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Wu H, Fan Y, Bao Y, Zhou Q, Xu L, Xu Y. Construction of a ferroptosis and hypoxia-related gene signature in cervical cancer to assess tumour immune microenvironment and predict prognosis. J OBSTET GYNAECOL 2024; 44:2321323. [PMID: 38425023 DOI: 10.1080/01443615.2024.2321323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND This study aimed to investigate the potential role of ferroptosis/hypoxia-related genes in cervical cancer to improve early management and treatment of cervical cancer. METHODS All data were downloaded from public databases. Ferroptosis/hypoxia-related genes associated with cervical cancer prognosis were selected to construct a risk score model. The relationship between risk score and clinical features, immune microenvironment and prognosis were analysed. RESULTS Risk score model was constructed based on eight signature genes. Drug prediction analysis showed that bevacizumab and cisplatin were related to vascular endothelial growth factor A. Risk score, as an independent prognostic factor of cervical cancer, had a good survival prediction effect. The two groups differed significantly in degree of immune cell infiltration, gene expression, tumour mutation burden and somatic variation. CONCLUSIONS We developed a novel prognostic gene signature combining ferroptosis/hypoxia-related genes, which provides new ideas for individual treatment of cervical cancer.
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Affiliation(s)
- Haiyan Wu
- Department of Gynecology, Chengdu Second People's Hospital, Chengdu, China
| | - Yayun Fan
- Department of Gynecology, Chengdu Second People's Hospital, Chengdu, China
| | - Yuanyuan Bao
- Department of Gynecology, Chengdu Second People's Hospital, Chengdu, China
| | - Qing Zhou
- Department of Gynecology, Chengdu Second People's Hospital, Chengdu, China
| | - Lei Xu
- Department of Gynecology, The First Affiliated Hospital of Chengdu Medical College, Chengdu City, PR China
| | - Yao Xu
- Department of Gynecology, The First Affiliated Hospital of Chengdu Medical College, Chengdu City, PR China
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Jiang J, Wu B, Sun Y, Xiang J, Shen C, He X, Ying H, Xia Z. Anlotinib reversed resistance to PD-1 inhibitors in recurrent and metastatic head and neck cancers: a real-world retrospective study. Cancer Immunol Immunother 2024; 73:199. [PMID: 39105897 PMCID: PMC11303650 DOI: 10.1007/s00262-024-03784-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/17/2024] [Indexed: 08/07/2024]
Abstract
Patients with recurrent or metastatic head and neck cancers (R/M HNCs) are prone to developing resistance after immunotherapy. This retrospective real-world study aims to investigate whether the addition of anlotinib can reverse resistance to PD-1 inhibitors (PD-1i) and evaluate the efficacy and safety of this combination in R/M HNCs. Main outcomes included objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), duration of response (DOR), and safety. Potential biomarkers included PD-L1 expression, lipid index, and genomic profiling. Twenty-one patients with R/M HNCs were included, including 11 nasopharyngeal carcinoma (NPC), five head and neck squamous cell carcinoma (HNSCC), three salivary gland cancers (SGC), and two nasal cavity or paranasal sinus cancers (NC/PNC). Among all patients, ORR was 47.6% (95% CI: 28.6-66.7), with 2 (9.5%) complete response; DCR was 100%. At the median follow-up of 17.1 months, the median PFS and OS were 14.3 months (95% CI: 5.9-NR) and 16.7 months (95% CI:8.4-NR), respectively. The median DOR was 11.2 months (95% CI: 10.1-NR). As per different diseases, the ORR was 45.5% for NPC, 60.0% for HNSCC, 66.7% for SGC, and 50.0% for NC/PNC. Most treatment-related adverse events (TRAEs) were grade 1 or 2 (88.9%). The most common grades 3-4 TRAE was hypertension (28.6%), and two treatment-related deaths occurred due to bleeding. Therefore, adding anlotinib to the original PD-1i could reverse PD-1 blockade resistance, with a favorable response rate, prolonged survival, and acceptable toxicity, indicating the potential as a second-line and subsequent therapy choice in R/M HNCs.
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Affiliation(s)
- Jianyun Jiang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Bin Wu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Department of Radiology, Fudan University Shanghai Cancer Centre, Shanghai, 200032, China
| | - Ying Sun
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Jun Xiang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Chunying Shen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Xiayun He
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Hongmei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China.
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China.
| | - Zuguang Xia
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China.
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3
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Salani R, McCormack M, Kim YM, Ghamande S, Hall SL, Lorusso D, Barraclough L, Gilbert L, Guzman Ramirez A, Lu CH, Sabatier R, Colombo N, Hu Y, Krishnan V, Molinero L, Feng Y, Kim N, Castro M, Lin YG, Monk BJ. A non-comparative, randomized, phase II trial of atezolizumab or atezolizumab plus tiragolumab for programmed death-ligand 1-positive recurrent cervical cancer (SKYSCRAPER-04). Int J Gynecol Cancer 2024; 34:1140-1148. [PMID: 38858106 DOI: 10.1136/ijgc-2024-005588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE To evaluate tiragolumab (anti-TIGIT) and atezolizumab (anti-PD-L1) as second- or third-line therapy for PD-L1-positive persistent/recurrent cervical cancer. METHODS In the open-label, non-comparative, randomized phase II SKYSCRAPER-04 trial (NCT04300647), patients with PD-L1-positive (SP263 tumor area positivity ≥5%) recurrent/persistent cervical cancer after 1-2 chemotherapy lines (≥1 platinum-based) were randomized 3:1 to atezolizumab 1200 mg with/without tiragolumab 600 mg every 3 weeks until disease progression or unacceptable toxicity. Stratification factors were performance status, prior (chemo)radiotherapy, and disease status. The primary endpoint was independent review committee-assessed confirmed objective response rate per RECIST v1.1 in patients receiving tiragolumab plus atezolizumab. An objective response rate ≥21% (one-sample z-test p≤0.0245) was required for statistical significance versus a historical reference. RESULTS Protocol-defined independent review committee-assessed objective response rates were 19.0% (95% CI 12.6 to 27.0) in 126 patients receiving tiragolumab plus atezolizumab (p=0.0787 vs historical reference) and 15.6% (95% CI 6.5 to 29.5) in 45 atezolizumab-treated patients. Response rates were higher in PD-L1high (tumor area positivity ≥10%) than PD-L1low (tumor area positivity 5%-9%) subgroups with both regimens. At 8.5 months' median follow-up, independent review committee-assessed progression-free survival was 2.8 months (95% CI 1.7 to 4.1) with tiragolumab plus atezolizumab and 1.9 months (95% CI 1.5 to 3.0) with atezolizumab. In post hoc analyses (10.4 months' median follow-up), median overall survival was 11.1 months (95% CI 9.6 to 14.5) with the combination and 10.6 months (95% CI 6.9 to 13.8) with atezolizumab (crossover permitted). In the combination group, 3% of patients had adverse events requiring treatment discontinuation and 8% had grade ≥3 adverse events of special interest; corresponding values in the single-agent arm were 4% and 11%. There were no treatment-related deaths or new safety findings. CONCLUSION The objective response rate with the tiragolumab-plus-atezolizumab combination was numerically higher than the historical reference but did not reach statistical significance.
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Affiliation(s)
- Ritu Salani
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, California, USA
| | - Mary McCormack
- Department of Oncology, University College London Hospitals, London, UK
| | - Yong-Man Kim
- Gynecologic Cancer Center, Asan Cancer Institute, Asan Medical Center, University of Ulsan, Seoul, Korea (the Republic of)
| | - Sharad Ghamande
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
| | - Shaundra L Hall
- National Cervical Cancer Coalition, Research Triangle Park, North Carolina, USA
| | - Domenica Lorusso
- Gynecologic Oncology Unit, Fondazione Policlinico Gemelli IRCCS and Catholic University of the Sacred Heart, Rome, Italy
| | - Lisa Barraclough
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Lucy Gilbert
- The Gerald Bronfman Department of Oncology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | | | - Chien-Hsing Lu
- Department of OB/GYN, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Renaud Sabatier
- Department of Medical Oncology, Aix-Marseille University, CRCM, Inserm, CNRS, Institut Paoli-Calmettes, Marseille, France
| | - Nicoletta Colombo
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Gynecologic Oncology Program, European Institute of Oncology IRCCS, Milan, Italy
| | - Youyou Hu
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | | | - Yuning Feng
- Genentech, Inc, South San Francisco, California, USA
| | - Nicole Kim
- Genentech, Inc, South San Francisco, California, USA
| | | | - Yvonne G Lin
- Genentech, Inc, South San Francisco, California, USA
| | - Bradley J Monk
- Department of Oncology, HonorHealth University of Arizona College of Medicine and Creighton University School of Medicine, Phoenix, Arizona, USA
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4
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Pereira D, Alves N, Sousa Â, Valente JFA. Metal-based approaches to fight cervical cancer. Drug Discov Today 2024; 29:104073. [PMID: 38944184 DOI: 10.1016/j.drudis.2024.104073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 06/11/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024]
Abstract
Cervical cancer (CC) is one of the leading causes of death among women worldwide. The current treatments for this cancer consist of invasive methods such as chemotherapeutic drugs, radiation, immunotherapy and surgery, which could lead to severe side effects and hinder the patient's life quality. Although metal-based therapies, including cisplatin and ruthenium-based compounds, offer promising alternatives, they lack specificity and harm healthy cells. Combining metal nanoparticles with standard approaches has demonstrated remarkable efficacy and safety in the fight against CC. Overall, this review is intended to show the latest advancements and insights into metal-based strategies, creating a promising path for more effective and safer treatments in the battle against CC.
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Affiliation(s)
- Diana Pereira
- CICS-UBI-Health Sciences Research Centre, Universidade da Beira Interior, Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal; CDRSP-IPL-Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Marinha Grande, 2430-028 Leiria, Portugal
| | - Nuno Alves
- CDRSP-IPL-Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Marinha Grande, 2430-028 Leiria, Portugal
| | - Ângela Sousa
- CICS-UBI-Health Sciences Research Centre, Universidade da Beira Interior, Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal.
| | - Joana F A Valente
- CDRSP-IPL-Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Marinha Grande, 2430-028 Leiria, Portugal.
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5
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Kumar Kore R, Shirbhate E, Singh V, Mishra A, Veerasamy R, Rajak H. New Investigational Drug's Targeting Various Molecular Pathways for Treatment of Cervical Cancer: Current Status and Future Prospects. Cancer Invest 2024; 42:627-642. [PMID: 38966000 DOI: 10.1080/07357907.2024.2373841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
Currently, cervical cancer (CC) is the fourth recorded widespread cancer among women globally. There are still many cases of metastatic or recurring disease discovered, despite the incidence and fatality rates declining due to screening identification and innovative treatment approaches. Palliative chemotherapy continues to be the standard of care for patients who are not contenders for curative therapies like surgery and radiotherapy. This article seeks to provide a thorough and current summary of therapies that have been looked into for the management of CC. The authors emphasize the ongoing trials while reviewing the findings of clinical research. Agents that use biological mechanisms to target different molecular pathways such as epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), mammalian target of rapamycin (mTOR), poly ADP-ribosepolymerase (PARP), and epigenetic biological mechanisms epitomize and offer intriguing research prospects.
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Affiliation(s)
- Rakesh Kumar Kore
- Department of Pharmacy, Guru Ghasidas University, Bilaspur, Chhattisgarh, India
| | - Ekta Shirbhate
- Department of Pharmacy, Guru Ghasidas University, Bilaspur, Chhattisgarh, India
| | - Vaibhav Singh
- Department of Pharmacy, Guru Ghasidas University, Bilaspur, Chhattisgarh, India
| | - Achal Mishra
- Department of Pharmacy, Guru Ghasidas University, Bilaspur, Chhattisgarh, India
| | | | - Harish Rajak
- Department of Pharmacy, Guru Ghasidas University, Bilaspur, Chhattisgarh, India
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6
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da Costa AABA, Souza RP, Pandolfi NC, de Souza Castro F, Baiocchi G, Guimarães APG. Should we consider progression-free survival benefits enough for drug approvals in locally advanced cervical cancer? Gynecol Oncol 2024; 189:109-110. [PMID: 39084160 DOI: 10.1016/j.ygyno.2024.07.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Alexandre Andre B A da Costa
- Department of Medical Oncology, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, Sao Paulo, SP 01509-900, Brazil.
| | - Ronaldo Pereira Souza
- Department of Medical Oncology, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, Sao Paulo, SP 01509-900, Brazil
| | - Natasha Carvalho Pandolfi
- Department of Medical Oncology, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, Sao Paulo, SP 01509-900, Brazil
| | - Fabrício de Souza Castro
- Department of Medical Oncology, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, Sao Paulo, SP 01509-900, Brazil
| | - Glauco Baiocchi
- Department of Gynecology Oncology, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, Sao Paulo, SP 01509-900, Brazil
| | - Andrea Paiva G Guimarães
- Department of Medical Oncology, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, Sao Paulo, SP 01509-900, Brazil
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Sznurkowski JJ, Bodnar L, Szylberg Ł, Zołciak-Siwinska A, Dańska-Bidzińska A, Klasa-Mazurkiewicz D, Rychlik A, Kowalik A, Streb J, Bidziński M, Sawicki W. The Polish Society of Gynecological Oncology Guidelines for the Diagnosis and Treatment of Cervical Cancer (v2024.0). J Clin Med 2024; 13:4351. [PMID: 39124620 PMCID: PMC11313441 DOI: 10.3390/jcm13154351] [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: 06/19/2024] [Revised: 07/11/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Recent publications underscore the need for updated recommendations addressing less radical surgery for <2 cm tumors, induction chemotherapy, or immunotherapy for locally advanced stages of cervical cancer, as well as for the systemic therapy for recurrent or metastatic cervical cancer. Aim: To summarize the current evidence for the diagnosis, treatment, and follow-up of cervical cancer and provide evidence-based clinical practice recommendations. Methods: Developed according to AGREE II standards, the guidelines classify scientific evidence based on the Agency for Health Technology Assessment and Tariff System criteria. Recommendations are graded by evidence strength and consensus level from the development group. Key Results: (1) Early-Stage Cancer: Stromal invasion and lymphovascular space involvement (LVSI) from pretreatment biopsy identify candidates for surgery, particularly for simple hysterectomy. (2) Surgical Approach: Minimally invasive surgery is not recommended, except for T1A, LVSI-negative tumors, due to a reduction in life expectancy. (3) Locally Advanced Cancer: concurrent chemoradiation (CCRT) followed by brachytherapy (BRT) is the cornerstone treatment. Low-risk patients (fewer than two metastatic nodes or FIGO IB2-II) may consider induction chemotherapy (ICT) followed by CCRT and BRT after 7 days. High-risk patients (two or more metastatic nodes or FIGO IIIA, IIIB, and IVA) benefit from pembrolizumab with CCRT and maintenance therapy. (4) Metastatic, Persistent, and Recurrent Cancer: A PD-L1 status from pretreatment biopsy identifies candidates for Pembrolizumab with available systemic treatment, while triplet therapy (Atezolizumab/Bevacizumab/chemotherapy) becomes a PD-L1-independent option. Conclusions: These evidence-based guidelines aim to improve clinical outcomes through precise treatment strategies based on individual risk factors, predictors, and disease stages.
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Affiliation(s)
- Jacek J. Sznurkowski
- Profesor Sznurkowski Podmiot Leczniczy, ul. Stefana Żeromskiego 23A, 81-246 Gdynia, Poland
| | - Lubomir Bodnar
- Faculty of Medical Sciences and Health Sciences, University of Siedlce, 08-110 Siedlce, Poland;
- Department of Clinical Oncology and Radiotherapy, Siedlce Cancer Center, 08-110 Siedlce, Poland
| | - Łukasz Szylberg
- Department of Tumor Pathology and Pathomorphology, Oncology Centre Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland;
- Department of Obstetrics, Gynecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland
| | - Agnieszka Zołciak-Siwinska
- Department of Gynecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.Z.-S.); (A.R.); (M.B.)
| | - Anna Dańska-Bidzińska
- Department of Gynecologic Oncology, Second Clinic of Obstetrics and Gynecology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Dagmara Klasa-Mazurkiewicz
- Department of Obstetrics and Gynecological Oncology, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Agnieszka Rychlik
- Department of Gynecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.Z.-S.); (A.R.); (M.B.)
| | - Artur Kowalik
- Department of Molecular Diagnostics, Holy Cross Cancer Center, 25-734 Kielce, Poland;
- Division of Medical Biology, Institute of Biology, Jan Kochanowski University, 25-406 Kielce, Poland
| | - Joanna Streb
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Mariusz Bidziński
- Department of Gynecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.Z.-S.); (A.R.); (M.B.)
| | - Włodzimierz Sawicki
- Department of Obstetrics and Gynecological Oncology, Medical University of Warsaw, 02-091 Warsaw, Poland;
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8
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Liu B, Zhou H, Tan L, Siu KTH, Guan XY. Exploring treatment options in cancer: Tumor treatment strategies. Signal Transduct Target Ther 2024; 9:175. [PMID: 39013849 PMCID: PMC11252281 DOI: 10.1038/s41392-024-01856-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 07/18/2024] Open
Abstract
Traditional therapeutic approaches such as chemotherapy and radiation therapy have burdened cancer patients with onerous physical and psychological challenges. Encouragingly, the landscape of tumor treatment has undergone a comprehensive and remarkable transformation. Emerging as fervently pursued modalities are small molecule targeted agents, antibody-drug conjugates (ADCs), cell-based therapies, and gene therapy. These cutting-edge treatment modalities not only afford personalized and precise tumor targeting, but also provide patients with enhanced therapeutic comfort and the potential to impede disease progression. Nonetheless, it is acknowledged that these therapeutic strategies still harbour untapped potential for further advancement. Gaining a comprehensive understanding of the merits and limitations of these treatment modalities holds the promise of offering novel perspectives for clinical practice and foundational research endeavours. In this review, we discussed the different treatment modalities, including small molecule targeted drugs, peptide drugs, antibody drugs, cell therapy, and gene therapy. It will provide a detailed explanation of each method, addressing their status of development, clinical challenges, and potential solutions. The aim is to assist clinicians and researchers in gaining a deeper understanding of these diverse treatment options, enabling them to carry out effective treatment and advance their research more efficiently.
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Affiliation(s)
- Beilei Liu
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
- State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
| | - Hongyu Zhou
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Licheng Tan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Kin To Hugo Siu
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Xin-Yuan Guan
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China.
- State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China.
- Advanced Energy Science and Technology Guangdong Laboratory, Huizhou, China.
- MOE Key Laboratory of Tumor Molecular Biology, Jinan University, Guangzhou, China.
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9
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Vergote I, González-Martín A, Fujiwara K, Kalbacher E, Bagaméri A, Ghamande S, Lee JY, Banerjee S, Maluf FC, Lorusso D, Yonemori K, Van Nieuwenhuysen E, Manso L, Woelber L, Westermann A, Covens A, Hasegawa K, Kim BG, Raimondo M, Bjurberg M, Cruz FM, Angelergues A, Cibula D, Barraclough L, Oaknin A, Gennigens C, Nicacio L, Teng MSL, Whalley E, Soumaoro I, Slomovitz BM. Tisotumab Vedotin as Second- or Third-Line Therapy for Recurrent Cervical Cancer. N Engl J Med 2024; 391:44-55. [PMID: 38959480 DOI: 10.1056/nejmoa2313811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
BACKGROUND Recurrent cervical cancer is a life-threatening disease, with limited treatment options available when disease progression occurs after first-line combination therapy. METHODS We conducted a phase 3, multinational, open-label trial of tisotumab vedotin as second- or third-line therapy in patients with recurrent or metastatic cervical cancer. Patients were randomly assigned, in a 1:1 ratio, to receive tisotumab vedotin monotherapy (2.0 mg per kilogram of body weight every 3 weeks) or the investigator's choice of chemotherapy (topotecan, vinorelbine, gemcitabine, irinotecan, or pemetrexed). The primary end point was overall survival. RESULTS A total of 502 patients underwent randomization (253 were assigned to the tisotumab vedotin group and 249 to the chemotherapy group); the groups were similar with respect to demographic and disease characteristics. The median overall survival was significantly longer in the tisotumab vedotin group than in the chemotherapy group (11.5 months [95% confidence interval {CI}, 9.8 to 14.9] vs. 9.5 months [95% CI, 7.9 to 10.7]), results that represented a 30% lower risk of death with tisotumab vedotin than with chemotherapy (hazard ratio, 0.70; 95% CI, 0.54 to 0.89; two-sided P = 0.004). The median progression-free survival was 4.2 months (95% CI, 4.0 to 4.4) with tisotumab vedotin and 2.9 months (95% CI, 2.6 to 3.1) with chemotherapy (hazard ratio, 0.67; 95% CI, 0.54 to 0.82; two-sided P<0.001). The confirmed objective response rate was 17.8% in the tisotumab vedotin group and 5.2% in the chemotherapy group (odds ratio, 4.0; 95% CI, 2.1 to 7.6; two-sided P<0.001). A total of 98.4% of patients in the tisotumab vedotin group and 99.2% in the chemotherapy group had at least one adverse event that occurred during the treatment period (defined as the period from day 1 of dose 1 until 30 days after the last dose); grade 3 or greater events occurred in 52.0% and 62.3%, respectively. A total of 14.8% of patients stopped tisotumab vedotin treatment because of toxic effects. CONCLUSIONS In patients with recurrent cervical cancer, second- or third-line treatment with tisotumab vedotin resulted in significantly greater efficacy than chemotherapy. (Funded by Genmab and Seagen [acquired by Pfizer]; innovaTV 301 ClinicalTrials.gov number, NCT04697628.).
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Affiliation(s)
- Ignace Vergote
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Antonio González-Martín
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Keiichi Fujiwara
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Elsa Kalbacher
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Andrea Bagaméri
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Sharad Ghamande
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Jung-Yun Lee
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Susana Banerjee
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Fernando Cotait Maluf
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Domenica Lorusso
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Kan Yonemori
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Els Van Nieuwenhuysen
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Luis Manso
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Linn Woelber
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Anneke Westermann
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Allan Covens
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Kosei Hasegawa
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Byoung-Gie Kim
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Miriam Raimondo
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Maria Bjurberg
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Felipe Melo Cruz
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Antoine Angelergues
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - David Cibula
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Lisa Barraclough
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Ana Oaknin
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Christine Gennigens
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Leo Nicacio
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Melinda Siew Leng Teng
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Elizabeth Whalley
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Ibrahima Soumaoro
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
| | - Brian M Slomovitz
- From Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, and the Belgium and Luxembourg Gynaecological Oncology Group, Leuven (I.V., E.V.N.), and Centre Hospitalier Universitaire de Liège, Liege (C.G.) - all in Belgium; Cancer Center Clínica Universidad de Navarra (A.G.-M.), Hospital Universitario 12 de Octubre (L.M.), and Grupo Español de Investigación en Cáncer de Ovario (GEICO) (A.G.-M.), Madrid, and Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.) - all in Spain; Saitama Medical School International Medical Center, Saitama (K.F., K.H.), and the National Cancer Center Hospital, Tokyo (K.Y.) - both in Japan; Centre Hospitalier Universitaire de Besançon, Besançon (E.K.), and GINECO (E.K., A.A.) and Groupe Hospitalier Diaconesses Croix Saint-Simon (A.A.), Paris - all in France; Országos Onkológiai Intézet, Budapest, Hungary (A.B.); Georgia Cancer Center, Augusta University, Augusta (S.G.); Yonsei University College of Medicine (J.-Y.L.) and Samsung Medical Center, Sungkyunkwan University School of Medicine (B.-G.K.) - both in Seoul, South Korea; the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London (S.B.), and the Christie NHS Foundation Trust, Clinical Oncology, Manchester (L.B.) - both in the United Kingdom; Hospital Beneficencia Portuguesa de São Paulo (F.C.M.), Hospital Israelita Albert Einstein de São Paulo (F.C.M.), and Instituto Brasileiro de Controle do Câncer (F.M.C.) - all in Sao Paulo; Fondazione Policlinico Gemelli IRCCS and Catholic University of Sacred Heart, Rome (D.L.); Arbeitsgemeinschaft Gynäkologische Onkologie Study Group and University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Amsterdam University Medical Centers, Amsterdam (A.W.); Sunnybrook Research Institute, Toronto (A.C.); Medica Oncólogia Clinica en Grupo Gamma, Rosario, Argentina (M.R.); Skåne University Hospital and Lund University, Lund, Sweden (M.B.); First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic (D.C.); Pfizer, Bothell, WA (L.N., M.S.L.T., E.W.); Genmab US, Princeton, NJ (I.S.); and Mount Sinai Medical Center, Miami Beach, FL (B.M.S.)
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Diggs A, Huang Y, Melamed A, Szamreta E, Monberg MJ, Hershman D, Wright JD. Patterns of use of primary and first-line chemotherapy for recurrence among patients with cervical cancer. Int J Gynecol Cancer 2024; 34:1001-1010. [PMID: 38851239 DOI: 10.1136/ijgc-2023-004860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Little is known about real-world patterns of chemotherapy use in patients with cervical cancer. OBJECTIVE To examine the patterns of chemotherapy use in patients with cervical cancer METHODS: We identified patients with cervical cancer in the IBM MarketScan Database who underwent primary hysterectomy or radiation therapy between 2011 and 2020 and described their treatment in the primary setting and at first recurrence. RESULTS We identified 5390 patients: 2667 (49.5%) underwent primary hysterectomy and 2723 (50.5%) primary radiotherapy. Among patients who underwent primary hysterectomy, 979 (36.7%) received adjuvant radiation, and 617 (23.1%) received primary chemotherapy. The most common chemotherapy regimens were single-agent platinum (51.7%), platinum combination therapy (42.9%), and non-platinum (3.4%). Among patients treated with primary radiation, 73.6% received primary/concurrent chemotherapy, either platinum alone (66.4% of those who received chemotherapy), platinum combinations (32.2%), or non-platinum (1.4%). The median duration of primary chemotherapy was 1.2 months. Therapy for recurrent cervical cancer was initiated in 959 patients. The most common regimens were platinum combination (63.9%), non-platinum cytotoxic agents (16.5%), single-agent platinum (14.9%), targeted therapy with bevacizumab (6.0%), and immunotherapy with pembrolizumab (3.2%). Overall, the proportion of patients treated with single-agent platinum therapy increased from 17.4% in 2011 to 32.1% in 2019, while platinum combinations decreased from 64.1% to 41.5% over the same years. Use of non-platinum agents increased from 18.5% in 2011 to 32.9% in 2018 and 26.4% in 2019. CONCLUSIONS Platinum-based chemotherapy is the most commonly used therapy in patients with cervical cancer in the primary setting and at the time of recurrence. The rate of use of non-platinum agents at first recurrence has increased over time.
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Affiliation(s)
- Alexandra Diggs
- Columbia University College of Physicians and Surgeons, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Yongmei Huang
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Alexander Melamed
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Dawn Hershman
- Columbia University College of Physicians and Surgeons, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Merck & Co Inc, Rahway, New Jersey, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Merck & Co Inc, Rahway, New Jersey, USA
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11
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Sauvage LM, Bentahila R, Tran Y, Guénégou-Arnoux A, Fabiano E, Bats AS, Borghese B, Durdux C. Radiation Proctitis in Patients With Locally Advanced Cervical Cancer Treated by Chemoradiation: Analysis and Predictive Factors From a Retrospective Cohort. Am J Clin Oncol 2024; 47:311-316. [PMID: 38557436 DOI: 10.1097/coc.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Radiation proctitis is a misunderstanding complication of chemoradiation in locally advanced cervical cancer. The objective of our study is to provide a detailed description and analysis of predictive factors associated with radiation proctitis in a retrospective cohort of patients treated by chemoradiation for locally advanced cervical cancer. METHODS All patients treated by exclusive chemoradiation or chemoradiation followed by brachytherapy for locally advanced cervical cancer from 2011 to 2017 were included in the study. A bivariate analysis was conducted to establish correlations between the occurrence of radiation proctitis and various clinical and technical variables. RESULTS A total of 128 patients were included in the study. The mean dose (SD) to the planning target volume was 47.1 Gy (6.2). Fifty-nine (46.1%) patients underwent brachytherapy. Sixteen patients (12.5%) developed radiation proctitis, grade 2 or higher in 12 patients (9.3%). In univariate analysis, anticoagulant or antiplatelet treatments ( P =0.039), older age ( P =0.049), rectal volume irradiated at 40 Gy ( P =0.01) and 30 Gy ( P =0.037) were significantly associated with the occurrence of a grade ≥2 radiation proctitis. The delivered dose to 2 cm 3 of rectum (D2cm 3 ) showed a potential association with the occurrence of radiation proctitis of all grades ( P =0.064). CONCLUSIONS This study highlights clinical and technical factors that should be considered in assessing the risk of radiation proctitis. These results contribute to a better understanding of this complication.
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Affiliation(s)
| | | | - Yohan Tran
- Department of Clinical Research, Clinical Investigations-Epidemiology Center, INSERM
| | | | | | | | - Bruno Borghese
- Department of Gynecology, Cochin-Port Royal Hospital, Paris-Cité University, Paris, France
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12
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Li S, Gao K, Yao D. Comprehensive Analysis of angiogenesis associated genes and tumor microenvironment infiltration characterization in cervical cancer. Heliyon 2024; 10:e33277. [PMID: 39021997 PMCID: PMC11252983 DOI: 10.1016/j.heliyon.2024.e33277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 06/15/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
Background Cervical cancer is among the most prevalent malignancies worldwide. This study explores the relationships between angiogenesis-related genes (ARGs) and immune infiltration, and assesses their implications for the prognosis and treatment of cervical cancer. Additionally, it develops a diagnostic model based on angiogenesis-related differentially expressed genes (ARDEGs). Methods We systematically evaluated 15 ARDEGs using Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), Gene Set Enrichment Analysis (GSEA), and Gene Set Variation Analysis (GSVA). Immune cell infiltration was assessed using a single-sample gene-set enrichment analysis (ssGSEA) algorithm. We then constructed a diagnostic model for ARDEGs using Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis and evaluated the diagnostic value of this model and the hub genes in predicting clinical outcomes and immunotherapy responses in cervical cancer. Results A set of ARDEGs was identified from the Cancer Genome Atlas (TCGA), Gene Expression Omnibus (GEO), and UCSC Xena database. We performed KEGG, GO, and GSEA analyses on these genes, revealing significant involvement in cell proliferation, differentiation, and apoptosis. The ARDEGs diagnostic model, constructed using LASSO regression analysis, showed high predictive accuracy in cervical cancer patients. We developed a reliable nomogram and decision curve analysis to evaluate the clinical utility of the ARDEG diagnostic model. The 15 ARDEGs in the model were associated with clinicopathological features, prognosis, and immune cell infiltration. Notably, ITGA5 expression and the abundance of immune cell infiltration (specifically mast cell activation) were highly correlated. Conclusion This study identifies the prognostic characteristics of ARGs in cervical cancer patients, elucidating aspects of the tumor microenvironment. It enhances the predictive accuracy of immunotherapy outcomes and establishes new strategies for immunotherapeutic interventions.
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Affiliation(s)
- Shuzhen Li
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, 530021, PR China
| | - Kun Gao
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, 530021, PR China
| | - Desheng Yao
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, 530021, PR China
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13
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Fontenot VE, Francoeur A, Tewari KS. Review of emerging biological therapies for recurrent and advanced metastatic cervical cancer. Expert Opin Biol Ther 2024:1-5. [PMID: 38916224 DOI: 10.1080/14712598.2024.2373320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/24/2024] [Indexed: 06/26/2024]
Affiliation(s)
| | - Alex Francoeur
- Irvine, Medical Center, University of California, Orange, CA, USA
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14
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Kalogera E, Nevala WK, Finnes HD, Suman VJ, Schimke JM, Strand CA, Kottschade LA, Kudgus RA, Buhrow SA, Becher LR, Geng L, Glaser GE, Grudem ME, Jatoi A, Klampe CM, Kumar A, Langstraat CL, McWilliams RR, Wahner Hendrickson AE, Weroha SJ, Yan Y, Reid JM, Markovic SN, Block MS. A Phase I Trial of Nab-Paclitaxel/Bevacizumab (AB160) Nano-Immunoconjugate Therapy for Gynecologic Malignancies. Clin Cancer Res 2024; 30:2623-2635. [PMID: 38530846 PMCID: PMC11176914 DOI: 10.1158/1078-0432.ccr-23-3196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/13/2024] [Accepted: 03/21/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE AB160 is a 160-nm nano-immunoconjugate consisting of nab-paclitaxel (ABX) nanoparticles noncovalently coated with bevacizumab (BEV) for targeted delivery into tissues expressing high levels of VEGF. Preclinical data showed that AB160 resulted in greater tumor targeting and tumor inhibition compared with sequential treatment with ABX then BEV. Given individual drug activity, we investigated the safety and toxicity of AB160 in patients with gynecologic cancers. PATIENTS AND METHODS A 3+3 phase I trial was conducted with three potential dose levels in patients with previously treated endometrial, cervical, and platinum-resistant ovarian cancer to ascertain the recommended phase II dose (RP2D). AB160 was administered intravenously on days 1, 8, and 15 of a 28-day cycle (ABX 75-175 mg/m2, BEV 30-70 mg/m2). Pharmacokinetic analyses were performed. RESULTS No dose-limiting toxicities (DLT) were seen among the three dose levels tested. Grade 3/4 toxicities included neutropenia, thromboembolic events, and leukopenia. DL2 (ABX 150 mg/m2, BEV 60 mg/m2) was chosen as the RP2D. Seven of the 19 patients with measurable disease (36.8%) had confirmed partial responses (95% confidence interval, 16.3%-61.6%). Pharmacokinetic analyses demonstrated that AB160 allowed 50% higher paclitaxel dosing and that paclitaxel clearance mirrored that of therapeutic antibodies. CONCLUSIONS The safety profile and clinical activity of AB160 supports further clinical testing in patients with gynecologic cancers; the RP2D is DL2 (ABX 150 mg/m2, BEV 60 mg/m2).
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Affiliation(s)
- Eleftheria Kalogera
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Vera J. Suman
- Division of Biomedical Statistics and Bioinformatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Jill M. Schimke
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Carrie A. Strand
- Division of Biomedical Statistics and Bioinformatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Lisa A. Kottschade
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Rachel A. Kudgus
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sarah A. Buhrow
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Liyi Geng
- Department of Immunology, Mayo Clinic, Rochester, Minnesota
| | - Gretchen E. Glaser
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Megan E. Grudem
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Aminah Jatoi
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Carolyn M. Klampe
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Amanika Kumar
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Carrie L. Langstraat
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Robert R. McWilliams
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - S. John Weroha
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Yiyi Yan
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Joel M. Reid
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Svetomir N. Markovic
- Department of Immunology, Mayo Clinic, Rochester, Minnesota
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Matthew S. Block
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
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15
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Walker CA, Edwards C, McIntire D, Makepeace L, Holloway SB, Kakadiaris E, Spirtos AN, Miller DS, Lea JS. Predicting VTE and utility of thromboprophylaxis in metastatic and recurrent cervical cancer. Gynecol Oncol 2024; 188:22-26. [PMID: 38875744 DOI: 10.1016/j.ygyno.2024.05.028] [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: 04/28/2024] [Accepted: 05/25/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE Patients with cervical cancer who are diagnosed with venous thromboembolism (VTE) have worse outcomes compared to those not affected. There has yet to be a reliable method to predict or prevent VTE in cervical cancer patients. Our objective is to describe the incidence of VTE in patients with recurrent and metastatic (r/mCC) and determine risk factors that may predict VTE in this setting. METHODS We performed an observational cohort study of 386 patients with r/mCC who received at least one line of systemic chemotherapy. We collected demographic, clinical, histologic data and Khorana scores for all patients. Inclusion and exclusion criteria were applied before analysis. Statistical analysis was performed using Pearson chi-square, Student's t-test, and Wilcoxon rank-sum. RESULTS 232 patients were included for evaluation. Mean age was 49 years (range 20-83). The majority (167, 72%) of patients had squamous cell histology. 169 (72.8%) patients received treatment for recurrent disease and 63 (27.2%) for metastatic, stage IVB disease. 180 (78%) patients received prior radiation and 134 (58%) received bevacizumab. VTE was diagnosed in 89 (38%) patients. There were no statistically significant differences amongst clinical and pathologic characteristics between patients who developed VTE and those who did not. There was no significant association between BMI, Khorana score, radiation, bevacizumab, or immunotherapy and the development of VTE. CONCLUSION Approximately 40% of patients with r/mCC experienced a new VTE. There were no independent risk factors that could predict VTE in this population. Due to the overwhelmingly high incidence of VTE, prophylactic anticoagulation could be strongly considered in patients with r/mCC.
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Affiliation(s)
- Christopher A Walker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Carson Edwards
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Don McIntire
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Lydia Makepeace
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Steven Blaine Holloway
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Ev Kakadiaris
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Alexandra N Spirtos
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - David S Miller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Jayanthi S Lea
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
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Cardoso-Carneiro D, Pinheiro J, Fontão P, Nogueira R, Gabriela-Freitas M, Raquel-Cunha A, Mendes A, Longatto-Filho A, Marques F, Moreira MAR, Reis RM, Martinho O. Unveiling the RKIP and EGFR Inverse Relationship in Solid Tumors: A Case Study in Cervical Cancer. Cancers (Basel) 2024; 16:2182. [PMID: 38927888 PMCID: PMC11202200 DOI: 10.3390/cancers16122182] [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: 04/17/2024] [Revised: 05/20/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Raf Kinase Inhibitor Protein (RKIP) is recognized as a bona fide tumor suppressor gene, and its diminished expression or loss is associated with the progression and poor prognosis of various solid tumors. It exerts multifaceted roles in carcinogenesis by modulating diverse intracellular signaling pathways, including those governed by HER receptors such as MAPK. Given the significance of HER receptor overexpression in numerous tumor types, we investigated the potential oncogenic relationship between RKIP and HER receptors in solid tumors. Through a comprehensive in silico analysis of 30 TCGA PanCancer Atlas studies encompassing solid tumors (10,719 samples), we uncovered compelling evidence of an inverse correlation between RKIP and EGFR expression in solid tumors observed in 25 out of 30 studies. Conversely, a predominantly positive association was noted for the other HER receptors (ERBB2, ERBB3, and ERBB4). In particular, cervical cancer (CC) emerged as a tumor type exhibiting a robust inverse association between RKIP and EGFR expression, a finding that was further validated in a cohort of 202 patient samples. Subsequent in vitro experiments involving pharmacological and genetic modulation of EGFR and RKIP showed that RKIP depletion led to significant upregulation of EGFR mRNA levels and induction of EGFR phosphorylation. Conversely, EGFR overactivation decreased RKIP expression in CC cell lines. Additionally, we identified a common molecular signature among patients depicting low RKIP and high EGFR expression and demonstrated the prognostic value of this inverse correlation in CC patients. In conclusion, our findings reveal an inverse association between RKIP and EGFR expression across various solid tumors, shedding new light on the underlying molecular mechanisms contributing to the aggressive phenotype associated with RKIP and EGFR in cervical cancer.
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Affiliation(s)
- Diana Cardoso-Carneiro
- Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, 4710-057 Braga, Portugal; (D.C.-C.); (J.P.); (P.F.); (R.N.); (M.G.-F.); (A.R.-C.); (A.M.); (A.L.-F.); (R.M.R.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
| | - Joana Pinheiro
- Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, 4710-057 Braga, Portugal; (D.C.-C.); (J.P.); (P.F.); (R.N.); (M.G.-F.); (A.R.-C.); (A.M.); (A.L.-F.); (R.M.R.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
| | - Patrícia Fontão
- Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, 4710-057 Braga, Portugal; (D.C.-C.); (J.P.); (P.F.); (R.N.); (M.G.-F.); (A.R.-C.); (A.M.); (A.L.-F.); (R.M.R.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
| | - Rosete Nogueira
- Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, 4710-057 Braga, Portugal; (D.C.-C.); (J.P.); (P.F.); (R.N.); (M.G.-F.); (A.R.-C.); (A.M.); (A.L.-F.); (R.M.R.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
- CGC Genetics/Centro de Genética Clínica, Unilabs-Laboratory of Pathology, 4000-432 Porto, Portugal
| | - Maria Gabriela-Freitas
- Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, 4710-057 Braga, Portugal; (D.C.-C.); (J.P.); (P.F.); (R.N.); (M.G.-F.); (A.R.-C.); (A.M.); (A.L.-F.); (R.M.R.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
| | - Ana Raquel-Cunha
- Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, 4710-057 Braga, Portugal; (D.C.-C.); (J.P.); (P.F.); (R.N.); (M.G.-F.); (A.R.-C.); (A.M.); (A.L.-F.); (R.M.R.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
| | - Adriana Mendes
- Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, 4710-057 Braga, Portugal; (D.C.-C.); (J.P.); (P.F.); (R.N.); (M.G.-F.); (A.R.-C.); (A.M.); (A.L.-F.); (R.M.R.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
| | - Adhemar Longatto-Filho
- Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, 4710-057 Braga, Portugal; (D.C.-C.); (J.P.); (P.F.); (R.N.); (M.G.-F.); (A.R.-C.); (A.M.); (A.L.-F.); (R.M.R.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
- Medical Laboratory of Medical Investigation (LIM), Department of Pathology, Medical School, University of São Paulo, São Paulo 01246-903, SP, Brazil
- Molecular Oncology Research Center (CPOM), Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil
| | - Fábio Marques
- Department of Pathology, School of Medicine, Federal University of Goiás, Goiás 74605-050, GO, Brazil; (F.M.); (M.A.R.M.)
| | - Marise A. R. Moreira
- Department of Pathology, School of Medicine, Federal University of Goiás, Goiás 74605-050, GO, Brazil; (F.M.); (M.A.R.M.)
| | - Rui M. Reis
- Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, 4710-057 Braga, Portugal; (D.C.-C.); (J.P.); (P.F.); (R.N.); (M.G.-F.); (A.R.-C.); (A.M.); (A.L.-F.); (R.M.R.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
- Molecular Oncology Research Center (CPOM), Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil
| | - Olga Martinho
- Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, 4710-057 Braga, Portugal; (D.C.-C.); (J.P.); (P.F.); (R.N.); (M.G.-F.); (A.R.-C.); (A.M.); (A.L.-F.); (R.M.R.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
- Molecular Oncology Research Center (CPOM), Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil
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17
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Di X, Gao Z, Yu H, Liu X, Zhao J, Wang J, Zhang H. 125I seed brachytherapy for non-central pelvic recurrence of cervical cancer after external beam radiotherapy. Radiat Oncol 2024; 19:70. [PMID: 38849839 PMCID: PMC11162001 DOI: 10.1186/s13014-024-02454-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/13/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE To investigate the efficacy of 125I seed brachytherapy for non-central pelvic recurrence of cervical cancer after external beam radiotherapy, and to analyze the clinical influential factors. METHODS Between June 2015 and April 2022, 32 patients with 41 lesions were treated with 125I seed brachytherapy. The seeds were implanted under the guidance of CT and/or 3D-printed template images at a median dose of 100 Gy (range, 80-120 Gy), and the local control rate (LCR) and survival rates were calculated. We used multivariate logistic regression to identify prognosis predictors, and receiver operating characteristic (ROC) curve analysis to determine the optimal cut-off values. RESULTS The median follow-up was 48.52 months (range, 4-86 months), and the 6-, 12-, and 24-month LCR was 88.0%, 63.2%, and 42.1%, respectively. The 1- and 2-year survival rates were 36% and 33%, respectively, and the median survival time was 13.26 months. No significant adverse events occurred. Multivariate regression analysis showed that tumor diameter, tumor stage, and LCR were independent factors influencing survival. ROC curve analysis showed that the area under the curve for tumor diameter and D90 were 0.765 and 0.542, respectively, with cut-off values of 5.3 cm and 108.5 Gy. CONCLUSIONS The present findings indicate that 125I seed brachytherapy is feasible for treating non-central pelvic recurrence of cervical cancer after external beam radiotherapy. Further, tumor diameter < 5.3 cm and immediate postoperative D90 > 108.5 Gy were associated with better efficacy.
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Affiliation(s)
- Xuemin Di
- Department of Oncology, Hebei General Hospital, 348 West Heping Road, Shijiazhuang, Hebei, 050051, China
| | - Zhen Gao
- Department of Oncology, Hebei General Hospital, 348 West Heping Road, Shijiazhuang, Hebei, 050051, China
| | - Huimin Yu
- Department of Oncology, Hebei General Hospital, 348 West Heping Road, Shijiazhuang, Hebei, 050051, China
| | - Xiaoli Liu
- Department of Oncology, Hebei General Hospital, 348 West Heping Road, Shijiazhuang, Hebei, 050051, China
| | - Jinxin Zhao
- Department of Oncology, Hebei General Hospital, 348 West Heping Road, Shijiazhuang, Hebei, 050051, China
| | - Juan Wang
- Department of Oncology, Hebei General Hospital, 348 West Heping Road, Shijiazhuang, Hebei, 050051, China
| | - Hongtao Zhang
- Department of Oncology, Hebei General Hospital, 348 West Heping Road, Shijiazhuang, Hebei, 050051, China.
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18
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Lian J, Li M, Duan M, Sun Y, Wang Z, Guo X, Li J, Gao G, Li K. NK-92 cells labeled with Fe 3O 4-PEG-CD56/Avastin@Ce6 nanoprobes for the targeted treatment and noninvasive therapeutic evaluation of breast cancer. J Nanobiotechnology 2024; 22:313. [PMID: 38840120 PMCID: PMC11151526 DOI: 10.1186/s12951-024-02599-x] [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: 07/22/2023] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
Adoptive cellular immunotherapy as a promising and alternative cancer therapy platform is critical for future clinical applications. Natural killer (NK) cells have attracted attention as an important type of innate immune regulatory cells that can rapidly kill multiple adjacent cancer cells. However, these cells are significantly less effective in treating solid tumors than in treating hematological tumors. Herein, we report the synthesis of a Fe3O4-PEG-CD56/Avastin@Ce6 nanoprobe labeled with NK-92 cells that can be used for adoptive cellular immunotherapy, photodynamic therapy and dual-modality imaging-based in vivo fate tracking. The labeled NK-92 cells specifically target the tumor cells, which increases the amount of cancer cell apoptosis in vitro. Furthermore, the in vivo results indicate that the labeled NK-92 cells can be used for tumor magnetic resonance imaging and fluorescence imaging, adoptive cellular immunotherapy, and photodynamic therapy after tail vein injection. These data show that the developed multifunctional nanostructure is a promising platform for efficient innate immunotherapy, photodynamic treatment and noninvasive therapeutic evaluation of breast cancer.
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Affiliation(s)
- Jingge Lian
- Department of Radiology, Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 201600, P.R. China
- Department of Radiology, Peking University Third Hospital, Beijing, 100191, China
| | - Meng Li
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, China
| | - Meng Duan
- Department of Instrument Science and Technology, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Yaqian Sun
- Department of Radiology, Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 201600, P.R. China
- Department of Immunology, School of Cell and Gene Therapy, Songjiang Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, P.R. China
| | - Zilin Wang
- Department of Radiology, Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 201600, P.R. China
| | - Xinyu Guo
- Department of Radiology, Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 201600, P.R. China
| | - Jingchao Li
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, China.
| | - Guo Gao
- Department of Instrument Science and Technology, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
| | - Kangan Li
- Department of Radiology, Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 201600, P.R. China.
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Isohashi F, Yoshida K, Murakami N, Masui K, Ishihara S, Ohkubo Y, Kaneyasu Y, Kinoshita R, Kotsuma T, Takaoka Y, Tanaka E, Nagao A, Ogawa K, Yamazaki H. Reirradiation for recurrent gynecologic cancer using high-dose-rate brachytherapy in Japan: A multicenter survey on practice patterns and outcomes. Radiother Oncol 2024; 195:110269. [PMID: 38583719 DOI: 10.1016/j.radonc.2024.110269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND PURPOSE The aim of the study is to examine the present status of reirradiation with high-dose-rate (HDR) brachytherapy for recurrent gynecologic cancer in Japan and to determine the role of this therapy in clinical practice. MATERIALS AND METHODS A retrospective multicenter chart review was performed for reirradiation for gynecologic cancer using HDR brachytherapy. Each center provided information on patient characteristics, treatment outcomes, and complications. RESULTS The study included 165 patients treated at 9 facilities from 2000 to 2018. The analysis of outcomes included 142 patients treated with curative intent. The median follow-up time for survivors was 30 months (range 1-130 months). The 3-year overall survival (OS), progression-free survival (PFS), and local control (LC) rates were 53 % (95 %CI: 42-63 %), 44 % (35-53 %), and 61 % (50-70 %) for cervical cancer; 100 % (NA), 64 % (30-85 %), and 70 % (32-89 %) for endometrial cancer; and 54 % (13-83 %), 38 % (6-72 %), and 43 % (6-78 %) for vulvar and vaginal cancer, respectively. In multivariate analysis, interval to reirradiation (<1 year) was a significant risk factor for OS, PFS and LC; Gross Tumor Volume (≥25 cm3) was a significant risk factor for OS. Toxicities were analyzed in all enrolled patients (n = 165). Grade ≥ 3 late toxicities occurred in 49 patients (30 %). A higher cumulative EQD2 (α/β = 3) was significantly associated with severe complications. CONCLUSION Reirradiation with HDR brachytherapy for recurrent gynecologic cancer is effective, especially in cases with a long interval before reirradiation.
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Affiliation(s)
- Fumiaki Isohashi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of Radiation Oncology, Nara Medical University, Kashihara, Nara, Japan.
| | - Ken Yoshida
- Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan; Department of Radiology, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tsukiji, Tokyo, Japan; Department of Radiation Oncology, Juntendo University, Hongo, Tokyo, Japan
| | - Koji Masui
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shunichi Ishihara
- Department of Radiology, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan; Department of Radiology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Yu Ohkubo
- Department of Radiation Oncology, Saku Central Hospital Advanced Care Center, Saku, Nagano, Japan
| | - Yuko Kaneyasu
- Department of Radiation Oncology, National Hospital Organization Fukuyama Medical Center, Fukuyama, Hiroshima, Japan; Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi, Hiroshima, Japan
| | - Rumiko Kinoshita
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Tadayuki Kotsuma
- Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan; Department of Radiation Oncology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yuji Takaoka
- Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan; Department of Radiology, Saito Yukoukai Hospital, Ibaraki, Osaka, Japan
| | - Eiichi Tanaka
- Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Ayaka Nagao
- Department of Radiation Oncology, National Cancer Center Hospital, Tsukiji, Tokyo, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hideya Yamazaki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Ditto A, Longo M, Chiarello G, Mariani L, Paolini B, Leone Roberti Maggiore U, Martinelli F, Bogani G, Raspagliesi F. Are biomarkers expression and clinical-pathological factors predictive markers of the efficacy of neoadjuvant chemotherapy for locally advanced cervical cancer? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108311. [PMID: 38554552 DOI: 10.1016/j.ejso.2024.108311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 03/03/2024] [Accepted: 03/24/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION To predict the overall pathologic response to neoadjuvant chemotherapy (NACT) of patients with locally advanced cervical cancer (LACC) creating a prediction model based on clinical-pathological factors and biomarkers (p53, Bcl1 and Bcl2) and to evaluate the prognostic outcomes of NACT. MATERIALS AND METHODS This is a retrospective study of 88 consecutive patients with LACC who underwent NACT followed by nerve sparing surgery with retroperitoneal lymphadenectomy at National Cancer Institute of Milan, between January 2000 and June 2013. Clinical pathologic data were retrieved from the institutional database. Biomarkers (p53, Bcl1 and Bcl2) were evaluated before and after NACT in the specimen. To investigate their role as predictors of response, we tried several statistical machine learning algorithms. RESULTS Responders to NACT showed a 5-years survival between 100%(CR) and 85.7%(PR). Clinical factors were the most important predictor of response. Age, BMI and grade represented the most important predictors of response at random forest analysis. Tree-based boosting revealed that after adjusting for other prognostic factors, age, grade, BMI and tumor size were independent predictors of response to NACT, while p53 was moderately related to response to NACT. Area under the curve (crude estimate): 0.871. Whereas Bcl1 and Bcl2, were not predictors for response to NACT. The final logistic regression reported that grade was the only significant predictor of response to NACT. CONCLUSION Combined model that included clinical pathologic variables plus p53 cannot predict response to NACT. Despite this, NACT remain a safe treatment in chemosensitive patients avoiding collateral sequelae related to chemo-radiotherapy.
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Affiliation(s)
- Antonino Ditto
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy.
| | - Mariangela Longo
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | - Giulia Chiarello
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | - Luigi Mariani
- Statistics Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | - Biagio Paolini
- Pathology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | | | - Fabio Martinelli
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | - Giorgio Bogani
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | - Francesco Raspagliesi
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
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Li S, Pan W, Song J, Zhen L, Chen Y, Liu W, Zhang Y, Chen L, Huang Q, Zheng S, Zheng X. Distant organ metastasis patterns and prognosis of cervical adenocarcinoma: a population-based retrospective study. Front Med (Lausanne) 2024; 11:1401700. [PMID: 38873215 PMCID: PMC11169833 DOI: 10.3389/fmed.2024.1401700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
Background Adenocarcinoma is a common histological subtype of cervical cancer, accounting for 10-15% of all cases. The prognosis of cervical adenocarcinoma with distant organ metastases remains unclear. Therefore, our study aimed to investigate the patterns and prognosis of distant organ metastasis in cervical adenocarcinoma. Methods We obtained data from the Surveillance, Epidemiology, and End Results (SEER) database spanning from 2010 to 2019. Cox regression, Kaplan-Meier, and log-rank analyses were conducted. Results We observed that adenocarcinoma (AC) of the cervix primarily metastasizes to single organs, with a rate of 73.3%. The lungs are the most common organs of metastasis, followed by the liver and bones. Patients with bone metastases have a median survival period of 12 months, which is slightly longer compared to metastasis in other organs. Distant organ metastasis, age, positive lymph nodes, higher AJCC stages, larger tumor diameter, and higher cell grades are related to poor prognosis (p < 0.001). Furthermore, we have observed that surgical intervention, radiotherapy, and chemotherapy can potentially provide benefits for patients with distant organ metastases. Conclusion Metastasis is an independent prognostic factor for cervical adenocarcinoma patients. Surgery, radiotherapy, and chemotherapy can provide an overall survival advantage for patients with distant organ metastases.
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Affiliation(s)
- Suyu Li
- Department of Radiation Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medical for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wuyuan Pan
- Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medical for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Jianrong Song
- Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medical for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Lan Zhen
- Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medical for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yusha Chen
- Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medical for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Weijian Liu
- Department of Clinical Medicine, Xinxiang Medical University, Xinxiang, Henan, China
| | - Yulong Zhang
- Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medical for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Lingsi Chen
- Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medical for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiuyuan Huang
- Department of Radiation Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medical for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shixiong Zheng
- Fuzhou Second Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou, China
| | - Xiangqin Zheng
- Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medical for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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22
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Chang L, Zhao K. Construction and validation of an innovative prognostic nomogram for overall survival in cervical cancer patients with lung metastasis: an analysis utilizing the SEER database. Front Oncol 2024; 14:1397454. [PMID: 38779094 PMCID: PMC11109392 DOI: 10.3389/fonc.2024.1397454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Purpose To facilitate patient consultation and assist in clinical decision-making, we developed a predictive model to analyze the overall survival (OS) rate of cervical cancer patients with concurrent lung metastasis for 6 months, 1 year, or 2 years. Methods We extracted data on patients diagnosed with cervical cancer and concurrent lung metastasis between 2010 and 2020 from the Surveillance, Epidemiology, and End Results (SEER) database. Through a random assignment process, these patients were allocated to either a training cohort or a validation cohort, maintaining a 7:3 ratio. Utilizing both univariate and multivariate Cox regression analyses, we determined the independent prognostic factors influencing OS. To enhance predictive accuracy, we developed a nomogram model incorporating these identified independent prognostic variables. Model effectiveness was subsequently assessed using various metrics, including receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Results We gathered data on 1330 patients diagnosed with cervical cancer with lung metastases. An OS nomogram was developed, accounting for factors such as histological type, presence of metastases in other organs (brain, liver), surgical interventions, radiation therapy, and chemotherapy. The ROC curves, calibration plots, and DCA curves demonstrated the commendable predictive performance of the nomogram in assessing the prognosis of cervical cancer patients with lung metastases in both the training and validation cohorts. Conclusion By utilizing clinical data from the SEER database, we have effectively devised a nomogram capable of predicting the 6-month, 1-year, and 2-year survival rates of cervical cancer patients with lung metastases. The nomogram boasts high accuracy, offering precise prognostic predictions. Its implementation can guide the formulation of individualized follow-up and treatment plans for enhanced patient care.
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Affiliation(s)
- Linlin Chang
- Department of 2st Gynecologic Oncology, Jilin Cancer Hospital, Changchun, China
| | - Kangkang Zhao
- Department of 4st Radiotherapy, Jilin Cancer Hospital, Changchun, China
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23
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Monk BJ, Colombo N, Tewari KS, Tekin C, Keefe SM, Lorusso D. Reply to P.-H. Luo et al. J Clin Oncol 2024; 42:1596-1598. [PMID: 38452314 DOI: 10.1200/jco.24.00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- Bradley J Monk
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
| | - Nicoletta Colombo
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
| | - Krishnansu S Tewari
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
| | - Cumhur Tekin
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
| | - Stephen M Keefe
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
| | - Domenica Lorusso
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
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Oaknin A, Moore K, Meyer T, López-Picazo González J, Devriese LA, Amin A, Lao CD, Boni V, Sharfman WH, Park JC, Tahara M, Topalian SL, Magallanes M, Molina Alavez A, Khan TA, Copigneaux C, Lee M, Garnett-Benson C, Wang X, Naumann RW. Nivolumab with or without ipilimumab in patients with recurrent or metastatic cervical cancer (CheckMate 358): a phase 1-2, open-label, multicohort trial. Lancet Oncol 2024; 25:588-602. [PMID: 38608691 DOI: 10.1016/s1470-2045(24)00088-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND In preliminary findings from the recurrent or metastatic cervical cancer cohort of CheckMate 358, nivolumab showed durable anti-tumour responses, and the combination of nivolumab plus ipilimumab showed promising clinical activity. Here, we report long-term outcomes from this cohort. METHODS CheckMate 358 was a phase 1-2, open-label, multicohort trial. The metastatic cervical cancer cohort enrolled patients from 30 hospitals and cancer centres across ten countries. Female patients aged 18 years or older with a histologically confirmed diagnosis of squamous cell carcinoma of the cervix with recurrent or metastatic disease, an Eastern Cooperative Oncology Group performance status of 0 or 1, and up to two previous systemic therapies were enrolled into the nivolumab 240 mg every 2 weeks group, the randomised groups (nivolumab 3 mg/kg every 2 weeks plus ipilimumab 1 mg/kg every 6 weeks [NIVO3 plus IPI1] or nivolumab 1 mg/kg every 3 weeks plus ipilimumab 3 mg/kg every 3 weeks for four cycles then nivolumab 240 mg every 2 weeks [NIVO1 plus IPI3]), or the NIVO1 plus IPI3 expansion group. All doses were given intravenously. Patients were randomly assigned (1:1) to NIVO3 plus IPI1 or NIVO1 plus IPI3 via an interactive voice response system. Treatment continued until disease progression, unacceptable toxicity, or consent withdrawal, or for up to 24 months. The primary endpoint was investigator-assessed objective response rate. Anti-tumour activity and safety were analysed in all treated patients. This study is registered with ClinicalTrials.gov (NCT02488759) and is now completed. FINDINGS Between October, 2015, and March, 2020, 193 patients were recruited in the recurrent or metastatic cervical cancer cohort of CheckMate 358, of whom 176 were treated. 19 patients received nivolumab monotherapy, 45 received NIVO3 plus IPI1, and 112 received NIVO1 plus IPI3 (45 in the randomised group and 67 in the expansion group). Median follow-up times were 19·9 months (IQR 8·2-44·8) with nivolumab, 12·6 months (7·8-37·1) with NIVO3 plus IPI1, and 16·7 months (7·2-27·5) with pooled NIVO1 plus IPI3. Objective response rates were 26% (95% CI 9-51; five of 19 patients) with nivolumab, 31% (18-47; 14 of 45 patients) with NIVO3 plus IPI1, 40% (26-56; 18 of 45 patients) with randomised NIVO1 plus IPI3, and 38% (29-48; 43 of 112 patients) with pooled NIVO1 plus IPI3. The most common grade 3-4 treatment-related adverse events were diarrhoea, hepatic cytolysis, hyponatraemia, pneumonitis, and syncope (one [5%] patient each; nivolumab group), diarrhoea, increased gamma-glutamyl transferase, increased lipase, and vomiting (two [4%] patients each; NIVO3 plus IPI1 group), and increased lipase (nine [8%] patients) and anaemia (seven [6%] patients; pooled NIVO1 plus IPI3 group). Serious treatment-related adverse events were reported in three (16%) patients in the nivolumab group, 12 (27%) patients in the NIVO3 plus IPI1 group, and 47 (42%) patients in the pooled NIVO1 plus IPI3 group. There was one treatment-related death due to immune-mediated colitis in the NIVO1 plus IPI3 group. INTERPRETATION Nivolumab monotherapy and nivolumab plus ipilimumab combination therapy showed promise in the CheckMate 358 study as potential treatment options for recurrent or metastatic cervical cancer. Future randomised controlled trials of nivolumab plus ipilimumab or other dual immunotherapy regimens are warranted to confirm treatment benefit in this patient population. FUNDING Bristol Myers Squibb and Ono Pharmaceutical.
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Affiliation(s)
- Ana Oaknin
- Medical Oncology Service, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Kathleen Moore
- Stephenson Cancer Center, Oklahoma City, OK, USA; Sarah Cannon Research Institute, Nashville, TN, USA
| | - Tim Meyer
- University College London, London, UK
| | | | - Lot A Devriese
- Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | - Asim Amin
- Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | | | - Valentina Boni
- Medical Oncology, START Madrid, Centro Integral Oncológico Clara Campal, Hospital Madrid Norte Sanchinarro, Madrid, Spain
| | - William H Sharfman
- Johns Hopkins Bloomberg-Kimmel Institute for Cancer Immunotherapy and Kimmel Cancer Center, Baltimore, MD, USA
| | | | - Makoto Tahara
- National Cancer Center Hospital East, Kashiwa, Japan
| | - Suzanne L Topalian
- Johns Hopkins Bloomberg-Kimmel Institute for Cancer Immunotherapy and Kimmel Cancer Center, Baltimore, MD, USA
| | | | | | | | | | - Michelle Lee
- Bristol Myers Squibb, Princeton, NJ, USA; Syneos Health, Morrisville, NC, USA
| | | | - Xuya Wang
- Bristol Myers Squibb, Princeton, NJ, USA
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Lou H, Cai H, Huang X, Li G, Wang L, Liu F, Qin W, Liu T, Liu W, Wang ZM, Li B, Xia Y, Wang J. Cadonilimab Combined with Chemotherapy with or without Bevacizumab as First-Line Treatment in Recurrent or Metastatic Cervical Cancer (COMPASSION-13): A Phase 2 Study. Clin Cancer Res 2024; 30:1501-1508. [PMID: 38372727 PMCID: PMC11016896 DOI: 10.1158/1078-0432.ccr-23-3162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/04/2023] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE Immune checkpoint inhibitors (ICI) have been a potential treatment option for patients with cervical cancer in several clinical studies. We investigated the safety and efficacy of cadonilimab, a bispecific antibody targeting PD-1 and CTLA-4, plus standard therapy for the first-line treatment of R/M CC (recurrent and/or metastatic cervical cancer). PATIENTS AND METHODS Eligible patients were assigned to 3 cohorts: cohort A-15 (cadonilimab 15 mg/kg every 3 weeks (Q3W) plus chemotherapy), cohort A-10 (cadonilimb 10 mg/kg Q3W plus chemotherapy), and cohort B-10 (cadonilimab 10 mg/kg Q3W plus chemotherapy and bevacizumab). They received the corresponding treatments until disease progression, unacceptable toxicity, withdrawal of consent, or investigator decision. The primary objective was safety; the secondary endpoints included objective overall response (ORR), duration of response, disease control rate, progression-free survival, and overall survival. This study is registered with ClinicalTrials.gov (NCT04868708). RESULTS As of February 13, 2023, treatment-related adverse events (TRAE) occurred in 45 (100.0%) patients. Grade ≥3 TRAEs were reported in 33 (73.3%) patients. Immune-related adverse events (irAE) occurred in 29 (64.4%) patients and grade ≥3 irAEs were observed in 9 (20.0%) patients. Seven (15.6%) of 45 patients permanently discontinued cadonilimab treatment due to TRAEs. One death due to hemorrhagic shock occurred in cohort B-10. Among 44 patients who underwent at least one post-baseline tumor assessment, the ORR was 66.7% in cohort A-15, 68.8% in cohort A-10, 92.3% in cohort B-10, and 79.3% in cohorts A-10 and B-10 combined. CONCLUSIONS Cadonilimab combined with standard therapy was acceptable, with encouraging antitumor activity in patients with R/M CC.
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Affiliation(s)
- Hanmei Lou
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Hongbing Cai
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xin Huang
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Guiling Li
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Wang
- Henan Cancer Hospital, Zhengzhou, China
| | - Fei Liu
- Akeso Biopharma Inc., Zhongshan, China
| | | | - Ting Liu
- Akeso Biopharma Inc., Zhongshan, China
| | - Wei Liu
- Akeso Biopharma Inc., Zhongshan, China
| | | | | | - Yu Xia
- Akeso Biopharma Inc., Zhongshan, China
| | - Jing Wang
- Hunan Cancer Hospital, Changsha, China
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Liu P, Xie L, Wu Q, Huang L, Liu X, Li W, Cai J, Wang Z, Yang P, Cai L. TIE1 promotes cervical cancer progression via Basigin-matrix metalloproteinase axis. Int J Biol Sci 2024; 20:2297-2309. [PMID: 38617545 PMCID: PMC11008262 DOI: 10.7150/ijbs.93667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/23/2024] [Indexed: 04/16/2024] Open
Abstract
Background: Tyrosine kinase with immunoglobulin and EGF-like domains 1 (TIE1) is known as an orphan receptor prominently expressed in endothelial cells and participates in angiogenesis by regulating TIE2 activity. Our previous study demonstrated elevated TIE1 expression in cervical cancer cells. However, the role of TIE1 in cervical cancer progression, metastasis and treatment remains elusive. Methods: Immunohistochemistry staining for TIE1 and Basigin was performed in 135 human cervical cancer tissues. Overexpressing vectors and siRNAs were used to manipulate gene expression in tumor cells. Colony formation, wound healing, and transwell assays were used to assess cervical cancer cell proliferation and migration in vitro. Subcutaneous xenograft tumor and lung metastasis mouse models were established to examine tumor growth and metastasis. Co-Immunoprecipitation and Mass Spectrometry were applied to explore the proteins binding to TIE1. Immunoprecipitation and immunofluorescence staining were used to verify the interaction between TIE1 and Basigin. Cycloheximide chase assay and MG132 treatment were conducted to analyze protein stability. Results: High TIE1 expression was associated with poor survival in cervical cancer patients. TIE1 overexpression promoted the proliferation, migration and invasion of cervical cancer cells in vitro, as well as tumor growth and metastasis in vivo. In addition, Basigin, a transmembrane glycoprotein, was identified as a TIE1 binding protein, suggesting a pivotal role in matrix metalloproteinase regulation, angiogenesis, cell adhesion, and immune responses. Knockdown of Basigin or treatment with the Basigin inhibitor AC-73 reversed the tumor-promoting effect of TIE1 in vitro and in vivo. Furthermore, we found that TIE1 was able to interact with and stabilize the Basigin protein and stimulate the Basigin-matrix metalloproteinase axis. Conclusion: TIE1 expression in cervical cells exerts a tumor-promoting effect, which is at least in part dependent on its interaction with Basigin. These findings have revealed a TIE2-independent mechanism of TIE1, which may provide a new biomarker for cervical cancer progression, and a potential therapeutic target for the treatment of cervical cancer patients.
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Affiliation(s)
- Pan Liu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lisha Xie
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Qiulei Wu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lin Huang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiaoli Liu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wenhan Li
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jing Cai
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zehua Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ping Yang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi 832003, China
| | - Liqiong Cai
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Chen D, Cai B, Zhu Y, Ma Y, Yu X, Xiong J, Shen J, Tie W, Zhang Y, Guo F. Targeting histone demethylases JMJD3 and UTX: selenium as a potential therapeutic agent for cervical cancer. Clin Epigenetics 2024; 16:51. [PMID: 38576048 PMCID: PMC10993516 DOI: 10.1186/s13148-024-01665-3] [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: 12/09/2023] [Accepted: 03/26/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The intriguing connection between selenium and cancer resembles a captivating puzzle that keeps researchers engaged and curious. While selenium has shown promise in reducing cancer risks through supplementation, its interaction with epigenetics in cervical cancer remains a fascinating yet largely unexplored realm. Unraveling the intricacies of selenium's role and its interaction with epigenetic factors could unlock valuable insights in the battle against this complex disease. RESULT Selenium has shown remarkable inhibitory effects on cervical cancer cells in various ways. In in vitro studies, it effectively inhibits the proliferation, migration, and invasion of cervical cancer cells, while promoting apoptosis. Selenium also demonstrates significant inhibitory effects on human cervical cancer-derived organoids. Furthermore, in an in vivo study, the administration of selenium dioxide solution effectively suppresses the growth of cervical cancer tumors in mice. One of the mechanisms behind selenium's inhibitory effects is its ability to inhibit histone demethylases, specifically JMJD3 and UTX. This inhibition is observed both in vitro and in vivo. Notably, when JMJD3 and UTX are inhibited with GSK-J4, similar biological effects are observed in both in vitro and in vivo models, effectively inhibiting organoid models derived from cervical cancer patients. Inhibiting JMJD3 and UTX also induces G2/M phase arrest, promotes cellular apoptosis, and reverses epithelial-mesenchymal transition (EMT). ChIP-qPCR analysis confirms that JMJD3 and UTX inhibition increases the recruitment of a specific histone modification, H3K27me3, to the transcription start sites (TSS) of target genes in cervical cancer cells (HeLa and SiHa cells). Furthermore, the expressions of JMJD3 and UTX are found to be significantly higher in cervical cancer tissues compared to adjacent normal cervical tissues, suggesting their potential as therapeutic targets. CONCLUSIONS Our study highlights the significant inhibitory effects of selenium on the growth, migration, and invasion of cervical cancer cells, promoting apoptosis and displaying promising potential as a therapeutic agent. We identified the histone demethylases JMJD3 and UTX as specific targets of selenium, and their inhibition replicates the observed effects on cancer cell behavior. These findings suggest that JMJD3 and UTX could be valuable targets for selenium-based treatments of cervical cancer.
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Affiliation(s)
- Dezhi Chen
- Ningbo Institute of Innovation for Combined Medicine and Engineering (NIIME), Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, 315100, Zhejiang Province, China
- The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Bo Cai
- The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi Province, China
- Jiangxi Maternal and Child Health Hospital, Nanchang, 330008, Jiangxi Province, China
| | - Yingying Zhu
- Ningbo Institute of Innovation for Combined Medicine and Engineering (NIIME), Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, 315100, Zhejiang Province, China
| | - Yimin Ma
- Ningbo Institute of Innovation for Combined Medicine and Engineering (NIIME), Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, 315100, Zhejiang Province, China
| | - Xiaoting Yu
- The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Jieqi Xiong
- Jiangxi Maternal and Child Health Hospital, Nanchang, 330008, Jiangxi Province, China
| | - Jiaying Shen
- Ningbo Institute of Innovation for Combined Medicine and Engineering (NIIME), Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, 315100, Zhejiang Province, China
| | - Weiwei Tie
- Ningbo Institute of Innovation for Combined Medicine and Engineering (NIIME), Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, 315100, Zhejiang Province, China
| | - Yisheng Zhang
- Ningbo Institute of Innovation for Combined Medicine and Engineering (NIIME), Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, 315100, Zhejiang Province, China
| | - Fei Guo
- Ningbo Institute of Innovation for Combined Medicine and Engineering (NIIME), Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, 315100, Zhejiang Province, China.
- The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi Province, China.
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Babayan LM, Bouts C, Guntupalli S, Marjon NA. Exploring tisotumab vedotin in recurrent cervical cancer: A case series including an HPV-independent gastric type adenocarcinoma. Gynecol Oncol Rep 2024; 52:101356. [PMID: 38523623 PMCID: PMC10958683 DOI: 10.1016/j.gore.2024.101356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
Metastatic and recurrent cervical cancer is difficult to treat with limited options following platinum-based chemotherapy. Tisotumab vedotin (TV) is an antibody drug conjugate (ADC) targeted at a tissue factor (TF), which is a cell surface protein that is upregulated in the majority of cervical cancers. Prior clinical trials have demonstrated efficacy of TV in metastatic and recurrent cervical cancer with an objective response rate of 24-26 % with an 8.3 month duration of response. In this case series, we present 3 patients with recurrent or progressive cervical cancer of three different histologies (squamous cell, adenocarcinoma, and human papillomavirus (HPV)-independent gastric type carcinomas). We demonstrate a 100 % complete response rate with average time of complete response of 4.33 months. The duration of response was not reached as none of our patients had a confirmed progression at the time of writing this manuscript, but the mean time since the initiation of treatment was 6.1 months. In concordance with the clinical trials, our patients tolerated TV well although the grade 3 ocular toxicities were higher in our patients compared to prior data. This case series presents data confirming the efficacy and tolerability of TV in patients with recurrent cervical cancer, including an HPV-independent gastric type cervical cancer.
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Affiliation(s)
- Lisa Marie Babayan
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Catherine Bouts
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Saketh Guntupalli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicole A. Marjon
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, USA
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Gass P, Thiel FC, Häberle L, Ackermann S, Theuser AK, Hummel N, Boehm S, Kimmig R, Reinthaller A, Becker S, Hilpert F, Janni W, Vergote I, Harter P, Emons J, Hein A, Beckmann MW, Fasching PA, Pöschke P. Primary results of the AGO-Zervix-1 Study: A prospective, randomized phase III study to compare the effects of paclitaxel and topotecan with those of cisplatin and topotecan in the treatment of patients with recurrent and persistent cervical cancer. Gynecol Oncol 2024; 183:25-32. [PMID: 38490057 DOI: 10.1016/j.ygyno.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Before the era of immunotherapies and antibody-drug conjugates, there were limited chemotherapeutic options for patients with recurrent and metastatic cervical cancer. Combination therapies with cisplatin have shown some superiority over monotherapy. This study examined platinum-free treatment regimens, comparing a combination of topotecan and paclitaxel (TP) with topotecan and cisplatin (TC) in patients with recurrent or metastatic cervical cancer, with or without prior platinum-based treatment. METHODS The AGO-Zervix-1 Study (NCT01405235) is a prospective, randomized phase III study in which patients were randomly assigned at a 1:1 ratio to treatment within the control arm with topotecan (0.75 mg/m2) on days 1-3 and cisplatin (50 mg/m2) on day 1 every 3 weeks and in the study arm topotecan (1.75 mg/m2) and paclitaxel (70 mg/m2) on days 1, 8, and 15 every 4 weeks or treatment. The primary study aim was overall survival; progression-free survival, toxicity, and quality of life were secondary aims. The interim and final analysis is here reported after recruitment of 173 of 312 planned patients. RESULTS Median overall survival in the TP arm was 9.6 months, compared with 12.0 months in the TC arm (log-rank test, P = 0.33). Median progression-free survival rates were 4.4 months with TP and 4.2 months with TC (log-rank test, P = 0.47). Leukopenia and nausea/vomiting were more frequent in the cisplatin-containing arm. Otherwise, toxicity profiles were comparable. There were no differences in FACT-G-assessed quality of life. CONCLUSION Platinum-based combination chemotherapy remains the standard of care chemotherapy regimen for patients with recurrent or metastatic cervical cancer.
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Affiliation(s)
- Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Falk C Thiel
- Department of Gynecology and Obstetrics, Alb Fils Clinics, Klinik am Eichert, Göppingen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany; Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany
| | - Sven Ackermann
- Department of Gynecology and Obstetrics, Klinikum Darmstadt, Darmstadt, Germany
| | | | - Nadine Hummel
- Institut für Frauengesundheit GmbH, Erlangen, Germany
| | - Sibylle Boehm
- Institut für Frauengesundheit GmbH, Erlangen, Germany
| | - Rainer Kimmig
- Department of Gynecology and Obstetrics, Essen University Hospital, Essen, Germany
| | - Alexander Reinthaller
- Department of Gynecology and Gynecologic Oncology, AKH Vienna University Hospital, Vienna, Austria
| | - Sven Becker
- Department of Gynecology and Obstetrics, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Felix Hilpert
- Onkologisches Therapiezentrum, Krankenhaus Jerusalem, Hamburg, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Ignace Vergote
- Department of Gynaecology and Obstetrics, Division of Gynaecological Oncology, Leuven University Hospitals, Leuven, Belgium
| | - Phlipp Harter
- Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Hein
- Department of Gynaecology and Obstetrics, Klinikum Esslingen, Esslingen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Patrik Pöschke
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Le Guévelou J, Selleret L, Laas E, Lecuru F, Kissel M. Cervical Cancer Associated with Pregnancy: Current Challenges and Future Strategies. Cancers (Basel) 2024; 16:1341. [PMID: 38611019 PMCID: PMC11011172 DOI: 10.3390/cancers16071341] [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: 02/19/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer during pregnancy is defined as a tumor diagnosed in a pregnant woman or up to 1-year post-partum. While being a rare disease, cervical cancer is probably one of the most challenging medical conditions, with the dual stake of treating the cancer without compromising its chances for cure, while preserving the pregnancy and the health of the fetus and child. To date, guidelines for gynecological cancers are provided through international consensus meetings with expert panels, giving insights on both diagnosis, treatment, and obstetrical care. However, these expert guidelines do not discuss the various approaches than can be found within the literature, such as alternative staging modalities or innovative surgical approaches. Also, the obstetrical care of women diagnosed with cervical cancer during pregnancy requires specific considerations that are not provided within our current standard of care. This systematic review aims to fill the gap on current issues with regards to the management of cervical cancer during pregnancy and provide future directions within this evolving landscape.
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Affiliation(s)
- Jennifer Le Guévelou
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Department of Radiation Oncology, Centre Eugène Marquis, 35000 Rennes, France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75005 Paris, France
- Cancer Associé à La Grossesse (CALG), French CALG Network, 75005 Paris, France
| | - Enora Laas
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
| | - Fabrice Lecuru
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
- Université de Paris, 75006 Paris, France
| | - Manon Kissel
- Department of Radiation Oncology, Institut Curie, 75005 Paris, France
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31
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Fang C, Zhou Y, Feng Y, He L, Yu J, Li Y, Feng M, Pan M, Zhao L, Tang D, Li X, Tan B, An R, Zheng X, Si M, Zhang B, Li L, Kang X, Zhou Q, Liu J. QL1604 plus paclitaxel-cisplatin/carboplatin in patients with recurrent or metastatic cervical cancer: an open-label, single-arm, phase II trial. J Gynecol Oncol 2024; 35:35.e77. [PMID: 38606822 DOI: 10.3802/jgo.2024.35.e77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/28/2024] [Accepted: 02/25/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE QL1604 is a highly selective, humanized monoclonal antibody against programmed death protein 1. We assessed the efficacy and safety of QL1604 plus chemotherapy as first-line treatment in patients with advanced cervical cancer. METHODS This was a multicenter, open-label, single-arm, phase II study. Patients with advanced cervical cancer and not previously treated with systemic chemotherapy were enrolled to receive QL1604 plus paclitaxel and cisplatin/carboplatin on day 1 of each 21-day cycle for up to 6 cycles, followed by QL1604 maintenance treatment. RESULTS Forty-six patients were enrolled and the median follow-up duration was 16.5 months. An 84.8% of patients had recurrent disease and 13.0% had stage IVB disease. The objective response rate (ORR) per Response Evaluation Criteria in Advanced Solid Tumors (RECIST) v1.1 was 58.7% (27/46). The immune ORR per immune RECIST was 60.9% (28/46). The median duration of response was 9.6 months (95% confidence interval [CI]=5.5-not estimable). The median progression-free survival was 8.1 months (95% CI=5.7-14.0). Forty-five (97.8%) patients experienced treatment-related adverse events (TRAEs). The most common grade≥3 TRAEs (>30%) were neutrophil count decrease (50.0%), anemia (32.6%), and white blood cell count decrease (30.4%). CONCLUSION QL1604 plus paclitaxel-cisplatin/carboplatin showed promising antitumor activity and manageable safety profile as first-line treatment in patients with advanced cervical cancer. Programmed cell death protein 1 inhibitor plus chemotherapy may be a potential treatment option for the patient population who have contraindications or can't tolerate bevacizumab, which needs to be further verified in phase III confirmatory study. Trial RegistrationClinicalTrials.gov Identifier: NCT04864782.
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Affiliation(s)
- Cheng Fang
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yun Zhou
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yanling Feng
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Liping He
- Department of Gynecological Oncology Surgery, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Jinjin Yu
- Department of Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yuzhi Li
- Department of Gynecologic Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Mei Feng
- Department of Gynecological Radiation Oncology, Fujian Cancer Hospital, Fuzhou, China
| | - Mei Pan
- Department of Medical Oncology, Jiangxi Maternal and Child Health Care Hospital, Nanchang, China
| | - Lina Zhao
- Department of Radiotherapy, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Dihong Tang
- Gynecological Oncology Department IV, Hunan Cancer Hospital, Changsha, China
| | - Xiumin Li
- Department of Gynecology, Linyi Cancer Hospital, Linyi, China
| | - Buzhen Tan
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ruifang An
- Department of Gynecology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | | | - Meimei Si
- Qilu Pharmaceutical Co., Ltd., Jinan, China
| | | | - Lingyan Li
- Qilu Pharmaceutical Co., Ltd., Jinan, China
| | | | - Qi Zhou
- Gynecological Oncology Center, Chongqing University Cancer Hospital, Chongqing, China.
| | - Jihong Liu
- Department of Gynecological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
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Zhu R, Chen TZ, Sun MT, Zhu CR. Advanced cervix cancer patient with chemotherapy-induced grade IV myelosuppression achieved complete remission with cadonilimab: A case report. World J Clin Cases 2024; 12:1510-1516. [PMID: 38576806 PMCID: PMC10989456 DOI: 10.12998/wjcc.v12.i8.1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/18/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The prognosis for patients with advanced metastatic cervix cancer (MCC) is poor, and this disease continues to pose a considerable therapeutic challenge. Despite the administration of first-line regimens consisting of cisplatin, paclitaxel, and bevacizumab, survival rates for patients with metastasis remain poor. The emergence of bispecific antibodies (BsAbs) offers a novel treatment option for patients diagnosed with MCC. CASE SUMMARY In this report, we present a patient with MCC who was treated with cadonilimab monotherapy at a dose of 6 mg/kg every two weeks after chemotherapy was proven to be intolerable. The patient exhibited a sustained complete response for a duration of 6 months, demonstrating an optimistic outlook. CONCLUSION This case illustrates the considerable efficacy of cadonilimab for treating advanced MCC. Therefore, BsAb therapy is a promising strategy for effectively treating patients with advanced MCC and should be considered as an option when patients are intolerant to standard chemotherapy.
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Affiliation(s)
- Rui Zhu
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Tian-Ze Chen
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Meng-Ting Sun
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Chun-Rong Zhu
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
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33
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Peng C, Li X, Tang W, Zhu W, Yan P, Chen J, Zhang X, Guo Q, Wu Q, Wang Q, Liu N, Ma A, Lu Y, Lv P, Liu J, Xie P. Real-world outcomes of first-line maintenance therapy for recurrent or metastatic cervical cancer: A multi-center retrospective study. Int Immunopharmacol 2024; 129:111578. [PMID: 38330795 DOI: 10.1016/j.intimp.2024.111578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Maintenance therapy (MT) for recurrent or metastatic cervical cancer remains non-standardized. This study assessed MT effectiveness using a comprehensive approach and identifies prognosis factors inpatients with recurrent or metastatic cervical cancer. METHODS From January 2019 and December 2021, over 6000 patients from six Chinese institutions were retrospectively examined. Patients had recurrent/metastatic cervical cancer and underwent first-line chemotherapy with or without MT. We calculated overall and progression-free survival using Kaplan-Meier analysis, comparing via log-rank test, and conducted Cox regression for prognostic factors. RESULTS Overall, 274 patients were stratified into an MT group (n = 77) and a non-MT group (n = 197). The 3-year OS rates were 52.5 % and 28.0 % for the MT and non-MT groups, respectively. The MT group had significantly enhanced median OS (37 vs. 21 months; HR, 0.43; 95 % CI, 0.30-0.61; P < 0.001) and PFS (21 vs. 14 months; HR, 0.65; 95 % CI, 0.47-0.90; P = 0.014) compared with the non-MT group. No significant differences in efficacy were observed among the various MT regimens, whether PD-1 monoclonal antibody, targeted therapeutic agents, or a combination of both. Extended PFS and OS were observed in patients receiving > 8 MT cycles. Multivariate analyses revealed that oligometastasis, MT, exclusive prior surgery (as opposed to combined surgery and radiotherapy), and extended interval before recurrence were independent OS predictors (P = 0.045, P < 0.001, P = 0.010, and P = 0.005, respectively); oligometastasis, concurrent radiotherapy, MT, and extended interval before recurrence were independent PFS predictors (P = 0.004, P = 0.007, P = 0.009, and P = 0.003). CONCLUSIONS The MT integration markedly extended PFS and OS in patients diagnosed with recurrent or metastatic cervical cancer.
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Affiliation(s)
- Chen Peng
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China; Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xiaolin Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Wenjie Tang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Wanqi Zhu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Peile Yan
- China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Jinlong Chen
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xueliang Zhang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Qiufen Guo
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Qian Wu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Qian Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Naifu Liu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Anqun Ma
- East Hospital of Shandong First Medical University Affiliated Provincial Hospital, Jinan, Shandong, China
| | - Yuanyuan Lu
- The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Pengzhong Lv
- The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, Shandong, China
| | - Jing Liu
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Peng Xie
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
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Sitler CA, Tian C, Hamilton CA, Richardson MT, Chan JK, Kapp DS, Leath CA, Casablanca Y, Washington C, Chappell NP, Klopp AH, Shriver CD, Tarney CM, Bateman NW, Conrads TP, Maxwell GL, Phippen NT, Darcy KM. Immuno-Molecular Targeted Therapy Use and Survival Benefit in Patients with Stage IVB Cervical Carcinoma in Commission on Cancer ®-Accredited Facilities in the United States. Cancers (Basel) 2024; 16:1071. [PMID: 38473428 DOI: 10.3390/cancers16051071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE To investigate IMT use and survival in real-world stage IVB cervical cancer patients outside randomized clinical trials. METHODS Patients diagnosed with stage IVB cervical cancer during 2013-2019 in the National Cancer Database and treated with chemotherapy (CT) ± external beam radiation (EBRT) ± intracavitary brachytherapy (ICBT) ± IMT were studied. The adjusted hazard ratio (AHR) and 95% confidence interval (CI) for risk of death were estimated in patients treated with vs. without IMT after applying propensity score analysis to balance the clinical covariates. RESULTS There were 3164 evaluable patients, including 969 (31%) who were treated with IMT. The use of IMT increased from 11% in 2013 to 46% in 2019. Age, insurance, facility type, sites of distant metastasis, and type of first-line treatment were independently associated with using IMT. In propensity-score-balanced patients, the median survival was 18.6 vs. 13.1 months for with vs. without IMT (p < 0.001). The AHR was 0.72 (95% CI = 0.64-0.80) for adding IMT overall, 0.72 for IMT + CT, 0.66 for IMT + CT + EBRT, and 0.69 for IMT + CT + EBRT + ICBT. IMT-associated survival improvements were suggested in all subgroups by age, race/ethnicity, comorbidity score, facility type, tumor grade, tumor size, and site of metastasis. CONCLUSIONS IMT was associated with a consistent survival benefit in real-world patients with stage IVB cervical cancer.
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Affiliation(s)
- Collin A Sitler
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA 70115, USA
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, Los Angeles School of Medicine, University of California, Los Angeles, CA 90024, USA
| | - John K Chan
- Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA 94010, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL 35249, USA
| | - Yovanni Casablanca
- Gynecologic Oncology Division, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA
| | - Christina Washington
- Gynecologic Oncology Division, Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Nicole P Chappell
- Gynecologic Oncology Division, GW Medical Faculty Associates, George Washington University, Washington, DC 20037, USA
| | - Ann H Klopp
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Christopher M Tarney
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Nicholas W Bateman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA 22042, USA
| | - George Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA 22042, USA
| | - Neil T Phippen
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
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Żak K, Satora M, Skrabalak I, Tarkowski R, Ostrowska-Leśko M, Bobiński M. The Potential Influence of Residual or Recurrent Disease on Bevacizumab Treatment Efficacy in Ovarian Cancer: Current Evidence and Future Perspectives. Cancers (Basel) 2024; 16:1063. [PMID: 38473419 DOI: 10.3390/cancers16051063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
There were high hopes for the new antiangiogenic medicament, bevacizumab, which could inhibit the creation of new blood vessels through binding to isoform A of vascular endothelial growth factor (VEGF). However, it is not only blood vessels that are responsible for tumor cell spread. During the process of tumor growth, lymphangiogenesis is mediated by other members of the VEGF family, specifically VEGF-C and VEGF-D, which act independent to bevacizumab. Therefore, based on the mechanism of bevacizumab action and the processes of angio- and lymphangiogenesis, we formed three hypotheses: (1) if the lymph nodes in primary ovarian cancers are metastatic, the outcome of bevacizumab treatment is worsened; (2) concerning the second-line treatment, bevacizumab will act in a weakened manner if recurrence occurs in lymph nodes as opposed to a local recurrence; (3) patients treated by bevacizumab are more likely to have recurrences in lymph nodes. These hypotheses raise the issue of the existing knowledge gap, which concerns the effect of bevacizumab on metastatic lymph nodes.
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Affiliation(s)
- Klaudia Żak
- Department of Medical Chemistry, Medical University of Lublin, 20-059 Lublin, Poland
| | - Małgorzata Satora
- I Chair and Department of Oncological Gynaecology and Gynaecology, Student Scientific Association, Medical University of Lublin, 20-059 Lublin, Poland
| | - Ilona Skrabalak
- I Chair and Department of Oncological Gynaecology and Gynaecology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Rafał Tarkowski
- I Chair and Department of Oncological Gynaecology and Gynaecology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Marta Ostrowska-Leśko
- Chair and Department of Toxicology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Marcin Bobiński
- I Chair and Department of Oncological Gynaecology and Gynaecology, Medical University of Lublin, 20-059 Lublin, Poland
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Yildirim HC, Anik H, Ozdemir DA, Ismayilov R, Akyildiz A, Cayiroz K, Ceyhan F, Kavruk O, Guven DC, Ates O, Usubutun A, Arik Z. Effect of hypoxia-inducible factor-1 alpha expression on survival in patients with metastatic cervical squamous cell carcinoma treated with first-line chemotherapy and bevacizumab. BIOMOLECULES & BIOMEDICINE 2024; 24:998-1003. [PMID: 38447002 PMCID: PMC11293214 DOI: 10.17305/bb.2024.10255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
This study addresses the gap in understanding the prognostic relevance of hypoxia-inducible factor-1 alpha (HIF-1 alpha) expression in metastatic cervical squamous cell carcinoma (SCC) patients undergoing anti-vascular endothelial growth factor (VEGF)-based therapy. A retrospective multicenter study (n = 34) explored HIF-1 alpha expression via immunohistochemistry in patients treated with platinum chemotherapy and bevacizumab. Median progression-free survival (PFS) was significantly lower in the HIF-1 alpha low score group compared to the high score group (4.9 vs 12.9 months, P = 0.014). Similarly, the median overall survival (OS) was significantly reduced in the HIF-1 alpha low score group (8.3 vs 20.4 months, P = 0.006). This study, the first of its kind, highlights the prognostic significance of HIF-1 alpha expression in metastatic cervical SCC patients treated with bevacizumab-based therapy.
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Affiliation(s)
- Hasan Cagri Yildirim
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Hicran Anik
- Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Training and Research Hospital, Ankara, Turkey
| | - Deniz Ates Ozdemir
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Rashad Ismayilov
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arif Akyildiz
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Kerim Cayiroz
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fahri Ceyhan
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Oguzalp Kavruk
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Ozturk Ates
- Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Training and Research Hospital, Ankara, Turkey
| | - Alp Usubutun
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zafer Arik
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Peters I, Marchetti C, Scambia G, Fagotti A. New windows of surgical opportunity for gynecological cancers in the era of targeted therapies. Int J Gynecol Cancer 2024; 34:352-362. [PMID: 38438181 DOI: 10.1136/ijgc-2023-004580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Precision medicine through molecular profiling has taken a prominent role in the treatment of solid tumors and it is widely expected that this will continue to expand. With respect to gynecological cancers, a major change has particularly been observed in the treatment landscape of epithelial ovarian, endometrial, and cervical cancers. Regarding the former, maintenance therapy with either poly(ADP-ribose) polymerase inhibitors (PARPi) and/or bevacizumab has become an indispensable treatment option following the traditional combination of cytoreductive surgery and platinum-based chemotherapy. Considering endometrial cancer, the molecular classification system has now been incorporated into virtually every guideline available and molecular-directed treatment strategies are currently being researched, presumably leading to a further transformation of its treatment paradigm. After all, treatment with immune-checkpoint inhibitors that target the programmed cell death 1 (PD-1) receptor has already been shown to significantly improve disease outcomes in these patients, especially in those with mismatch repair deficient, microsatellite stability-high (MMRd-MSI-H) disease. Similarly, in recurrent/metastatic cervical cancer patients, these agents elicited improved survival rates when being added to platinum-based chemotherapy with or without bevacizumab. Interestingly, implications of these targeted therapies for surgical management have been touched on to a minor extent, but are at least as intriguing. This review therefore aims to address the wide-ranging opportunities the molecular tumor characteristics and their corresponding targeted therapies have to offer for the surgical management of epithelial ovarian, endometrial, and cervical cancers, both in the primary and recurrent setting.
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Affiliation(s)
- Inge Peters
- Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Claudia Marchetti
- Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Fagotti
- Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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Wilson EM, Eskander RN, Binder PS. Recent Therapeutic Advances in Gynecologic Oncology: A Review. Cancers (Basel) 2024; 16:770. [PMID: 38398161 PMCID: PMC10887183 DOI: 10.3390/cancers16040770] [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: 01/13/2024] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Gynecologic malignancies have high incidence rates both nationally and internationally, and cervical, endometrial, and ovarian cancers account for high mortality rates worldwide. Significant research is ongoing to develop targeted therapies to address unmet needs in the field and improve patient outcomes. As tumors mutate and progress through traditional lines of treatment, new therapies must be developed to overcome resistance and target cancer-specific receptors and mutations. Recent advances in the development of immunotherapy and antibody-drug conjugates have resulted in compelling and clinically meaningful results in cervical, endometrial, and ovarian cancers. In the last decade, several immunotherapy agents have received FDA approval or NCCN guideline recommendation for the treatment of gynecologic malignancies, including dostarlimab for advanced or recurrent endometrial cancer and pembrolizumab for advanced or recurrent cervical and endometrial cancers. Several other immunotherapeutic agents are under active investigation. Development of antibody-drug conjugates including tisotumab vedotin in cervical cancer, mirvetuximab soravtansine in ovarian cancer, and trastuzumab deruxtecan in multiple gynecologic cancers has translated into exciting efficacy signals, prompting full drug approvals and additional investigation. This article aims to review recent novel advances in targeted treatments for gynecologic malignancies, highlighting the trials and data underlying these novel interventions.
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Affiliation(s)
| | | | - Pratibha S. Binder
- Moores Cancer Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, CA 92037, USA; (E.M.W.); (R.N.E.)
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Ma Y, Yang Z, Liu J, Wang D. CD48 suppresses proliferation and migration as an immune-related prognostic signature in the cervical cancer immune microenvironment. Carcinogenesis 2024; 45:57-68. [PMID: 37279525 DOI: 10.1093/carcin/bgad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 05/10/2023] [Accepted: 06/02/2023] [Indexed: 06/08/2023] Open
Abstract
Cervical cancer (CC) is one of the most common malignant tumors in gynecology. Immunotherapy and targeted therapy are two particularly effective treatments. In this study, weighted gene co-expression network analysis and CIBERSORT algorithm that quantifies the composition of immune cells were used to analyze CC expression data based on the GEO database and identify modules related to T cells. Five candidate hub genes were identified by tumor-infiltrating immune cells estimation and Kaplan-Meier survival analysis according to CC data from The Cancer Genome Atlas (TCGA). Chemotherapeutic response, methylation, and gene mutation analyses were implemented so that the five candidate hub genes identified may be the potential biomarkers and therapeutic targets which were related to T cell infiltration. Moreover, the results of RT-qPCR revealed that CD48 was a tumor suppressor gene, which was negatively correlated with CC stages, lymph node metastasis, and differentiation. Furthermore, the functional study verified that the interference of CD48 was able to boost the proliferation and migration ability in vitro and the growth of transplanted tumors in vivo. Overall, we identified molecular targets related to immune infiltration and prognosis, regarded CD48 as a key molecule involved in the progression of CC, thus providing new insights into the development of molecular therapy and immunotherapeutics against CC.
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Affiliation(s)
- Yue Ma
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P. R. China
| | - Zhuo Yang
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P. R. China
| | - Jing Liu
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P. R. China
| | - Danbo Wang
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P. R. China
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Tewari KS, Colombo N, Monk BJ, Dubot C, Cáceres MV, Hasegawa K, Shapira-Frommer R, Salman P, Yañez E, Gümüş M, Olivera Hurtado de Mendoza M, Samouëlian V, Castonguay V, Arkhipov A, Tekin C, Li K, Toker S, Keefe SM, Lorusso D. Pembrolizumab or Placebo Plus Chemotherapy With or Without Bevacizumab for Persistent, Recurrent, or Metastatic Cervical Cancer: Subgroup Analyses From the KEYNOTE-826 Randomized Clinical Trial. JAMA Oncol 2024; 10:185-192. [PMID: 38095881 PMCID: PMC10722390 DOI: 10.1001/jamaoncol.2023.5410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/22/2023] [Indexed: 12/17/2023]
Abstract
Importance The KEYNOTE-826 randomized clinical trial showed statistically significant and clinically meaningful survival benefits with the addition of pembrolizumab to chemotherapy with or without bevacizumab in patients with persistent, recurrent, or metastatic cervical cancer. Treatment effects in patient subgroups of the study population are unknown. Objective To assess efficacy outcomes in patient subgroups of KEYNOTE-826. Design, Setting, and Participants Exploratory subgroup analyses were conducted in a global, phase 3, randomized, double-blind, placebo-controlled clinical trial. Participants included women with persistent, recurrent, or metastatic adenocarcinoma, adenosquamous carcinoma, or squamous cell carcinoma of the cervix that had not been treated with systemic chemotherapy and was not amenable to curative treatment. This subanalysis was conducted from November 20, 2018, to May 3, 2021. Interventions Pembrolizumab, 200 mg, every 3 weeks or placebo for up to 35 cycles plus chemotherapy (paclitaxel, 175 mg/m2, plus cisplatin, 50 mg/m2, or carboplatin AUC 5 [area under the free carboplatin plasma concentration vs time curve]) with or without bevacizumab, 15 mg/kg. Main Outcomes and Measures Overall survival (OS) and progression-free survival (PFS) by investigator assessment per Response Evaluation Criteria in Solid Tumors version 1.1 in subgroups defined by use of bevacizumab (yes or no), choice of platinum (carboplatin or cisplatin), prior chemoradiotherapy (CRT) exposure only (yes or no), and histologic type (squamous or nonsquamous) in patients with programmed cell death ligand 1-positive tumors (defined as a combined positive score [CPS] ≥1) and in the intention-to-treat population. Results A total of 617 patients (median age, 51 years; range, 22-82 years) were enrolled in the trial. In the CPS greater than or equal to 1 population, hazard ratios (HRs) for OS favored the pembrolizumab group in all subgroups: with bevacizumab (HR, 0.62; 95% CI, 0.45-0.87) and without bevacizumab (HR, 0.67; 95% CI, 0.47-0.96), use of carboplatin (HR, 0.65; 95% CI, 0.50-0.85) and cisplatin (HR, 0.53; 95% CI, 0.27-1.04), with prior CRT only (HR, 0.56; 95% CI, 0.39-0.81) and without prior CRT only (HR, 0.72; 95% CI, 0.52-1.00), and squamous (HR, 0.60; 95% CI, 0.46-0.79) and nonsquamous (HR, 0.70; 95% CI, 0.41-1.20) histologic type. In the intention-to-treat population, HRs for OS also favored the pembrolizumab group in all subgroups: with bevacizumab (HR, 0.63; 95% CI, 0.47-0.87) and without bevacizumab (HR, 0.74; 95% CI, 0.53-1.04), use of carboplatin (HR, 0.69; 95% CI, 0.54-0.89) or cisplatin (HR, 0.59; 95% CI, 0.32-1.09), with prior CRT only (HR, 0.64; 95% CI, 0.45-0.91) and without prior CRT only (HR, 0.71; 95% CI, 0.53-0.97), and squamous (HR, 0.61; 95% CI, 0.47-0.80) and nonsquamous (HR, 0.76; 95% CI, 0.47-1.23) histologic type. Similar to OS, the addition of pembrolizumab prolonged PFS across all subgroups in the CPS greater than or equal to 1 and intention-to-treat populations. Conclusions and Relevance The findings of this trial suggest that adding pembrolizumab to chemotherapy with or without bevacizumab improved OS across subgroups of patients with persistent, recurrent, or metastatic cervical cancer. Trial Registration ClinicalTrials.gov Identifier: NCT03635567.
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Affiliation(s)
| | - Nicoletta Colombo
- Gynecologic Oncology, European Institute of Oncology IRCCS and Università degli Studi di Milano Bicocca, Milan, Italy
| | - Bradley J. Monk
- HonorHealth Research Institute, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix
| | - Coraline Dubot
- Oncologie Médicale, Institut Curie Saint Cloud, and GINECO, Paris, France
| | - M. Valeria Cáceres
- Medical Oncology, Instituto de Oncologia Angel H. Roffo, Buenos Aires, Argentina
| | - Kosei Hasegawa
- Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | | | - Pamela Salman
- Medical Oncology, Oncovida Cancer Center, Providencia, Santiago, Chile
| | - Eduardo Yañez
- Medical Oncology, Universidad de la Frontera, Temuco, Chile
| | - Mahmut Gümüş
- Medical Oncology, Istanbul Medeniyet University Hospital, Istanbul, Turkey
| | | | - Vanessa Samouëlian
- Gynecologic Oncology, Centre Hospitalier de l’Université de Montréal, Centre de Recherche de l’Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Vincent Castonguay
- Medical Oncology, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Alexander Arkhipov
- Oncology and Chemical Therapy, Medical Rehabilitation Center Under the Ministry of Health of Russian Federation, Moscow, Russian Federation
| | | | - Kan Li
- Oncology, Merck & Co, Inc, Rahway, New Jersey
| | | | | | - Domenica Lorusso
- Gynaecology Oncology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
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Bian Y, Zhang Z, Deng X, Wen Q, Li D. Case report: Giant lymph node metastases: a new opportunity for cancer radioimmunotherapy? Front Immunol 2024; 15:1357601. [PMID: 38348039 PMCID: PMC10859527 DOI: 10.3389/fimmu.2024.1357601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Abstract
Background Despite the significant progress made in radiotherapy and chemotherapy for the treatment of cervical cancer, patients with lymph node metastasis still have a poor prognosis. It is widely accepted that lymph node metastasis plays a crucial role in the spread of cancer to other organs and is considered an independent factor in predicting a poor prognosis. However, recent research suggests that the importance of lymph nodes in tumor therapy needs to be reevaluated, as preserving the integrity of lymph nodes before immunotherapy can enhance treatment effectiveness. Case presentation In this report, we present two cases of advanced cervical cancer patients with giant metastatic lymph node lesions in the neck. These patients were effectively treated with a combination of local radiotherapy and immunotherapy after conventional chemoradiotherapy had failed. The combination therapy resulted in significant clinical improvements, with patient 1 achieving over 12 months of progression-free survival (PFS) and patient 2 maintaining sustained remission for an impressive 24 months. Conclusions The combination of local radiotherapy and immunotherapy shows promise as a viable treatment option for cervical cancer patients with distant lymph node metastasis, and the giant lymph node metastases may play an important role in this process, which might provide a new opportunity for cancer radioimmunotherapy.
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Affiliation(s)
- Yuan Bian
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Zhenhua Zhang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xiangyu Deng
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Qinglian Wen
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dan Li
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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Qin Y, Guan P, Li D, He H, He W, Tan L, Deng X, Liao B, Wen Q, Zhang Z. Successful inguinal interstitial brachytherapy in metastatic cervical carcinoma: a case report. Front Oncol 2024; 13:1330681. [PMID: 38288097 PMCID: PMC10822930 DOI: 10.3389/fonc.2023.1330681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
Background Treatment of metastatic cervical cancer is a tricky issue. Currently, the National Comprehensive Cancer Network (NCCN) guideline recommends chemotherapy combined with bevacizumab for recurrent or metastatic cervical cancer. Still, the recurrence rate is high and the survival rate is low after standard treatment. We urgently need to achieve a multimodal therapy approach for recurrent or metastatic cervical cancer. Case description We report the case of a patient with stage IB2 cervical squamous carcinoma who developed multiple metastases within a short term after receiving first-line standard treatment, and she underwent interstitial brachytherapy after systemic therapy with an encouraging outcome. The patient developed suspected inguinal lymph node metastases after 9 months at the end of first-line therapy and multiple metastases in the inguinal lymph nodes, anterior abdominal wall, and right lung after 17 months. As the patient had residual inguinal lymph nodes after systemic therapy, she received 3D-printed template-guided interstitial brachytherapy to the inguinal lymph nodes and maintenance therapy. By Sep 2023, she had achieved a good treatment outcome with a progression-free survival (PFS) of 36 months. Conclusion Based on our patient response, when multiple metastases develop in the short term in early-stage cervical squamous carcinoma after first-line therapy, we may consider implementing local therapy combined with systemic therapy.
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Affiliation(s)
- Yi Qin
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan, China
| | - Ping Guan
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan, China
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Li
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan, China
| | - Huailin He
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan, China
| | - Wenfeng He
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan, China
| | - Longjing Tan
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan, China
| | - Xiangyu Deng
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan, China
| | - Bizhen Liao
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinglian Wen
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenhua Zhang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Luzhou, Sichuan, China
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Lin YT, Wang C, He XY, Yao QM, Chen J. Comparative cost-effectiveness of first-line pembrolizumab plus chemotherapy vs. chemotherapy alone in persistent, recurrent, or metastatic cervical cancer. Front Immunol 2024; 14:1345942. [PMID: 38274823 PMCID: PMC10808689 DOI: 10.3389/fimmu.2023.1345942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
Background Treating persistent, recurrent, or metastatic cervical cancer remains challenging. Although pembrolizumab, combined with chemotherapy and bevacizumab, offers a promising first-line option, its cost-effectiveness within the Chinese healthcare system has not been established. Methods A partitioned survival model was constructed using patient data from the KEYNOTE-826 trial. Efficacy, safety, and economic data from both trial and real-world practices were utilized to determine the costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) of the treatment strategies. Comprehensive insights were gained through the sensitivity and subgroup analyses. Results Over five years, the combination of pembrolizumab, chemotherapy, and bevacizumab offered an additional 1.18 QALYs compared to that provided by standard treatments. This regimen increased the costs by US$ 134,502.57, resulting in an ICER of US$ 114,275.67 per QALY, relative to traditional treatment costs. The ICER for the pembrolizumab regimen was further calibrated to be US$ 52,765.69 per QALY. Both ICER values surpassed China's established willingness-to-pay threshold. Importantly, subgroup analysis revealed enhanced cost-effectiveness in patients presenting with a programmed death-ligand 1 combined positive score (PD-L1 CPS) ≥10. Conclusion Introducing pembrolizumab alongside chemotherapy and bevacizumab may not be a cost-effective primary strategy for advanced cervical cancer against current standards. However, for patients with a PD-L1 CPS ≥10, the therapeutic and economic outcomes could be improved by adjusting the pembrolizumab price.
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Affiliation(s)
- Ying-tao Lin
- Clinical Medical Research Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
- Department of Drug Clinical Trial Institution, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Chang Wang
- Department of Lymphoma & Head and Neck Tumors, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Xiao-yan He
- Department of Endocrinology, Fuqing City Hospital of Fujian, Fuqing City Hospital Affiliated to Fujian Medical University, Fuqing, Fujian, China
| | - Qi-min Yao
- College of Finance, Fujian Jiangxia University, Fuzhou, Fujian, China
| | - Jian Chen
- Department of Gynecological-Surgical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
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44
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Song L, Liang X, Zhu M, Su Q, Li F. Knowledge mapping of immunotherapy in cervical carcinoma: a bibliometric analysis (2000-2023). Front Immunol 2024; 14:1328103. [PMID: 38264659 PMCID: PMC10803603 DOI: 10.3389/fimmu.2023.1328103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/15/2023] [Indexed: 01/25/2024] Open
Abstract
Background Cervical carcinoma is a type of malignant tumor that primarily develops in the cervix, the lower part of the uterus. In recent years, Despite the considerable progress made in immunotherapy research for cervical carcinoma, an important aspect has been largely overlooked - the absence of a comprehensive bibliometric analysis in this field. By employing bibliometric techniques, this study aims to fill this gap and provide a comprehensive overview of the knowledge structure and research hotspots within the realm of immunotherapy in cervical carcinoma. Method A comprehensive search was conducted on the web of science core collection(WoSCC) database to identify publications related to immunotherapy specifically for the treatment of cervical carcinoma. The search spanned the period from the year 2000 to 2023. Several analytical tools were employed. These included VOSviewers, CiteSpace, and the R package "bibliometrix". Results A total of 654 research articles from 66 different countries have been included in the analysis. The United States and China have emerged as the leading countries in publishing research on immunotherapy in cervical carcinoma. Leiden University and Memorial Sloan-Kettering Cancer Center from the Netherlands and the United States respectively have a close cooperation. Fudan University from China and the German Cancer Research Center are also among the key institutions leading research in this area. Frontiers in Oncology has emerged as the most popular and widely recognized publication in the field of immunotherapy in cervical carcinoma. Journal of Clinical Oncology is frequently cited by researchers in this area. Van Der Burg, Sjoerd H has published the highest number of papers. Tewari, Krishnansu S has been the most co-cited author. Keywords such as PD-L1, chemotherapy, and immune checkpoint inhibitors have gained significant attention in recent years. Conclusion This is the first bibliometric study that comprehensively summarizes the research trends and developments of immunotherapy in cervical carcinoma. This groundbreaking study not only summarizes the current research trends and developments in immunotherapy for cervical carcinoma but also provides a reference for scholars studying the treatment of cervical cancer.
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Affiliation(s)
- Ling Song
- Clinical Laboratory Medicine, Binhai New Area Hospital of Traditional Chinese Medicine, Fourth Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xinmei Liang
- Clinical Laboratory Medicine, Binhai New Area Hospital of Traditional Chinese Medicine, Fourth Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Min Zhu
- Clinical Laboratory Medicine, Binhai New Area Hospital of Traditional Chinese Medicine, Fourth Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qiang Su
- Clinical Laboratory Medicine, Beijin Shijitan Hospital, Capital Medical University, Beijing, China
| | - Fengzhou Li
- The First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning, China
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Oaknin A, Gladieff L, Martínez-García J, Villacampa G, Takekuma M, De Giorgi U, Lindemann K, Woelber L, Colombo N, Duska L, Leary A, Godoy-Ortiz A, Nishio S, Angelergues A, Rubio MJ, Fariñas-Madrid L, Yamaguchi S, Lorusso D, Ray-Coquard I, Manso L, Joly F, Alarcón J, Follana P, Romero I, Lebreton C, Pérez-Fidalgo JA, Yunokawa M, Dahlstrand H, D'Hondt V, Randall LM. Atezolizumab plus bevacizumab and chemotherapy for metastatic, persistent, or recurrent cervical cancer (BEATcc): a randomised, open-label, phase 3 trial. Lancet 2024; 403:31-43. [PMID: 38048793 DOI: 10.1016/s0140-6736(23)02405-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND The GOG240 trial established bevacizumab with chemotherapy as standard first-line therapy for metastatic or recurrent cervical cancer. In the BEATcc trial (ENGOT-Cx10-GEICO 68-C-JGOG1084-GOG-3030), we aimed to evaluate the addition of an immune checkpoint inhibitor to this standard backbone. METHODS In this investigator-initiated, randomised, open-label, phase 3 trial, patients from 92 sites in Europe, Japan, and the USA with metastatic (stage IVB), persistent, or recurrent cervical cancer that was measurable, previously untreated, and not amenable to curative surgery or radiation were randomly assigned 1:1 to receive standard therapy (cisplatin 50 mg/m2 or carboplatin area under the curve of 5, paclitaxel 175 mg/m2, and bevacizumab 15 mg/kg, all on day 1 of every 3-week cycle) with or without atezolizumab 1200 mg. Treatment was continued until disease progression, unacceptable toxicity, patient withdrawal, or death. Stratification factors were previous concomitant chemoradiation (yes vs no), histology (squamous cell carcinoma vs adenocarcinoma including adenosquamous carcinoma), and platinum backbone (cisplatin vs carboplatin). Dual primary endpoints were investigator-assessed progression-free survival according to Response Evaluation Criteria in Solid Tumours version 1.1 and overall survival analysed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT03556839, and is ongoing. FINDINGS Between Oct 8, 2018, and Aug 20, 2021, 410 of 519 patients assessed for eligibility were enrolled. Median progression-free survival was 13·7 months (95% CI 12·3-16·6) with atezolizumab and 10·4 months (9·7-11·7) with standard therapy (hazard ratio [HR]=0·62 [95% CI 0·49-0·78]; p<0·0001); at the interim overall survival analysis, median overall survival was 32·1 months (95% CI 25·3-36·8) versus 22·8 months (20·3-28·0), respectively (HR 0·68 [95% CI 0·52-0·88]; p=0·0046). Grade 3 or worse adverse events occurred in 79% of patients in the experimental group and in 75% of patients in the standard group. Grade 1-2 diarrhoea, arthralgia, pyrexia, and rash were increased with atezolizumab. INTERPRETATION Adding atezolizumab to a standard bevacizumab plus platinum regimen for metastatic, persistent, or recurrent cervical cancer significantly improves progression-free and overall survival and should be considered as a new first-line therapy option. FUNDING F Hoffmann-La Roche.
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Affiliation(s)
- Ana Oaknin
- Medical Oncology Service, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | | | | | - Guillermo Villacampa
- SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebron Institute of Oncology, Barcelona, Spain; The Institute of Cancer Research, London, UK
| | | | - Ugo De Giorgi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Kristina Lindemann
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Oslo University Hospital, Oslo, Norway
| | - Linn Woelber
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicoletta Colombo
- Gynecologic Oncology Department, European Institute of Oncology IRCCS Milan, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Linda Duska
- University of Virginia Cancer Center, Charlottesville, VA, USA
| | | | | | | | | | | | - Lorena Fariñas-Madrid
- Medical Oncology Service, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Domenica Lorusso
- Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Catholic University of Sacred Heart, Rome, Italy
| | | | - Luis Manso
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Ignacio Romero
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - J Alejandro Pérez-Fidalgo
- University Hospital of Valencia, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain; CIBERONC, Valencia, Spain
| | | | - Hanna Dahlstrand
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden
| | | | - Leslie M Randall
- Massey Comprehensive Cancer Center, VCUHealth, Richmond, VA, USA
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Mileshkin LR, Manoharan S. Improving survival from metastatic, recurrent, or persistent cervical cancer. Lancet 2024; 403:2-4. [PMID: 38048788 DOI: 10.1016/s0140-6736(23)02690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Linda R Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne and University of Melbourne, Melbourne, VIC 3000, Australia.
| | - Sathya Manoharan
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne and University of Melbourne, Melbourne, VIC 3000, Australia
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García E, Ayoub N, Tewari KS. Recent breakthroughs in the management of locally advanced and recurrent/metastatic cervical cancer. J Gynecol Oncol 2024; 35:e30. [PMID: 38072400 PMCID: PMC10792211 DOI: 10.3802/jgo.2024.35.e30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 01/17/2024] Open
Abstract
Cervical cancer continues to be a global threat affecting individuals in resource poor communities disproportionately. The treatment paradigm for this disease is ever evolving with recent innovations propelling oncologic outcomes to a new frontier offering survival benefits for patients struggling with locally advanced disease and metastatic/recurrent carcinoma. Immunologic checkpoint inhibitors and anti-body drug conjugates represent two novel drug classes that have demonstrable activity in this disease, particularly in the first-line and second-line treatment paradigm for recurrence. The tolerability of these novel medicines and associated durable responses underscore regulatory approval by the U.S. Food and Drug Administrations and their implementation in clinic.
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Affiliation(s)
- Eduardo García
- University California, Irvine, Medical Center, Orange, CA, USA.
| | - Natalie Ayoub
- Adventist Health White Memorial, Medical Center, Los Angeles, CA, USA
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Zhang JF, Okai B, Iovoli A, Goulenko V, Attwood K, Lim J, Hess RM, Abad AP, Prasad D, Fenstermaker RA. Bevacizumab and gamma knife radiosurgery for first-recurrence glioblastoma. J Neurooncol 2024; 166:89-98. [PMID: 38175460 PMCID: PMC10824796 DOI: 10.1007/s11060-023-04524-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/25/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Glioblastoma (GBM) is the most common central nervous system malignancy in adults. Despite decades of developments in surgical management, radiation treatment, chemotherapy, and tumor treating field therapy, GBM remains an ultimately fatal disease. There is currently no definitive standard of care for patients with recurrent glioblastoma (rGBM) following failure of initial management. OBJECTIVE In this retrospective cohort study, we set out to examine the relative effects of bevacizumab and Gamma Knife radiosurgery on progression-free survival (PFS) and overall survival (OS) in patients with GBM at first-recurrence. METHODS We conducted a retrospective review of all patients with rGBM who underwent treatment with bevacizumab and/or Gamma Knife radiosurgery at Roswell Park Comprehensive Cancer Center between 2012 and 2022. Mean PFS and OS were determined for each of our three treatment groups: Bevacizumab Only, Bevacizumab Plus Gamma Knife, and Gamma Knife Only. RESULTS Patients in the combined treatment group demonstrated longer post-recurrence median PFS (7.7 months) and median OS (11.5 months) compared to glioblastoma patients previously reported in the literature, and showed improvements in total PFS (p=0.015), total OS (p=0.0050), post-recurrence PFS (p=0.018), and post-recurrence OS (p=0.0082) compared to patients who received either bevacizumab or Gamma Knife as monotherapy. CONCLUSION This study demonstrates that the combined use of bevacizumab with concurrent stereotactic radiosurgery can have improve survival in patients with rGBM.
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Affiliation(s)
- Jeff F Zhang
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Bernard Okai
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Austin Iovoli
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Victor Goulenko
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Ryan M Hess
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Ajay P Abad
- Department of Neuro-Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Dheerendra Prasad
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Robert A Fenstermaker
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
- Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
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Liu F, Chen W, Pan Y, Wang C, Tang Y, Chou H, Chao A, Yang L, Lai C. Clinical factor-based risk stratification for precision therapy in locally advanced squamous cell carcinoma of the uterine cervix. Cancer Med 2024; 13:e6746. [PMID: 38192162 PMCID: PMC10807568 DOI: 10.1002/cam4.6746] [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: 05/18/2023] [Revised: 11/04/2023] [Accepted: 11/15/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Concurrent chemoradiotherapy (CCRT) is the standard of care for locally advanced cervical cancer. In this study, we analyzed the pretreatment clinical and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) characteristics of patients with locally advanced cervical squamous cell carcinoma (SCC) to develop a scoring prototype for risk stratification. METHODS Two cohorts were constructed in this study. Cohort 1 comprised patients with cervical SCC with 2009 FIGO stage III-IVA or stage I-II with positive pelvic or para-aortic lymph node (PALN) on PET/CT from AGOG09-001 trial. Cohort 2 comprised patients with similar characteristics who had received adequate therapy in our hospital between 2016 and 2021. Pretreatment patient characteristics and PET/CT parameters including maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV) of primary tumor and nodal SUVmax were assessed for cancer-specific survival (CSS) using multivariate Cox regression. RESULTS Analysis of combined data from cohorts 1 (n = 55) and 2 (n = 128) indicated age ≥ 66 years, primary tumor MTV ≥87 mL, and positive PALN on PET/CT to be independently significant adverse predictors for CSS (p < 0.001, p = 0.014, and p = 0.026, respectively) with a median follow-up duration of 51 months. Assigning a score of 1 to each adverse predictor, patients with cumulative risk scores of 0, 1, 2, and 3 were discovered to have a 5-year CSS of 86.9%, 71.0%, 32.2%, and 0%, respectively (p < 0.001). CONCLUSION Age, primary tumor MTV, and positive PALN on PET/CT may serve as independent predictors of poor survival in patients with locally advanced cervical SCC. Our findings indicate that patients without any adverse factors can receive standard CCRT, whereas those with at least one adverse factor can consider novel combination therapies or clinical trials.
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Affiliation(s)
- Feng‐Yuan Liu
- Department of Nuclear Medicine and Molecular Imaging CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
- School of Medicine, National Tsing Hua UniversityHsinchuTaiwan
- Gynecologic Cancer Research CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
| | - Wei‐Chun Chen
- Gynecologic Cancer Research CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
- Department of Obstetrics and GynecologyNew Taipei City Municipal Tucheng HospitalNew Taipei CityTaiwan
- Department of Obstetrics and GynecologyChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
| | - Yu‐Bin Pan
- Clinical Trial Center, Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Chun‐Chieh Wang
- Gynecologic Cancer Research CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
- Department of Radiation OncologyChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
| | - Yun‐Hsin Tang
- Gynecologic Cancer Research CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
- Department of Obstetrics and GynecologyChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
| | - Hung‐Hsueh Chou
- School of Medicine, National Tsing Hua UniversityHsinchuTaiwan
- Gynecologic Cancer Research CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
- Department of Obstetrics and GynecologyChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
| | - Angel Chao
- Gynecologic Cancer Research CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
- Department of Obstetrics and GynecologyChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
| | - Lan‐Yan Yang
- Clinical Trial Center, Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Chyong‐Huey Lai
- Gynecologic Cancer Research CenterChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
- Department of Obstetrics and GynecologyChang Gung Memorial Hospital at Linkou and Chang Gung University College of MedicineTaoyuanTaiwan
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D'Oria O, Bogani G, Cuccu I, D'Auge TG, Di Donato V, Caserta D, Giannini A. Pharmacotherapy for the treatment of recurrent cervical cancer: an update of the literature. Expert Opin Pharmacother 2024; 25:55-65. [PMID: 38159033 DOI: 10.1080/14656566.2023.2298329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Cervical cancer is the fourth most common cause of cancer-related death worldwide. High-risk locally advanced or recurrent/metastatic cervical cancers have a poor prognosis with routine treatments. The objective of this study is to analyze the data available in the literature on therapies and molecules currently in use to improve the prognosis of recurrent cervical cancer. AREAS COVERED An extensive literature search was conducted by authors to identify relevant trials on various databases. Articles in English published until September 2023 that investigate different pharmacotherapy strategies for the treatment of recurrent cervical cancer, were included. Results of various pharmacological regimens including different combinations of chemotherapy, immune checkpoint inhibitors, DNA damage repair inhibitors and antibody-drug conjugates were analyzed. EXPERT OPINION In recent years, there have been significant improvements in the outcomes of recurrent/metastatic cervical cancer. However, these improvements do not address the unmet need in terms of oncological outcomes. The introduction of immunotherapy and targeted therapies showed advantages in cervical cancer patients. New therapies and combination strategies must be implemented. Centralization of care and enrollment in clinical trials are of paramount importance. Primary and secondary prevention remains the fundamental goal to reduce the burden of cervical cancer.
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Affiliation(s)
- Ottavia D'Oria
- Department of Medical and Surgical Sciences and Translational Medicine, Course in "Translational Medicine and Oncology", Sapienza University, Rome, Italy
- Obstetrics and Gynecological Unit, Department of Woman's and Child's Health, San Camillo-Forlanini Hospital, Rome, Italy
| | - Giorgio Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Ilaria Cuccu
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Tullio Golia D'Auge
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Donatella Caserta
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital Sapienza University of Rome, Rome, Italy
| | - Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, Course in "Translational Medicine and Oncology", Sapienza University, Rome, Italy
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
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