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Harutyunyan L, Manvelyan E, Karapetyan N, Bardakhchyan S, Jilavyan A, Tamamyan G, Avagyan A, Safaryan L, Zohrabyan D, Movsisyan N, Avinyan A, Galoyan A, Sargsyan M, Harutyunyan M, Nersoyan H, Stepanyan A, Galstyan A, Danielyan S, Muradyan A, Jilavyan G. A Survival Analysis of Patients with Recurrent Epithelial Ovarian Cancer Based on Relapse Type: A Multi-Institutional Retrospective Study in Armenia. Curr Oncol 2024; 31:1323-1334. [PMID: 38534933 PMCID: PMC10968888 DOI: 10.3390/curroncol31030100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/11/2024] [Accepted: 02/27/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Annually, approximately 200 new ovarian cancer cases are diagnosed in Armenia, which is considered an upper-middle-income country. This study aimed to summarize the survival outcomes of patients with relapsed ovarian cancer in Armenia based on the type of recurrence, risk factors, and choice of systemic treatment. METHODS This retrospective case-control study included 228 patients with relapsed ovarian cancer from three different institutions. RESULTS The median age of the patients was 55. The median follow-up times from relapse and primary diagnosis were 21 and 48 months, respectively. The incidence of platinum-sensitive relapse was 81.6% (186), while platinum-resistant relapse was observed in only 18.4% (42) of patients. The median post-progression survival of the platinum-sensitive group compared to the platinum-resistant group was 54 vs. 25 months (p < 0.001), respectively, while the median survival after relapse was 25 vs. 13 months, respectively; three- and five-year post-progression survival rates in these groups were 31.2% vs. 23.8%, and 15.1% vs. 9.5%, respectively (p = 0.113). CONCLUSIONS Overall, despite new therapeutic approaches, ovarian cancer continues to be one of the deadly malignant diseases affecting women, especially in developing countries with a lack of resources, where chemotherapy remains the primary available systemic treatment for the majority of patients. Low survival rates demonstrate the urgent need for more research focused on this group of patients with poor outcomes.
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Affiliation(s)
- Lilit Harutyunyan
- Department of General Oncology, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia; (N.K.); (A.A.); (N.M.); (A.M.); (G.J.)
- Oncology Clinic, Mikaelyan Institute of Surgery, Ezras Hasratian 9, Yerevan 0052, Armenia; (A.A.); (A.G.); (M.S.)
| | - Evelina Manvelyan
- Department of Reproductive Biology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
| | - Nune Karapetyan
- Department of General Oncology, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia; (N.K.); (A.A.); (N.M.); (A.M.); (G.J.)
- Clinic of Adults’ Oncology and Chemotherapy at Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia; (S.B.); (L.S.); (D.Z.); (M.H.)
- Immune Oncology Research Institute, 7 Nersisyan St., Yerevan 0014, Armenia;
- Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia;
| | - Samvel Bardakhchyan
- Clinic of Adults’ Oncology and Chemotherapy at Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia; (S.B.); (L.S.); (D.Z.); (M.H.)
- Immune Oncology Research Institute, 7 Nersisyan St., Yerevan 0014, Armenia;
- Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia;
| | - Aram Jilavyan
- National Center of Oncology of Armenia, 76 Fanarjyan St., Yerevan 0052, Armenia; (A.J.); (H.N.); (A.S.); (A.G.)
- Department of Gynecologic Oncology, National Center of Oncology of Armenia, 76 Fanarjyan St., Yerevan 0052, Armenia
| | - Gevorg Tamamyan
- Immune Oncology Research Institute, 7 Nersisyan St., Yerevan 0014, Armenia;
- Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia;
- Pediatric Cancer and Blood Disorders Center of Armenia, 7 Nersisyan St., Yerevan 0014, Armenia
- Pediatric Oncology and Hematology Department, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia
| | - Armen Avagyan
- Department of General Oncology, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia; (N.K.); (A.A.); (N.M.); (A.M.); (G.J.)
- Oncology Clinic, Mikaelyan Institute of Surgery, Ezras Hasratian 9, Yerevan 0052, Armenia; (A.A.); (A.G.); (M.S.)
| | - Liana Safaryan
- Clinic of Adults’ Oncology and Chemotherapy at Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia; (S.B.); (L.S.); (D.Z.); (M.H.)
- Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia;
| | - Davit Zohrabyan
- Clinic of Adults’ Oncology and Chemotherapy at Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia; (S.B.); (L.S.); (D.Z.); (M.H.)
- Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia;
| | - Narine Movsisyan
- Department of General Oncology, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia; (N.K.); (A.A.); (N.M.); (A.M.); (G.J.)
- Oncology Clinic, Mikaelyan Institute of Surgery, Ezras Hasratian 9, Yerevan 0052, Armenia; (A.A.); (A.G.); (M.S.)
- Anesthesiology and Intensive Care Department, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia
- Armenian Association for the Study of Pain, 12 Kievyan Str. Apt. 20, Yerevan 0028, Armenia
| | - Anna Avinyan
- Oncology Clinic, Mikaelyan Institute of Surgery, Ezras Hasratian 9, Yerevan 0052, Armenia; (A.A.); (A.G.); (M.S.)
| | - Arevik Galoyan
- Oncology Clinic, Mikaelyan Institute of Surgery, Ezras Hasratian 9, Yerevan 0052, Armenia; (A.A.); (A.G.); (M.S.)
| | - Mariam Sargsyan
- Oncology Clinic, Mikaelyan Institute of Surgery, Ezras Hasratian 9, Yerevan 0052, Armenia; (A.A.); (A.G.); (M.S.)
- Immune Oncology Research Institute, 7 Nersisyan St., Yerevan 0014, Armenia;
| | - Martin Harutyunyan
- Clinic of Adults’ Oncology and Chemotherapy at Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia; (S.B.); (L.S.); (D.Z.); (M.H.)
- Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia;
| | - Hasmik Nersoyan
- National Center of Oncology of Armenia, 76 Fanarjyan St., Yerevan 0052, Armenia; (A.J.); (H.N.); (A.S.); (A.G.)
- Clinical Research and Cancer Registry Department, National Center of Oncology after V.A. Fanarjian, 76 Fanarjyan St., Yerevan 0052, Armenia
| | - Arevik Stepanyan
- National Center of Oncology of Armenia, 76 Fanarjyan St., Yerevan 0052, Armenia; (A.J.); (H.N.); (A.S.); (A.G.)
- Clinical Research and Cancer Registry Department, National Center of Oncology after V.A. Fanarjian, 76 Fanarjyan St., Yerevan 0052, Armenia
| | - Armenuhi Galstyan
- National Center of Oncology of Armenia, 76 Fanarjyan St., Yerevan 0052, Armenia; (A.J.); (H.N.); (A.S.); (A.G.)
- Diagnostic Service of the National Center of Oncology, 76 Fanarjyan St., Yerevan 0052, Armenia
| | - Samvel Danielyan
- Yeolyan Hematology and Oncology Center, 7 Nersisyan St., Yerevan 0014, Armenia;
| | - Armen Muradyan
- Department of General Oncology, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia; (N.K.); (A.A.); (N.M.); (A.M.); (G.J.)
| | - Gagik Jilavyan
- Department of General Oncology, Yerevan State Medical University after M. Heratsi, 2 Koryun St., Yerevan 0025, Armenia; (N.K.); (A.A.); (N.M.); (A.M.); (G.J.)
- National Center of Oncology of Armenia, 76 Fanarjyan St., Yerevan 0052, Armenia; (A.J.); (H.N.); (A.S.); (A.G.)
- Department of Gynecologic Oncology, National Center of Oncology of Armenia, 76 Fanarjyan St., Yerevan 0052, Armenia
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Singh N, Jayraj AS, Sarkar A, Mohan T, Shukla A, Ghatage P. Pharmacotherapeutic treatment options for recurrent epithelial ovarian cancer. Expert Opin Pharmacother 2023; 24:49-64. [PMID: 35968667 DOI: 10.1080/14656566.2022.2112030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Almost 80% of epithelial ovarian cancer present in advanced stage at diagnosis and despite excellent response to surgery and chemotherapy, more than 70% cancers recur. Subsequent therapies become decreasingly effective in controlling the disease, with each successful therapy being effective for a shorter duration. As a result, there is a need for novel therapeutic strategies to effectively treat recurrence. AREAS COVERED In this extensive literature review of high-quality articles, we have focused on surveillance strategy to detect recurrence early, classification of recurrence based on timeline, role of surgery, chemotherapy, and targeted agents such as anti-angiogenetic drugs, PARP inhibitors, and immune checkpoint inhibitors in platinum-sensitive and platinum-resistant disease, respectively. EXPERT OPINION Recurrent ovarian cancers (ROC) are represented by a heterogenous group of patient population in terms of platinum-free interval (PFI), histology, molecular characteristics and immune recognition. In today's era of precision medicine, chemotherapy should be combined with appropriate targeted agent in a multipronged approach to prolong survival and provide better quality of life outcomes by minimizing side effects.
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Affiliation(s)
- Nilanchali Singh
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | | | - Avir Sarkar
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Trishala Mohan
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Amlin Shukla
- Division of Reproductive Biology, Indian Council of Medical Research, New Delhi, India
| | - Prafull Ghatage
- Gynaecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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Identification of Potential Parkinson's Disease Drugs Based on Multi-Source Data Fusion and Convolutional Neural Network. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27154780. [PMID: 35897954 PMCID: PMC9369596 DOI: 10.3390/molecules27154780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/20/2022]
Abstract
Parkinson’s disease (PD) is a serious neurodegenerative disease. Most of the current treatment can only alleviate symptoms, but not stop the progress of the disease. Therefore, it is crucial to find medicines to completely cure PD. Finding new indications of existing drugs through drug repositioning can not only reduce risk and cost, but also improve research and development efficiently. A drug repurposing method was proposed to identify potential Parkinson’s disease-related drugs based on multi-source data integration and convolutional neural network. Multi-source data were used to construct similarity networks, and topology information were utilized to characterize drugs and PD-associated proteins. Then, diffusion component analysis method was employed to reduce the feature dimension. Finally, a convolutional neural network model was constructed to identify potential associations between existing drugs and LProts (PD-associated proteins). Based on 10-fold cross-validation, the developed method achieved an accuracy of 91.57%, specificity of 87.24%, sensitivity of 95.27%, Matthews correlation coefficient of 0.8304, area under the receiver operating characteristic curve of 0.9731 and area under the precision–recall curve of 0.9727, respectively. Compared with the state-of-the-art approaches, the current method demonstrates superiority in some aspects, such as sensitivity, accuracy, robustness, etc. In addition, some of the predicted potential PD therapeutics through molecular docking further proved that they can exert their efficacy by acting on the known targets of PD, and may be potential PD therapeutic drugs for further experimental research. It is anticipated that the current method may be considered as a powerful tool for drug repurposing and pathological mechanism studies.
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The Profile of MicroRNA Expression and Potential Role in the Regulation of Drug-Resistant Genes in Doxorubicin and Topotecan Resistant Ovarian Cancer Cell Lines. Int J Mol Sci 2022; 23:ijms23105846. [PMID: 35628654 PMCID: PMC9144982 DOI: 10.3390/ijms23105846] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 12/09/2022] Open
Abstract
Epithelial ovarian cancer has the highest mortality among all gynecological malignancies. The main reasons for high mortality are late diagnosis and development of resistance to chemotherapy. Resistance to chemotherapeutic drugs can result from altered expression of drug-resistance genes regulated by miRNA. The main goal of our study was to detect differences in miRNA expression levels in two doxorubicin (DOX)- and two topotecan (TOP)-resistant variants of the A2780 drug-sensitive ovarian cancer cell line by miRNA microarray. The next aim was to recognize miRNAs as factors responsible for the regulation of drug-resistance genes. We observed altered expression of 28 miRNA that may be related to drug resistance. The upregulation of miR-125b-5p and miR-935 and downregulation of miR-218-5p was observed in both DOX-resistant cell lines. In both TOP-resistant cell lines, we noted the overexpression of miR-99a-5p, miR-100-5p, miR-125b-5p, and miR-125b-2-3p and decreased expression of miR-551b-3p, miR-551b-5p, and miR-383-5p. Analysis of the targets suggested that expression of important drug-resistant genes such as the collagen type I alpha 2 chain (COL1A2), protein Tyrosine Phosphatase Receptor Type K (PTPRK), receptor tyrosine kinase—EPHA7, Roundabout Guidance Receptor 2 (ROBO2), myristoylated alanine-rich C-kinase substrate (MARCK), and the ATP-binding cassette subfamily G member 2 (ABCG2) can be regulated by miRNA.
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Flörkemeier I, Steinhauer TN, Hedemann N, Ölander M, Artursson P, Clement B, Bauerschlag DO. Newly developed dual topoisomerase inhibitor P8-D6 is highly active in ovarian cancer. Ther Adv Med Oncol 2021; 13:17588359211059896. [PMID: 34887943 PMCID: PMC8649464 DOI: 10.1177/17588359211059896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022] Open
Abstract
Background: Ovarian cancer (OvCa) constitutes a rare and highly
aggressive malignancy and is one of the most lethal of all gynaecologic
neoplasms. Due to chemotherapy resistance and treatment limitations because
of side effects, OvCa is still not sufficiently treatable. Hence, new drugs
for OvCa therapy such as P8-D6 with promising antitumour properties have a
high clinical need. The benzo[c]phenanthridine P8-D6 is an
effective inductor of apoptosis by acting as a dual topoisomerase I/II
inhibitor. Methods: In the present study, the effectiveness of P8-D6 on OvCa
was investigated in vitro. In various OvCa cell lines and
ex vivo primary cells, the apoptosis induction compared
with standard therapeutic agents was determined in two-dimensional
monolayers. Expanded by three-dimensional and co-culture, the P8-D6 treated
cells were examined for changes in cytotoxicity, apoptosis rate and membrane
integrity via scanning electron microscopy (SEM). Likewise, the effects of
P8-D6 on non-cancer human ovarian surface epithelial cells and primary human
hepatocytes were determined. Results: This study shows a significant P8-D6-induced increase in
apoptosis and cytotoxicity in OvCa cells which surpasses the efficacy of
well-established drugs like cisplatin or the topoisomerase inhibitors
etoposide and topotecan. Non-cancer cells were affected only slightly by
P8-D6. Moreover, no hepatotoxic effect in in vitro studies
was detected. Conclusion: P8-D6 is a strong and rapid inductor of apoptosis and
might be a novel treatment option for OvCa therapy.
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Affiliation(s)
- Inken Flörkemeier
- Department of Gynaecology and Obstetrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Tamara N Steinhauer
- Department of Pharmaceutical and Medicinal Chemistry, Christian-Albrechts-University Kiel, Pharmaceutical Institute, Kiel, Germany
| | - Nina Hedemann
- Department of Gynaecology and Obstetrics, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Magnus Ölander
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Per Artursson
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Bernd Clement
- Department of Pharmaceutical and Medicinal Chemistry, Christian-Albrechts-University Kiel, Pharmaceutical Institute, Kiel, Germany
| | - Dirk O Bauerschlag
- Department of Gynaecology and Obstetrics, University Medical Centre Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
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Molinaro C, Martoriati A, Pelinski L, Cailliau K. Copper Complexes as Anticancer Agents Targeting Topoisomerases I and II. Cancers (Basel) 2020; 12:E2863. [PMID: 33027952 PMCID: PMC7601307 DOI: 10.3390/cancers12102863] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
Organometallics, such as copper compounds, are cancer chemotherapeutics used alone or in combination with other drugs. One small group of copper complexes exerts an effective inhibitory action on topoisomerases, which participate in the regulation of DNA topology. Copper complexes inhibitors of topoisomerases 1 and 2 work by different molecular mechanisms, analyzed herein. They allow genesis of DNA breaks after the formation of a ternary complex, or act in a catalytic mode, often display DNA intercalative properties and ROS production, and sometimes display dual effects. These amplified actions have repercussions on the cell cycle checkpoints and death effectors. Copper complexes of topoisomerase inhibitors are analyzed in a broader synthetic view and in the context of cancer cell mutations. Finally, new emerging treatment aspects are depicted to encourage the expansion of this family of highly active anticancer drugs and to expend their use in clinical trials and future cancer therapy.
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Affiliation(s)
- Caroline Molinaro
- Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, F-59000 Lille, France; (C.M.); (A.M.)
| | - Alain Martoriati
- Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, F-59000 Lille, France; (C.M.); (A.M.)
| | - Lydie Pelinski
- Univ. Lille, CNRS, Centrale Lille, Univ. Artois, UMR 8181-UCCS-Unité de Catalyse et Chimie du Solide, F-59000 Lille, France;
| | - Katia Cailliau
- Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, F-59000 Lille, France; (C.M.); (A.M.)
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Menyhárt O, Fekete JT, Győrffy B. Gene Expression Indicates Altered Immune Modulation and Signaling Pathway Activation in Ovarian Cancer Patients Resistant to Topotecan. Int J Mol Sci 2019; 20:E2750. [PMID: 31195594 PMCID: PMC6600443 DOI: 10.3390/ijms20112750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/15/2019] [Accepted: 05/31/2019] [Indexed: 12/26/2022] Open
Abstract
Epithelial ovarian cancer (EOC) is one of the deadliest gynecological malignancies. Topotecan remains an essential tool in second-line therapy; even so, most patients develop resistance within a short period of time. We aimed to identify biomarkers of topotecan resistance by using gene expression signatures derived from patient specimens at surgery and available subsequent responses to therapy. Gene expression was collected for 1436 patients and 10,103 genes. Based on disease progression, patients were categorized as responders/nonresponders depending on their progression free survival (PFS) state at 9, 12, 15 and 18 months after surgery. For each gene, the median expression was compared between responders and nonresponders for two treatment regimens (chemotherapy including/excluding topotecan) with Mann-Whitney U test at each of the four different PFS cutoffs. Statistical significance was accepted in the case of p < 0.05 with a fold change (FC) ≥ 1.44. Four genes (EPB41L2, HLA-DQB1, LTF and SFRP1) were consistently overexpressed across multiple PFS cutoff times in initial tumor samples of patients with disease progression following topotecan treatment. A common theme linked to topotecan resistance was altered immune modulation. Genes associated with disease progression after systemic chemotherapy emphasize the role of the initial organization of the tumor microenvironment in therapy resistance. Our results uncover biomarkers with potential utility for patient stratification.
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Affiliation(s)
- Otília Menyhárt
- 2nd Department of Pediatrics, Semmelweis University, Tűzoltó u. 7-9, H-1094 Budapest, Hungary.
- MTA TTK Lendület Cancer Biomarker Research Group, Institute of Enzymology, Hungarian Academy of Sciences, Magyar tudósok körútja 2., H-1117 Budapest, Hungary.
| | - János Tibor Fekete
- 2nd Department of Pediatrics, Semmelweis University, Tűzoltó u. 7-9, H-1094 Budapest, Hungary.
- MTA TTK Lendület Cancer Biomarker Research Group, Institute of Enzymology, Hungarian Academy of Sciences, Magyar tudósok körútja 2., H-1117 Budapest, Hungary.
| | - Balázs Győrffy
- 2nd Department of Pediatrics, Semmelweis University, Tűzoltó u. 7-9, H-1094 Budapest, Hungary.
- MTA TTK Lendület Cancer Biomarker Research Group, Institute of Enzymology, Hungarian Academy of Sciences, Magyar tudósok körútja 2., H-1117 Budapest, Hungary.
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Somashekhar SP, Ashwin KR, Rauthan A, Rohit KC. Pressurized IntraPeritoneal Aerosol Chemotherapy vs. intravenous chemotherapy for unresectable peritoneal metastases secondary to platinum resistant ovarian cancer - study protocol for a randomized control trial. Pleura Peritoneum 2019; 4:20180111. [PMID: 31198851 PMCID: PMC6545874 DOI: 10.1515/pp-2018-0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 01/31/2019] [Indexed: 12/22/2022] Open
Abstract
Background Despite optimal surgery and appropriate first-line chemotherapy, ∼70–80 % of patients with epithelial ovarian cancer will develop disease relapse. The prognosis is poor especially for women with Platinum resistant ovarian cancer. The standard treatment for these groups of patients is non-platinum-containing chemotherapy like taxanes, anthracyclines, gemcitabine, topotecan, and trabectedin. These drugs in various combinations and sequences provide modest survival or symptomatic benefit but with significant side effects. Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is a minimally-invasive drug-delivery technique specifically addressing limited tissue penetration and poor drug distribution with promising results. PIPAC is a novel method of delivering normothermic chemotherapy into the abdominal cavity as an aerosol under pressure. This concept seems to enhance the effectiveness of intra peritoneal chemotherapy by taking advantage of the physical properties of gas and pressure by generating an artificial pressure gradient and enhancing tissue uptake and distributing drugs homogeneously within the closed and expanded peritoneal cavity. Thus, due to the high local bioavailability during PIPAC, the chemotherapy dosage can be reduced which in turn largely prevents systemic side effects and organ toxicity. Methods The study aims to investigate the therapeutic efficacy measured as objective tumour response according to Response Evaluation Criteria in Solid Tumours (RECIST) criteria, of PIPAC in comparison with conventional Intravenous chemotherapy for women with recurrent platinum resistant ovarian cancer with peritoneal metastasis (PM). Consecutive patients diagnosed with PM secondary to platinum-resistant ovarian cancer will be randomized to PIPAC group or IV chemotherapy group. The primary objective of this study is to determine the efficacy after three cycles of PIPAC with cisplatin and doxorubicin in comparison with six cycles of systemic chemotherapy. The secondary outcome measures include morbidity and mortality, overall survival and disease specific survival. Analysis is by intention to treat. Aim Assess the objective tumour response of PIPAC in comparison with systemic intravenous chemotherapy for women with platinum-resistant ovarian cancer. Study type Prospective randomized control intervention trial. Intervention model IV Chemotherapy group (Control group) PIPAC group (Experimental group) Masking Open label. Primary purpose Treatment. Sample size Calculated sample size is 97 and rounded to 100. For each treatment group sample size of 50 will be considered. Primary outcome criteria Objective tumour response according to Response Evaluation Criteria in Solid Tumours (RECIST) criteria version 1.1. Discussion PIPAC in women with platinum resistant ovarian PM has good response owing to superior tissue penetration and better drug distribution. The procedure is safe and well tolerated owing it to its minimal invasiveness. Typical side-effects of systemic chemotherapy, such as alopecia, peripheral neurotoxicity, nausea and myelosuppression are absent. We expect reduction of ascites with symptomatic relief and CA 125 levels. PIPAC is a novel technique for selected patients with platinum resistant ovarian PM and further investigation in comparative clinical trials with conventional chemotherapy will establish its role as a good palliative treatment option. Ethics committee approval Obtained. Status Recruiting. Trial registration number REF/2018/08/021223 Registered on Clinical Trials Registry – India (CTRI); www.ctri.nic.in
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Affiliation(s)
- S P Somashekhar
- Consultant Surgical & Gynec. Onco & Robotic Surgeon, HIPEC Super Specialist, Manipal Comprehensive Cancer Center, Manipal Hospital, Bangalore, India
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Oxaliplatin plus leucovorin and 5-fluorouracil (FOLFOX-4) as a salvage chemotherapy in heavily-pretreated platinum-resistant ovarian cancer. BMC Cancer 2018; 18:1267. [PMID: 30567527 PMCID: PMC6300035 DOI: 10.1186/s12885-018-5180-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/04/2018] [Indexed: 01/09/2023] Open
Abstract
Background The purpose of this study was to evaluate the clinical impact of oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX-4) chemotherapy in terms of the response rate, progression-free/overall survival (PFS/OS) and safety profile in patients with heavily pretreated recurrent epithelial ovarian cancer. Methods Clinical data were reviewed in 29 patients who received FOLFOX-4 as more than third-line chemotherapy, consisting of 85 mg/m2 of oxaliplatin, 200 mg/m2 of leucovorin, and bolus 400 mg/m2 on day 1 of 5-fluorouracil, followed by a 22-h infusion of 600 mg/m2 of 5-fluorouracil for 2 consecutive days every 3 weeks. We also compared the efficacy and toxicity of FOLFOX-4 with that of topotecan, a standard treatment, given at a dosage of 1.5 mg/m2 every three weeks in 26 patients. Results The median age of enrolled patients was 60 years (range 33 to 85). A median of 4 cycles (range 1–17) of FOLFOX-4 were administered. Complete response and partial response were observed in one (3.5%) and 5 (17.2.2%) patients, respectively, while stable disease was reported in 8 (27.6%) patients. Among all patients, grade 3–4 anemia, neutropenia, and thrombocytopenia were observed in 0 (0%), 5 (17.2%), and 3 (10.3%) cases, respectively. Grade 3–4 fatigue was recorded in one (3.4%) patient and diarrhea in 2 (6.9%). Median PFS and OS were 2.8 months [95% confidence interval (CI) 1.7–4.9] and 6.2 months (95% CI 2.4–14.6), respectively. No significant differences in terms of efficacy and toxicity were observed between patients receiving FOLFOX-4 and those treated with topotecan. Conclusions The FOLFOX-4 regimen would seem to obtain similar survival rates to those of standard therapy with topotecan in platinum-resistant ovarian cancer. Further randomized trials are warranted to confirm our findings.
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Ricci JW, Lovato DM, Severns V, Sklar LA, Larson RS. Novel ABCG2 Antagonists Reverse Topotecan-Mediated Chemotherapeutic Resistance in Ovarian Carcinoma Xenografts. Mol Cancer Ther 2016; 15:2853-2862. [PMID: 27671528 DOI: 10.1158/1535-7163.mct-15-0789] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 08/17/2016] [Accepted: 09/14/2016] [Indexed: 11/16/2022]
Abstract
Chemotherapeutic resistance remains a challenge in the treatment of ovarian carcinoma, especially in recurrent disease. Despite the fact that most patients with newly diagnosed tumors attain complete remission following cytoreductive surgery and chemotherapy, ovarian carcinoma has a recurrence rate that exceeds 75%. The ATP-binding cassette family G member 2 (ABCG2) efflux protein has been described as one mechanism that confers multiple-drug resistance to solid tumors and contributes to topotecan resistance in ovarian carcinoma. In fact, one clinical trial demonstrated ABCG2 expression in all patients with primary or recurrent ovarian carcinoma. On the basis of our previous work, we hypothesized that three compounds (CID44640177, CID1434724, and CID46245505), which represent a new piperazine-substituted pyrazolo[1,5]pyrimidine substructure class of ABCG2-specific antagonists, would restore chemosensitivity to drug-resistant ovarian cancer in vitro and in vivo To address the treatment difficulties associated with chemotherapeutic resistance in ovarian cancer, we combined each compound (CID44640177, CID1434724, and CID46245505) with topotecan and administered the mixture to chemoresistant Igrov1/T8 ovarian cancer cells in vitro and Igrov1/T8 xenografts in CB-17 SCID mice. We found that only nanomolar concentrations of each ABCG2 inhibitor in combination with topotecan were required to restore chemosensitivity to Igrov1/T8 cells in vitro In vivo, substantial tumor reduction was achieved with each compound in 4 days, with CID1434724 causing the largest reduction in excess of 60%. No signs of secondary toxic effects were observed with the ABCG2 antagonists. These novel compounds should be viewed as promising drug candidates to reverse ABCG2-mediated chemoresistance. Mol Cancer Ther; 15(12); 2853-62. ©2016 AACR.
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Affiliation(s)
- Jerec W Ricci
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico
| | - Debbie M Lovato
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico
| | - Virginia Severns
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico
| | - Larry A Sklar
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Richard S Larson
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico.
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Wagner U, Harter P, Hilpert F, Mahner S, Reuß A, du Bois A, Petru E, Meier W, Ortner P, König K, Lindel K, Grab D, Piso P, Ortmann O, Runnebaum I, Pfisterer J, Lüftner D, Frickhofen N, Grünwald F, Maier BO, Diebold J, Hauptmann S, Kommoss F, Emons G, Radeleff B, Gebhardt M, Arnold N, Calaminus G, Weisse I, Weis J, Sehouli J, Fink D, Burges A, Hasenburg A, Eggert C. S3-Guideline on Diagnostics, Therapy and Follow-up of Malignant Ovarian Tumours: Short version 1.0 - AWMF registration number: 032/035OL, June 2013. Geburtshilfe Frauenheilkd 2013; 73:874-889. [PMID: 24771937 PMCID: PMC3859160 DOI: 10.1055/s-0033-1350713] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Defferrari C, Campora S, D'Amico M, Piccardo A, Biscaldi E, Rosselli D, Pasa A, Puntoni M, Gozza A, Gennari A, Zanardi S, Lionetto R, Bandelloni M, DeCensi A. A case series of low dose bevacizumab and chemotherapy in heavily pretreated patients with epithelial ovarian cancer. J Ovarian Res 2012; 5:17. [PMID: 22732001 PMCID: PMC3408333 DOI: 10.1186/1757-2215-5-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 06/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The addition of bevacizumab to standard chemotherapy prolongs progression free survival in the first line treatment of epithelial ovarian cancer (EOC), but its cost/effectiveness is debated. We assessed the safety and activity of a lower dose of bevacizumab in pretreated advanced stage EOC. METHODS We treated 15 patients, mostly with platinum resistant EOC, who had received a median of four prior cytotoxic regimens, with bevacizumab 5-7.5 mg/kg q21 days in combination with either carboplatin (n = 8), oral cyclofosfamide (n = 5) or weekly paclitaxel (n = 2). Bevacizumab was administered until disease progression. Tumor response was assessed by CA125 and fusion 18 F-FDG PET/contrast enhanced CT. RESULTS The median number of bevacizumab cycles was 21 (range 3-59). The median baseline CA125 was 272 U/ml and decreased to 15.2 U/ml at nadir. Tumor response was 4 complete response (CR) (26.7%) and 7 partial response (PR) (46.7%) by chemotherapy (CT), with an overall response rate of 73.4% (95% CI, 51.0 - 95.8) according to Response Evaluation Criteria In Solid Tumors (RECIST), and 6 CR (40%) and 4 PR (26.7%) by PET, for an overall metabolic response rate of 67% (95%CI, 42.8 - 90.6) according to PET Response Criteria in Solid Tumors (PERCIST). Median progression free survival (PFS) was 21 months and median overall survival (OS) was 24 months. Grade 3 adverse events related to bevacizumab were hypertension (n = 2), proteinuria (n = 1) and epistaxis (n = 5). Treatment was delayed in five patients for nasal bleeding or uncontrolled hypertension. CONCLUSIONS Low-dose bevacizumab and chemotherapy was well tolerated and active in a heavily pretreated population of advanced EOC. Further studies should assess the activity of low dose bevacizumab in EOC.
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Affiliation(s)
- Carlotta Defferrari
- Unit of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Sara Campora
- Unit of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Mauro D'Amico
- Unit of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | | | | | | | - Ambra Pasa
- Unit of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Matteo Puntoni
- Scientific Direction, E.O. Ospedali Galliera, Genoa, Italy
| | - Alberto Gozza
- Unit of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Alessandra Gennari
- Unit of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Silvia Zanardi
- Unit of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Rita Lionetto
- Health Direction, E.O. Ospedali Galliera, Genoa, Italy
| | | | - Andrea DeCensi
- Unit of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
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Hilman S, Koh PK, Collins S, Allerton R. The use of treosulfan and gemcitabine in the treatment of platinum-resistant ovarian cancer. Oncol Lett 2010; 1:209-213. [PMID: 22966284 DOI: 10.3892/ol_00000038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 09/28/2009] [Indexed: 11/06/2022] Open
Abstract
The combination of treosulfan and gemcitabine (TG) has been shown to have activity in ovarian cancer. These two agents are thought to be synergistic, with gemcitabine causing the persistence of treosulfan-induced DNA crosslinks. This study aimed to investigate the response rates, survival and toxicity in patients with platinum-resistant ovarian cancer treated with TG. A retrospective case note review of the patients treated with TG was performed in one cancer centre between May 1st, 2000 and November 1st, 2005. Estimates of cumulative survival were obtained using the Kaplan-Meier method. Forty-nine patients were identified; median age at diagnosis was 55 years (range, 31-72) and the median follow-up was 45.1 months (range, 12.2-118.3). TG was used as second-, third-, fourth- and fifth-line chemotherapy in 15, 19, 13 and 2 patients, respectively. Fifteen patients (30.6%) had stable disease; 25 (51%), a partial response; 1 (2%), a complete response and 8 (16.3%) had progressive disease. Median survival following diagnosis was 45.1 months and the median relapse-free survival was 12 months. The median survival time from the start of TG was 13.7 months with a relapse-free survival of 6.3 months. The median number of cycles given was 7. The most common toxicity recorded was myelosuppression. There were no treatment-related deaths. TG chemotherapy produced favourable response rates in a heavily pre-treated group of patients with platinum-resistant epithelial ovarian cancer. This doublet warrants further investigation in a phase III trial setting.
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Affiliation(s)
- S Hilman
- Deansley Oncology Centre, New Cross Hospital, Wolverhampton WV10 OQP
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