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Ibanez KR, Donohue D, Malys T, Lee JM. Gynecologic Cancer InterGroup CA125 response has a high negative predictive value for CHK1 inhibitor RECIST response in recurrent ovarian cancer. Sci Rep 2024; 14:17459. [PMID: 39075200 PMCID: PMC11286792 DOI: 10.1038/s41598-024-68338-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/22/2024] [Indexed: 07/31/2024] Open
Abstract
We investigated the association of CA125 response with prognosis and RECIST response/progressive disease (PD) criteria in recurrent high grade serous ovarian cancer (HGSOC) patients treated with a cell cycle checkpoint kinase 1 inhibitor (CHK1i), prexasertib. 81 patients had measurable disease per RECISTv1.1, of which 72 and 70 were measurable by Gynecologic Cancer InterGroup (GCIG) CA125 response and PD criteria, respectively. Univariate and multivariate analyses showed that GCIG CA125 response (n = 32) is associated with improved progression-free survival (PFS) and overall survival (OS) compared to no GCIG CA125 response (n = 40) (median PFS 8.0 vs. 3.5 months [HR: 0.30, 95% CI: 0.18-0.51, p < 0.0001]; median OS 19.8 vs. 10.0 months [HR: 0.38, 95% CI: 0.23-0.64, p < 0.001]) independent of BRCA mutation status, platinum-sensitivity, previous PARP inhibitor therapy, ECOG performance status, and FIGO stage. Notably, GCIG CA125 response had a high negative predictive value (NPV: 93%, 95% CI: 80-98), but poor positive predictive value (PPV: 53%, 95% CI: 35-71) in predicting RECIST response. CA125 PD criteria also showed poor concordance with RECIST PD (PPV 56%, 95% CI: 40-71; NPV 33%, 95% CI: 17-54). Therefore, serum CA125 may be useful as a highly accessible prognostic and predictive biomarker to CHK1i therapy in recurrent HGSOC.
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Affiliation(s)
- Kristen R Ibanez
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Room 6B12, Bethesda, MD, 20892, USA
| | - Duncan Donohue
- Statistical Consulting and Scientific Programming Group, Computer and Statistical Services, Data Management Services, Inc. (a BRMI Company), NCI, Frederick, MD, 21702, USA
| | - Tyler Malys
- Statistical Consulting and Scientific Programming Group, Computer and Statistical Services, Data Management Services, Inc. (a BRMI Company), NCI, Frederick, MD, 21702, USA
| | - Jung-Min Lee
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Room 6B12, Bethesda, MD, 20892, USA.
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2
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Piatek S, Panek G, Lewandowski Z, Piatek D, Kosinski P, Bidzinski M. Nadir CA-125 has prognostic value for recurrence, but not for survival in patients with ovarian cancer. Sci Rep 2021; 11:18190. [PMID: 34521891 PMCID: PMC8440776 DOI: 10.1038/s41598-021-97564-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 08/20/2021] [Indexed: 11/09/2022] Open
Abstract
The objective of this study was to evaluate the nadir CA-125 in patients with epithelial ovarian cancer. A total of 168 patients who achieved complete remission (no clinical and radiological signs, CA-125 ≤ 35 U/ml) after first-line treatment were enrolled in the study. The relationship between CA-125 and survival was examined by applying generalized additive models to the Cox proportional hazards model. The median CA-125 concentration after the treatment was 10 U/ml (2.7–35 U/ml). The nadir CA-125 was related to progression-free survival but not to overall survival. The risk of recurrence in patients with 11–25 U/ml and 26–35 U/ml compared to patients with ≤ 10 U/ml was 1.87 (p < 0.0024) and 2.17 (p < 0.018), respectively. An increased risk of recurrence according to the nadir CA-125 (≤ 10 U/ml vs. 11–25 U/ml and ≤ 10 U/ml vs. 26–35 U/ml) was found in patients with high-grade tumours (hazard ratio, HR = 2.08 and 2.59, respectively), advanced disease (HR = 2.38 and 2.03, respectively), serous histology (HR = 2.08 and 2.43, respectively) and after complete cytoreduction (HR = 2.7 and 2.72, respectively). No correlation between the CA-125 nadir and recurrence risk was found in patients with early-stage disease or those receiving neoadjuvant chemotherapy or bevacizumab.
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Affiliation(s)
- Szymon Piatek
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie National Research Institute Of Oncology, Roentgen Street 5, 02-781, Warsaw, Poland.
| | - Grzegorz Panek
- 1St Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Zbigniew Lewandowski
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, Warsaw, Poland
| | - Dominika Piatek
- 1St Department of Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Przemyslaw Kosinski
- 1St Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Bidzinski
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie National Research Institute Of Oncology, Roentgen Street 5, 02-781, Warsaw, Poland
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3
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Yuan Z, Zhang Y, Cao D, Shen K, Li Q, Zhang G, Wu X, Cui M, Yue Y, Cheng W, Wang L, Qu P, Tao G, Hou J, Sun L, Meng Y, Li G, Li C, Shi H, Chen Y. Pegylated liposomal doxorubicin in patients with epithelial ovarian cancer. J Ovarian Res 2021; 14:12. [PMID: 33423683 PMCID: PMC7798203 DOI: 10.1186/s13048-020-00736-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of PLD in treating of in patients who experience epithelial ovarian, fallopian tubal, and peritoneal cancer progression within 12 months after the first-line platinum-based therapy. METHODS This was an open-label, single-arm and multicenter clinical trial. The ORR was the interim primary objective, and the DCR, AEs and QOL were the secondary objectives. The impact of factors on efficacy outcomes, the change trend of CA125 and the artificial platinum-free interval were exploratory endpoints. RESULTS Totally, 115 patients were enrolled in this study and included in the ITT population. Moreover, 101 patients were included in the safety population. The median follow-up time was 4 months (IQR 2-6). In the ITT population, the confirmed ORR was 37.4% (95% CI, 28.4-46.4%), and the DCR was 65.2% (95% CI, 56.4-74.1%). The previous response status to platinum-based chemotherapy and baseline CA125 levels were significantly correlated with the ORR. The ORR was significantly higher in patients with a CA125 decrease after the first cycle than in the patients with a CA125 increase. The most common grade 3 or higher AE was hand-foot syndrome (3 [3.0%] of 101 patients). No statistically significant differences existed between the baseline and the postbaseline questionnaires. CONCLUSIONS For patients who experience platinum-resistant and platinum-refractory relapse, the use of PLD may be acceptable because of the associated satisfactory efficacy, low frequency of AEs and high patient QOL. Moreover, a low CA125 level at baseline and a reduction in CA125 after the first cycle are predictive factors for satisfactory efficacy.
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Affiliation(s)
- Zhen Yuan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, Zip code: 100730, China
| | - Ying Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, Zip code: 100730, China.
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, Zip code: 100730, China.
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, Zip code: 100730, China.
| | - Qingshui Li
- Department of Gynecologic Oncology, Shandong Cancer Hospital & Institute, Shandong, China
| | - Guonan Zhang
- Department of Gynecologic Oncology, Sichuan Cancer Hospital & Institute, Sichuan, China
| | - Xiaohua Wu
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Manhua Cui
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Jilin, China
| | - Ying Yue
- Department of Obstetrics and Gynecology, The First Bethune Hospital of Jilin University, Jilin, China
| | - Wenjun Cheng
- Department of Obstetrics and Gynecology, Jiangsu Province Hospital, Jiangsu, China
| | - Li Wang
- Department of Gynecologic Oncology, He Nan Cancer Hospital, Henan, China
| | - Pengpeng Qu
- Department of Obstetrics and Gynecology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Guangshi Tao
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Hunan, China
| | - Jianqing Hou
- Department of Obstetrics and Gynecology, Yantai Yuhuangding Hospital, Shandong, China
| | - Lixin Sun
- Department of Gynecologic Oncology, Shanxi Cancer Hospital, Shanxi, China
| | - Yuanguang Meng
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China
| | - Guiling Li
- Department of Obstetrics and Gynecology, Wuhan Union Hospital of China, Hubei, China
| | - Changzhong Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Shandong, China
| | - Huirong Shi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Yaqing Chen
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Zhejiang, China
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Robelin P, Tod M, Colomban O, Lachuer J, Ray-Coquard I, Rauglaudre GD, Joly F, Chevalier-Place A, Combe P, Lortholary A, Hamizi S, Raban N, Ferron G, Meunier J, Berton-Rigaud D, Alexandre J, Kaminsky MC, Dubot C, Leary A, Malaurie E, You B. Comparative analysis of predictive values of the kinetics of 11 circulating miRNAs and of CA125 in ovarian cancer during first line treatment (a GINECO study). Gynecol Oncol 2020; 159:256-263. [DOI: 10.1016/j.ygyno.2020.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/11/2020] [Indexed: 01/26/2023]
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5
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Piatek S, Panek G, Lewandowski Z, Bidzinski M, Piatek D, Kosinski P, Wielgos M. Rising serum CA-125 levels within the normal range is strongly associated recurrence risk and survival of ovarian cancer. J Ovarian Res 2020; 13:102. [PMID: 32878632 PMCID: PMC7469284 DOI: 10.1186/s13048-020-00681-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 07/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In clinical practice alterations in CA-125 concentration within normal range in patients with ovarian cancer after first-line treatment are common. Even minor increase in CA-125 concentration is associated with patients' anxiety and difficult interpretation and counselling for clinicians. The aim of this study was to evaluate the significance of CA-125 fluctuations within reference level in patients who suffered from ovarian cancer with complete response after first-line treatment. RESULTS 168 patients with epithelial ovarian cancer, who achieved complete remission after first line treatment were enrolled in the study. CA-125 concentration assessment was carried out during follow up visits. The recurrence of the disease was diagnosed on the first appearance of symptoms: clinical, radiological or histopathological/cytological. PFS and 5-year survival rate was calculated with Kaplan-Meier plots. Statistical analysis was performed with SAS / STAT® 9.4 / 14.4, SAS Institute Inc., Cary, NC, USA, 2017. Median concentration of CA-125 after first-line therapy was 10 U/ml. Increasing CA-125 concentration by > 5 U/ml, 3 and 6 months after the treatment was associated with higher risk of relapse (HR = 7.6, p < 0.0001 and HR = 5.29, p < 0.0001 respectively). 5-year survival rate was significantly lower in patients with increased CA-125 by 5 U/ml, 3 and 6 months after therapy (56.79% vs 0 and 50.62% vs 15.55%). CONCLUSIONS Increased concentration of CA-125 by > 5 U/ml within normal range, 3 and 6 months after treatment was unfavorable prognostic factor in ovarian cancer patients with complete response to primary therapy.
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Affiliation(s)
- Szymon Piatek
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 1/3 Starynkiewicza Square, 02-015, Warsaw, Poland. .,Department of Gynecological Oncology, The Maria Sklodowska-Curie Institute - Oncology Center in Warsaw, 5 Roentgena Street, 02-781, Warsaw, Poland.
| | - Grzegorz Panek
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 1/3 Starynkiewicza Square, 02-015, Warsaw, Poland
| | - Zbigniew Lewandowski
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, 3 Oczki Street, 02-00, Warsaw, Poland
| | - Mariusz Bidzinski
- Department of Gynecological Oncology, The Maria Sklodowska-Curie Institute - Oncology Center in Warsaw, 5 Roentgena Street, 02-781, Warsaw, Poland
| | - Dominika Piatek
- 1st Department of Radiology, Medical University of Warsaw, 5 Chałubińskiego Street, 02-004, Warsaw, Poland
| | - Przemyslaw Kosinski
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 1/3 Starynkiewicza Square, 02-015, Warsaw, Poland
| | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 1/3 Starynkiewicza Square, 02-015, Warsaw, Poland
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6
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Haunschild CE, Tewari KS. Bevacizumab use in the frontline, maintenance and recurrent settings for ovarian cancer. Future Oncol 2020; 16:225-246. [PMID: 31746224 PMCID: PMC7036749 DOI: 10.2217/fon-2019-0042] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/15/2019] [Indexed: 12/16/2022] Open
Abstract
On 13 June 2018, Genentech, Inc. issued a press release announcing that the US FDA had approved the antiangiogenesis drug, bevacizumab, in combination with chemotherapy for frontline and maintenance therapy for women with newly diagnosed ovarian cancer. Regulatory approval was based on the National Cancer Institute-sponsored Gynecologic Oncology Group (GOG) protocol 0218, the Phase III, randomized, placebo-controlled, double-blind, multi-center and multi-national clinical trial that met its primary end point, progression-free survival. Bevacizumab is now approved in the frontline, platinum-sensitive recurrent and platinum-resistant recurrent settings for epithelial ovarian cancer. This review will address the broad range of clinical trials addressing the efficacy of bevacizumab use in ovarian cancer.
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Affiliation(s)
- Carolyn E Haunschild
- Clinical Instructor, Department of Obstetrics & Gynecology, Research Fellow, Division of Gynecologic Oncology, University of California, 333 City Blvd West, Suite 1400, Orange, CA 92868, USA
| | - Krishnansu S Tewari
- Professor & Division Director, Director, Division of Gynecologic Oncology, University of California, 333 City Blvd, Orange, CA 92868, USA
- Department of Obstetrics & Gynecology, University of California, The City Tower, 333 City Blvd, West – Suite 1400, Orange, CA 92868, USA
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7
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Colombo N, Sessa C, Bois AD, Ledermann J, McCluggage WG, McNeish I, Morice P, Pignata S, Ray-Coquard I, Vergote I, Baert T, Belaroussi I, Dashora A, Olbrecht S, Planchamp F, Querleu D. ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease. Int J Gynecol Cancer 2019; 29:ijgc-2019-000308. [PMID: 31048403 DOI: 10.1136/ijgc-2019-000308] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/25/2019] [Indexed: 12/29/2022] Open
Abstract
The development of guidelines is one of the core activities of the European Society for Medical Oncology (ESMO) and European Society of Gynaecologial Oncology (ESGO), as part of the mission of both societies to improve the quality of care for patients with cancer across Europe. ESMO and ESGO jointly developed clinically relevant and evidence-based recommendations in several selected areas in order to improve the quality of care for women with ovarian cancer. The ESMO-ESGO consensus conference on ovarian cancer was held on April 12-14, 2018 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of ovarian cancer. Before the conference, the expert panel worked on five clinically relevant questions regarding ovarian cancer relating to each of the following four areas: pathology and molecular biology, early-stage and borderline tumours, advanced stage disease and recurrent disease. Relevant scientific literature, as identified using a systematic search, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. The recommendations presented here are thus based on the best available evidence and expert agreement. This article presents the recommendations of this ESMO-ESGO consensus conference, together with a summary of evidence supporting each recommendation.
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Affiliation(s)
- N Colombo
- Division of Medical Gynecologic Oncology, European Institute of Oncology IRCCS, University of Milan-Bicocca, Milan, Italy
| | - C Sessa
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - A du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - J Ledermann
- Department of Oncology and Cancer Trials, UCL Cancer Institute, London, UK
| | - W G McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | - I McNeish
- Department of Surgery and Cancer, Imperial College, London, UK
| | - P Morice
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - S Pignata
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy
| | - I Ray-Coquard
- Department of Medical and Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - I Vergote
- Department of Gynaecological Oncology, Leuven Cancer Institute, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - T Baert
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - I Belaroussi
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - A Dashora
- Department of Cellular Pathology, Maidstone and Tunbridge Wells NHS Trust, Kent, UK
| | - S Olbrecht
- Department of Gynaecological Oncology, Leuven Cancer Institute, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - F Planchamp
- Clinical Research Unit, Institut Bergonié, Bordeaux, France
| | - D Querleu
- Department of Surgery, Institut Bergonié, Bordeaux, France
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8
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Colombo N, Sessa C, du Bois A, Ledermann J, McCluggage WG, McNeish I, Morice P, Pignata S, Ray-Coquard I, Vergote I, Baert T, Belaroussi I, Dashora A, Olbrecht S, Planchamp F, Querleu D. ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease†. Ann Oncol 2019; 30:672-705. [PMID: 31046081 DOI: 10.1093/annonc/mdz062] [Citation(s) in RCA: 611] [Impact Index Per Article: 122.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
The development of guidelines recommendations is one of the core activities of the European Society for Medical Oncology (ESMO) and European Society of Gynaecologial Oncology (ESGO), as part of the mission of both societies to improve the quality of care for patients with cancer across Europe. ESMO and ESGO jointly developed clinically relevant and evidence-based recommendations in several selected areas in order to improve the quality of care for women with ovarian cancer. The ESMO-ESGO consensus conference on ovarian cancer was held on 12-14 April 2018 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of ovarian cancer. Before the conference, the expert panel worked on five clinically relevant questions regarding ovarian cancer relating to each of the following four areas: pathology and molecular biology, early-stage and borderline tumours, advanced stage disease and recurrent disease. Relevant scientific literature, as identified using a systematic search, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. The recommendations presented here are thus based on the best available evidence and expert agreement. This article presents the recommendations of this ESMO-ESGO consensus conference, together with a summary of evidence supporting each recommendation.
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Affiliation(s)
- N Colombo
- Division of Medical Gynecologic Oncology, European Institute of Oncology IRCCS, University of Milan-Bicocca, Milan, Italy.
| | - C Sessa
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - A du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - J Ledermann
- Department of Oncology and Cancer Trials, UCL Cancer Institute, London
| | - W G McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast
| | - I McNeish
- Department of Surgery and Cancer, Imperial College, London, UK
| | - P Morice
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - S Pignata
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', Naples, Italy
| | - I Ray-Coquard
- Department of Medical and Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - I Vergote
- Department of Gynaecological Oncology, Leuven Cancer Institute, Leuven; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - T Baert
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - I Belaroussi
- Department of Gynecologic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - A Dashora
- Department of Cellular Pathology, Maidstone and Tunbridge Wells NHS Trust, Kent, UK
| | - S Olbrecht
- Department of Gynaecological Oncology, Leuven Cancer Institute, Leuven; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | | | - D Querleu
- Department of Surgery, Institut Bergonié, Bordeaux, France.
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9
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Kang SK, Reinhold C, Atri M, Benson CB, Bhosale PR, Jhingran A, Lakhman Y, Maturen KE, Nicola R, Pandharipande PV, Salazar GM, Shipp TD, Simpson L, Small W, Sussman BL, Uyeda JW, Wall DJ, Whitcomb BP, Zelop CM, Glanc P. ACR Appropriateness Criteria ® Staging and Follow-Up of Ovarian Cancer. J Am Coll Radiol 2019; 15:S198-S207. [PMID: 29724422 DOI: 10.1016/j.jacr.2018.03.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/12/2022]
Abstract
In the management of epithelial ovarian cancers, imaging is used for cancer detection and staging, both before and after initial treatment. The decision of whether to pursue initial cytoreductive surgery for ovarian cancer depends in part on accurate staging. Contrast-enhanced CT of the abdomen and pelvis (and chest where indicated) is the current imaging modality of choice for the initial staging evaluation of ovarian cancer. Fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT and MRI may be appropriate for problem-solving purposes, particularly when lesions are present on CT but considered indeterminate. In patients who achieve remission, clinical suspicion for relapse after treatment prompts imaging evaluation for recurrence. Contrast-enhanced CT is the modality of choice to assess the extent of recurrent disease, and fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT is also usually appropriate, as small metastatic foci may be identified. If imaging or clinical examination confirms a recurrence, the extent of disease and timing of disease recurrence then determines the choice of treatments, including surgery, chemotherapy, and radiation therapy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Stella K Kang
- Principal Author, New York University Medical Center, New York, New York.
| | | | - Mostafa Atri
- Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | - Anuja Jhingran
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yulia Lakhman
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Refky Nicola
- State University of New York Upstate Medical University, Syracuse, New York
| | | | | | - Thomas D Shipp
- Brigham & Women's Hospital, Boston, Massachusetts; American Congress of Obstetricians and Gynecologists
| | - Lynn Simpson
- Columbia University, New York, New York; American Congress of Obstetricians and Gynecologists
| | - William Small
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | - Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont
| | | | | | - Bradford P Whitcomb
- Tripler Army Medical Center, Honolulu, Hawaii; Society of Gynecologic Oncology
| | - Carolyn M Zelop
- Valley Hospital, Ridgewood, New Jersey, and NYU School of Medicine, New York, New York; American Congress of Obstetricians and Gynecologists
| | - Phyllis Glanc
- Specialty Chair, Sunnybrook Health Sciences Centre Bayview Campus, Toronto, Ontario, Canada
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10
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Lindemann K, Kristensen G, Mirza M, Davies L, Hilpert F, Romero I, Ayhan A, Burges A, Rubio M, Raspagliesi F, Huizing M, Creemers GJ, Lykka M, Lee C, Gebski V, Pujade-Lauraine E. Poor concordance between CA-125 and RECIST at the time of disease progression in patients with platinum-resistant ovarian cancer: analysis of the AURELIA trial. Ann Oncol 2016; 27:1505-1510. [DOI: 10.1093/annonc/mdw238] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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11
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Lheureux S, Karakasis K, Kohn EC, Oza AM. Ovarian cancer treatment: The end of empiricism? Cancer 2015; 121:3203-11. [PMID: 26096019 PMCID: PMC4744728 DOI: 10.1002/cncr.29481] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/12/2015] [Accepted: 05/05/2015] [Indexed: 01/06/2023]
Abstract
The diagnosis, investigation, and management of ovarian cancer are in a state of flux-balancing ever rapid advances in our understanding of its biology with 3 decades of clinical trials. Clinical trials that started with empirically driven selections have evolved in an evidence-informed manner to gradually improve outcome. Has this improved understanding of the biology and associated calls to action led to appropriate changes in therapy? In this review, the authors discuss incorporating emerging data on biology, combinations, dose, and scheduling of new and existing agents with patient preferences in the management of women with ovarian cancer.
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Affiliation(s)
- Stephanie Lheureux
- Division of Medical Oncology and Hematology, Bras Family Drug Development ProgramPrincess Margaret Cancer CenterTorontoOntarioCanada
| | - Katherine Karakasis
- Division of Medical Oncology and Hematology, Bras Family Drug Development ProgramPrincess Margaret Cancer CenterTorontoOntarioCanada
| | - Elise C. Kohn
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and DiagnosisNational Cancer InstituteBethesdaMaryland
| | - Amit M. Oza
- Division of Medical Oncology and Hematology, Bras Family Drug Development ProgramPrincess Margaret Cancer CenterTorontoOntarioCanada
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12
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Marcus CS, Maxwell GL, Darcy KM, Hamilton CA, McGuire WP. Current approaches and challenges in managing and monitoring treatment response in ovarian cancer. J Cancer 2014; 5:25-30. [PMID: 24396495 PMCID: PMC3881218 DOI: 10.7150/jca.7810] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/25/2013] [Indexed: 12/13/2022] Open
Abstract
Epithelial ovarian cancer is the leading cause of death among gynecologic malignancies. Treatment of recurrent ovarian cancer remains a challenge despite advances in surgical and chemotherapeutic options. A goal of many providers is to detect recurrences as early as possible and initiate treatment though there is controversy as to whether this impacts outcome. Elevations in CA125 and radiological findings may precede symptoms of recurrence by several months. While detection of recurrences by physical exam alone is unusual, a thorough exam in conjunction with reported symptoms and elevated CA125 is sufficient to detect 80-90% of recurrences. A spiral CT scan may be used to confirm recurrence in the setting of asymptomatic CA125 elevation and a PET/CT can yield additional insight if the CT is inconclusive. Initiating chemotherapy prior to the development of symptoms, even in the setting of elevated CA125, does not impact overall survival primarily because the efficacy of available treatments in the recurrent setting is poor. More information about tumor biology and ways to predict which patients will benefit from available treatment options is required. Consequently, the approach to post-treatment surveillance should be individualized taking into account the clinical benefit of the second-line therapy, versus the costs and morbidity of the surveillance method.
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Affiliation(s)
- Charlotte S Marcus
- 1. Department of Defense Gynecologic Cancer Center of Excellence, Women's Health Integrated Research Center at Inova Health System, Annandale, VA 22003, USA ; 2. Gynecologic Oncology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - G Larry Maxwell
- 1. Department of Defense Gynecologic Cancer Center of Excellence, Women's Health Integrated Research Center at Inova Health System, Annandale, VA 22003, USA ; 3. Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, VA22042, USA
| | - Kathleen M Darcy
- 1. Department of Defense Gynecologic Cancer Center of Excellence, Women's Health Integrated Research Center at Inova Health System, Annandale, VA 22003, USA
| | - Chad A Hamilton
- 1. Department of Defense Gynecologic Cancer Center of Excellence, Women's Health Integrated Research Center at Inova Health System, Annandale, VA 22003, USA ; 2. Gynecologic Oncology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - William P McGuire
- 4. Department of Medicine, Inova Fairfax Hospital, Falls Church, VA 22042, USA
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Mitchell DG, Javitt MC, Glanc P, Bennett GL, Brown DL, Dubinsky T, Harisinghani MG, Harris RD, Horowitz NS, Pandharipande PV, Pannu HK, Podrasky AE, Royal HD, Shipp TD, Siegel CL, Simpson L, Wong-You-Cheong JJ, Zelop CM. ACR Appropriateness Criteria Staging and Follow-up of Ovarian Cancer. J Am Coll Radiol 2013; 10:822-7. [DOI: 10.1016/j.jacr.2013.07.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 07/22/2013] [Indexed: 01/22/2023]
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Leone Roberti Maggiore U, Valenzano Menada M, Venturini PL, Ferrero S. Sorafenib for ovarian cancer. Expert Opin Investig Drugs 2013; 22:1049-62. [DOI: 10.1517/13543784.2013.802769] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Umberto Leone Roberti Maggiore
- University of Genoa, San Martino Hospital and National Institute for Cancer Research, Department of Obstetrics and Gynecology,
Largo R. Benzi 1, 16132 Genoa, Italy ;
| | - Mario Valenzano Menada
- University of Genoa, San Martino Hospital and National Institute for Cancer Research, Department of Obstetrics and Gynecology,
Largo R. Benzi 1, 16132 Genoa, Italy ;
| | - Pier Luigi Venturini
- University of Genoa, San Martino Hospital and National Institute for Cancer Research, Department of Obstetrics and Gynecology,
Largo R. Benzi 1, 16132 Genoa, Italy ;
| | - Simone Ferrero
- University of Genoa, San Martino Hospital and National Institute for Cancer Research, Department of Obstetrics and Gynecology,
Largo R. Benzi 1, 16132 Genoa, Italy ;
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Recurrence patterns after extended treatment with bevacizumab for ovarian, fallopian tube, and primary peritoneal cancers. Gynecol Oncol 2013; 130:295-9. [PMID: 23632207 DOI: 10.1016/j.ygyno.2013.04.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 04/19/2013] [Accepted: 04/22/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate patterns of recurrence for ovarian, fallopian tube, and primary peritoneal cancer patients undergoing extended treatment with bevacizumab (BEV). METHODS A retrospective review of patients with primary ovarian, fallopian tube, or peritoneal cancer treated with BEV alone or in combination with other chemotherapy from 2001 to 2011 was performed. Qualified patients were identified by chemotherapy records. Electronic medical records, labs, and imaging reports were reviewed and abstracted. RESULTS Of 108 patients identified, 89 patients met study criteria by having disease progression either during treatment with BEV or after discontinuing BEV without initiating any other treatment. Patients on extended BEV therapy (>12 cycles) were more likely to recur in extra-visceral sites (p=0.04), especially in lymph nodes (p=0.0002), and presented with fewer symptoms at time of recurrence (p=0.02), compared to patients who had received ≤ 12 cycles. CA-125 becomes less reliable for the detection of recurrent disease with extended BEV therapy (p=0.03 for ≤12 cycles vs. p=0.08 for >12 cycles). Radiology was superior to CA-125, symptom, and physical exam, in detecting recurrence with extended BEV therapy (all p<0.0001). CONCLUSIONS Extended treatment with BEV in ovarian, fallopian tube, and peritoneal cancers results in alterations in the patterns of recurrence. Radiologic imaging is more reliable than CA-125, symptoms, or physical exam, in identifying recurrent disease in patients undergoing BEV treatment. As novel targeted therapies continue to be employed, guidelines for gynecologic cancer surveillance must continue to be reexamined.
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Wenham RM, Lapolla J, Lin HY, Apte SM, Lancaster JM, Judson PL, Gonzalez-Bosquet J, Herschberger A, Havrilesky LJ, Secord AA. A phase II trial of docetaxel and bevacizumab in recurrent ovarian cancer within 12 months of prior platinum-based chemotherapy. Gynecol Oncol 2013; 130:19-24. [PMID: 23623830 DOI: 10.1016/j.ygyno.2013.04.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 04/15/2013] [Accepted: 04/17/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The efficacy and safety of bevacizumab and docetaxel were evaluated in women who developed recurrent epithelial ovarian, fallopian, or peritoneal cancer within 12 months of platinum-based therapy. METHODS Patients received docetaxel (40 mg/m(2)) on days 1 and 8 and bevacizumab (15 mg/kg) on day 1 of a 21-daycycle. Primary endpoint was 6-month progression-free survival (PFS). RESULTS Forty-one patients were evaluable for PFS and 38 for best response; 46% had platinum-free intervals (PFI) of <6 months and 54% between 6 and 12 months. The 6-month PFS was 43.9% (95% confidence interval (CI(95%))=28.6-58.2%). Median PFS (months) was 5.2 (CI(95%)=4.4-7.2) for all patients, 6.2 (CI(95%)=4.1-7.4) for patients with PFI <6 months, and 5.1 (CI(95%)=3.0-7.2) for those with PFI ≥ 6 months. Twenty-two patients showed overall response (CR+PR) (57.9%; CI(95%)=40.8-73.7%), and 32 showed clinical benefit (CR+PR+SD) (84.2%; CI(95%)=68.8-94.0%). For those with complete or partial responses, median duration of response was 4.8 months (0.7-14.5). Median overall survival was 12.4 months (CI(95%)=10.0-21.9). The most common grade 3/4 adverse events (AEs) were neutropenia (14.6% of patients), followed by leukopenia, fatigue, metabolic, and gastrointestinal, with 66% showing any grade 3/4 toxicity. Most common AEs of any grade were gastrointestinal (93%), fatigue (73%), and pain (73%). Four (10%) patients developed hypertension, 1 a gastrointestinal perforation, and another a colovesicular fistula. CONCLUSIONS Bevacizumab and docetaxel administered in patients with recurrent ovarian cancer is an active regimen without new unanticipated toxicities. This combination should be an option for further study or clinical use in recurrent ovarian cancer.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bevacizumab
- Carcinoma, Ovarian Epithelial
- Disease-Free Survival
- Docetaxel
- Drug Resistance, Neoplasm
- Drug Synergism
- Fallopian Tube Neoplasms/drug therapy
- Female
- Humans
- Infusions, Intravenous
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasms, Glandular and Epithelial/drug therapy
- Organoplatinum Compounds/therapeutic use
- Ovarian Neoplasms/drug therapy
- Peritoneal Neoplasms/drug therapy
- Taxoids/administration & dosage
- Taxoids/adverse effects
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Affiliation(s)
- Robert M Wenham
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.
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Raja FA, Hook JM, Ledermann JA. Biomarkers in the development of anti-angiogenic therapies for ovarian cancer. Cancer Treat Rev 2012; 38:662-72. [DOI: 10.1016/j.ctrv.2011.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 11/28/2011] [Accepted: 11/30/2011] [Indexed: 12/24/2022]
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18
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Ilhan-Mutlu A, Wagner L, Widhalm G, Wöhrer A, Bartsch S, Czech T, Heinzl H, Leutmezer F, Prayer D, Marosi C, Base W, Preusser M. Exploratory investigation of eight circulating plasma markers in brain tumor patients. Neurosurg Rev 2012; 36:45-55; discussion 55-6. [PMID: 22763625 DOI: 10.1007/s10143-012-0401-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 11/25/2011] [Accepted: 05/20/2012] [Indexed: 11/28/2022]
Abstract
Several blood biomarkers have been established for the early diagnosis, screening and follow-up of non central nervous system cancers. However, there is lack of knowledge on biochemical blood alterations in brain tumor patients. In this study, we prospectively collected blood plasma samples of 105 adult brain tumor patients with diffuse low-grade glioma (World Health Organization (WHO) II, n = 7), anaplastic glioma (WHO III, n = 10), glioblastoma multiforme (WHO IV, glioblastoma multiforme (GBM)) (n = 34), meningioma (WHO I, n = 8), atypical meningioma (WHO II, n = 5), and intracerebral metastasis (ICM; n = 41). In each case, we measured plasma concentrations of neuropeptide Y, brain-derived neurotrophic factor, glial cell line-derived neurotrophic factor, placental growth factor (PlGF), S100B, secretagogin, interleukin 8, and glial fibrillary acidic protein (GFAP) using enzyme-linked immunosorbent assay. Plasma marker concentrations were correlated to patient parameters including neuropathological diagnosis and neuroradiological features. Most of the markers were detectable in all diagnostic categories in variable concentrations. GFAP plasma detectability was strongly associated with a diagnosis of GBM (p < 0.001). Plasma GFAP and plasma placental growth factor showed promising moderate potential in the differential diagnosis of unifocal GBM versus unifocal supratentorial ICM (area under the curve = 0.73, p < 0.05). To summarize, our data show that none of the investigated markers is suitable to substitute histological diagnosis. However, measurement of circulating GFAP and PlGF may support neuroradiological differential diagnosis of GBM versus ICM.
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Affiliation(s)
- Aysegul Ilhan-Mutlu
- Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Pignata S, Cannella L, Leopardo D, Bruni GS, Facchini G, Pisano C. Follow-up with CA125 after primary therapy of advanced ovarian cancer: in favor of continuing to prescribe CA125 during follow-up. Ann Oncol 2012; 22 Suppl 8:viii40-viii44. [PMID: 22180398 DOI: 10.1093/annonc/mdr470] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Serum cancer antigen 125 (CA125) is widely used in ovarian cancer to monitor the effectiveness of therapy both in first line and recurrence. It is also widely used during follow-up, where it is able to identify a percentage of patients with asymptomatic recurrence. Although a recent Medical Research Council (UK)/European Organisation for Research and Treatment of Cancer trial has demonstrated that early chemotherapy in asymptomatic patients based only on CA125 increase does not prolong survival, we still believe that CA125 monitoring should be prescribed to patients during follow-up. In fact, it can help to identify patients who should undergo radiology in order to select those that can benefit from surgery or from early treatment before the onset of symptoms, which are usually related to an excessive disease burden. The delay of disease symptoms, such as those associated with the appearance of ascites or bowel occlusion, is in our view an important goal of our treatment of recurrence. Moreover, research should be done in patients with asymptomatic CA125 increase in order to identify more effective therapies that will improve survival. Finally, the reliability of CA125 as a surrogate of response under treatment with biological agents should be validated in prospective trials.
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Affiliation(s)
- S Pignata
- Division of Medical Oncology, Department of Urology and Gynecology, National Cancer Institute of Naples, Via Mariano Semmola, Naples, Italy.
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20
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Xu M, Rettig MP, Sudlow G, Wang B, Akers WJ, Cao D, Mutch DG, DiPersio JF, Achilefu S. Preclinical evaluation of Mab CC188 for ovarian cancer imaging. Int J Cancer 2012; 131:1351-9. [PMID: 22130973 DOI: 10.1002/ijc.27380] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 11/08/2011] [Indexed: 12/20/2022]
Abstract
Cancer stem cells (CSCs) have been successfully isolated from solid tumors and are believed to be initiating cells of primary, metastatic and recurrent tumors. Imaging and therapeutic reagents targeted to CSCs have potential to detect subclinical tumors and completely eradicate the disease. Previously, we have demonstrated that Mab CC188 binds to colon cancer CD133- and CD133+ (CSCs) cells. In this study, we examined the reactivity of Mab CC188 to ovarian cancer cells including CD133+ cells and primary tumor tissues using immunofluorescence staining methods and tissue microarray technique. We also explored the feasibility of using NIR dye-labeled Mab CC188 probe to image ovarian tumors in vivo. Mab CC188 stains both CD133- and CD133+ cells of ovarian cancer. Tissue microarray analysis reveals that 75% (92/123) of ovarian cancer cases are positively stained with Mab CC188. Weak positive (±), positive (+), strong positive (++) and very strong positive (+++) stains are 14.8, 3.7, 11 and 24.4%, respectively. In contrast, Mab CC188 staining is low in normal cells and tissues. In vivo study show that significant amounts of the probe accumulates in the excretion organs in the early period postinjection. At 24 hr, the imaging probes have largely accumulates in the tumor, while the intensity of the imaging probe decreases in the liver. The tumor uptake was still evident at 120-hr postinjection. Our work suggests that Mab CC188-based imaging and therapeutic reagents are capable of detecting early stage ovarian tumors and effectively treating the tumor.
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Affiliation(s)
- M Xu
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
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21
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Randall LM, Sill MW, Burger RA, Monk BJ, Buening B, Sorosky JI. Predictive value of serum CA-125 levels in patients with persistent or recurrent epithelial ovarian cancer or peritoneal cancer treated with bevacizumab on a Gynecologic Oncology Group phase II trial. Gynecol Oncol 2011; 124:563-8. [PMID: 22138229 DOI: 10.1016/j.ygyno.2011.11.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 11/14/2011] [Accepted: 11/16/2011] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare two methods of determining therapeutic response and disease progression - modified Gynecologic Cancer Intergroup (GCIG) criteria based on CA-125 and Radiographic Evaluation Criteria in Solid Tumors (RECIST), in a phase II trial of bevacizumab for patients with recurrent or persistent epithelial ovarian and peritoneal carcinoma. METHODS Patients were treated with bevacizumab 15 mg/kg every 21 days. Modified GCIG definitions of progression and response were retrospectively applied and compared to RECIST-defined progression and response. The prognostic significance of CA-125- and RECIST-defined responses and progressions were explored. RESULTS Sixty-two patients were evaluable by RECIST, 59 for progression by CA-125, and 45 for response by CA-125. Median progression-free survival (PFS) by RECIST and progression-free interval (PFI) by CA-125 were 4.7 and 5.2 months respectively. However, 12.9% of those with CA-125 defined progression remained progression-free according to RECIST for at least 8 months. Thirteen of 62 patients (21%) had response by RECIST and 14/45 (31%) by CA-125. Time dependent analyses indicated that progression by CA-125 was associated with a 5.2 fold increased risk of progression by RECIST, and response by CA-125 had a 5 fold decrease in risk of progression by RECIST. Landmark and time dependent analyses showed prognostic value of responses by CA-125 and RECIST. CONCLUSIONS In this study, disease assessment by RECIST and CA-125 appears to correlate in general. However, approximately 10% of patients might demonstrate progression earlier by CA-125.
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Affiliation(s)
- Leslie M Randall
- Division of Gynecologic Oncology, Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange, CA 92868, USA
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22
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Suenaga M, Matsusaka S, Ueno M, Yamamoto N, Shinozaki E, Mizunuma N, Yamaguchi T, Hatake K. Predictors of the efficacy of FOLFIRI plus bevacizumab as second-line treatment in metastatic colorectal cancer patients. Surg Today 2011; 41:1067-74. [DOI: 10.1007/s00595-010-4432-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 09/22/2010] [Indexed: 10/18/2022]
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23
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Trimble EL, Birrer MJ, Hoskins WJ, Marth C, Petryshyn R, Quinn M, Thomas GM, Kitchener HC, Aghajanian C, Alberts DS, Armstrong D, Brown J, Coleman RL, Colombo N, Eisenhauer E, Friedlander M, Fujiwara K, Hunsberger S, Kaye S, Ledermann JA, Lee S, Look K, Mannel R, McNeish IA, Minasian L, Oza A, Paul J, Poveda A, Pujade-Lauraine E, Schoenfeldt M, Swart AM, von Gruenigen V, Wenzel L. Current academic clinical trials in ovarian cancer: Gynecologic Cancer Intergroup and US National Cancer Institute Clinical Trials Planning Meeting, May 2009. Int J Gynecol Cancer 2011; 20:1290-8. [PMID: 21151709 DOI: 10.1111/igc.0b013e3181ee1c01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To review the current status of large phase academic clinical trials for women with ovarian cancer, address cross-cutting issues, and identify promising areas for future collaboration. METHODS In May 2009, the Gynecologic Cancer Intergroup, which represents 19 Cooperative Groups conducting trials for women with gynecologic cancer, and the US National Cancer Institute convened a Clinical Trials Planning Meeting. RESULTS The topics covered included the impact of new developments in cancer biology upon molecular targets and novel agents, pharmacogenomics, advances in imaging, the potential benefit of diet and exercise to reduce the risk of recurrence, academic partnership with industry, statistical considerations for phases 2 and 3 trials, trial end points, and symptom benefit and health-related quality-of-life issues. The clinical trials discussed spanned the spectrum of ovarian cancer from initial diagnosis, staging, and cytoreductive surgery to consolidation chemotherapy, and treatment of recurrent disease. CONCLUSIONS Ongoing and effective collaboration with industry, government, and patients aims to ensure that the most important scientific questions can be answered rapidly. We encourage women with ovarian cancer and their oncologists to consider participation in the academic clinical trials conducted by the member groups of the Gynecologic Cancer Intergroup.
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Affiliation(s)
- Edward L Trimble
- National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-7436, USA.
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Abstract
Bevacizumab is a monoclonal antibody that binds to VEGF, a circulating protein involved in the promotion of angiogenesis and probably tumor growth and progression. Bevacizumab has demonstrated anticancer activity in several cancers, either combined with chemotherapy or when used as a single agent, and has been approved by the US FDA as a treatment for several cancers. As VEGF has been implicated in ovarian cancer progression and ascites formation, and high levels of VEGF have been found in plasma and ascites in women with ovarian cancer, bevacizumab has been tested as an anticancer therapy in ovarian cancer. Documented single-agent activity of bevacizumab in recurrent ovarian cancer has led to combination studies with both biologic agents as well as other chemotherapy agents in both recurrent and newly diagnosed cancer. One trial in patients with recurrent, heavily pretreated ovarian cancer demonstrated a higher than predicted risk of gastrointestinal perforation, and although a lower incidence of gastrointestinal perforation has been reported in less heavily pretreated patients, patients and their physicians must be aware of this risk. Upfront studies testing the impact of adding bevacizumab to carboplatin and paclitaxel chemotherapy for the treatment of newly diagnosed cancer are currently underway, and one Phase III randomized study (Gynecologic Oncology Group study 218) was recently presented and will be discussed in this article.
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Affiliation(s)
- Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brooklyn Avenue, Boston, MA 02215, USA.
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Friedlander M, Hancock KC, Rischin D, Messing MJ, Stringer CA, Matthys GM, Ma B, Hodge JP, Lager JJ. A Phase II, open-label study evaluating pazopanib in patients with recurrent ovarian cancer. Gynecol Oncol 2010; 119:32-7. [PMID: 20584542 DOI: 10.1016/j.ygyno.2010.05.033] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 05/24/2010] [Accepted: 05/29/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The progression-free and median survival of patients with advanced ovarian cancer has not appreciably improved over the last decade. Novel targeted therapies, particularly antiangiogenic agents, may potentially improve clinical outcomes in patients with ovarian cancer. This phase II, open-label study evaluated oral pazopanib monotherapy in patients with low-volume recurrent ovarian cancer. METHODS Patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal carcinoma with complete CA-125 response to initial platinum-based chemotherapy and subsequent elevation of CA-125 to ≥ 42 U/mL (> 2 × ULN) were treated with pazopanib 800 mg once daily until PD or unacceptable toxicity. This Green-Dahlberg study required 2 CA-125 responses in stage I (20 patients) to proceed to stage II (15 patients). The primary endpoint was CA-125 response (≥ 50% decrease from baseline, confirmed ≥ 21 days after initial evaluation). RESULTS Eleven of 36 patients (31%) had a CA-125 response to pazopanib, with median time to response of 29 days and median response duration of 113 days. Overall response rate was 18% in patients with measurable disease at baseline. The most common adverse events leading to discontinuation of study drug were grade 3 ALT (8%) and AST (8%) elevation. Only 1 grade 4 toxicity (peripheral edema) was reported. CONCLUSIONS Pazopanib monotherapy was relatively well tolerated, with toxicity similar to other small-molecule, oral angiogenesis inhibitors, and demonstrated promising single-agent activity in patients with recurrent ovarian cancer. Further studies evaluating the potential role of pazopanib in patients with ovarian cancer are ongoing.
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Combination therapy: intermittent sorafenib with bevacizumab yields activity and decreased toxicity. Br J Cancer 2010; 102:495-9. [PMID: 20051952 PMCID: PMC2822947 DOI: 10.1038/sj.bjc.6605514] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We previously reported preliminary results of our phase I study of continuous daily sorafenib with bevacizumab every other week for solid tumours. Toxicity was moderate, leading to additional dose levels (DL) testing intermittent sorafenib dosing. METHODS Seventeen patients with advanced solid tumours were treated on three additional DLs testing sorafenib days 1-5 per week. Dose level 4 was sorafenib 200 mg twice daily (b.i.d.) and bevacizumab 5 mg kg(-1). DL5 alternated between bevacizumab 10 mg kg(-1)-sorafenib 200 mg b.i.d. (A) and sorafenib 400 mg b.i.d. with bevacizumab 5 mg kg(-1) (B). Outcome and toxicity data from 19 epithelial ovarian cancer (EOC) patients from DL 1-5 were analysed. RESULTS Fewer patients required sorafenib dose reduction with the intermittent schedule (41 vs 74% daily, P=0.01). Hand-foot skin reaction (HFSR) remained the primary cause of dose reduction (n=5). Partial responses (12%) or disease stabilisation > or =4 months (53%; median 6 (4-26)) occurred in most patients on the intermittent schedule. Partial response occurred in 47% EOC patients treated in pooled analysis of duration 4-37 months. CONCLUSION Intermittent sorafenib dosing with bevacizumab has promising clinical activity and less sorafenib dose reduction and side effects, but does not ameliorate HFSR. We are conducting a phase II clinical trial with intermittent sorafenib and bevacizumab in patients with EOC.
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Antivascular therapy for epithelial ovarian cancer. JOURNAL OF ONCOLOGY 2009; 2010:372547. [PMID: 20072701 PMCID: PMC2804796 DOI: 10.1155/2010/372547] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 09/28/2009] [Indexed: 12/19/2022]
Abstract
Ovarian cancer is the fifth largest cancer killer in women. Improved understanding of the molecular pathways implicated in the pathogenesis of ovarian cancer has led to the investigation of novel targeted therapies. Ovarian cancer is characterized by an imbalance between pro- and antiangiogenic factors in favor of angiogenesis activation. Various antivascular strategies are currently under investigation in ovarian cancer. They can schematically be divided into antiangiogenic and vascular-disrupting therapies. This paper provides a comprehensive review of these new treatments targeting the tumor vasculature in this disease. Promising activities have been detected in phase II trials, and results of phase III clinical trials are awaited eagerly.
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Azad NS, Aragon-Ching JB, Dahut WL, Gutierrez M, Figg WD, Jain L, Steinberg SM, Turner ML, Kohn EC, Kong HH. Hand-foot skin reaction increases with cumulative sorafenib dose and with combination anti-vascular endothelial growth factor therapy. Clin Cancer Res 2009; 15:1411-6. [PMID: 19228742 DOI: 10.1158/1078-0432.ccr-08-1141] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE Sorafenib, a vascular endothelial growth factor (VEGF) receptor-2 and RAF kinase inhibitor, commonly causes skin toxicity. We retrospectively analyzed dermatologic toxicity in patients receiving combined antiangiogenic therapy involving sorafenib and bevacizumab. EXPERIMENTAL DESIGN Castration-resistant prostate cancer and metastatic non-small cell lung cancer patients were accrued to phase II studies, receiving sorafenib 400 mg twice daily. A phase I study explored sorafenib 200 to 400 mg twice daily with bevacizumab 5 to 10 mg/kg every 2 weeks in patients with advanced solid tumors. The probability of development of maximum grade of dermatologic toxicity as a function of the cumulative dose of sorafenib was determined. Additional analyses compared extent of toxicity, pharmacokinetics, and patient risk factors. RESULTS Ninety-six patients were enrolled: 54 received sorafenib and 42 received bevacizumab/sorafenib. Hand-foot skin reaction (HFSR) was observed in 50 of 96 (52%) patients. Grade 2 to 3 HFSR developed in 16 of 54 (30%) sorafenib patients and 24 of 42 (57%) bevacizumab/sorafenib patients (P=0.012) and was associated with cumulative sorafenib exposure (P=0.0008). Twenty-four of 42 phase I patients randomized to start with bevacizumab had increased risk of grade 2 to 3 HFSR than those starting with sorafenib (P=0.013) after adjusting for association between HFSR risk and hypertension (P=0.01), which was the only toxicity associated with HFSR. There was no association between HFSR and baseline history of neuropathy, prior taxane/platinum treatment, or systemic sorafenib levels. CONCLUSIONS Sorafenib-related HFSR is associated with increasing cumulative sorafenib dose. HFSR is increased in patients treated with bevacizumab/sorafenib combination anti-VEGF therapy, and this finding is not explained by pharmacokinetic interaction between the two agents. Our results suggest that the pathophysiology of HFSR may be related to VEGF inhibition.
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Affiliation(s)
- Nilofer S Azad
- Medical Oncology Branch, Biostatistics and Data Management Section, Center for Cancer Research, NIH, Bethesda, Maryland 20892, USA
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Current World Literature. Curr Opin Obstet Gynecol 2009; 21:101-9. [DOI: 10.1097/gco.0b013e3283240745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW Despite advances in management over recent years, epithelial ovarian cancer remains the most lethal gynaecological malignancy. Methods of early detection, as well as improved therapeutic options, are urgently needed. RECENT FINDINGS Currently, a number of targeted therapies, including vascular endothelial growth factor inhibitors, poly-ADP-ribose polymerase inhibitors and folate receptor inhibitors look promising in this arena and this article will review a number of these drugs and the evidence pertaining to their use. SUMMARY Much further research is required to define if, when and how best to integrate these novel therapies, and also to define associated biomarkers that predict toxicity and select patients most likely to derive benefit. Individualized therapy is not an impossible dream, but there is still a long way to go.
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Affiliation(s)
- Fiona Collinson
- University of Leeds, St James' University Hospital, Leeds, UK.
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Affiliation(s)
- Wafic M Elmasri
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
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Markman M. The Myth of Measurable Disease in Ovarian Cancer: Revisited. Cancer Invest 2009; 27:11-2. [DOI: 10.1080/07357900802427950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Azad N, Minasian L, Kohn E. Reply to Lack of reliability of CA125 response criteria with anti-VEGF molecularly targeted therapy. Cancer 2008. [DOI: 10.1002/cncr.23894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Markman M. Lack of reliability of CA125 response criteria with anti-VEGF molecularly targeted therapy. Cancer 2008; 113:2832-3; author reply 2833-4. [DOI: 10.1002/cncr.23893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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