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Miyamoto E, Yoshihara M, Iyoshi S, Mogi K, Uno K, Fujimoto H, Kitami K, Yoshikawa N, Kajiyama H. Factors affecting the long-term prognosis of patients in the AYA generation with epithelial ovarian cancer: A multicenter propensity score matching analysis. Int J Gynaecol Obstet 2024. [PMID: 38607295 DOI: 10.1002/ijgo.15479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/20/2024] [Accepted: 03/10/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Ovarian carcinoma (OvCa) is more common in the elderly, but also affects the adolescent and young adult (AYA) generation, which refers to those aged 15-39 years. Although the characteristics of OvCa may differ between AYAs and non-AYAs, limited information is currently available on differences in prognostic factors. Therefore, we herein investigated prognostic factors for and the prognosis of OvCa in AYAs. We also examined the prognostic impact of fertility-sparing surgery in a subgroup analysis. METHODS We retrospectively collected data on 4897 patients with OvCa from the databases of multiple institutions and ultimately included 1161 patients with epithelial ovarian cancer (EOC). We performed a survival analysis to compare AYAs and non-AYAs with backgrounds that conformed to those of AYAs using the propensity score (PS) matching method. A Cox regression analysis was also conducted to evaluate each predictor of recurrence-free survival (RFS) and overall survival (OS) in the original population. As a subgroup analysis, a multivariate analysis stratified by the AYA and non-AYA generations was performed. RESULTS In total, 119 AYA patients were included in this study. After PS adjustments, no significant differences were observed in RFS or OS between AYAs and non-AYAs. Prognostic factors differed between AYAs and non-AYAs, particularly in histology and cytology. A multivariate analysis stratified by the AYA and non-AYA generations described that uterine-preserving surgery (UPS) did not have a significant impact on the prognosis of AYAs or non-AYAs. In cases with recurrence, no significant differences were observed in RFS and recurrent sites in the two groups. CONCLUSION Characteristic prognostic factors for EOC in AYAs were identified. The present results indicate the limited prognostic impact of UPS for EOC in AYAs.
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Affiliation(s)
- Emiri Miyamoto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masato Yoshihara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shohei Iyoshi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kazumasa Mogi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kaname Uno
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University Graduate School of Medicine, Lund, Sweden
| | - Hiroki Fujimoto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Discipline of Obstetrics and Gynecology, Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Kazuhisa Kitami
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Nobuhisa Yoshikawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Vega B, Desai R, Solk P, McKoy JM, Flores AM, Phillips SM, Barber EL. Increasing physical activity among older adults with gynecologic cancers: a qualitative study. Support Care Cancer 2024; 32:282. [PMID: 38600364 DOI: 10.1007/s00520-024-08483-6] [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: 12/12/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The purpose of this study was to gain an understanding of older gynecologic cancer patients' preferences and opinions related to physical activity during chemotherapy, including interventions to promote physical activity. METHODS Gynecologic cancer patients 60 years or older receiving chemotherapy at a single institution within the last 12 months completed questionnaires and a semi-structured interview asking about their preferences for physical activity interventions aimed at promoting physical activity while receiving treatment. RESULTS Among the 30 gynecologic cancer patients surveyed and interviewed, a majority agreed with the potential usefulness of a physical activity intervention during chemotherapy (67%) and most reported they would be willing to use an activity tracker during chemotherapy (73%). They expressed a preference for an aerobic activity intervention such as walking, indicated a desire for education from their clinical team on the effects physical activity can have on treatment symptoms, and stated a need for an intervention that could be accessed from anywhere and anytime. Additionally, they emphasized a need for an intervention that considered their treatment symptoms as these were a significant barrier to physical activity while on chemotherapy. CONCLUSION In this study of older gynecologic cancer patients receiving chemotherapy, most were open to participating in a virtually accessible and symptom-tailored physical activity intervention to promote physical activity during chemotherapy.
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Affiliation(s)
- Brenda Vega
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E Superior Suite 05-138, Chicago, IL, 60611, USA
| | - Ria Desai
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Payton Solk
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ann Marie Flores
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emma L Barber
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E Superior Suite 05-138, Chicago, IL, 60611, USA.
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Nassauer L, Staecker H, Huang P, Renslo B, Goblet M, Harre J, Warnecke A, Schott JW, Morgan M, Galla M, Schambach A. Protection from cisplatin-induced hearing loss with lentiviral vector-mediated ectopic expression of the anti-apoptotic protein BCL-XL. MOLECULAR THERAPY. NUCLEIC ACIDS 2024; 35:102157. [PMID: 38450280 PMCID: PMC10915631 DOI: 10.1016/j.omtn.2024.102157] [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: 09/13/2023] [Accepted: 02/15/2024] [Indexed: 03/08/2024]
Abstract
Cisplatin is a highly effective chemotherapeutic agent, but it can cause sensorineural hearing loss (SNHL) in patients. Cisplatin-induced ototoxicity is closely related to the accumulation of reactive oxygen species (ROS) and subsequent death of hair cells (HCs) and spiral ganglion neurons (SGNs). Despite various strategies to combat ototoxicity, only one therapeutic agent has thus far been clinically approved. Therefore, we have developed a gene therapy concept to protect cochlear cells from cisplatin-induced toxicity. Self-inactivating lentiviral (LV) vectors were used to ectopically express various antioxidant enzymes or anti-apoptotic proteins to enhance the cellular ROS scavenging or prevent apoptosis in affected cell types. In direct comparison, anti-apoptotic proteins mediated a stronger reduction in cytotoxicity than antioxidant enzymes. Importantly, overexpression of the most promising candidate, Bcl-xl, achieved an up to 2.5-fold reduction in cisplatin-induced cytotoxicity in HEI-OC1 cells, phoenix auditory neurons, and primary SGN cultures. BCL-XL protected against cisplatin-mediated tissue destruction in cochlear explants. Strikingly, in vivo application of the LV BCL-XL vector improved hearing and increased HC survival in cisplatin-treated mice. In conclusion, we have established a preclinical gene therapy approach to protect mice from cisplatin-induced ototoxicity that has the potential to be translated to clinical use in cancer patients.
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Affiliation(s)
- Larissa Nassauer
- Institute of Experimental Hematology, Hannover Medical School, 30625 Hannover, Germany
| | - Hinrich Staecker
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, KS 66160, USA
| | - Peixin Huang
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, KS 66160, USA
| | - Bryan Renslo
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, KS 66160, USA
| | - Madeleine Goblet
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Hannover Medical School, 30625 Hannover, Germany
| | - Jennifer Harre
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Hannover Medical School, 30625 Hannover, Germany
| | - Athanasia Warnecke
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Hannover Medical School, 30625 Hannover, Germany
| | - Juliane W. Schott
- Institute of Experimental Hematology, Hannover Medical School, 30625 Hannover, Germany
| | - Michael Morgan
- Institute of Experimental Hematology, Hannover Medical School, 30625 Hannover, Germany
| | - Melanie Galla
- Institute of Experimental Hematology, Hannover Medical School, 30625 Hannover, Germany
| | - Axel Schambach
- Institute of Experimental Hematology, Hannover Medical School, 30625 Hannover, Germany
- Division of Hematology/Oncology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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Maiorano BA, Maiorano MFP, Lorusso D, Di Maio M, Maiello E. Efficacy and safety of PARP inhibitors in elderly patients with advanced ovarian cancer: a systematic review and meta-analysis. Int J Gynecol Cancer 2022; 32:ijgc-2022-003614. [PMID: 36229080 PMCID: PMC9664098 DOI: 10.1136/ijgc-2022-003614] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 09/15/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Poly-(ADP-ribose)-polymerase (PARP) inhibitors have shown to be effective as maintenance treatment in patients with advanced ovarian cancer. Although most ovarian cancers develop after age 65, older patients are often under-represented in clinical trials. OBJECTIVE To assess the efficacy and safety of PARP inhibitors versus placebo as maintenance therapy in older patients with ovarian cancer. METHODS This systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items of Systematic reviews and Meta-Analysis (PRISMA) guidelines. We searched PubMed, Embase, Cochrane databases, and the American Society of Clinical Oncology (ASCO), European Society of Medical Oncology (ESMO), Society of Gynecologic Oncology (SGO) meeting abstracts, for randomized clinical trials using maintenance with PARP inhibitors in patients with advanced ovarian cancer, up to June 30, 2021. The measured outcomes were progression-free survival and safety (number and grade of adverse events), stratified by age (cut-off point: 65 years). RESULTS A total of eight phase III trials were selected. Among the 4364 patients, 1435 (32.9%) were aged ≥65 (919 receiving PARP inhibitors, 516 receiving placebo). Compared with placebo, maintenance with PARP inhibitors improved progression-free survival in older patients (HR=0.54; 95% CI 0.45 to 0.65; p<0.00001). No differences were found in progression-free survival in comparison with a younger population (HR=0.47; p=0.13). Only hematologic adverse events were available for the age subgroups, and no differences emerged for all-grade hematologic adverse events (risk ratio (RR)=1.22, p=0.33 for anemia; RR=0.97, p=0.74 for neutropenia) and severe neutropenia (RR=0.97, p=0.86); old women were at lower risk of severe anemia (RR=0.79, p=0.04) but had a higher risk of severe thrombocytopenia (RR=1.27, p=0.01). CONCLUSIONS Maintenance with PARP inhibitors prolongs progression-free survival compared with placebo, both as monotherapy and combined with chemotherapy or bevacizumab, in older patients with advanced ovarian cancer (high-quality evidence). Hematologic safety is similar to that seen in younger patients. No overall survival data are available at this time. PROSPERO REGISTRATION NUMBER CRD42021261039.
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Affiliation(s)
- Brigida Anna Maiorano
- Oncology Unit, Foundation Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
- Translational Medicine and Surgery Department, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Rome, Italy
| | - Mauro Francesco Pio Maiorano
- Department of Biomedical Sciences and Human Oncology, Obstetrics and Gynecology Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Foundation Policlinic "A. Gemelli" IRCCS, Rome, Italy
- Scientific Directorate, Foundation Policlinic "A. Gemelli" IRCCS, Rome, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - Evaristo Maiello
- Oncology Unit, Foundation Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
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Park SJ, Mun J, Yim GW, Lee M, Chung HH, Kim JW, Park NH, Song YS, Kim HS. Is increased chronological age a contraindication to debulking surgery for elderly patients with advanced ovarian cancer? J OBSTET GYNAECOL 2022; 42:3254-3259. [PMID: 36000804 DOI: 10.1080/01443615.2022.2112021] [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: 01/06/2023]
Abstract
We collected data of elderly patients aged 65 years and older who underwent debulking surgery for advanced ovarian cancer in order to explore the impact of old age on surgical outcomes and complications. A total of 120 patients were classified as follows: group 1, 65-69 years (n = 58); group 2, 70-74 years (n = 38); group 3, 75-79 years (n = 17); group 4, ≥80 years (n = 7). There were no differences in most of the characteristics, surgical extent and outcomes, and postoperative complications between the four groups, whereas polypharmacy was more common (6 vs. 5-16; p=.02) and operation time was shorter (median, 194 vs. 285-330 min; p=.02) in group 4. Factors related to frailty rather than age, polypharmacy, preoperative albumin level, estimated blood loss and transfusion increased the risk of postoperative complications. Thus, the impact of old age on surgical extent, outcomes and postoperative complications may be minimal in elderly patients with advanced ovarian cancer. Impact StatementWhat is already known on this subject? Optimal debulking surgery is a significant factor in improving the prognosis of ovarian cancer but it is not easy to perform such radical surgery on elderly patients in fear of increasing surgical morbidity and mortality. Some studies suggest that underlying comorbidities may be a stronger contributing factor to increasing such risk rather than old age although there is not enough evidence yet.What do the results of this study add? Through this study, we could see that increased age is not the determining cause of increased morbidity and mortality in elderly patients who undergo optimal debulking surgery in ovarian cancer. There are other aspects describing a patient's health status that can predict prognosis better rather than age.What are the implications of these findings for clinical practice and/or further research? Old age need not be a contraindication when performing optimal debulking surgery in elderly patients with advanced ovarian cancer.
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Affiliation(s)
- Soo Jin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaehee Mun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ga Won Yim
- Department of Obstetrics and Gynecology, Dongguk University College of Medicine, Goyang, Republic of Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Noh Hyun Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Yunokawa M, Onda T, Ishikawa M, Yaegashi N, Kanao H. Current treatment status of older patients with gynecological cancers. Jpn J Clin Oncol 2022; 52:825-832. [PMID: 35640242 DOI: 10.1093/jjco/hyac082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/29/2022] [Indexed: 11/14/2022] Open
Abstract
The percentage of older patients with gynecological malignancies has recently been on the rise. Although prospective studies focusing on the treatment of older patients have been conducted for ovarian cancer, mainly in Europe, there have been scarce literature on cervical and endometrial cancers, and information on their treatment is currently lacking. One of the characteristics of older patients is that not only their performance status but also other factors, such as physical, mental and social factors, cause a large variability, and individual differences in their response to treatments. One of the major issues in the treatment of older patients is how to objectively measure these individual differences and link them to the appropriate treatment selection. In this review, clinical evidence for the guided treatment of older patients with gynecological cancer will be reviewed.
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Affiliation(s)
- Mayu Yunokawa
- Department of Gynecology, The Cancer Institute Hospital of JFCR, Tokyo, Japan
- Department of Medical Oncology, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Takashi Onda
- Department of Gynecological Oncology & Gynecology, Sanno Hospital, Tokyo, Japan
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hiroyuki Kanao
- Department of Gynecology, The Cancer Institute Hospital of JFCR, Tokyo, Japan
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Exploring Older Women's Attitudes to and Experience of Treatment for Advanced Ovarian Cancer: A Qualitative Phenomenological Study. Cancers (Basel) 2021; 13:cancers13061207. [PMID: 33801991 PMCID: PMC8001330 DOI: 10.3390/cancers13061207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/28/2022] Open
Abstract
Simple Summary Older women with ovarian cancer often receive less anti-cancer treatment than younger women despite evidence showing they may benefit from similar levels of treatment. Little is known, however, about older women’s preferences toward chemotherapy and treatment experience. We aimed to understand the lived experience of older women with ovarian cancer undergoing chemotherapy though interviews and focus groups. Participants expressed a strong desire to undergo full treatment to improve survival for themselves and for their families. Women did not see their age as a reason to have less intensive treatment. Despite feeling overwhelmed with information and daily tasks due to fatigue, participants did not want cancer to interfere with their daily lives. Women felt distressed by logistical issues with transportation and communication between healthcare providers; however, they still felt positive about their care experience and desire for treatment. Older women may benefit from additional help to support effective communication around treatment preferences. Abstract Older women with ovarian cancer more often receive less intensive treatment and early discontinuation compared to younger women. There is little understanding of older women’s treatment experience and whether this contributes to declining intensive treatment. We aimed to explore the lived experience of older patients with advanced ovarian cancer undergoing chemotherapy, their treatment preferences and treatment burden. We conducted a phenomenological qualitative study with 15 women who had completed at least three cycles of first-line chemotherapy for advanced epithelial ovarian cancer, aged 65 years or older at the first cycle, at one tertiary cancer centre. We conducted interviews and focus groups and analysed the transcripts using inductive thematic analysis. Women reported a strong preference for active treatment despite treatment burden and toxicities. Participants undertook treatment to lengthen their lives for themselves and their families. Participants did not see age as a barrier to treatment. Patients expressed determination not to let cancer interfere with daily life. Women felt overwhelmed with information and struggled with daily tasks due to fatigue. Logistical issues, such as transportation and ineffective communication between healthcare providers, caused substantial distress. Despite these logistical burdens and toxicities, participants were positive about their care experience and desire for anticancer treatment. Older women may benefit from additional support to facilitate effective communication during the early stages of treatment.
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Ge T, Liu T, Guo L, Chen Z, Lou G. MicroRNA-302 represses epithelial-mesenchymal transition and cisplatin resistance by regulating ATAD2 in ovarian carcinoma. Exp Cell Res 2020; 396:112241. [PMID: 32835657 DOI: 10.1016/j.yexcr.2020.112241] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/07/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022]
Abstract
Epithelial-mesenchymal transition (EMT) is an important contributor to drug resistance in ovarian cancer. The aims of this study were to explore the potential role of the miR-302 cluster in modulating EMT and cisplatin resistance in ovarian cancer. We used qRT-PCR and western blotting to show that miR-302 expression was lower in chemoresistant than in chemosensitive cells, and miR-302 was upregulated in chemosensitive, but not chemoresistant ovarian cancer cells in response to cisplatin treatment. We identified ATAD2 as a target of miR-302 and showed that ectopic expression of miR-302 increased cisplatin sensitivity and inhibited EMT and the invasiveness of cisplatin-resistant cells in vitro by targeting ATAD2. Knockdown of ATAD2 restored cisplatin sensitivity and reversed EMT/metastasis in cisplatin-resistant cells, as shown by western blotting and invasion/migration assays. The effect of miR-302 overexpression on EMT and invasiveness was mediated by the modulation of β-catenin nuclear expression. Immunofluorescence analysis showed that ATAD2 overexpression reversed the miR-302-induced downregulation of nuclear β-catenin in cisplatin resistant cells. A xenograft tumor model was used to show that miR-302 increases the antitumor effect of cisplatin in vivo. Taken together, these results identify a potential regulatory axis involving miR-302 and ATAD2 with a role in chemoresistance, indicating that activation of miR-302 or inactivation of ATAD2 could serve as a novel approach to reverse cisplatin resistance in ovarian cancer.
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Affiliation(s)
- Tingting Ge
- Department of Gynecology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Tianbo Liu
- Department of Gynecology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Liyuan Guo
- Department of Gynecology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Zhuo Chen
- Department of Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Ge Lou
- Department of Gynecology, Harbin Medical University Cancer Hospital, Harbin, China.
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Michaan N, Park SY, Lim MC. Comprehensive geriatric assessment is correlated to overall survival among gynaecologic oncology patients. Jpn J Clin Oncol 2020; 50:276-281. [PMID: 31822898 DOI: 10.1093/jjco/hyz178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/16/2019] [Accepted: 10/25/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To investigate the correlation of comprehensive geriatric assessment to overall survival among older gynaecologic oncology patients. METHODS Between 2011 and 2017, patients >70 years had geriatric assessment before treatment. Geriatric assessment included the following tests: Old American resource and services, instrumental activities of daily living, modified Barthels index, mini-mental state examination, geriatric depression scale, mini-nutritional assessment, risk of falling and medication use. Overall survival was calculated for patients' groups below and above median tests scores. Univariate as well as multivariate analysis was done to evaluate the association between each variable and survival. RESULTS About 120 patients had geriatric assessment. Mean patients' age was 76.4 ± 5. A total of 78 Patients had ovarian cancer, 16 uterine cancer, 17 cervical cancer and 9 had other gynaecologic malignancies. No correlation was found between age, BMI (body mass index) and cancer type to overall survival. Patients with scores below cut-off values of modified Barthels index, instrumental activities of daily living, mini-nutritional assessment and mini-nutritional assessment had significantly shorter overall survival (P = 0.004, 0.031, 0.046 and 0.004, respectively). This remained significant in both univariate and multivariate analysis. CONCLUSIONS Gynaecologic oncology patients with lower geriatric assessment scores have significantly lower overall survival, irrespective of cancer type. Geriatric assessment tests allow objective assessment of older patients with worst prognosis before treatment planning.
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Affiliation(s)
- Nadav Michaan
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Center for Uterine Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Sang Yoon Park
- Center for Uterine Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea.,Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea.,Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
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10
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Salyer C, Kobelka C, Barrie A, Weintraub MR, Powell CB. Clinical characteristics and outcomes in elderly women with BRCA1 and BRCA2 mutations. Gynecol Oncol 2019; 154:374-378. [PMID: 31160070 DOI: 10.1016/j.ygyno.2019.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Describe clinical characteristics and risk reducing strategies utilized among women with a BRCA mutation who lived to age 75 and above. METHODS A retrospective study of women with BRCA mutations identified from 1995 to 2015 in a California health care system. From a database of 1189 women, 69 participants were identified who lived to age 75 or older. Demographic and clinical characteristics were recorded, as well as cancer history and risk-reducing strategies utilized. Descriptive and bivariate analyses were used to analyze the cohort. RESULTS The median age of the cohort at study entry was 78 (IQR: 76-84) and the median age at time of genetic testing was 73 (IQR 68-79). Fifty (72%) women had a prior history of breast cancer and 27 (39%) had a history of ovarian cancer. Three of 19 (16%) women with no history of breast cancer elected to undergo a risk-reducing mastectomy (RRM) after their positive genetic test. Among 30 women with ovaries still in place, 14 (47%) underwent a risk-reducing salpingo-oophorectomy (RRSO); six were age 70 or older at the time of surgery. Four (6%) women in the cohort developed BRCA-related cancer after testing, one developed breast cancer and three developed pancreatic cancer. CONCLUSIONS Most women with BRCA mutations surviving beyond age 75 received their genetic test result at an older age and had a history of BRCA-related cancer. Women continued surveillance and risk reducing surgeries at an older age. Pancreatic cancer was the most common new cancer diagnosed in older BRCA mutation carriers.
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Affiliation(s)
- Chelsea Salyer
- Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America; Kaiser Permanente Genetics Department, San Francisco, CA, United States of America; Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America; Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America; Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America
| | - Christine Kobelka
- Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America; Kaiser Permanente Genetics Department, San Francisco, CA, United States of America; Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America; Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America; Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America
| | - Allison Barrie
- Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America; Kaiser Permanente Genetics Department, San Francisco, CA, United States of America; Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America; Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America; Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America
| | - Miranda Ritterman Weintraub
- Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America; Kaiser Permanente Genetics Department, San Francisco, CA, United States of America; Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America; Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America; Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America
| | - C Bethan Powell
- Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America; Kaiser Permanente Genetics Department, San Francisco, CA, United States of America; Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America; Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America; Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America; Division of Research, Kaiser Permanente Northern California, Oakland CA, United States of America.
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11
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Yoshida Y. Current treatment of older patients with recurrent gynecologic cancer. Curr Opin Obstet Gynecol 2019; 31:340-344. [PMID: 30946034 DOI: 10.1097/gco.0000000000000543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Gynecologic cancer patients of elderly has been increasing rapidly. Useful information on older patients, especially, with recurrent gynecological cancer is extremely limited. RECENT FINDINGS A unified concept for assessing treatment risk was proposed when providing cancer treatment to older patients. Fit: patients capable of withstanding the same standard treatment as healthy younger patients; Vulnerable: patients incapable of withstanding the same standard treatment as healthy younger patients, but capable of undergoing some sort of treatment; and Frail: patients incapable of withstanding the same standard treatment as healthy younger patients, and also unsuitable to undergo any kind of active treatment.It is important to identify vulnerability by using geriatric assessment as a patient background factor, to intervene if treatment is required, and to modify the intensity of treatment in an attempt to extend overall survival, decrease adverse events, improve health-related quality of life, and reduce medical costs. SUMMARY It is important to carry out a pretreatment functional assessment of older cancer patients using the geriatric assessment, and to choose the method of treatment for older patients in light of its results with recurrent gynecological cancer in addition to chronological age.
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Affiliation(s)
- Yoshio Yoshida
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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12
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[Epithelial ovarian cancer and elderly patients. Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. ACTA ACUST UNITED AC 2019; 47:238-249. [PMID: 30712964 DOI: 10.1016/j.gofs.2018.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Indexed: 11/24/2022]
Abstract
In ovarian, tubal and primary peritoneal cancers, older adults have an over-mortality due to more aggressive disease (NP4), surgical and chemotherapy under treatment (NP4) and co-morbidities (NP4). Older age is at higher risk for postoperative morbidity and mortality (NP4). Surgery is more often incomplete in this elderly population (NP4). Older age is a risk factor for lower dose intensity in adjuvant chemotherapy (NP4) and incomplete chemotherapy (NP4). Nevertheless, the benefit of a complete surgery remains identical to that of the younger population (NP2). Preoperative functional assessment identifies patients at risk for postoperative complications (NP4). The perioperative risk depends on three variables, the ASA score, the age and the complexity score of the surgery (NP4). It is recommended to perform cytoreduction surgery in an expert centre (grade C) and on the basis of geriatric expertise analysing functional and physical performance (grade C). The benefit/risk balance of surgery should be assessed on a case-by-case basis for the most at-risk (NP4) populations defined by: (i) age≥80 years, especially if albuminemia≤37g/L; (ii) age≥75 years and FIGO stage IV; (iii) age≥75 years, stage FIGO III and≥1 comorbidity. A comprehensive geriatric assessment is recommended prior to the management of an elderly person with primary ovarian, tubal or peritoneal cancer (grade C). The GVS (Geriatric Vulnerability Score) is used to identify vulnerable elderly patients (NP2). In fit elderly patients, it is recommended to perform intravenous chemotherapy identical to that of younger patients (ie platinum-based dual therapy) (grade B). In vulnerable elderly patients, various adapted chemotherapy regimens have been prospectively evaluated in non-comparative trials, and seem feasible considering specific and nonspecific toxicities: carboplatin monotherapy (NP2), carboplatin AUC2+paclitaxel 60mg/m2 3 weeks/4 (NP2), carboplatin AUC 4-5+paclitaxel 135mg/m2/3 weeks (NP2), carboplatin AUC5/3 weeks+paclitaxel 60mg/m2/week (NP3). In the absence of comparative data, no recommendation can be made in this population. Primary chemotherapy decreases the complexity of the surgical procedure and perioperative morbidity and mortality during interval surgery (NP1). It should be considered after 70 years in cases of comorbidities and/or peritoneal carcinomatosis sufficient for complex initial surgery (NP4).
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13
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Kim J, Chang Y, Kim TJ, Lee JW, Kim BG, Bae DS, Choi CH. Optimal cutoff age for predicting prognosis associated with serous epithelial ovarian cancer: what is the best age cutoff? J Gynecol Oncol 2018; 30:e11. [PMID: 30479095 PMCID: PMC6304408 DOI: 10.3802/jgo.2019.30.e11] [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: 06/18/2018] [Revised: 09/19/2018] [Accepted: 09/27/2018] [Indexed: 01/14/2023] Open
Abstract
Objective Elderly age is one of the poor prognostic factors in epithelial ovarian cancer (EOC), but the optimal age cut-off is not known. The present study sought to identify the ideal age cutoff that represents a negative prognostic factor in EOC, considering the geriatric assessment. Methods Hazard ratios (HRs) with p-values were calculated using all possible age cutoffs with stage, histology, grade, optimality and comorbidities as covariates in multivariate Cox regression model. The trends of p-value and HR by age cutoff were further evaluated in a subgroup of histology and in The Cancer Genome Atlas (TCGA) dataset. In addition, propensity score-matching analysis using the identified age cutoff was performed. Results An age of 66 years was shown to be the most significant cutoff for defining old age with independent prognostic power (HR=1.45; 95% confidence interval=1.04–2.03; p=0.027). This result was also observed with the analyses of serous histology subgroup and with the analysis of a TCGA dataset with serous EOC. In survival analysis, patients aged ≥66 years had significantly worse overall survival compared with younger individuals (56 months vs. 87 months; p=0.006), even following propensity score matching (57 vs. 78 months; p=0.038). Conclusion An age of 66 years is the best cutoff to define elderly age in serous EOC patients considering the geriatric assessment, and this information can be used in the administration of individualized therapies in elderly EOC patients.
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Affiliation(s)
- Jihye Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Youjean Chang
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Tae Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Jeong Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Byoung Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Duk Soo Bae
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
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14
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Korc-Grodzicki B, Tew W, Hurria A, Yulico H, Lichtman S, Hamlin P, Bosl G. Development of a Geriatric Service in a Cancer Center: Lessons Learned. J Oncol Pract 2018; 13:107-112. [PMID: 28972835 DOI: 10.1200/jop.2016.017590] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Beatriz Korc-Grodzicki
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - William Tew
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Arti Hurria
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Heidi Yulico
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Stuart Lichtman
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Paul Hamlin
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - George Bosl
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
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15
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Cioffi R, Bergamini A, Rabaiotti E, Petrone M, Pella F, Ferrari D, Mangili G, Candiani M. Neoadjuvant chemotherapy in high-risk ovarian cancer patients: Role of age. TUMORI JOURNAL 2018; 105:168-173. [PMID: 30157707 DOI: 10.1177/0300891618792468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review a single-center clinical experience with neoadjuvant chemotherapy (NACT) in a population of frail epithelial ovarian cancer (EOC) patients and investigate the prognostic role of advanced age. METHODS We retrospectively reviewed clinical data from 102 advanced EOC patients treated with NACT and presenting high perioperative risk. Patients were divided into 2 groups: group A, including patients aged 70 years or older; and group B, including patients below 70 years old. Univariate and multivariate analyses were performed to compare survival and prognostic factors for survival between the two groups. RESULTS Forty-two patients (41.2%) were older than 70 years. Elderly patients were more likely to present comorbidities ( p = 0.0001), poor performance status ( p = 0.04), and multiple indications for NACT ( p = 0.03). They showed a reduced response to NACT, since only 64% of elderly patients underwent surgical debulking (98.3% vs 64.3%, p = 0.001) and, among these, half of them were optimally debulked (79.3% vs 50%, p = 0.01). Median progression-free survival (PFS) and overall survival (OS) were significantly lower in group A (respectively, 9 vs 13 months, p = 0.005, and 21 vs 29 months, p = 0.01). Advanced age, IV stage, presence of ascites, and residual disease >1 cm were significantly associated with a lower PFS. However, when analyzing factors associated with OS, the only significant ones were higher American Society of Anesthesiologists score and residual disease >1 cm. CONCLUSIONS Age was not found to be a prognostic factor for survival. This highlights the necessity of validated geriatric assessment tools predicting functional age and treatment tolerability to avoid undertreatment of elderly patients.
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Affiliation(s)
- Raffaella Cioffi
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuela Rabaiotti
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Micaela Petrone
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Pella
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Ferrari
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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16
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Xu Y, Gao W, Zhang Y, Wu S, Liu Y, Deng X, Xie L, Yang J, Yu H, Su J, Sun L. ABT737 reverses cisplatin resistance by targeting glucose metabolism of human ovarian cancer cells. Int J Oncol 2018; 53:1055-1068. [PMID: 30015875 PMCID: PMC6065457 DOI: 10.3892/ijo.2018.4476] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/20/2018] [Indexed: 12/12/2022] Open
Abstract
The poor prognosis and high mortality of patients with ovarian cancer result in part from their poor response to platinum-based chemotherapy. However, the precise mechanism behind cisplatin resistance is still not fully understood. In the present study, the authors explored the mechanism of resistance to cisplatin from the perspective of glucose metabolism in human ovarian cancer. The experiments using genetically matched ovarian cancer cell lines SKOV3 (cisplatin-sensitive) and SKOV3/DDP (cisplatin-resistant) in the present study provided some important findings. First, in comparison to SKOV3 cells, SKOV3/DDP cells exhibited decreased dependence on aerobic glycolysis and an increased demand for glucose. Secondly, the stable overexpression of Bcl-2 and ability to shift metabolism towards oxidative phosphorylation (OXPHOS) in SKOV3/DDP cells were associated with increased oxygen consumption. Furthermore, the metabolic characteristic of elevated OXPHOS primarily comprised most mitochondrial-derived reactive oxygen species (ROS) and, at least in part, contributed to the slight pro-oxidant state of SKOV3/DDP cells in turn. Thirdly, SKOV3/DDP cells reset the redox balance by overexpressing the key enzyme glucose 6-phosphate dehydrogenase (G6PD) of the pentose phosphate pathway to eliminate the cytotoxicity of highly elevated ROS. Furthermore, the inhibition of Bcl-2 reduced the OXPHOS and sensitivity of SKOV3/DDP cells to cisplatin in a selective manner. Furthermore, when combined with 2-deoxyglucose (2-DG), the anticancer effect of the Bcl-2 inhibitor ABT737 was greatly potentiated and hypoxia-inducible factor 1α (HIF-1α) appeared to be closely associated with Bcl-2 family members in the regulation of glucose metabolism. These results suggested that the special glucose metabolism in SKOV3/DDP cells might be selectively targeted by disrupting Bcl-2-dependent OXPHOS.
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Affiliation(s)
- Yunjie Xu
- Department of Pathophysiology, Basic College of Medicine, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Weinan Gao
- School of Clinical Medicine, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yong Zhang
- Department of Pathophysiology, Basic College of Medicine, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Shanshan Wu
- Department of Pathophysiology, Basic College of Medicine, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yanan Liu
- Department of Pathophysiology, Basic College of Medicine, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xinyue Deng
- Department of Pathophysiology, Basic College of Medicine, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Lili Xie
- Department of Oral Geriatrics, School and Hospital of Stomatology, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jiayan Yang
- Department of Pathophysiology, Basic College of Medicine, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Huimei Yu
- Department of Pathophysiology, Basic College of Medicine, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jing Su
- Department of Pathophysiology, Basic College of Medicine, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Liankun Sun
- Department of Pathophysiology, Basic College of Medicine, Jilin University, Changchun, Jilin 130021, P.R. China
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Abstract
Age is the most important risk factor for the occurrence of cancer, and a declining mortality from heart disease and other non-cancer causes leaves an older population that is at high risk of developing cancer. Choosing the optimal treatment for older cancer patients may be a challenge. Firstly, older age and associated factors such as comorbidities, functional limitations, and cognitive impairment are risk factors for adverse effects of cancer treatment. Secondly, older patients are often excluded from clinical trials, and current clinical guidelines rarely address how to manage cancer in patients who have comorbidities or functional limitations. The importance of incorporating frailty assessment into the preoperative evaluation of older surgical patients has received increasing attention over the last 10 years. Furthermore, studies that include endpoints such as functional status, cognitive status, and quality of life beyond the standard endpoints, i.e. postoperative morbidity and mortality, are starting to emerge. This review looks at recent evidence regarding geriatric assessment and frailty in older surgical cancer patients and provides a summary of newer studies in colorectal, liver, pancreatic, and gynecological cancer and renal and central nervous system tumors.
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Affiliation(s)
- Siri Rostoft
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Riccardo A Audisio
- St Helens Teaching Hospital Trust, University of Liverpool, Liverpool, UK
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18
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Phillips A, Singh K, Pounds R, Sundar S, Kehoe S, Nevin J, Elattar A, Balega J. Predictive value of the age-adjusted Charlston co-morbidity index on peri-operative complications, adjuvant chemotherapy usage and survival in patients undergoing debulking surgery after neo-adjuvant chemotherapy for advanced epithelial ovarian cancer. J OBSTET GYNAECOL 2017; 37:1070-1075. [PMID: 28741395 DOI: 10.1080/01443615.2017.1324413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to determine whether the age-adjusted Charlston co-morbidity index (ACCI) can predict post-operative complications, adjuvant chemotherapy usage and overall survival (OS) in patients with advanced epithelial ovarian cancer (AOC) treated with neoadjuvant chemotherapy (NACT). A review was performed of all cytoreductive surgeries performed between 16/8/07-3/2/14 for AOC at a UK Cancer Centre. All surgeries were stratified by ACCI into three groups: Low (0-1), Intermediate (2-3) and High (≥4). Of the 293 cases the ACCI distribution was: 74 (25.26%) low, 164 (55.97%) intermediate and 55 (18.77%) high. Patients with a high ACCI were less likely to receive adjuvant chemotherapy (p = .023), more likely to receive fewer adjuvant cycles (p = .0057) but no more likely to experience complications. Median OS for patients with a low, intermediate and high ACCI was 44.58 (95%CI 36.98-52.19), 34.65 (95%CI 29.48-39.82) and 33.37 (95%CI 17.47-49.27) months. ACCI was associated with OS (p < .01) confirmed on multivariate analysis (p = .03). The ACCI is, therefore, a marker of survival in these patients and predicts adjuvant chemotherapy usage. Impact statement The Age-Adjusted Charlston Co-morbidity Index has previously been identified as a predictor of survival in both medical and surgical conditions. Recently it has also been validated in patients undergoing primary cytoreductive surgery for advanced ovarian cancer. This study is the first to validate the Age-Adjusted Charlston Co-morbidity Index in patients undergoing cytoreductive surgery following neoadjuvant chemotherapy. Our findings demonstrate that it can be used to not only predict overall survival in women undergoing debulking surgery after neo-adjuvant chemotherapy but also predicts the uptake and commencement of adjuvant chemotherapy. Such findings are important considerations to enable an informed patient choice regarding interval surgery in the more co-morbid patients. More importantly, although the ACCI can be used as a marker of overall survival, even in the most co-morbid of patients there remains a significant survival advantage following surgery to the extent that it should not be contraindicated in this cohort. The ACCI is being increasingly incorporated into various clinical trials as a standard demographic measure and this study validates its inclusion in patients undergoing interval debulking surgery.
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Affiliation(s)
- Andrew Phillips
- a Pan-Birmingham Gynaecological Cancer Centre , City Hospital , Birmingham , UK
| | - Kavita Singh
- a Pan-Birmingham Gynaecological Cancer Centre , City Hospital , Birmingham , UK
| | - Rachel Pounds
- a Pan-Birmingham Gynaecological Cancer Centre , City Hospital , Birmingham , UK
| | - Sudha Sundar
- a Pan-Birmingham Gynaecological Cancer Centre , City Hospital , Birmingham , UK
| | - Sean Kehoe
- a Pan-Birmingham Gynaecological Cancer Centre , City Hospital , Birmingham , UK
| | - James Nevin
- a Pan-Birmingham Gynaecological Cancer Centre , City Hospital , Birmingham , UK
| | - Ahmed Elattar
- a Pan-Birmingham Gynaecological Cancer Centre , City Hospital , Birmingham , UK
| | - Janos Balega
- a Pan-Birmingham Gynaecological Cancer Centre , City Hospital , Birmingham , UK
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Preference of elderly patients' to oral or intravenous chemotherapy in heavily pre-treated recurrent ovarian cancer: final results of a prospective multicenter trial. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2017; 4:6. [PMID: 28286660 PMCID: PMC5341434 DOI: 10.1186/s40661-017-0040-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/16/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Palliative systemic treatment in elderly gynaecological cancer patients remains a major challenge. In recurrent ovarian cancer (ROC), treosulfan an active alkylating drug showed similar cytotoxicity whether as oral (p.o.) or intravenous (i.v.) application. The aim of this innovative trial was to evaluate the preference of elderly patients (≥65 years) for p.o. or i.v. chemotherapy focusing compliance, outcome, toxicities, and geriatric aspects as secondary endpoints. METHODS Patients with ROC had the free choice between treosulfan i.v. (7000 mg/m2 d1, q29d) or p.o. (600 mg/m2 daily d1-28, q57d). Only indecisive participants were randomized. RESULTS Overall 123 patients with 2nd to 5th recurrence were registered and 119 received at least one cycle of chemotherapy. 85.7% preferred treosulfan i.v. and 14.3% oral, where only three patients were randomized. Main reasons for i.v. preference associated with individual expectations of lower rate of gastrointestinal disorders, higher activity and tolerability of treatment. Median of applied chemotherapies was three (range 1-12 cycles), with most common grade 3/4 toxicities thrombopenia (18.7%), leukopenia (15.7%), ascites (7.6%), bowel obstruction (6.7%), and abdominal pain (4.2%). Median time until progression/overall survival was 5.2/7.8 months (i.v.), and 5.6/10.4 months (p.o.), respectively, without significant differences in efficacy. CONCLUSIONS Elderly patients with recurrent ovarian cancer asked and demonstrated active participation in the decision-making process of their oncological treatment and favoured predominantly the i.v. application. Treosulfan was generally well-tolerated despite comorbidities and heavy pre-treatment. Our study demonstrates that patients' preference did not influence prognosis negatively and remains important in gynaecologic oncology decision practice. EUDRACT NR 2004-000719-25; NCT 00170690.
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20
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Sorio R, Roemer-Becuwe C, Hilpert F, Gibbs E, García Y, Kaern J, Huizing M, Witteveen P, Zagouri F, Coeffic D, Lück HJ, González-Martín A, Kristensen G, Levaché CB, Lee CK, Gebski V, Pujade-Lauraine E. Safety and efficacy of single-agent bevacizumab-containing therapy in elderly patients with platinum-resistant recurrent ovarian cancer: Subgroup analysis of the randomised phase III AURELIA trial. Gynecol Oncol 2017; 144:65-71. [DOI: 10.1016/j.ygyno.2016.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/02/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
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21
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Wright AA, Bohlke K, Armstrong DK, Bookman MA, Cliby WA, Coleman RL, Dizon DS, Kash JJ, Meyer LA, Moore KN, Olawaiye AB, Oldham J, Salani R, Sparacio D, Tew WP, Vergote I, Edelson MI. Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline. Gynecol Oncol 2016; 143:3-15. [PMID: 27650684 PMCID: PMC5413203 DOI: 10.1016/j.ygyno.2016.05.022] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer. METHODS The Society of Gynecologic Oncology and the American Society of Clinical Oncology convened an Expert Panel and conducted a systematic review of the literature. RESULTS Four phase III clinical trials form the primary evidence base for the recommendations. The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer, neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality. RECOMMENDATIONS All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be evaluated by a gynecologic oncologist prior to initiation of therapy. The primary clinical evaluation should include a CT of the abdomen and pelvis, and chest imaging (CT preferred). Women with a high perioperative risk profile or a low likelihood of achieving cytoreduction to <1cm of residual disease (ideally to no visible disease) should receive neoadjuvant chemotherapy. Women who are fit for primary cytoreductive surgery, and with potentially resectable disease, may receive either neoadjuvant chemotherapy or primary cytoreductive surgery. However, primary cytoreductive surgery is preferred if there is a high likelihood of achieving cytoreduction to <1cm (ideally to no visible disease) with acceptable morbidity. Before neoadjuvant chemotherapy is delivered, all patients should have confirmation of an invasive ovarian, fallopian tube, or peritoneal cancer. Additional information is available at www.asco.org/NACT-ovarian-guideline and www.asco.org/guidelineswiki.
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Affiliation(s)
- Alexi A Wright
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA, United States
| | - Deborah K Armstrong
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Michael A Bookman
- US Oncology Research and Arizona Oncology, Tucson, AZ, United States
| | | | - Robert L Coleman
- University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Don S Dizon
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, United States
| | | | - Larissa A Meyer
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kathleen N Moore
- Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK, United States
| | | | - Jessica Oldham
- Society of Gynecologic Oncology, Chicago, IL, United States
| | - Ritu Salani
- The Ohio State University, Columbus, OH, United States
| | | | - William P Tew
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ignace Vergote
- Leuven Cancer Institute, Leuven, European Union, Belgium
| | - Mitchell I Edelson
- Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA, United States.
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Wright AA, Bohlke K, Armstrong DK, Bookman MA, Cliby WA, Coleman RL, Dizon DS, Kash JJ, Meyer LA, Moore KN, Olawaiye AB, Oldham J, Salani R, Sparacio D, Tew WP, Vergote I, Edelson MI. Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2016; 34:3460-73. [PMID: 27502591 PMCID: PMC5512594 DOI: 10.1200/jco.2016.68.6907] [Citation(s) in RCA: 267] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer. METHODS The Society of Gynecologic Oncology and the American Society of Clinical Oncology convened an Expert Panel and conducted a systematic review of the literature. RESULTS Four phase III clinical trials form the primary evidence base for the recommendations. The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer, neoadjuvant chemotherapy and interval cytoreduction are noninferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality. RECOMMENDATIONS All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be evaluated by a gynecologic oncologist prior to initiation of therapy. The primary clinical evaluation should include a CT of the abdomen and pelvis, and chest imaging (CT preferred). Women with a high perioperative risk profile or a low likelihood of achieving cytoreduction to < 1 cm of residual disease (ideally to no visible disease) should receive neoadjuvant chemotherapy. Women who are fit for primary cytoreductive surgery, and with potentially resectable disease, may receive either neoadjuvant chemotherapy or primary cytoreductive surgery. However, primary cytoreductive surgery is preferred if there is a high likelihood of achieving cytoreduction to < 1 cm (ideally to no visible disease) with acceptable morbidity. Before neoadjuvant chemotherapy is delivered, all patients should have confirmation of an invasive ovarian, fallopian tube, or peritoneal cancer. Additional information is available at www.asco.org/NACT-ovarian-guideline and www.asco.org/guidelineswiki.
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Affiliation(s)
- Alexi A Wright
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Kari Bohlke
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Deborah K Armstrong
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Michael A Bookman
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - William A Cliby
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Robert L Coleman
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Don S Dizon
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Joseph J Kash
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Larissa A Meyer
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Kathleen N Moore
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Alexander B Olawaiye
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Jessica Oldham
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Ritu Salani
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Dee Sparacio
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - William P Tew
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Ignace Vergote
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium
| | - Mitchell I Edelson
- Alexi A. Wright, Dana-Farber Cancer Institute, Harvard Medical School; Don S. Dizon, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Deborah K. Armstrong, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; William A. Cliby, Mayo Clinic, Rochester, MN; Robert L. Coleman and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX; Joseph J. Kash, Edward Cancer Center, Naperville; Jessica Oldham, Society of Gynecologic Oncology, Chicago, IL; Kathleen N. Moore, Stephenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK; Alexander B. Olawaiye, University of Pittsburgh Medical Center, Pittsburgh; Mitchell I. Edelson, Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA; Ritu Salani, The Ohio State University, Columbus, OH; Dee Sparacio, Hightstown, New Jersey; William P. Tew, Memorial Sloan-Kettering Cancer Center, New York, NY; and Ignace Vergote, Leuven Cancer Institute, Leuven, Belgium.
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Meng Y, Hu J, Chen Y, Yu T, Hu L. Silencing MARCH1 suppresses proliferation, migration and invasion of ovarian cancer SKOV3 cells via downregulation of NF-κB and Wnt/β-catenin pathways. Oncol Rep 2016; 36:2463-2470. [PMID: 27633480 PMCID: PMC5055210 DOI: 10.3892/or.2016.5076] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/27/2016] [Indexed: 11/25/2022] Open
Abstract
Membrane-associated RING-CH (MARCH) belongs to the family of RING-CH type E3 ubiquitin ligases. MARCH1 ubiquitinates and downregulates MHC class II expression in APCs and targets major players of the immune system. However, the role of MARCH1 in ovarian cancer has not been elucidated. The present study investigated the function of MARCH1 in ovarian cancer and the potential mechanisms involved. MARCH1 expression was examined in human ovarian cancer tissue specimens by immunohistochemistry. The role of MARCH1 in ovarian cancer cells was assessed by cell proliferation, migration and invasion assays with MARCH1 gene silencing. To investigate the mechanism by which MARCH1 functions, correlation between MARCH1 and the cell signaling pathways were analyzed using a luciferase reporter assay, real-time RT-PCR, western blot assay and immunofluorescence. MARCH1 was found to be overexpressed in ovarian cancer tissues when compared to adjacent non-tumor and normal ovarian tissues. Silencing MARCH1 inhibited SKOV3 cell proliferation, invasion and migration, as well as inhibiting the NF-κB and the Wnt/β-catenin pathways. MARCH1 functions as a tumor promoter by upregulating the NF-κB and the Wnt/β-catenin pathways, indicating that MARCH1 may be a therapeutic target for patients with ovarian cancer.
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Affiliation(s)
- Ying Meng
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, P.R. China
| | - Jianguo Hu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, P.R. China
| | - Yuhong Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, P.R. China
| | - Tinghe Yu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, P.R. China
| | - Lina Hu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, P.R. China
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Feasibility of dose-dense paclitaxel/carboplatin therapy in elderly patients with ovarian, fallopian tube, or peritoneal cancer. Cancer Chemother Pharmacol 2016; 78:745-52. [PMID: 27522647 DOI: 10.1007/s00280-016-3100-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 07/06/2016] [Indexed: 01/21/2023]
Abstract
PURPOSE Weekly dose-dense paclitaxel (PTX) in combination with carboplatin (CBDCA) every 3 weeks (ddTC therapy) is a standard treatment for patients with advanced ovarian cancer. However, there is no detailed analysis of the feasibility of ddTC therapy in elderly patients with ovarian cancer. METHODS We identified patients diagnosed with ovarian, fallopian tube, or peritoneal cancer who received ddTC therapy at the National Cancer Center Hospital from April 2003 to April 2013. We assessed the feasibility of ddTC therapy in elderly patients aged 70 years or older (elderly group), comparing relative dose intensity (RDI) for PTX, CBDCA, and ddTC; adverse events; and rate of chemotherapy discontinuation to those in patients below 70 years of age (younger group). RESULTS A total of 143 patients (elderly group, 22; younger group, 121) was analyzed. A comparison of RDI between these two groups showed no significant differences for PTX, CBDCA, and ddTC. Nonhematological and hematological toxicity profiles of the elderly and younger groups were similar, except that severe peripheral neuropathy (Grade 2 or higher) was more common in the elderly group. There was no significant difference in the rate of chemotherapy discontinuation (elderly group, 13.6 % vs. younger group, 7.4 %, p = 0.397). CONCLUSIONS Our study showed that ddTC therapy was feasible for elderly patients. However, to prevent severe neuropathy, PTX dose reduction deserves consideration.
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Bluhm M, Connell CM, Janz N, Bickel K, DeVries R, Silveira M. Oncologists’ End of Life Treatment Decisions. J Appl Gerontol 2016. [DOI: 10.1177/0733464815595510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Optimal treatment decisions for older end-stage cancer patients are complicated, and are influenced by oncologists’ attitudes and beliefs about older patients. Nevertheless, few studies have explored oncologists’ perspectives on how patient age affects their treatment decisions. Methods: In-depth interviews were conducted with 17 oncologists to examine factors that influence their chemotherapy decisions for adults with incurable cancer near death. Transcripts of recorded interviews were coded and content analyzed. Results: Oncologists identified patient age as a key factor in their chemotherapy decisions. They believed older adults were less likely to want or tolerate treatment, and felt highly motivated to treat younger patients. Discussion: Qualitative analysis of in-depth interviews resulted in a nuanced understanding of how patient age influences oncologists’ chemotherapy decisions. Such understanding may inform practice efforts aimed at enhancing cancer care at the end of life for older patients.
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Affiliation(s)
| | | | | | - Kathleen Bickel
- Veterans Affairs White River Junction Medical Center, Geisel School of Medicine at Dartmouth, USA
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Gibson SJ, Fleming GF, Temkin SM, Chase DM. The Application and Outcome of Standard of Care Treatment in Elderly Women with Ovarian Cancer: A Literature Review over the Last 10 Years. Front Oncol 2016; 6:63. [PMID: 27047797 PMCID: PMC4805611 DOI: 10.3389/fonc.2016.00063] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/04/2016] [Indexed: 12/29/2022] Open
Abstract
The rising number and increasing longevity of the elderly population calls for improvements and potentially a more personalized approach to the treatment of cancer in this group. Elderly patients frequently present with a number of comorbidities, complicating surgery and chemotherapy tolerability. In the case of ovarian cancer, elderly women present with more advanced disease, making the issue of providing adequate treatment without significant morbidity critical. Most studies support the application of standard of care treatment to elderly women with ovarian cancer, yet it seems to be offered less frequently in the elderly. The objective of this review is to examine the application and outcome of standard of care treatment in elderly women with ovarian cancer. The aim is to ultimately improve the approach to treatment in this group.
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Affiliation(s)
- Steven J Gibson
- The Division of Gynecologic Oncology, University of Arizona Cancer Center, St. Joseph's Hospital and Medical Center, Creighton University School of Medicine , Phoenix, AZ , USA
| | - Gini F Fleming
- Department of Medicine, The Division of Hematology/Oncology, Knapp Center for Biomedical Discovery, The University of Chicago , Chicago, IL , USA
| | - Sarah M Temkin
- The Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Johns Hopkins University , Baltimore, MD , USA
| | - Dana M Chase
- The Division of Gynecologic Oncology, University of Arizona Cancer Center, St. Joseph's Hospital and Medical Center, Creighton University School of Medicine , Phoenix, AZ , USA
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Overcoming cisplatin resistance of ovarian cancer cells by targeting HIF-1-regulated cancer metabolism. Cancer Lett 2016; 373:36-44. [PMID: 26801746 DOI: 10.1016/j.canlet.2016.01.009] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 01/23/2023]
Abstract
Cisplatin is currently one of the most effective chemotherapeutic drugs used for treating ovarian cancer; however, resistance to cisplatin is common. In this study, we explored an experimental strategy for overcoming cisplatin resistance of human ovarian cancer from the new perspective of cancer cell metabolism. By using two pairs of genetically matched cisplatin-sensitive and cisplatin-resistant ovarian cancer cell lines, we tested the hypothesis that downregulating hypoxia-inducible factor-1 (HIF-1), which regulates metabolic enzymes involved in glycolysis, is a promising strategy for overcoming cisplatin resistance of human ovarian cancer cells. We found that cisplatin downregulated the level of the regulatable α subunit of HIF-1, HIF-1α, in cisplatin-sensitive ovarian cancer cells through enhancing HIF-1α degradation but did not downregulate HIF-1α in their cisplatin-resistant counterparts. Overexpression of a degradation-resistant HIF-1α (HIF-1α ΔODD) reduced cisplatin-induced apoptosis in cisplatin-sensitive cells, whereas genetic knockdown of HIF-1α or pharmacological promotion of HIF-1α degradation enhanced response to cisplatin in both cisplatin-sensitive and cisplatin-resistant ovarian cancer cells. We further demonstrated that knockdown of HIF-1α improved the response of cisplatin-resistant ovarian cancer cells to cisplatin by redirecting the aerobic glycolysis in the resistant cancer cells toward mitochondrial oxidative phosphorylation, leading to cell death through overproduction of reactive oxygen species. Our findings suggest that the HIF-1α-regulated cancer metabolism pathway could be a novel target for overcoming cisplatin resistance in ovarian cancer.
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Yao Y, Yu L, Su X, Wang Y, Li W, Wu Y, Cheng X, Zhang H, Wei X, Chen H, Zhang R, Gou L, Chen X, Xie Y, Zhang B, Zhang Y, Yang J, Wei Y. Synthesis, characterization and targeting chemotherapy for ovarian cancer of trastuzumab-SN-38 conjugates. J Control Release 2015; 220:5-17. [PMID: 26439663 DOI: 10.1016/j.jconrel.2015.09.058] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/20/2015] [Accepted: 09/28/2015] [Indexed: 02/05/2023]
Abstract
Antibody-drug conjugates (ADCs), combining monoclonal antibody with high cytotoxicity chemotherapeutic drug (warhead), have been successfully applied for clinical cancer therapy. Linker technology to select and design linker connecting warhead with antibody, is critical to the success of therapeutic ADCs. In this study, three kinds of linkers were designed to connect SN-38, the bioactive metabolite of the anticancer drug irinotecan (CPT-11), which is 100-1000 times more potent than CPT-11, with the anti-HER2 antibody trastuzumab to prepare three different ADC conjugates (T-SN38 A, B and C). Meanwhile, we compared the anti-ovarian cancer effect of these three T-SN38 conjugates with trastuzumab in vitro and in vivo. Our in vitro results showed that T-SN38 A, B and C (drug-to-antibody ratio, DAR=3.7, 3.2, 3.4) were 2 to 3 times as cytotoxic as SN-38, and the IC50 for these three conjugates on SKOV-3 cell line at 72 h were 5.2 ± 0.3, 4.4 ± 0.7, and 5.1 ± 0.4 nM respectively. In our in vivo studies, T-SN38 conjugates had well targeting ability for tumor tissue and all three of them had much higher anti-ovarian cancer potency than trastuzumab. Among of them, T-SN38 B, which coupled SN-38 with trastuzumab by a carbonate bond, has the best anti-ovarian cancer potency. In conclusion, the novel HER2-targeting ADCs T-SN38 have great potential for HER2-positive ovarian cancer. Moreover, the SN-38-Linkers designed in this study can also be used to connect with other antibodies for the therapy of other cancers.
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Key Words
- 10-hydroxycamptothecin (PubChem CID: 97,226)
- 4-dimethylaminopyridine (PubChem CID:14,284)
- 7-ethyl-10-hydroxycamptothecin (PubChem CID:104,842)
- Antibody-drug conjugates (ADCs)
- Bi-function linker
- N-hydroxysuccinimide (PubChem CID:80,170)
- Ovarian cancer
- PEG4 (PubChem CID:21,896,924)
- SN-38
- Targeting chemotherapy
- Trastuzumab
- dicyclohexylcarbodiimide (PubChem CID:10,868)
- dithiothreitol (PubChem CID:19,001)
- ethyldiisopropylamine (PubChem CID:81,531)
- mercaptoacetic acid (PubChem CID:1133)
- triphosgene (PubChem CID:94,429)
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Affiliation(s)
- Yuqin Yao
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China; Research Center for Public Health and Preventive Medicine, West China School of Public Health/No.4 West China Teaching Hospital, Sichuan University, PR China; Guangdong Zhongsheng Pharmaceutical Co., Ltd., PR China
| | - Lin Yu
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Xiaolan Su
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Yuxi Wang
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Wenting Li
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Yangpin Wu
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Xiangzheng Cheng
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Hang Zhang
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Xian Wei
- Guangdong Zhongsheng Pharmaceutical Co., Ltd., PR China
| | - Hao Chen
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Rundong Zhang
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Lantu Gou
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Xiaoxin Chen
- Guangdong Zhongsheng Pharmaceutical Co., Ltd., PR China
| | - Yongmei Xie
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China.
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hostpital, Sichuan University, PR China
| | - Yonghui Zhang
- Pharmacology & Pharmaceutical Sciences School of Medicine/ Collaborative Innovation Center for Biotherapy, Tsinghua University, Beijing, PR China
| | - Jinliang Yang
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China.
| | - Yuquan Wei
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
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Neoadjuvant chemotherapy vs primary debulking surgery for advanced ovarian cancer. What is the debate regarding the ideal treatment: approach? age? or cost? Am J Obstet Gynecol 2015; 212:695-6. [PMID: 26042956 DOI: 10.1016/j.ajog.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 01/30/2015] [Accepted: 02/09/2015] [Indexed: 11/23/2022]
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Duska LR, Tew WP, Moore KN. Epithelial ovarian cancer in older women: defining the best management approach. Am Soc Clin Oncol Educ Book 2015:e311-21. [PMID: 25993191 DOI: 10.14694/edbook_am.2015.35.e311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Epithelial ovarian cancer is a cancer of older women. In fact, almost half of women diagnosed with ovarian cancer will be older than age 64, and 25% will be older than age 74. Therefore, it is crucial to examine the available data in older populations to optimize the therapeutic approach without negatively affecting the quality of life permanently. Unfortunately, little prospective data are available in this under-represented population of women. Although ovarian cancer traditionally has been approached with aggressive cytoreductive surgery, older patients may benefit from a less aggressive surgical approach and, in some cases, may be candidates for neoadjuvant chemotherapy followed by an interval cytoreduction. Modalities do exist for assessing an older woman's ability to tolerate surgery and chemotherapy, and these tools should be familiar to clinicians who are caring for this population of women in making treatment decisions. Ongoing planned trials to evaluate pretreatment assessment for older patients will provide objective, feasible, clinical tools for applying our treatment-based knowledge. Future trials of both surgery and chemotherapy, including a focus on the sequence of these two treatment modalities, are crucial to guide decision making in this vulnerable population and to improve outcomes for all.
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Affiliation(s)
- Linda R Duska
- From the University of Virginia, Charlottesville, VA; Memorial Sloan Kettering Cancer Center, New York NY; University of Oklahoma, Oklahoma City, OK
| | - William P Tew
- From the University of Virginia, Charlottesville, VA; Memorial Sloan Kettering Cancer Center, New York NY; University of Oklahoma, Oklahoma City, OK
| | - Kathleen N Moore
- From the University of Virginia, Charlottesville, VA; Memorial Sloan Kettering Cancer Center, New York NY; University of Oklahoma, Oklahoma City, OK
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