controls (average RCT MHR = 0.85; range 0.56-1.10) and lowered progression (average RCT SHR = 0.73; range 0.43-1.03). Among real-world patients who used either the treatment or the control arm regimens evaluated in the relevant RCT, RW MHRs were 0.6% (95% confidence interval -3.5% to 4.8%) higher than RCT MHRs, and RW MHRs were 15.7% (95% confidence interval 11.0% to 20.5%) higher than RCT SHRs. CONCLUSIONS Real-world OS treatment benefits were similar to those observed in RCTs based on OS endpoints, but were 16% less than RCT efficacy estimates based on surrogate endpoints. These results, however, varied by tumor and line of therapy.
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Affiliation(s)
- Darius N Lakdawalla
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
| | | | - Ningqi Hou
- Precision Health Economics, Los Angeles, CA, USA
| | - Desi Peneva
- Precision Health Economics, Los Angeles, CA, USA
| | - Seanna Vine
- Precision Health Economics, Los Angeles, CA, USA
| | - Jinhee Park
- Novartis Pharmaceuticals, East Hanover, NJ, USA
| | - Jie Zhang
- Novartis Pharmaceuticals, East Hanover, NJ, USA
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164
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Valdes S, Naguib YW, Finch RA, Baze WB, Jolly CA, Cui Z. Preclinical Evaluation of the Short-Term Toxicity of 4-(N)-Docosahexaenoyl 2´, 2´- Difluorodeoxycytidine (DHA-dFdC). Pharm Res 2017; 34:1224-1232. [PMID: 28352993 PMCID: PMC5488709 DOI: 10.1007/s11095-017-2139-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/02/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE This study was designed to test the short-term toxicity of DHA-dFdC in a mouse model and its efficacy in a mouse model of leukemia at or below its repeat-dose maximum tolerated dose (RD-MTD). METHOD A repeat-dose dose-ranging toxicity study was designed to determine the tolerability of DHA-dFdC when administered to DBA/2 mice by intravenous (i.v.) injection on a repeat-dose schedule (i.e. injections on days 0, 3, 7, 10, and 13). In order to determine the effect of a lethal dose of DHA-dFdC, mice were injected i.v. with three doses of DHA-dFdC at 100 mg/kg on days 0, 3, and 5 (i.e. a lethal-RD). The body weight of mice was recorded two or three times a week. At the end of the study, major organs (i.e. heart, liver, spleen, kidneys, lung, and pancreas) of mice that received the lethal-RD or RD-MTD were weighed, and blood samples were collected for analyses. Finally, DHA-dFdC was i.v. injected into DBA/2 mice with syngeneic L1210 mouse leukemia cells to evaluate its efficacy at or below RD-MTD. RESULTS The RD-MTD of DHA-dFdC is 50 mg/kg. At 100 mg/kg, a lethal-RD, DHA-dFdC decreases the weights of mouse spleen and liver and significantly affected certain blood parameters (i.e. white blood cells, lymphocytes, eosinophils, and neutrophil segmented). At or below its RD-MTD, DHA-dFdC significantly prolonged the survival of L1210 leukemia-bearing mice. CONCLUSION DHA-dFdC has dose-dependent toxicity, affecting mainly spleen at a lethal-RD. At or below its RD-MTD, DHA-dFdC is effective against leukemia in a mouse model.
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Affiliation(s)
- Solange Valdes
- Pharmaceutics Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas, 78712, USA
| | - Youssef W Naguib
- Pharmaceutics Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas, 78712, USA
| | - Rick A Finch
- Department of Veterinary Sciences, Michale E. Keeling Center for Comparative Medicine and Research, University of Texas M.D. Anderson Cancer Center, Bastrop, Texas, 78602, USA
| | - Wallace B Baze
- Department of Veterinary Sciences, Michale E. Keeling Center for Comparative Medicine and Research, University of Texas M.D. Anderson Cancer Center, Bastrop, Texas, 78602, USA
| | - Christopher A Jolly
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, Texas, 78712, USA
| | - Zhengrong Cui
- Pharmaceutics Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas, 78712, USA.
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Lorusso D, Fontanella C, Maltese G, Lepori S, Tripodi E, Bogani G, Raspagliesi F. The safety of antiangiogenic agents and PARP inhibitors in platinum-sensitive recurrent ovarian cancer. Expert Opin Drug Saf 2017; 16:687-696. [PMID: 28471247 DOI: 10.1080/14740338.2017.1325871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Recurrence is a common event in endothelial ovarian cancer (EOC) patients, and the choice of the most appropriate treatment is driven by the platinum-free interval, molecular characteristics of the disease such as BRCA mutational status, previous treatments and toxicity. Areas covered: This review focuses on the main hematologic and non-hematologic toxicities correlated with the use of licensed antiangiogenic agents and PARP inhibitors in recurrent platinum-sensitive EOC, providing recommendations for their management. Expert opinion: The clinical research over the next years will be focused on a more precise characterization of molecular pathways underlying tumorigenesis of the five ovarian tumors, to improve the decision-making process in these rare diseases. For this purpose, new study designs and international collaborations will become mandatory. Immunotherapy, antiangiogenic agents and PARP inhibitors will be combined to build a treatment strategy algorithm which will allow patients to receive all the available treatment option, in the more appropriate sequence.
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Affiliation(s)
- Domenica Lorusso
- a Gynecologic Oncology , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Caterina Fontanella
- a Gynecologic Oncology , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Giuseppa Maltese
- a Gynecologic Oncology , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Stefano Lepori
- a Gynecologic Oncology , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Elisa Tripodi
- a Gynecologic Oncology , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Giorgio Bogani
- a Gynecologic Oncology , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Francesco Raspagliesi
- a Gynecologic Oncology , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
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Balasubramaniam S, Kim GS, McKee AE, Pazdur R. Regulatory considerations on endpoints in ovarian cancer drug development. Cancer 2017; 123:2604-2608. [PMID: 28499075 DOI: 10.1002/cncr.30652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/06/2016] [Accepted: 10/06/2016] [Indexed: 11/06/2022]
Abstract
Ovarian cancer remains a disease entity that is responsible for considerable morbidity and mortality among women worldwide. Modern drug research pipelines and accelerated drug development timelines applied to other disease entities have begun to make an impact on treatment options for patients with advanced ovarian cancer, as exemplified by the recent accelerated approval of 2 agents for this disease as the forerunners of a growing number of registrational trials. Regulatory flexibility for this serious and life-threatening condition spurs the consideration of intermediate endpoints for regulatory trial design, including potential applications in the development of newer therapeutic classes such as targeted therapies and immunotherapies for patients with advanced ovarian cancer. Cancer 2017;123:2604-8. © 2017 American Cancer Society.
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Affiliation(s)
- Sanjeeve Balasubramaniam
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Geoffrey S Kim
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Amy E McKee
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Richard Pazdur
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
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The Impact of an International Network (Gynecologic Cancer InterGroup) for Clinical Research on Global Capacity for Gynecologic Cancer Clinical Trials. Int J Gynecol Cancer 2017; 27:813-818. [PMID: 28441253 DOI: 10.1097/igc.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The objective of this study was to demonstrate that the construction of the Gynecologic Cancer InterGroup (GCIG) has increased collaboration and accrual to high-quality phase 3 trials at a global level. MATERIALS AND METHODS The GCIG is a collaboration of 29 international cooperative clinical trial groups committed to conduct of high-quality phase 3 trials among women with gynecologic cancer. A complete bibliography of the reported phase 3 trials has been developed and is available on the GCIG Web site http://www.gciggroup.com. A "GCIG trial" is a trial in which any 2 or more GCIG member groups are formally involved. We reviewed the output of the GCIG from 1997 to 2015 with respect to member participation and quality of publication (impact factor and citation index). The publications are considered in 3 cohorts, 1997 to 2002, 2003 to 2008, and 2009 to 2014, for the purposes of comparison and progress. A social network map has been developed for these publications to identify how the GCIG has increased capacity for clinical trials globally. RESULTS Using a global map, the number of member groups in the GCIG has increased in each of the 3 periods. The total annual number of publications and citations within the 1997 to 2015 period has increased significantly. The average number of citations per publication is demonstrated in each of the 3 periods. The steady increase in the number of citations is used as a proxy for the impact of the publications. The impact factor of the journal and the number of citations are reported for the 10 most highly cited publications. Finally, using a social networking methodology, networking has visibly and numerically increased in each of the 3 periods. CONCLUSIONS Evidence supports that the construction of the GCIG has increased collaboration and accrual to high-quality phase 3 trials at a global level among women with gynecologic cancer.
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188Re-Liposome Can Induce Mitochondrial Autophagy and Reverse Drug Resistance for Ovarian Cancer: From Bench Evidence to Preliminary Clinical Proof-of-Concept. Int J Mol Sci 2017; 18:ijms18050903. [PMID: 28441355 PMCID: PMC5454816 DOI: 10.3390/ijms18050903] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/17/2017] [Accepted: 04/20/2017] [Indexed: 12/13/2022] Open
Abstract
Despite standard treatment, about 70% of ovarian cancer will recur. Cancer stem cells (CSCs) have been implicated in the drug-resistance mechanism. Several drug resistance mechanisms have been proposed, and among these, autophagy plays a crucial role for the maintenance and tumorigenicity of CSCs. Compared to their differentiated counterparts, CSCs have been demonstrated to display a significantly higher level of autophagy flux. Moreover, mitophagy, a specific type of autophagy that selectively degrades excessive or damaged mitochondria, is shown to contribute to cancer progression and recurrence in several types of tumors. Nanomedicine has been shown to tackle the CSCs problem by overcoming drug resistance. In this work, we developed a nanomedicine, 188Re-liposome, which was demonstrated to target autophagy and mitophagy in the tumor microenvironment. Of note, the inhibition of autophagy and mitophagy could lead to significant tumor inhibition in two xenograft animal models. Lastly, we presented two cases of recurrent ovarian cancer, both in drug resistance status that received a level I dose from a phase I clinical trial. Both cases developing drug resistance showed drug sensitivity to 188Re-liposome. These results suggest that inhibition of autophagy and mitophagy by a nanomedicine may be a novel strategy to overcome drug resistance in ovarian cancer.
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Coleman RL, Brady MF, Herzog TJ, Sabbatini P, Armstrong DK, Walker JL, Kim BG, Fujiwara K, Tewari KS, O'Malley DM, Davidson SA, Rubin SC, DiSilvestro P, Basen-Engquist K, Huang H, Chan JK, Spirtos NM, Ashfaq R, Mannel RS. Bevacizumab and paclitaxel-carboplatin chemotherapy and secondary cytoreduction in recurrent, platinum-sensitive ovarian cancer (NRG Oncology/Gynecologic Oncology Group study GOG-0213): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 2017; 18:779-791. [PMID: 28438473 DOI: 10.1016/s1470-2045(17)30279-6] [Citation(s) in RCA: 414] [Impact Index Per Article: 59.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Platinum-based chemotherapy doublets are a standard of care for women with ovarian cancer recurring 6 months after completion of initial therapy. In this study, we aimed to explore the roles of secondary surgical cytoreduction and bevacizumab in this population, and report the results of the bevacizumab component here. METHODS The multicentre, open-label, randomised phase 3 GOG-0213 trial was done in 67 predominantly academic centres in the USA (65 centres), Japan (one centre), and South Korea (one centre). Eligible patients were adult women (aged ≥18 years) with recurrent measurable or evaluable epithelial ovarian, primary peritoneal, or fallopian tube cancer, and a clinical complete response to primary platinum-based chemotherapy, who had been disease-free for at least 6 months following last infused cycle of platinum. Patients were randomly assigned (1:1) to standard chemotherapy (six 3-weekly cycles of paclitaxel [175 mg/m2 of body surface area] and carboplatin [area under the curve 5]) or the same chemotherapy regimen plus bevacizumab (15 mg/kg of bodyweight) every 3 weeks and continued as maintenance every 3 weeks until disease progression or unacceptable toxicity. Individuals who participated in both the bevacizumab objective and surgical objective (which is ongoing) were randomly assigned (1:1:1:1) to receive either of these two chemotherapy regimens with or without prior secondary cytoreductive surgery. Randomisation for the bevacizumab objective was stratified by treatment-free interval and participation in the surgical objective. The primary endpoint was overall survival, analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00565851. FINDINGS Between Dec 10, 2007, and Aug 26, 2011, 674 women were enrolled and randomly assigned to standard chemotherapy (n=337) or chemotherapy plus bevacizumab (n=377). Median follow-up at the end of the trial on Nov 5, 2014, was 49·6 months in each treatment group (IQR 41·5-62·2 for chemotherapy plus bevacizumab; IQR 40·8-59·3 for chemotherapy), at which point 415 patients had died (214 in the chemotherapy group and 201 in the chemotherapy plus bevacizumab group). Based on pretreatment stratification data, median overall survival in the chemotherapy plus bevacizumab group was 42·2 months (95% CI 37·7-46·2) versus 37·3 months (32·6-39·7) in the chemotherapy group (hazard ratio [HR] 0·829; 95% CI 0·683-1·005; p=0·056). We identified incorrect treatment-free interval stratification data for 45 (7%) patients (equally balanced between treatment groups); a sensitivity analysis of overall survival based on the audited treatment-free interval stratification data gave an adjusted HR of 0·823 (95% CI 0·680-0·996; p=0·0447). In the safety population (all patients who initiated treatment), 317 (96%) of 325 patients in the chemotherapy plus bevacizumab group had at least one grade 3 or worse adverse event compared with 282 (86%) of 332 in the chemotherapy group; the most frequently reported of these in the chemotherapy plus bevacizumab group compared with the chemotherapy group were hypertension (39 [12%] vs two [1%]), fatigue (27 [8%] vs eight [2%]), and proteinuria (27 [8%] vs none). Two (1%) treatment-related deaths occurred in the chemotherapy group (infection [n=1] and myelodysplastic syndrome [n=1]) compared with nine (3%) in the chemotherapy plus bevacizumab group (infection [n=1], febrile neutropenia [n=1], myelodysplastic syndrome [n=1], secondary malignancy [n=1]; deaths not classified with CTCAE terms: disease progression [n=3], sudden death [n=1], and not specified [n=1]). INTERPRETATION The addition of bevacizumab to standard chemotherapy, followed by maintenance therapy until progression, improved the median overall survival in patients with platinum-sensitive recurrent ovarian cancer. Although the intention-to-treat analysis for overall survival was not significant, our sensitivity analysis based on corrected treatment-free interval stratification indicates that this strategy might be an important addition to the therapeutic armamentarium in these patients. FUNDING National Cancer Institute and Genentech.
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Affiliation(s)
- Robert L Coleman
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Mark F Brady
- NRG Oncology/Gynecologic Oncology Group Statistics & Data Center, University of Buffalo, Buffalo, NY, USA
| | - Thomas J Herzog
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, USA
| | - Paul Sabbatini
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deborah K Armstrong
- Departments of Obstetrics and Gynecology and Department of Medical Oncology, Johns Hopkins Kimmel Cancer Center, Baltimore, MD, USA
| | - Joan L Walker
- Department of Obstetrics and Gynecology, The University of Oklahoma, Oklahoma City, OK, USA
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwayn University School of Medicine, Seoul, South Korea
| | - Keiichi Fujiwara
- Department of Obstetrics and Gynecology, Saitama Medical University International Medical Center, Hidaka-Shi, Japan
| | - Krishnansu S Tewari
- Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA, USA
| | - David M O'Malley
- Department of Obstetrics and Gynecology, The Ohio State University, James Cancer Hospital, Columbus, OH, USA
| | - Susan A Davidson
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine and Denver Health Medical Center, Denver, CO, USA
| | - Stephen C Rubin
- Department of Obstetrics and Gynecology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Paul DiSilvestro
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, RI, USA
| | - Karen Basen-Engquist
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Helen Huang
- NRG Oncology/Gynecologic Oncology Group Statistics & Data Center, University of Buffalo, Buffalo, NY, USA
| | - John K Chan
- Gynecologic Cancer Program, California Pacific-Palo Alto Medical Foundation, Sutter Research Institute, San Francisco, CA, USA
| | | | | | - Robert S Mannel
- Department of Obstetrics and Gynecology, The University of Oklahoma, Oklahoma City, OK, USA
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Gadducci A, Guerrieri ME. PARP inhibitors alone and in combination with other biological agents in homologous recombination deficient epithelial ovarian cancer: From the basic research to the clinic. Crit Rev Oncol Hematol 2017; 114:153-165. [PMID: 28477743 DOI: 10.1016/j.critrevonc.2017.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/15/2017] [Accepted: 04/11/2017] [Indexed: 12/21/2022] Open
Abstract
Hereditary epithelial ovarian cancer [EOC] in germline BRCA mutation (gBRCAm) carriers has a distinct clinical behavior characterized by younger age, high- grade serous histology, advanced stage, visceral distribution of disease, high response to platinum and other non-platinum agents and better clinical outcome. Sporadic EOC with homologous recombination deficiency [HDR] but no gBRCAm has the same biological and clinical behavior as EOC in gBRCAm carriers ("BRCAness"phenotype). Biomarkers are in development to enable an accurate definition of molecular features of BRCAness phenotype, and trials are warranted to determine whether such HDR signature will predict sensitivity to PARP inhibitors in sporadic EOC. Moreover, the link between PARP inhibition and angiogenesis suppression, the immunologic properties of EOC in gBRCAm carriers, the HRD induced by PI3K inhibition in EOC cells in vitro strongly support novel clinical trials testing the combination of PARP inhibitors with other biological agents.
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Affiliation(s)
- Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy.
| | - Maria Elena Guerrieri
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
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Siddiqui MK, Tyczynski J, Pahwa A, Fernandes AW. Objective response rate is a possible surrogate endpoint for survival in patients with advanced, recurrent ovarian cancer. Gynecol Oncol 2017; 146:44-51. [PMID: 28395896 DOI: 10.1016/j.ygyno.2017.03.515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/29/2017] [Accepted: 03/31/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Evaluate literature to assess response rate as a surrogate endpoint of survival in ovarian cancer (OC). METHODS Systematic review consistent with PRISMA criteria, identified randomized, controlled trials reporting overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) in recurrent OC. MEDLINE® and Embase® searches (year 2000-March 23, 2015) were augmented by bibliographic screening. Proposed surrogate measures (independent variables) were ORR and disease control rate. True clinical outcomes (dependent variables) were median OS and PFS. Analyses were performed on unweighted and weighted data using correlation analysis, linear regression, and surrogate threshold effect (STE). Smaller STE indicates greater predictive precision with magnitude of STE dependent on variance of prediction. RESULTS Thirty-nine studies were included for review, representing 9223 platinum-sensitive and resistant patients. Objective response rate (r=0.82; P<0.001) was a better predictor than disease control rate (r=0.58; P<0.001) and strongly correlated with PFS (r=0.85; P<0.0001). Weighted-regression analysis demonstrated that for each 10% increase in ORR, PFS increased by 1.20months and OS by 2.83months. Regression analysis of treatment effects (odds ratio of response, hazard ratio of survival) suggests that a 10% increase in odds ratio of ORR would result in 2.5% reduction in the hazard ratio of OS. Based on weighted data, STE indicated that an ORR of ≥1% is needed to achieve nonzero OS benefit. CONCLUSION This systematic review supports ORR as a possible surrogate clinical trial endpoint for OS in recurrent OC with at least second-line therapy.
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Affiliation(s)
| | - Jerzy Tyczynski
- Global Medical Evidence and Outcomes Research, AstraZeneca, Gaithersburg, MD, USA
| | - Ankit Pahwa
- PAREXEL International, Chandigarh, Chandigarh, India
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172
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Houben E, van Haalen HGM, Sparreboom W, Overbeek JA, Ezendam NPM, Pijnenborg JMA, Severens JL, van Herk-Sukel MPP. Chemotherapy for ovarian cancer in the Netherlands: a population-based study on treatment patterns and outcomes. Med Oncol 2017; 34:50. [PMID: 28224447 DOI: 10.1007/s12032-017-0901-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/06/2017] [Indexed: 12/28/2022]
Abstract
Information on treatment patterns for ovarian cancer (OC) is limited. The aim of this study was to describe current patterns of chemotherapy and other systemic treatments for OC in the Netherlands and evaluate survival outcomes following subsequent lines of treatment. Data from the Eindhoven Cancer Registry, including on newly diagnosed cancer patients, were linked to the PHARMO Database Network, including information on in- and out-patient drug use. Patients diagnosed with OC between January 2000 and December 2010 were selected. An algorithm was used to identify separate lines of treatment. Data were studied descriptively. Detailed data on systemic drug use were available for 261 patients (17%) with OC. In first-line treatment, 87% of the patients (227/261) received platinum-based chemotherapy. Of the 161 patients receiving second-line treatment, 101 patients (63%) received platinum-based chemotherapy. In third line, this was 51% (53/103). The median number of treatment lines received by patients was two (interquartile range 1-3), and eight or more lines of chemotherapy were identified for 12 patients. Median survival from diagnosis onwards was 47 months from the end of first-line treatment, median survival was 32 months, and from the end of second-line treatment, it was 14 months. Predominantly beyond second-line treatment, there is much variety in treatment patterns with chemotherapy for OC. Although uncertainty remains regarding the desirability of this observed treatment variation, there seems a need for detailed clinical guidance, assuring that physicians can properly choose the most suitable treatment for each patient.
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Affiliation(s)
- E Houben
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands.
| | - H G M van Haalen
- AstraZeneca BV, Zoetermeer, The Netherlands.,Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - J A Overbeek
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands
| | - N P M Ezendam
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - J M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J L Severens
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - M P P van Herk-Sukel
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands
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173
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Lin CK, Bai MY, Hu TM, Wang YC, Chao TK, Weng SJ, Huang RL, Su PH, Lai HC. Preclinical evaluation of a nanoformulated antihelminthic, niclosamide, in ovarian cancer. Oncotarget 2016; 7:8993-9006. [PMID: 26848771 PMCID: PMC4891020 DOI: 10.18632/oncotarget.7113] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/18/2016] [Indexed: 12/13/2022] Open
Abstract
Ovarian cancer treatment remains a challenge and targeting cancer stem cells presents a promising strategy. Niclosamide is an “old” antihelminthic drug that uncouples mitochondria of intestinal parasites. Although recent studies demonstrated that niclosamide could be a potential anticancer agent, its poor water solubility needs to be overcome before further preclinical and clinical investigations can be conducted. Therefore, we evaluated a novel nanosuspension of niclosamide (nano-NI) for its effect against ovarian cancer. Nano-NI effectively inhibited the growth of ovarian cancer cells in which it induced a metabolic shift to glycolysis at a concentration of less than 3 μM in vitro and suppressed tumor growth without obvious toxicity at an oral dose of 100 mg/kg in vivo. In a pharmacokinetic study after oral administration, nano-NI showed rapid absorption (reaching the maximum plasma concentration within 5 min) and improved the bioavailability (the estimated bioavailability for oral nano-NI was 25%). In conclusion, nano-NI has the potential to be a new treatment modality for ovarian cancer and, therefore, further clinical trials are warranted.
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Affiliation(s)
- Chi-Kang Lin
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Tri-Service General Hospital, Taipei, Taiwan
| | - Meng-Yi Bai
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Teh-Min Hu
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chi Wang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Tri-Service General Hospital, Taipei, Taiwan
| | - Tai-Kuang Chao
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shao-Ju Weng
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Rui-Lan Huang
- Department of Obstetrics and Gynecology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Po-Hsuan Su
- Department of Obstetrics and Gynecology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hung-Cheng Lai
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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174
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The Efficacy of Low-Dose Paclitaxel Added to Combination Chemotherapy of Carboplatin and Gemcitabine or Pegylated Liposomal Doxorubicin. Int J Gynecol Cancer 2016; 26:443-8. [PMID: 26807640 DOI: 10.1097/igc.0000000000000630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Paclitaxel is known to produce the "platelet-sparing effect" that prevents the carboplatin-induced decrease in platelet count. We conducted a pilot study to assess whether the addition of low-dose paclitaxel to carboplatin-based combination chemotherapy prevents thrombocytopenia. METHODS Patients with platinum-sensitive recurrent ovarian cancer received intravenous (IV) paclitaxel at 60 mg/m(2) followed by IV carboplatin at an area under the curve of 6 and IV pegylated liposomal doxorubicin at 30 mg/m(2) on day 1 in a 28-day cycle (DC-LOP) or IV gemcitabine at 1000 mg/m(2) on days 1 and 8 in a 21-day cycle (GC-LOP). RESULTS During May 2011 to December 2011, 7 patients received 29 cycles of DC-LOP; during January 2012 to May 2013, 15 patients received 88 cycles of GC-LOP. Grade 3/4 thrombocytopenia occurred in 2 (33%) of 6 and 9 (56%) of 16 patients in the DC-LOP and GC-LOP groups, respectively. No grade 3/4 nonhematological toxicity was observed. Only one patient who received GC-LOP had grade 2 sensory and motor peripheral neuropathy. Paclitaxel-related toxicities, including muscle pain, arthralgia, and peripheral neuropathy, were consistently rare and mild. The response rates of DC-LOP and GC-LOP were 33% (0, complete response; 2, partial response; 3, stable disease; 1, progression disease) and 50% (2, complete response; 6, partial response; 7, stable disease; 1, progression disease), respectively. CONCLUSIONS Although low-dose paclitaxel addition did not alleviate thrombocytopenia in the setting of this pilot study, the results do not deny the existence of the "platelet-sparing effect" by low-dose paclitaxel. Further investigation of the carboplatin-based combination chemotherapy including a drug with mild hematological toxicity is warranted.
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175
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Sehouli J, Chekerov R, Reinthaller A, Richter R, Gonzalez-Martin A, Harter P, Woopen H, Petru E, Hanker L, Keil E, Wimberger P, Klare P, Kurzeder C, Hilpert F, Belau A, Zeimet A, Bover-Barcelo I, Canzler U, Mahner S, Meier W. Topotecan plus carboplatin versus standard therapy with paclitaxel plus carboplatin (PC) or gemcitabine plus carboplatin (GC) or pegylated liposomal doxorubicin plus carboplatin (PLDC): a randomized phase III trial of the NOGGO-AGO-Study Group-AGO Austria and GEICO-ENGOT-GCIG intergroup study (HECTOR). Ann Oncol 2016; 27:2236-2241. [DOI: 10.1093/annonc/mdw418] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/20/2016] [Accepted: 08/23/2016] [Indexed: 11/13/2022] Open
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176
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Webber K, Friedlander M. Chemotherapy for epithelial ovarian, fallopian tube and primary peritoneal cancer. Best Pract Res Clin Obstet Gynaecol 2016; 41:126-138. [PMID: 28027849 DOI: 10.1016/j.bpobgyn.2016.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/03/2016] [Accepted: 11/11/2016] [Indexed: 01/01/2023]
Abstract
Chemotherapy plays a key role in the management of women with epithelial ovarian, fallopian tube and primary peritoneal cancer (EOC). Platinum- and taxane-based regimens are the standard of care for adjuvant treatment in early-stage EOC and first-line therapy for advanced stage disease. Efforts to define the optimal scheduling, timing and route of administration are ongoing. The majority of women with EOC will develop recurrent disease, and treatment options for these women are depend on the time that has elapsed from first-line therapy. Platinum-based doublet chemotherapy is preferred for women with platinum-sensitive recurrent cancer. In platinum-resistant relapsed EOC, options are much more limited, and careful consideration of symptoms, performance status, anticipated toxicity and quality of life is essential when recommending chemotherapy for these women.
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Affiliation(s)
- Kate Webber
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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177
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Hasan S, Ricco A, Jenkins K, Lanciano R, Hanlon A, Lamond J, Yang J, Feng J, Good M, Noumoff J, Brady L. Survival and Control Prognosticators of Recurrent Gynecological Malignancies of the Pelvis and Para-aortic Region Treated with Stereotactic Body Radiation Therapy. Front Oncol 2016; 6:249. [PMID: 27921006 PMCID: PMC5118455 DOI: 10.3389/fonc.2016.00249] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/09/2016] [Indexed: 01/30/2023] Open
Abstract
Purpose To define prognostic factors associated with improved survival and local control (LC) for gynecologic cancer recurrences limited to the pelvis and para-aortic (PA) region using stereotactic body radiation therapy (SBRT). Methods Between 2/2008 and 7/2014, 30 women (35 targets) with pelvic or PA recurrence of endometrioid (n = 12), cervical (n = 11), ovarian (n = 3), uterine-serous (n = 2), or carcinosarcoma (n = 2) cancer were treated with SBRT. Eleven recurrences were located in the central pelvis, 11 along the pelvic sidewall (PSW), and 13 in the PA region. Results Five-year survival for all patients was 42% with a median survival of 43.4 months. Multivariate analysis revealed better performance status (PS), and smaller clinical tumor volume was significant for improved survival (p < 0.05). Conclusion SBRT is a local therapy for recurrent gynecological malignancies in the pelvis and PA region with curative potential. SBRT is especially effective for LC when targeting PSW or PA recurrence and for patients with a cervical/endometrioid uterine primary. Survival is improved for patients with better PS and smaller recurrence volume prior to SBRT.
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Affiliation(s)
- Shaakir Hasan
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Anthony Ricco
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Kaylette Jenkins
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Rachelle Lanciano
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Alexandra Hanlon
- University of Pennsylvania School of Nursing , Philadelphia, PA , USA
| | - John Lamond
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Jun Yang
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Jing Feng
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Michael Good
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Joel Noumoff
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
| | - Luther Brady
- Radiation Oncology, Philadelphia Cyberknife, Crozer-Keystone Healthcare System , Havertown, PA , USA
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178
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Paz-Ares L, Forster M, Boni V, Szyldergemajn S, Corral J, Turnbull S, Cubillo A, Teruel CF, Calderero IL, Siguero M, Bohan P, Calvo E. Phase I clinical and pharmacokinetic study of PM01183 (a tetrahydroisoquinoline, Lurbinectedin) in combination with gemcitabine in patients with advanced solid tumors. Invest New Drugs 2016; 35:198-206. [PMID: 27873130 DOI: 10.1007/s10637-016-0410-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/16/2016] [Indexed: 12/11/2022]
Abstract
Background To determine the recommended dose (RD) of a combination of PM01183 and gemcitabine in patients with advanced solid tumors. Methods Forty-five patients received escalating doses of PM01183/gemcitabine on Days 1 and 8 every 3 weeks (d1,8 q3wk) following a standard 3 + 3 design. Results PM01183 3.5 mg flat dose (FD)/gemcitabine 1000 mg/m2 was the highest dose level tested. Dose-limiting toxicities (DLTs) were mostly hematological and resulted in the expansion of a lower dose level (PM01183 3.5 mg FD/gemcitabine 800 mg/m2); 19 patients at this dose level were evaluable but >30% had DLT and >20% had febrile neutropenia. No DLT was observed in 11 patients treated at PM01183 3.0 mg FD/gemcitabine 800 mg/m2, which was defined as the RD. This regimen was feasible and tolerable with manageable toxicity; mainly grade 3/4 myelosuppression. Non-hematological toxicity comprised fatigue, nausea, vomiting, and transaminases increases. Fifteen (33%) patients received ≥6 cycles with no cumulative hematological toxicity. Pharmacokinetic analysis showed no evidence of drug-drug interaction. Nine of 38 patients had response as per RECIST (complete [3%] and partial [21%]), for an overall response rate (ORR) of 24% (95% Confidence Interval [CI] 12-40%). Eleven patients (29%) had disease stabilization ≥4 months. Responses were durable (median of 8.5 months): overall median progression-free survival (PFS) was 4.2 months (95% CI, 2.7-6.5 months). Conclusions The RD for this combination is PM01183 3.0 mg FD (or 1.6 mg/m2)/gemcitabine 800 mg/m2 d1,8 q3wk. This schedule is well tolerated and has antitumor activity in several advanced solid tumor types.
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Affiliation(s)
- Luis Paz-Ares
- Hospital Universitario Virgen del Rocío, Seville, Spain
- Chair of the Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Valentina Boni
- START Madrid, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | | | - Jesús Corral
- Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Samantha Turnbull
- University College of London Hospital, London, UK
- Clinical Research Fellow and SpR in Medical Oncology, Leeds Immunotherapy Team (LIT) at the Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Antonio Cubillo
- START Madrid, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | | | - Iker López Calderero
- Hospital Universitario Virgen del Rocío, Seville, Spain
- Consultant Clinical Oncologist in Can Misses Hospital, Ibiza, Spain
| | | | | | - Emiliano Calvo
- START Madrid, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Madrid, Spain.
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Poon C, Duan X, Chan C, Han W, Lin W. Nanoscale Coordination Polymers Codeliver Carboplatin and Gemcitabine for Highly Effective Treatment of Platinum-Resistant Ovarian Cancer. Mol Pharm 2016; 13:3665-3675. [PMID: 27712076 PMCID: PMC5673481 DOI: 10.1021/acs.molpharmaceut.6b00466] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Due to the ability of ovarian cancer (OCa) to acquire drug resistance, it has been difficult to develop efficient and safe chemotherapy for OCa. Here, we examined the therapeutic use of a new self-assembled core-shell nanoscale coordination polymer nanoparticle (NCP-Carbo/GMP) that delivers high loadings of carboplatin (28.0 ± 2.6 wt %) and gemcitabine monophosphate (8.6 ± 1.5 wt %). A strong synergistic effect was observed between carboplatin and gemcitabine against platinum-resistant OCa cells, SKOV-3 and A2780/CDPP, in vitro. The coadministration of carboplatin and gemcitabine in the NCP led to prolonged blood circulation half-life (11.8 ± 4.8 h) and improved tumor uptake of the drugs (10.2 ± 4.4% ID/g at 24 h), resulting in 71% regression and 80% growth inhibition of SKOV-3 and A2780/CDDP tumors, respectively. Our findings demonstrate that NCP particles provide great potential for the codelivery of multiple chemotherapeutics for treating drug-resistant cancer.
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Affiliation(s)
| | | | - Christina Chan
- Department of Chemistry, University of Chicago, 929 East 57th Street, Chicago, Illinois 60637, United States
| | - Wenbo Han
- Department of Chemistry, University of Chicago, 929 East 57th Street, Chicago, Illinois 60637, United States
| | - Wenbin Lin
- Department of Chemistry, University of Chicago, 929 East 57th Street, Chicago, Illinois 60637, United States
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180
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Musella A, Vertechy L, Romito A, Marchetti C, Giannini A, Sciuga V, Bracchi C, Tomao F, Di Donato V, De Felice F, Monti M, Muzii L, Benedetti Panici P. Bevacizumab in Ovarian Cancer: State of the Art and Unanswered Questions. Chemotherapy 2016; 62:111-120. [DOI: 10.1159/000448942] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/06/2016] [Indexed: 11/19/2022]
Abstract
Ovarian cancer is a most lethal gynecologic tumor. The mainstay treatment is cytoreductive surgery followed by platinum-based chemotherapy. However, a high percentage of patients recur, thus needing multiple treatments with a frequently poor prognosis. In the last two decades, research has focused on the potential of target therapies to improve the survival of patients affected by ovarian cancer. Bevacizumab is one of the most studied target therapies, and it is approved for first- and second-line treatment of advanced epithelial ovarian, fallopian tube, and primary peritoneal tumors. Despite its widespread use with favorable results, controversy regarding patient selection and the best schedule, dosage, and timing of bevacizumab still exists. This review summarizes the state of the art on the use of bevacizumab for ovarian cancer in front-line, recurrence, and neoadjuvant settings. This study focuses on the results of pivotal trials, emerging data, ongoing research, and still unanswered questions about the most adequate dosage of bevacizumab and its potential activity after disease progression or rechallenge in previously treated patients.
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181
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Sehouli J, Grabowski JP. Surgery for recurrent ovarian cancer: Options and limits. Best Pract Res Clin Obstet Gynaecol 2016; 41:88-95. [PMID: 27865654 DOI: 10.1016/j.bpobgyn.2016.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/05/2016] [Accepted: 10/15/2016] [Indexed: 11/30/2022]
Abstract
Cytoreductive surgery is the backbone of the multimodal therapy in primary ovarian cancer patients. Despite the effect of various tumor biological factors such as grading and histological subtype, the surgical outcome is the most important prognostic factor for both progression free- and overall survival. In contrast, the management of recurrent situation has long remained a subject of an emotional international discussion. To date, only few prospective studies have focused on the effect of surgery in relapsed ovarian cancer. The available retrospective data associate complete cytoreduction with prognosis improvement. However, the selection of patients eligible for surgery in recurrent situation is the essential issue. The establishment of predictive factors for complete tumor resection and defining the patient group with recurrent disease who might profit from this approach are crucial. The available predictors of complete resection depend on the results of primary surgery and the current patient's situation. Women who underwent primary complete cytoreduction are in good performance status, and those who have only minimal ascites volume (less than 500 ml) in the recurrent situation have 76% likelihood of undergoing complete resection and survival prolongation. Moreover, the complete cytoreduction in the tertiary cytoreductive approach has been evaluated and showed a potential positive influence on patients' survival. This review concentrates on the recent data and highlights the need of further randomized trials to develop and incorporate operative standards in recurrent ovarian cancer.
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Affiliation(s)
- J Sehouli
- Department of Gynecology, European Competence Center for Ovarian Cancer, Charité-University Medicine of Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - J P Grabowski
- Department of Gynecology, European Competence Center for Ovarian Cancer, Charité-University Medicine of Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Hefner J, Csef H. The Clinical Relevance of Beta Blockers in Ovarian Carcinoma: A Systematic Review. Geburtshilfe Frauenheilkd 2016; 76:1050-1056. [PMID: 27761025 DOI: 10.1055/s-0042-115016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The last ten years have seen hardly any improvement in the prognosis of ovarian carcinoma. There is a great need for new treatment strategies, and a recent retrospective study showing a survival advantage with the use of beta blockers met with a very positive response. This systematic review summarizes the current state of knowledge and research on the topic: A database analysis identified six clinical studies showing inconsistent results with respect to the administration of beta blockers and disease course. The 13 preclinical studies identified showed almost without exception both that catecholamines had detrimental effects on tumour progression, and that these effects could be influenced by pharmacological blockade. Overall the available evidence does not justify the use of beta blockers in clinical practice for ovarian carcinoma at the present time. This article also outlines details of research design required for further studies needed on the subject. Preclinical research findings are however very impressive: They not only form an important basis for the development of future clinical studies but also, through revealing new pathomechanisms, they already make an important contribution towards the development of new treatment strategies for ovarian carcinoma.
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Affiliation(s)
- J Hefner
- Arbeitsbereich Psychosomatische Medizin und Psychotherapie, Medizinische Klinik und Poliklinik II, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - H Csef
- Arbeitsbereich Psychosomatische Medizin und Psychotherapie, Medizinische Klinik und Poliklinik II, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
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183
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Concurrent Radiotherapy and Triweekly Carboplatin for the Definitive Treatment of Locally Advanced Laryngeal Carcinoma. Am J Clin Oncol 2016; 41:595-600. [PMID: 27635621 DOI: 10.1097/coc.0000000000000330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE STUDY In 2003, our institution adopted triweekly carboplatin (tCb) area under the curve (AUC) 5 as an alternative to high-dose cisplatin (100 mg/m) for select patients receiving definitive concurrent chemoradiation for locally advanced laryngeal carcinoma (LALC). Here, we present our experience and outcomes with this definitive concurrent chemoradiation regimen. METHODS From January 2003 through December 2013, 53 patients with stage III (60%) or IVA (40%) LALC were treated with tCb AUC 5 and concurrent radiotherapy to 70 Gy without neoadjuvant chemotherapy. Reasons for using carboplatin instead of cisplatin in these patients were: age 70 and older (21%), poor renal function (6%), presence of 1 or more major comorbid condition(s) (36%), and per discretion of the treating medical oncologist (38%). Primary disease site was glottis in 22 (42%) patients and supraglottis in 31 (58%) patients. RESULTS Median follow-up time was 63 months for surviving patients. Out of the 53 patients, 43 (81%) received all 3 cycles of carboplatin and all patients received their intended dose of radiotherapy. Although 17 (32%) patients required a feeding tube during treatment, only 2 (4%) required it long term. There were no acute treatment-related grade 4 or 5 hematologic toxicities. On last follow-up, 14 (26%) patients had died of intercurrent disease. For the subgroup of "RTOG 9111 eligible" patients in our cohort (n=46), 5-year estimates of overall survival, disease-free survival, laryngectomy-free survival, larynx preservation, and locoregional control were: 49%, 42%, 39%, 80%, and 63%, respectively. CONCLUSIONS In patients with LALC who are suboptimal candidates for high-dose cisplatin, our experience suggests that tCb AUC 5 with concurrent radiotherapy provides acceptable outcomes with tolerable toxicity.
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184
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Ovarian cancer. Nat Rev Dis Primers 2016. [PMID: 27558151 DOI: 10.1038/nrdp.2016.61]+[] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ovarian cancer is not a single disease and can be subdivided into at least five different histological subtypes that have different identifiable risk factors, cells of origin, molecular compositions, clinical features and treatments. Ovarian cancer is a global problem, is typically diagnosed at a late stage and has no effective screening strategy. Standard treatments for newly diagnosed cancer consist of cytoreductive surgery and platinum-based chemotherapy. In recurrent cancer, chemotherapy, anti-angiogenic agents and poly(ADP-ribose) polymerase inhibitors are used, and immunological therapies are currently being tested. High-grade serous carcinoma (HGSC) is the most commonly diagnosed form of ovarian cancer and at diagnosis is typically very responsive to platinum-based chemotherapy. However, in addition to the other histologies, HGSCs frequently relapse and become increasingly resistant to chemotherapy. Consequently, understanding the mechanisms underlying platinum resistance and finding ways to overcome them are active areas of study in ovarian cancer. Substantial progress has been made in identifying genes that are associated with a high risk of ovarian cancer (such as BRCA1 and BRCA2), as well as a precursor lesion of HGSC called serous tubal intraepithelial carcinoma, which holds promise for identifying individuals at high risk of developing the disease and for developing prevention strategies.
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185
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Matulonis UA, Sood AK, Fallowfield L, Howitt BE, Sehouli J, Karlan BY. Ovarian cancer. Nat Rev Dis Primers 2016. [PMID: 27558151 DOI: 10.1038/nrdp.2016.61] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Ovarian cancer is not a single disease and can be subdivided into at least five different histological subtypes that have different identifiable risk factors, cells of origin, molecular compositions, clinical features and treatments. Ovarian cancer is a global problem, is typically diagnosed at a late stage and has no effective screening strategy. Standard treatments for newly diagnosed cancer consist of cytoreductive surgery and platinum-based chemotherapy. In recurrent cancer, chemotherapy, anti-angiogenic agents and poly(ADP-ribose) polymerase inhibitors are used, and immunological therapies are currently being tested. High-grade serous carcinoma (HGSC) is the most commonly diagnosed form of ovarian cancer and at diagnosis is typically very responsive to platinum-based chemotherapy. However, in addition to the other histologies, HGSCs frequently relapse and become increasingly resistant to chemotherapy. Consequently, understanding the mechanisms underlying platinum resistance and finding ways to overcome them are active areas of study in ovarian cancer. Substantial progress has been made in identifying genes that are associated with a high risk of ovarian cancer (such as BRCA1 and BRCA2), as well as a precursor lesion of HGSC called serous tubal intraepithelial carcinoma, which holds promise for identifying individuals at high risk of developing the disease and for developing prevention strategies.
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Affiliation(s)
- Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, and Center for RNA Interference and Non-Coding RNA, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex, UK
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jalid Sehouli
- Charité Universitaetsmedizin Berlin Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Beth Y Karlan
- Women's Cancer Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
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186
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Abstract
Ovarian cancer is not a single disease and can be subdivided into at least five different histological subtypes that have different identifiable risk factors, cells of origin, molecular compositions, clinical features and treatments. Ovarian cancer is a global problem, is typically diagnosed at a late stage and has no effective screening strategy. Standard treatments for newly diagnosed cancer consist of cytoreductive surgery and platinum-based chemotherapy. In recurrent cancer, chemotherapy, anti-angiogenic agents and poly(ADP-ribose) polymerase inhibitors are used, and immunological therapies are currently being tested. High-grade serous carcinoma (HGSC) is the most commonly diagnosed form of ovarian cancer and at diagnosis is typically very responsive to platinum-based chemotherapy. However, in addition to the other histologies, HGSCs frequently relapse and become increasingly resistant to chemotherapy. Consequently, understanding the mechanisms underlying platinum resistance and finding ways to overcome them are active areas of study in ovarian cancer. Substantial progress has been made in identifying genes that are associated with a high risk of ovarian cancer (such as BRCA1 and BRCA2), as well as a precursor lesion of HGSC called serous tubal intraepithelial carcinoma, which holds promise for identifying individuals at high risk of developing the disease and for developing prevention strategies.
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Affiliation(s)
- Ursula A. Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Anil K. Sood
- Department of Gynecologic Oncology and Reproductive Medicine, and Center for RNA Interference and Non-Coding RNA, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex, UK
| | - Brooke E. Howitt
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jalid Sehouli
- Charité Universitaetsmedizin Berlin Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Beth Y. Karlan
- Women’s Cancer Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
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187
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Tew WP. Ovarian cancer in the older woman. J Geriatr Oncol 2016; 7:354-61. [PMID: 27499341 DOI: 10.1016/j.jgo.2016.07.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/02/2016] [Accepted: 07/18/2016] [Indexed: 02/08/2023]
Abstract
Ovarian cancer is the seventh most common cancer in women worldwide and accounts for nearly 4% of all new cases of cancer in women. Almost half of all patients with ovarian cancer are over the age of 65 at diagnosis, and over 70% of deaths from ovarian cancer occur in this same age group. As the population ages, the number of older women with ovarian cancer is increasing. Compared to younger women, older women with ovarian cancer receive less surgery and chemotherapy, develop worse toxicity, and have poorer outcomes. They are also significantly under-represented in clinical trials and thus application of standard treatment regimens can be challenging. Performance status alone has been shown to be an inadequate tool to predict toxicity of older patients from chemotherapy. Use of formal geriatric assessment tools is a promising direction for stratifying older patients on trials. Elderly-specific trials, adjustments to the eligibility criteria, modified treatment regimens, and interventions to decrease morbidities in the vulnerable older population should be encouraged.
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188
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Giornelli GH. Management of relapsed ovarian cancer: a review. SPRINGERPLUS 2016; 5:1197. [PMID: 27516935 PMCID: PMC4963348 DOI: 10.1186/s40064-016-2660-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/24/2016] [Indexed: 01/21/2023]
Abstract
Around 70 % of ovarian cancer patients relapse after primary cytoreductive surgery and standard first-line chemotherapy. The biology of relapse remains unclear, but cancer stem cells seem to play an important role. There are still some areas of controversy on how to manage these relapses and or progressions that occur almost unavoidably in the course of this disease with shorter intervals between them as the natural history of this disease develops. The goal of treatments investigated in this neoplasm has shifted to maintenance therapy, trying to extend the progression free intervals in a disease that is becoming more and more protracted.
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Affiliation(s)
- Gonzalo H Giornelli
- Genital-Urinary Department, Instituto Alexander Fleming, Cramer 1180, C1426ANZ Buenos Aires, Argentina
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189
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Januchowski R, Wojtowicz K, Sterzyſska K, Sosiſska P, Andrzejewska M, Zawierucha P, Nowicki M, Zabel M. Inhibition of ALDH1A1 activity decreases expression of drug transporters and reduces chemotherapy resistance in ovarian cancer cell lines. Int J Biochem Cell Biol 2016; 78:248-259. [PMID: 27443528 DOI: 10.1016/j.biocel.2016.07.017] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 12/29/2022]
Abstract
The high mortality of ovarian cancer patients results from the failure of treatment caused by the inherent or acquired chemotherapy drug resistance. It was reported that overexpression of aldehyde dehydrogenase A1 (ALDH1A1) in cancer cells can be responsible for the development of drug resistance. To add the high expression of the drug transporter proteins the ALDHA1 is considered as a molecular target in cancer therapy. Therefore, we analysed drug-resistant ovarian cancer cell lines according to ALDHA1 expression and the association with drug resistance. The expression of ALDH1A1, P-glycoprotein (P-gp) or breast cancer resistance protein (BCRP) was determined using a microarray and confirmed by Q-PCR, western blot and fluorescence analysis. ALDH1A1 activity was determined using an Aldefluor assay. The impact of all-trans retinoic acid (ATRA) and diethylaminobenzaldehyde (DEAB) on chemotherapy resistance was assessed by the MTT chemosensitivity assay. The most abundant expression of ALDH1A1 was noted in paclitaxel- and topotecan-resistant cell lines where two populations of ALDH-positive and ALDH-negative cells could be observed. Those cell lines also revealed the overexpression of P-gp and BCRP respectively, and were able to form spheres in non-adherent conditions. Pre-treatment with ATRA and DEAB reduced chemotherapy resistance in both cell lines. ATRA treatment led to downregulation of the ALDH1A1, P-gp and BCRP proteins. DEAB treatment led to downregulation of the P-gp protein and BCRP transcript and protein. Our results indicate that ALDH1A1-positive cancer cells can be responsible for drug resistance development in ovarian cancer. Developing more specific ALDH1A1 inhibitors can increase chemotherapy effectiveness in ovarian cancer.
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Affiliation(s)
- Radosſaw Januchowski
- Department of Histology and Embryology, Poznaſ University of Medical Sciences, Poland.
| | - Karolina Wojtowicz
- Department of Histology and Embryology, Poznaſ University of Medical Sciences, Poland
| | - Karolina Sterzyſska
- Department of Histology and Embryology, Poznaſ University of Medical Sciences, Poland
| | - Patrycja Sosiſska
- Department of Pathophysiology, Poznaſ University of Medical Sciences, Poland
| | | | - Piotr Zawierucha
- Department of Histology and Embryology, Poznaſ University of Medical Sciences, Poland; Department of Anatomy, Poznaſ University of Medical Sciences, Poland
| | - Michaſ Nowicki
- Department of Histology and Embryology, Poznaſ University of Medical Sciences, Poland
| | - Maciej Zabel
- Department of Histology and Embryology, Poznaſ University of Medical Sciences, Poland; Department of Histology and Embryology, Wroclaw Medical University, Poland
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190
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del Carmen MG, Supko JG, Horick NK, Rauh-Hain JA, Clark RM, Campos SM, Krasner CN, Atkinson T, Birrer MJ. Phase 1 and 2 study of carboplatin and pralatrexate in patients with recurrent, platinum-sensitive ovarian, fallopian tube, or primary peritoneal cancer. Cancer 2016; 122:3297-3306. [DOI: 10.1002/cncr.30196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 05/31/2016] [Accepted: 06/15/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Marcela G. del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital Cancer Center; Harvard Medical School; Boston Massachusetts
| | - Jeff G. Supko
- Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center; Harvard Medical School; Boston Massachusetts
| | - Nora K. Horick
- Department of Biostatistics; Massachusetts General Hospital; Boston Massachusetts
| | - J. Alejandro Rauh-Hain
- Division of Gynecologic Oncology, Massachusetts General Hospital Cancer Center; Harvard Medical School; Boston Massachusetts
| | - Rachel M. Clark
- Division of Gynecologic Oncology, Massachusetts General Hospital Cancer Center; Harvard Medical School; Boston Massachusetts
| | - Susana M. Campos
- Division of Medical Oncology, Dana Farber Cancer Institute; Harvard Medical School; Boston Massachusetts
| | - Carolyn N. Krasner
- Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center; Harvard Medical School; Boston Massachusetts
| | - Tina Atkinson
- Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center; Harvard Medical School; Boston Massachusetts
| | - Michael J. Birrer
- Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center; Harvard Medical School; Boston Massachusetts
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191
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Dia VP, Pangloli P, Jones L, McClure A, Patel A. Phytochemical concentrations and biological activities of Sorghum bicolor alcoholic extracts. Food Funct 2016; 7:3410-20. [PMID: 27406291 DOI: 10.1039/c6fo00757k] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Sorghum is an important cereal with reported health benefits. The objectives of this study were to measure the biological activities of alcoholic extracts of ten sorghum varieties and to determine the association between the color of the extracts and their biological activities. Variation on concentrations of bioactives among sorghum varieties was observed with ethanolic extracts giving higher concentrations than methanolic extracts. The color of the extracts significantly correlated with the concentrations of bioactives and with nitric oxide scavenging activity. Freeze-dried ethanol extract is more potent than freeze-dried methanol extract and caused cytotoxicity to A27801AP and PTX-10 OVCA with ED50 values of 0.69 and 1.29 mg mL(-1), respectively. Pre-treatment of OVCA with ethanol extract led to chemosensitization to paclitaxel and the proliferation and colony formation of OVCA cells were reduced by 14.7 to 44.6% and 36.4 to 40.1%, respectively. Sorghum is a potential source of colorants with health promoting properties. This is the first report on the capability of sorghum alcoholic extracts to cause cytotoxicity and chemosensitize ovarian cancer cells in vitro.
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Affiliation(s)
- Vermont P Dia
- Department of Food Science and Technology, The University of Tennessee Institute of Agriculture, Knoxville, TN, USA.
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192
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Markman M. Rational study endpoints in anti-neoplastic agent regulatory approval trials in the gynecologic malignancies. WOMEN'S HEALTH (LONDON, ENGLAND) 2016; 12:396-399. [PMID: 27638892 PMCID: PMC5373277 DOI: 10.1177/1745505716655555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 05/24/2016] [Indexed: 06/06/2023]
Abstract
A discussion of rational endpoints in clinical trials seeking regulatory approval for new anti-neoplastic agents involving the three major gynecologic malignancies, cancers of the ovary, cervix, and endometrial, is particularly interesting as (in the opinion of this commentator) the conclusion will be different in the individual cancers.
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Affiliation(s)
- Maurie Markman
- Cancer Treatment Centers of America, Philadelphia, PA, USA Drexel University College of Medicine, Philadelphia, PA, USA
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193
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Zecchin C, Gueorguieva I, Enas NH, Friberg LE. Models for change in tumour size, appearance of new lesions and survival probability in patients with advanced epithelial ovarian cancer. Br J Clin Pharmacol 2016; 82:717-27. [PMID: 27136318 DOI: 10.1111/bcp.12994] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/31/2016] [Accepted: 04/28/2016] [Indexed: 12/17/2022] Open
Abstract
AIMS The aims of this study were (i) to develop a modelling framework linking change in tumour size during treatment to survival probability in metastatic ovarian cancer; and (ii) to model the appearance of new lesions and investigate their relationship with survival and disease characteristics. METHODS Data from a randomized Phase III clinical trial comparing carboplatin monotherapy to gemcitabine plus carboplatin combotherapy in 336 patients with metastatic ovarian cancer were used. A population model describing change in tumour size based on drug treatment information was established and its relationship with time to appearance of new lesions and survival were investigated with time to event models. RESULTS The tumour size profiles were well characterized as evaluated by visual predictive checks. Metastasis in the liver at enrolment and change in tumour size up to week 12 were predictors of time to appearance of new lesions. Survival was predicted based on the patient tumour size and ECOG performance status at enrolment and on appearance of new lesions during treatment and change in tumour size up to week 12. Tumour size and survival data from a separate study were adequately predicted. CONCLUSIONS The proposed models simulate tumour dynamics following treatment and provide a link to the probability of developing new lesions as well as to survival. The models have potential to be used for optimizing the design of late phase clinical trials in metastatic ovarian cancer based on early phase clinical study results and simulation.
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Affiliation(s)
- Chiara Zecchin
- Global PK/PD&Pharmacometrics, Eli Lilly and Company, Windlesham, UK
| | | | - Nathan H Enas
- Research Advisor Statistics-Oncology, Eli Lilly and Company, Indianapolis, USA
| | - Lena E Friberg
- Department of Pharmaceutical Biosciences, Uppsala University, Sweden
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194
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Openshaw MR, Fotopoulou C, Blagden S, Gabra H. The next steps in improving the outcomes of advanced ovarian cancer. ACTA ACUST UNITED AC 2016; 11:355-67. [PMID: 26102473 DOI: 10.2217/whe.15.6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Worldwide ovarian cancer affects over 200,000 women per year. Overall survival rates are poor due to two predominate reasons. First, the majority of patients present with advanced disease creating significant difficulty with effecting disease eradication. Second, acquisition of chemotherapy resistance results in untreatable progressive disease. Advances in treatment of advanced ovarian cancer involve a spectrum of interventions including improvements in frontline debulking surgery and combination chemotherapy. Anti-angiogenic factors have been shown to have activity in frontline and recurrent disease while novel chemotherapeutic agents and targeted treatments are in development particularly for disease that is resistant to platinum-based chemotherapy. These developments aim to improve the progression-free and overall survival of women with advanced ovarian cancer.
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Affiliation(s)
- Mark R Openshaw
- Department of Medical Oncology, Hammersmith Hospital, Imperial College NHS, London, UK
| | - Christina Fotopoulou
- Department of Medical Oncology, Hammersmith Hospital, Imperial College NHS, London, UK
| | - Sarah Blagden
- Department of Medical Oncology, Hammersmith Hospital, Imperial College NHS, London, UK
| | - Hani Gabra
- Department of Medical Oncology, Hammersmith Hospital, Imperial College NHS, London, UK
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195
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High Efficacy and Low Toxicity of the Modified Docetaxel and Carboplatin Protocol in Patients with Recurrent Ovarian Cancer-A Phase 2 Cohort Study. Int J Gynecol Cancer 2016; 26:640-7. [PMID: 27101523 DOI: 10.1097/igc.0000000000000666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Most patients with epithelial ovarian cancer will experience a recurrence; currently, there is no cure. In patients with platinum-sensitive disease (platinum-free interval >6 months), a combination similar to that used as frontline therapy (carboplatin and paclitaxel) is recommended. However, it is associated with a high incidence (20%) of neurotoxicity. This study evaluated the efficacy and toxicity of combination docetaxel/carboplatin therapy in patients with platinum-sensitive recurrent ovarian cancer. METHODS Forty patients with recurrent, histologically proven ovarian, fallopian tube, or primary peritoneal cancer were enrolled in this phase 2 trial. The study protocol included combination therapy with docetaxel, 30 mg/m, on days 1 and 8, and carboplatin, area under the curve 5, on day 1, every 21 days. Twenty received the classical paclitaxel/carboplatin regimen (control group), and another 20 received the modified docetaxel/carboplatin protocol (study group). RESULTS Median follow-up was 78 months for the study group and 62 months for the control group. The study group had a higher overall response rate compared to controls: 80% and 30%, respectively (P = 0.004; relative risk, 9.3; 95% confidence interval, 2.18-39.96). Complete response was achieved in 60% and 25%, respectively (P = 0.054). The study group patients showed a superior 2-year survival rate of 75% compared with the 35% of the controls (P = 0.011; relative risk, 5.57; 95% confidence interval, 1.47-21.56). Hematological and neurological toxicity rates did not differ between the groups (P = 0.451 and P = 0.605, respectively). CONCLUSIONS Patients with recurrent ovarian cancer who received the modified docetaxel/carboplatin regimen had higher overall response and survival rates compared to those who had the paclitaxel/carboplatin regimen, with no difference in toxicity. Future larger studies should focus on strategies to compare this regimen to the current standard, with an emphasis on quality of life.
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196
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Sasso MS, Lollo G, Pitorre M, Solito S, Pinton L, Valpione S, Bastiat G, Mandruzzato S, Bronte V, Marigo I, Benoit JP. Low dose gemcitabine-loaded lipid nanocapsules target monocytic myeloid-derived suppressor cells and potentiate cancer immunotherapy. Biomaterials 2016; 96:47-62. [PMID: 27135716 DOI: 10.1016/j.biomaterials.2016.04.010] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/15/2016] [Accepted: 04/18/2016] [Indexed: 12/21/2022]
Abstract
Tumor-induced expansion of myeloid-derived suppressor cells (MDSCs) is known to impair the efficacy of cancer immunotherapy. Among pharmacological approaches for MDSC modulation, chemotherapy with selected drugs has a considerable interest due to the possibility of a rapid translation to the clinic. However, such approach is poorly selective and may be associated with dose-dependent toxicities. In the present study, we showed that lipid nanocapsules (LNCs) loaded with a lauroyl-modified form of gemcitabine (GemC12) efficiently target the monocytic (M-) MDSC subset. Subcutaneous administration of GemC12-loaded LNCs reduced the percentage of spleen and tumor-infiltrating M-MDSCs in lymphoma and melanoma-bearing mice, with enhanced efficacy when compared to free gemcitabine. Consistently, fluorochrome-labeled LNCs were preferentially uptaken by monocytic cells rather than by other immune cells, in both tumor-bearing mice and human blood samples from healthy donors and melanoma patients. Very low dose administration of GemC12-loaded LNCs attenuated tumor-associated immunosuppression and increased the efficacy of adoptive T cell therapy. Overall, our results show that GemC12-LNCs have monocyte-targeting properties that can be useful for immunomodulatory purposes, and unveil new possibilities for the exploitation of nanoparticulate drug formulations in cancer immunotherapy.
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Affiliation(s)
- Maria Stella Sasso
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
| | - Giovanna Lollo
- LUNAM Université - Micro et Nanomédecines Biomimétiques, F-49933 Angers, France; INSERM U1066, IBS-CHU, 4 Rue Larrey, F-49933 Angers Cedex 9, France
| | - Marion Pitorre
- LUNAM Université - Micro et Nanomédecines Biomimétiques, F-49933 Angers, France; INSERM U1066, IBS-CHU, 4 Rue Larrey, F-49933 Angers Cedex 9, France
| | - Samantha Solito
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
| | - Laura Pinton
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
| | - Sara Valpione
- Veneto Institute of Oncology IOV-IRCCS, 35128 Padova, Italy
| | - Guillaume Bastiat
- LUNAM Université - Micro et Nanomédecines Biomimétiques, F-49933 Angers, France; INSERM U1066, IBS-CHU, 4 Rue Larrey, F-49933 Angers Cedex 9, France
| | - Susanna Mandruzzato
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; Veneto Institute of Oncology IOV-IRCCS, 35128 Padova, Italy
| | - Vincenzo Bronte
- Immunology Section, Department of Medicine, University of Verona, 37135 Verona, Italy
| | - Ilaria Marigo
- Veneto Institute of Oncology IOV-IRCCS, 35128 Padova, Italy.
| | - Jean-Pierre Benoit
- LUNAM Université - Micro et Nanomédecines Biomimétiques, F-49933 Angers, France; INSERM U1066, IBS-CHU, 4 Rue Larrey, F-49933 Angers Cedex 9, France.
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197
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Mach CM, Lapp EA, Weddle KJ, Hunter RJ, Burns KA, Parker C, Brown J, Smith JA. Adjunct Histamine Blockers as Premedications to Prevent Carboplatin Hypersensitivity Reactions. Pharmacotherapy 2016; 36:482-7. [PMID: 26990212 DOI: 10.1002/phar.1739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the impact of premedications given as an adjunct to carboplatin on the incidence of hypersensitivity reactions in women with ovarian cancer. Medications of interest include a histamine1 (H1 ) and histamine2 (H2 ) blocker in addition to dexamethasone. METHODS This was a retrospective chart review evaluating the addition of an H1 and H2 blocker in addition to dexamethasone as standard premedications on the incidence of carboplatin hypersensitivity reactions (CHRs) in women with ovarian cancer. MAIN RESULTS The odds ratio for premedication use was 0.46 with a 95% confidence interval (0.17-1.27), suggesting that patients with premedication use had approximately half the risk of CHR compared with patients without premedication. The overall incidence of CHRs decreased from 7.9% at baseline to 3.2% after the addition of premedications. The incidence of CHRs was 5.2% in 58 patients with recurrent or progressive disease compared with 2.1% in 96 newly diagnosed patients. Lifetime dose greater than 3377 mg, number of cycles more than six, and progressive or recurrent disease were predictive factors of CHR in women with ovarian cancer. PRINCIPAL CONCLUSIONS Total lifetime exposure to carboplatin remains the greatest predictive factor of CHR in women with ovarian cancer. Although data analysis indicates the addition of premedications for all ovarian cancer patients receiving carboplatin did not result in a statistically significant reduction in CHRs, a patient benefit in CHR reduction was observed. A prospective study is needed to confirm these findings.
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Affiliation(s)
- Claire M Mach
- Department of Clinical Pharmacy and Administration, University of Houston, College of Pharmacy, Houston, Texas
| | - Elisabeth A Lapp
- University of Incarnate Word, Feik School of Pharmacy, San Antonio, Texas
| | - Kellie J Weddle
- Department of Pharmacy Practice, Purdue University, West Lafayette, Indiana
| | - Rodney J Hunter
- Department of Pharmacy Practice, Texas Southern University, College of Pharmacy and Health Sciences, Houston, Texas.,Department of Pharmacy, Memorial Hermann Hospital-UTHealth Cancer Center-TMC, Houston, Texas
| | - Kimberly A Burns
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Crystal Parker
- Department of Biostatistics and Applied Mathematics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Jubilee Brown
- Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Judith A Smith
- Department of Clinical Pharmacy and Administration, University of Houston, College of Pharmacy, Houston, Texas.,Department of Pharmacy Practice, Texas Southern University, College of Pharmacy and Health Sciences, Houston, Texas.,Department of Pharmacy, Memorial Hermann Hospital-UTHealth Cancer Center-TMC, Houston, Texas.,Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Texas Health Science Center, Houston, Texas
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198
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Unni SK, Schauerhamer MB, Deka R, Tyczynski JE, Fernandes AW, Stevens V, Brixner DI, Stenehjem DD. BRCA testing, treatment patterns and survival in platinum-sensitive recurrent ovarian cancer - an observational cohort study. J Ovarian Res 2016; 9:18. [PMID: 27004793 PMCID: PMC4802840 DOI: 10.1186/s13048-016-0227-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/11/2016] [Indexed: 02/06/2023] Open
Abstract
Background Breast cancer associated (BRCA) genes are critical for DNA repair. Mutations in BRCA1 and BRCA2 (BRCAm) result in loss of these repair mechanisms and potential carcinogenesis. Germline BRCAm are common in ovarian carcinomas, particularly in platinum-sensitive disease. The increased prevalence of BRCAm in platinum-sensitive disease is likely due to enhanced responsiveness to platinum chemotherapy from homologous recombination repair deficiency. The purpose of this study was to explore BRCA testing, treatment patterns and survival in platinum-sensitive recurrent (PSR) ovarian cancer. Methods This was an observational cohort analysis of PSR ovarian cancer treated at the Huntsman Cancer Institute from 1995 to 2012. Germline BRCA status was ascertained through chart review and categorized as BRCAm (BRCA1/2 positive), BRCAwt (BRCA wild type or variant of uncertain significance), and untested. Treatment patterns and survival were assessed from recurrence until death or last follow-up. The Kaplan-Meier method was used to evaluate survival from recurrence by BRCA status. Logistic regression and COX proportional hazard model was used to estimate predictors of BRCA testing and survival, respectively. Results Of the 168 PSR patients, 15 (9 %) were BRCAm, 25 (15 %) were BRCAwt, and 128 (76 %) were untested. Median age at PSR was 56 years for BRCAm and BRCAwt (p = 0.90) and 63 years for those untested (p = 0.033 vs BRCAm). Overall survival was similar between BRCAm and BRCAwt (median 50.4 vs 67.5 months, p = 0.86) and was 24.9 months in untested patients. Significant predictors for the likelihood of BRCA testing were age (OR = 0.93, 95 % CI 0.89, 0.97, p = 0.002), family history of breast or ovarian cancer (OR = 8.33, 95 % CI: 3.08, 22.59, p < 0.001), and cancer diagnosis year (OR = 10.02, 95 % CI: 3.22, 31.21, p < 0.001). BRCA-tested patients had a lower risk of death versus untested (HR 0.35, 95 % CI 0.17, 0.68, p = 0.001). Conclusions BRCAwt patients had similar outcomes to BRCAm patients, potentially owing to similar age at diagnosis, representing a BRCA testing channeling bias. Younger patients, those with a family history of breast or ovarian cancer, and those diagnosed more recently were more likely to be BRCA tested. BRCA tested patients had a lower risk of death. Electronic supplementary material The online version of this article (doi:10.1186/s13048-016-0227-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sudhir K Unni
- Department of Pharmacotherapy, Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, University of Utah, 30 South 2000 East, Rm 4834 (4th Floor), Salt Lake City, UT, 84112, USA
| | - Marisa B Schauerhamer
- Department of Pharmacotherapy, Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, University of Utah, 30 South 2000 East, Rm 4834 (4th Floor), Salt Lake City, UT, 84112, USA
| | - Rishi Deka
- Department of Pharmacotherapy, Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, University of Utah, 30 South 2000 East, Rm 4834 (4th Floor), Salt Lake City, UT, 84112, USA
| | | | | | - Vanessa Stevens
- Department of Pharmacotherapy, Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, University of Utah, 30 South 2000 East, Rm 4834 (4th Floor), Salt Lake City, UT, 84112, USA
| | - Diana I Brixner
- Department of Pharmacotherapy, Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, University of Utah, 30 South 2000 East, Rm 4834 (4th Floor), Salt Lake City, UT, 84112, USA.,Program in Personalized Health Care, University of Utah, Salt Lake City, UT, USA
| | - David D Stenehjem
- Department of Pharmacotherapy, Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, University of Utah, 30 South 2000 East, Rm 4834 (4th Floor), Salt Lake City, UT, 84112, USA. .,Huntsman Cancer Institute, Salt Lake City, UT, USA.
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Ledermann JA, Embleton AC, Raja F, Perren TJ, Jayson GC, Rustin GJS, Kaye SB, Hirte H, Eisenhauer E, Vaughan M, Friedlander M, González-Martín A, Stark D, Clark E, Farrelly L, Swart AM, Cook A, Kaplan RS, Parmar MKB. Cediranib in patients with relapsed platinum-sensitive ovarian cancer (ICON6): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2016; 387:1066-1074. [PMID: 27025186 DOI: 10.1016/s0140-6736(15)01167-8] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Angiogenesis is a validated clinical target in advanced epithelial ovarian cancer. Cediranib is an oral antiangiogenic vascular endothelial growth factor receptor 1-3 inhibitor that has shown antitumour activity in recurrent ovarian cancer. We assessed efficacy and safety of cediranib in combination with platinum-based chemotherapy and as continued maintenance treatment in patients with first relapse of platinum-sensitive ovarian cancer. METHODS In this randomised, three-arm, double-blind, placebo-controlled phase 3 trial, we randomly assigned patients aged 18 years or older with relapsed platinum-sensitive ovarian cancer at 63 centres in Australia, Canada, New Zealand, Spain, and the UK. Participants received up to six cycles of platinum-based chemotherapy (once every 3 weeks) then entered a maintenance phase. Participants were randomly allocated (2:3:3), with five stratification factors and in alternating blocks, to receive placebo alongside chemotherapy and then placebo only maintenance (arm A; reference), cediranib 20 mg once-daily alongside chemotherapy then placebo only maintenance (arm B; concurrent), or cediranib 20 mg once-daily alongside chemotherapy then cediranib 20 mg once-daily maintenance (arm C; maintenance). Patients continued treatment to progression or excessive toxic effects. The primary efficacy endpoint was progression-free survival between arms A and C. Efficacy analysis was by intention to treat. Safety was assessed in all patients who received the allocated study drug. This trial is registered with ClinicalTrials.gov, number NCT00532194; the ISRCTN registry, number ISRCTN68510403; and ANZ Clinical Trials Registry, number ACTRN1261000016003. FINDINGS We randomly assigned 486 [corrected] women between Nov 13, 2007, and Dec 23, 2011; results presented are for 456 patients randomly assigned subsequent to the 30mg safety phase. During a median of 19·5 months (IQR 14-26) follow-up, 113 (96%) of 118 women assigned to arm A and 141 (86%) of 164 assigned to arm C had disease progression. Median progression-free survival was 11·0 months (95% CI 10·4-11·7) in arm C and 8·7 months (7·7-9·4) in arm A (hazard ratio 0·56, 0·44-0·72, p<0·0001). 156 (90%) of 174 patients in arm B had disease progression, and median progression-free survival was 9·9 months (95% CI 9·4-10·5). Diarrhoea, neutropenia, hypertension, and voice changes were significantly more common, during chemotherapy with cediranib, and diarrhoea, hypothyroidism and voice changes were more common during maintenance. Poor compliance with cediranib was noted during maintenance treatment with toxic effects being the most common cause for discontinuation. INTERPRETATION Cediranib, when given orally with chemotherapy and continued as maintenance, yielded a meaningful improvement [corrected] in progression-free survival in women with recurrent platinum-sensitive ovarian cancer, albeit with added toxic effects. The positive results in ICON6 could provide women with a new therapeutic option for recurrent ovarian cancer. Assessment of the secondary endpoint of overall survival will need longer follow-up. FUNDING Medical Research Council, Cancer Research UK, Canadian Cancer Society Research Institute, Cancer Australia, National Gynecological Cancer Centre, and AstraZeneca.
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Affiliation(s)
- Jonathan A Ledermann
- Cancer Research UK and UCL Cancer Trials Centre, University College London and UCL Hospitals, London, UK.
| | - Andrew C Embleton
- Medical Research Council Clinical Trials Unit at UCL, University College London, London, UK
| | - Fharat Raja
- University College London Hospitals, London, UK
| | - Timothy J Perren
- St James's Institute of Oncology and Leeds Institute of Cancer Medicine and Pathology, Leeds, UK
| | - Gordon C Jayson
- Christie Hospital and University of Manchester, Manchester, UK
| | | | | | - Hal Hirte
- Juravinski Cancer Centre and McMaster University, Hamilton, ON, Canada
| | - Elizabeth Eisenhauer
- Canadian Cancer Trials Group (CCTG) and Queen's University, Kingston, ON, Canada
| | | | - Michael Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Antonio González-Martín
- Spanish Group for Investigation in Ovarian Cancer (GEICO) and MD Anderson Cancer Center Madrid, Madrid, Spain
| | | | - Elizabeth Clark
- Medical Research Council Clinical Trials Unit at UCL, University College London, London, UK
| | - Laura Farrelly
- Medical Research Council Clinical Trials Unit at UCL, University College London, London, UK
| | | | - Adrian Cook
- Medical Research Council Clinical Trials Unit at UCL, University College London, London, UK
| | - Richard S Kaplan
- Medical Research Council Clinical Trials Unit at UCL, University College London, London, UK
| | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit at UCL, University College London, London, UK
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Bukowska B, Rogalska A, Marczak A. New potential chemotherapy for ovarian cancer - Combined therapy with WP 631 and epothilone B. Life Sci 2016; 151:86-92. [PMID: 26944437 DOI: 10.1016/j.lfs.2016.02.095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/24/2016] [Accepted: 02/29/2016] [Indexed: 12/27/2022]
Abstract
Despite more modern therapeutics approaches and the use of new drugs for chemotherapy, patients with ovarian cancer still have poor prognosis and therefore, new strategies for its cure are highly needed. One of the promising ways is combined therapy, which has many advantages as minimizing drug resistance, enhancing efficacy of treatment, and reducing toxicity. Combined therapy has rich and successful history in the field of ovarian cancer treatment. Currently use therapy is usually based on platinum-containing agent (carboplatin or cisplatin) and a member of taxanes (paclitaxel or docetaxel). In the mid-2000s this standard regimen has been expanded with bevacizumab, monoclonal antibody directed to Vascular Endothelial Growth Factor (VEGF). Another drug combination with promising perspectives is WP 631 given together with epothilone B (Epo B). WP 631 is a bisanthracycline composed of two molecules of daunorubicin linked with a p-xylenyl linker. Epo B is a 16-membered macrolide manifesting similar mechanism of action to taxanes. Their effectiveness against ovarian cancer as single agents is well established. However, the combination of WP 631 and Epo B appeared to act synergistically, meaning that it is much more potent than the single drugs. The mechanism lying under its efficacy includes disturbing essential cell cycle-regulating proteins leading to mitotic slippage and following apoptosis, as well as affecting EpCAM and HMGB1 expression. In this article, we summarized the current state of knowledge regarding combined therapy based on WP 631 and Epo B as a potential way of ovarian cancer treatment.
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Affiliation(s)
- Barbara Bukowska
- Department of Medical Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143 Str, 90-236 Lodz, Poland.
| | - Aneta Rogalska
- Department of Medical Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143 Str, 90-236 Lodz, Poland
| | - Agnieszka Marczak
- Department of Medical Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143 Str, 90-236 Lodz, Poland
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