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Li C, Wang Z, Yang W, Ai G, Cheng Z. Application of Minimally Invasive Surgery-Multidisciplinary Team in Advanced and Recurrent Gynecological Cancers: 10-Year Exploration and Practice. Gynecol Minim Invasive Ther 2023; 12:141-147. [PMID: 37807982 PMCID: PMC10553593 DOI: 10.4103/gmit.gmit_64_22] [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: 06/09/2022] [Revised: 07/07/2022] [Accepted: 07/20/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives The treatment of advanced and recurrent gynecological cancers (ARGCs) remains more difficult evens. This assay aims to introduce the application of minimally invasive surgery-multidisciplinary team (MIS-MDT) as well as a comprehensive evaluation and treatment program of ARGC. Materials and Methods The diagnosis and treatment model of MDT collaboration has become a new model of clinical cancer treatment. In my country, it is in the start-up and trial stage. Our team began to explore surgical treatment of recurrent gynecological cancers in 2011 and has been committed to MDT treatment of ARGC for more than 3 years. Results So far, 61 patients have completed MDT treatment (28 of them were advanced gynecological cancer patients, 33 of them were recurrent gynecological cancer patients). Among them, MDT involved 43 times in gastrointestinal surgery, 21 times in urology, 5 times in the department of intractable abdominal diseases, and 5 times in other departments. After surgery, 58 patients (95%) restarted adjuvant therapy such as radiotherapy and chemotherapy. In addition, 32 patients (52.5%) underwent genetic and molecular testing, of which 14 patients (23%) accepted targeted and immunotherapy based on the testing results. After MIS-MDT treatment, the median progression-free survival of these patients was >30 months, respectively. Conclusion These patients have achieved good results after surgery of MDT. With continuous accumulation and summarization, we have systematically reviewed the diagnosis and treatment model of ARGC and guided clinical work as the model of Tongji Tenth Hospital (comprehensive evaluation and treatment).
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Affiliation(s)
- Caixia Li
- Department of Gynecology and Obstetrics, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhongjie Wang
- Department of Gynecology and Obstetrics, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Weihong Yang
- Department of Gynecology and Obstetrics, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, China
| | - Guihai Ai
- Department of Gynecology and Obstetrics, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhongping Cheng
- Department of Gynecology and Obstetrics, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, China
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Nie J, Wu H, Sun L, Ding Y, Luan Y, Wu J. Cost-effectiveness of fuzuloparib compared to routine surveillance, niraparib and olaparib for maintenance treatment of patients with germline BRCA1/2 mutation and platinum-sensitive recurrent ovarian carcinoma in China. Front Pharmacol 2023; 13:987337. [PMID: 36686677 PMCID: PMC9846494 DOI: 10.3389/fphar.2022.987337] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
Background: Maintenance therapy with the poly (ADP-ribose) polymerase inhibitors (PARPis) for platinum-sensitive recurrent ovarian carcinoma (OC) have proven to be effective compared with placebo. We aimed to evaluate the cost-effectiveness (CE) of maintenance fuzuloparib compared to routine surveillance (RS), niraparib and olaparib for platinum-sensitive recurrent OC from the Chinese healthcare systems. Method: A partitioned survival model with three-state (progression-free, progressed, death) was constructed utilizing TreeAge Pro 2011 software to evaluate the economic value of fuzuloparib, niraparib and olaparib maintenance treatment for platinum-sensitive recurrent OC based on the clinical data derived from FZOCUS-2, ENGOT-OV16/NOVA and ENGOT-Ov21/SOLO2. Transition probabilities were estimated from the reported survival probabilities in those trials. Cost and health preference data were derived from the literature. The quality-adjusted life-years (QALYs) and lifetime costs were measured for this analysis. A 5 years horizon and 5%/year discount rates were used. One-way analysis, and probabilistic sensitivity analysis (PSA) were performed to explore the model uncertainties. Results: Total cost of fuzuloparib, niraparib and olaparib were $31628.10, $48183.48 and $54605.54, whereas they had an incremental cost-utility ratio of $31992.69, $32216.08 and $23359.26 per additional progression-free survival (PFS) QALYs gained compared with RS, relatively. Model showed that maintenance fuzuloparib achieved at least an 85.5% probability of CE at the threshold of $37654.50/QALY. One-way sensitivity analysis revealed that the results were sensitive to the PFS and the price of medicines. Conclusion: Fuzuloparib was less cost-effective for patients with germline BRCA1/2 mutation and platinum-sensitive recurrent OC compared to olaparib, but was superior to niraparib from the Chinese healthcare systems perspective.
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Affiliation(s)
- Jing Nie
- Department of Pharmacy, Shandong Second Provincial General Hospital, Jinan, Shandong, China
| | - Huina Wu
- Department of Pharmacy, Shandong Second Provincial General Hospital, Jinan, Shandong, China
| | - Lei Sun
- Department of Pharmacy, Shandong Second Provincial General Hospital, Jinan, Shandong, China
| | - Yanjiao Ding
- Department of Pharmacy, Shandong Second Provincial General Hospital, Jinan, Shandong, China
| | - Yepeng Luan
- Department of Medicinal Chemistry, School of Pharmacy, Qingdao University Medical College, Qingdao University, Qingdao, Shandong, China
| | - Jiyong Wu
- Department of Pharmacy, Shandong Second Provincial General Hospital, Jinan, Shandong, China,*Correspondence: Jiyong Wu,
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Baek MH, Park EY, Ha HI, Park SY, Lim MC, Fotopoulou C, Bristow RE. Secondary Cytoreductive Surgery in Platinum-Sensitive Recurrent Ovarian Cancer: A Meta-Analysis. J Clin Oncol 2022; 40:1659-1670. [PMID: 35188810 DOI: 10.1200/jco.21.02085] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The survival impact of secondary cytoreductive surgery in patients with platinum-sensitive recurrent ovarian cancer was studied. METHODS We identified published studies from 1983 to 2021 following our inclusion criteria from MEDLINE, EMBASE, and Cochrane library. To integrate the effect size of single-arm studies, meta-analysis was performed using death rate as a primary outcome. The effect of complete cytoreduction and optimal cytoreduction on survival was evaluated using meta-regression. The pooled death rate was presented with a 95% CI. The publication bias was evaluated with the funnel plot and Egger's test, and sensitivity analysis was performed. To overcome missing death rates, the linear regression model was performed on log-transformed median overall survival (OS) time using study size as a weight. RESULTS Thirty-six studies with 2,805 patients reporting death rates were used for this meta-analysis of the 80 eligible studies. There was strong heterogeneity, with the P value of the Cochrane Q test of < 0.0001 and Higgins's I2 statistics of 86%; thus, we considered a random effect model. The pooled death rate was 44.2% (95% CI, 39.0 to 49.5), and both the complete and optimal cytoreductions were associated with better survival outcomes as significant moderators in the meta-regression model (P < .001 and P = .005, respectively). Although 14 studies were located outside the funnel plot, Egger's test indicated no publication bias (P = .327). A sensitivity analysis excluding 14 studies showed similar results. In the linear regression model on the basis of 57 studies, the median OS time increased by 8.97% and 7.04% when the complete and optimal cytoreduction proportion increased by 10%, respectively, after adjusting other variables. CONCLUSION Secondary cytoreductive surgery, resulting in maximal tumor resection, significantly prolongs OS in platinum-sensitive recurrent ovarian cancer.
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Affiliation(s)
- Min-Hyun Baek
- Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Young Park
- Biostatistics Collaboration Team, Research Core Center, National Cancer Center, Goyang, South Korea.,Department of Statistics and Data Science, Yonsei University, Seoul, South Korea
| | - Hyeong In Ha
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer and Center for Clinical Trials, National Cancer Center, Goyang, South Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer and Center for Clinical Trials, National Cancer Center, Goyang, South Korea.,Rare & Pediatric Cancer Branch and Immuno-oncology Branch, Division of Rare and Refractory Cancer, Research Institute, National Cancer Center, Goyang, South Korea.,Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Christina Fotopoulou
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - Robert E Bristow
- Division of Gynecologic Oncology, Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA
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Yang W, Cheng Z, Dai H, Long C, Liu H. Laparoscopic-based score assessment combined with a multiple disciplinary team in management of recurrent ovarian cancer: A single-center prospective study for personalized surgical therapy. Medicine (Baltimore) 2017; 96:e7440. [PMID: 28746186 PMCID: PMC5627812 DOI: 10.1097/md.0000000000007440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The aim of the study was to evaluate the effect of laparoscopic-based score combined with a multiple disciplinary team (MDT) for predicting optimal cytoreduction and perform personalized surgical treatment in recurrent ovarian cancer (ROC).The study is a single-center, prospective investigation. From March 2013 to May 2015, the consecutive treated patients with platinum-sensitive ROC were collected in Yangpu Hospital. The appropriated patients were enrolled into the study to perform the laparoscopic-based PIV (predictive index value) score assessment with an MDT for predicting optimal cytoreduction. The PIV cutoff value was confirmed to be 8. Patients of PIV <8 received laparoscopic/laparotomy secondary surgery following chemotherapy, and the ones with PIV ≥8 did chemotherapy alone. Sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV), and overall accuracy for each range of PIV score were calculated. All recruited patients participated in follow-up observation. Overall survival was recorded.In total, 58 eligible ROC patients received laparoscopy assessment. Forty-one patients of PIV <8 received secondary cytoreductive surgeries. Twenty-three (23/41 56.1%) attained optimal cytoreduction. However, 8 of 23 achieved completed cytoreduction. Also, 17 patients of PIV ≥8 underwent chemotherapy alone. Sensitivity, specificity, PPV, NPV, and overall accuracy for PIV ≥8 were 60%, 100%, 100%, 25%, and 64.7%, respectively. Overall survival in patients performing optimal cytoreduction was significantly higher than in those undergoing suboptimal cytoreduction or chemotherapy alone (45.9 ± 2.5 vs 36.7 ± 4.3 months, P = .047; 45.9 ± 2.5 vs 35.8 ± 3.4 months, P = .027).Laparoscopic-based score assessment plus MDT helps to identify the appropriate patients to perform optimal secondary cytoreduction and provide a personalized surgical approach in management of ROC.
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Affiliation(s)
- Weihong Yang
- Department of Obstetrics and Gynecology, Yangpu Hospital
- Institute of Gynecologic Minimally Invasive Medicine, Tongji University School of Medicine, Shanghai, China
| | - Zhongping Cheng
- Department of Obstetrics and Gynecology, Yangpu Hospital
- Institute of Gynecologic Minimally Invasive Medicine, Tongji University School of Medicine, Shanghai, China
| | - Hong Dai
- Department of Obstetrics and Gynecology, Yangpu Hospital
- Institute of Gynecologic Minimally Invasive Medicine, Tongji University School of Medicine, Shanghai, China
| | - Changchun Long
- Department of Obstetrics and Gynecology, Yangpu Hospital
- Institute of Gynecologic Minimally Invasive Medicine, Tongji University School of Medicine, Shanghai, China
| | - Hailun Liu
- Department of Obstetrics and Gynecology, Yangpu Hospital
- Institute of Gynecologic Minimally Invasive Medicine, Tongji University School of Medicine, Shanghai, China
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Mo H, Hao X, Liu Y, Wang L, Hu X, Xu J, Yang S, Xing P, Shi Y, Jia B, Wang Y, Li J, Wang H, Wang Z, Sun Y, Shi Y. A prognostic model for platinum-doublet as second-line chemotherapy in advanced non-small-cell lung cancer patients. Cancer Med 2016; 5:1116-24. [PMID: 26993156 PMCID: PMC4924370 DOI: 10.1002/cam4.689] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 11/08/2022] Open
Abstract
Poor prognosis of advanced non‐small‐cell lung cancer (NSCLC) patients and the promising therapeutic effect of platinum urge the oncologists to evaluate the role of platinum doublet as second‐line chemotherapy and establish the definition of platinum sensitivity in NSCLC. We retrospectively analyzed 364 advanced NSCLC patients who received platinum‐doublet regimens as second‐line chemotherapy after platinum‐based first‐line treatment. Patients were divided into four groups by their time‐to‐progression (TTP) after first‐line chemotherapy: 0–3, 4–6, 7–12, and >12‐month group, respectively. Treatment efficacy of patients' overall survival (OS), progression‐free survival (PFS), and response rate (RR), as well as treatment‐related toxicity, were compared among the four groups. A prognosis score system and a nomogram were established by Cox proportional hazard model, and validated by concordance index (c‐index). Median OS was 14.0, 16.0, 20.0, 25.0 months for patients in the 0–3, 4–6, 7–12, >12‐month group, respectively. Age ≤60 years (P = 0.002), female (P = 0.019), and TTP>12 months (P = 0.003) were independent prognostic factors. Prognostic score was calculated by adding 1 point each for any of the above three indicators, with a c‐index of 0.590 (95% confidential interval [CI], 0.552–0.627). Median OS were equal to 25.0, 16.0, and 11.0 months for best (2–3 points), intermediate (1 point) and worst (0 point) category, respectively (P < 0.0001). A nomogram that integrated patient's age, gender, and TTP for OS has a c‐index of 0.623 (95% CI, 0.603–0.643). Female, younger than 60 years, and TTP greater than 12 months may indicate prolonged survival after platinum‐doublet second‐line chemotherapy in advanced NSCLCpatients.
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Affiliation(s)
- Hongnan Mo
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Xuezhi Hao
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Yutao Liu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Lin Wang
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Xingsheng Hu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Jianping Xu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Sheng Yang
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Puyuan Xing
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Youwu Shi
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Bo Jia
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Yan Wang
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Junling Li
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Hongyu Wang
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Ziping Wang
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Yan Sun
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Yuankai Shi
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC); Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
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Angioli R, Capriglione S, Aloisi A, Ricciardi R, Scaletta G, Lopez S, Miranda A, Di Pinto A, Terranova C, Plotti F. A Predictive Score for Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer (SeC-Score): A Single-Centre, Controlled Study for Preoperative Patient Selection. Ann Surg Oncol 2015; 22:4217-23. [DOI: 10.1245/s10434-015-4534-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Indexed: 11/18/2022]
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Dong J, Zhang T, Wen B. Impact of Olaparib for Maintenance Monotherapy on Survival in Breast and Ovarian Cancer: A Systematic Review and Pooled Analysis of Published Trials. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ijmpcero.2015.44040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Ovarian cancer remains the fourth leading cause of cancer death in women in France. It is all too often diagnosed at an advanced stage with peritoneal carcinomatosis (PC), but remains confined to the peritoneal cavity throughout much of its natural history. Because of cellular selection pressure over time, most tumor recurrences eventually develop resistance to systemic platinum. Options for salvage therapy include alternative systemic chemotherapies and further cytoreductive surgery (CRS), but the prognosis remains poor. Over the past two decades, a new therapeutic approach to PC has been developed that combines CRS with hyperthermic intraperitoneal chemotherapy (HIPEC). This treatment strategy has already been shown to be effective in non-gynecologic carcinomatosis in numerous reports. There is a strong rationale for the use of HIPEC for PC of ovarian origin. On the one hand, three prospective randomized trials have demonstrated the superiority of intraperitoneal chemotherapy (without hyperthermia) in selected patients compared to systemic chemotherapy. Moreover, retrospective studies and case-control studies of HIPEC have reported encouraging survival data, especially when used to treat chemoresistant recurrence. However, HIPEC has specific morbidity and mortality; this calls for very careful selection of eligible patients by a multidisciplinary team in specialized centers. HIPEC needs to be evaluated by means of randomized trials for ovarian cancer at different developmental stages: as first line therapy, as consolidation, and for chemoresistant recurrence. Several European phase III studies are currently ongoing.
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Rutten MJ, Boldingh JHL, Schuit E, Trum H, van Driel W, Mol BWJ, Kenter GG, Buist MR. Development and internal validation of a prognostic model for survival after debulking surgery for epithelial ovarian cancer. Gynecol Oncol 2014; 135:13-8. [PMID: 25093289 DOI: 10.1016/j.ygyno.2014.07.099] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/19/2014] [Accepted: 07/28/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Predicting survival of patients with epithelial ovarian cancer (EOC) is based on prognosis of the population. Combining prognostic factors could facilitate survival prediction on the level of the individual patient. The aim of this study was to develop a prognostic model to predict five-year disease specific survival in patients with EOC, and to evaluate whether this would add to prediction based on prognosis of the population. PATIENTS AND METHODS A retrospective cohort study was performed of all EOC patients treated with primary debulking and adjuvant chemotherapy or neo-adjuvant chemotherapy and interval debulking surgery in three gynaecological-oncologic centres between 1998 and 2010. Primary outcome was 5-year disease-specific survival. We developed a Cox proportional hazard model using the LASSO-method to select the best combination of characteristics from 12 potential predictors and to correct for overfitting. Performance of the model was expressed as calibration and discrimination (c-statistic). A nomogram was developed to increase the clinical applicability of the model. RESULTS Of 840 patients with EOC 462 (55%) died within 5 years due to the disease. A combination of FIGO stage, residual tumour after surgery, primary or interval surgery, histology, performance status, age, amount of ascites and a family history suggestive of breast/ovarian cancer best predicted 5-year survival. The final model showed accurate calibration and the c-statistic was 0.71 (95% CI 0.69-0.74). CONCLUSIONS Five-year survival in all stage EOC patients can be predicted accurately using available characteristics. After external validation the model can be used for counselling of patients.
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Affiliation(s)
- M J Rutten
- Centre of Gynaecologic Oncology Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
| | - J H L Boldingh
- Centre of Gynaecologic Oncology Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - E Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - H Trum
- Centre of Gynaecologic Oncology Amsterdam, Free University Medical Center, Amsterdam, The Netherlands
| | - W van Driel
- Centre of Gynaecologic Oncology Amsterdam, Anthony van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - G G Kenter
- Centre of Gynaecologic Oncology Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - M R Buist
- Centre of Gynaecologic Oncology Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
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Poveda A, Ray-Coquard I, Romero I, Lopez-Guerrero JA, Colombo N. Emerging treatment strategies in recurrent platinum-sensitive ovarian cancer: Focus on trabectedin. Cancer Treat Rev 2014; 40:366-75. [DOI: 10.1016/j.ctrv.2013.08.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/29/2013] [Accepted: 08/01/2013] [Indexed: 10/26/2022]
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van de Laar R, Zusterzeel PLM, Van Gorp T, Buist MR, van Driel WJ, Gaarenstroom KN, Arts HJG, van Huisseling JCM, Hermans RHM, Pijnenborg JMA, Schutter EMJ, Pelikan HMP, Vollebergh JHA, Engelen MJA, Inthout J, Kruitwagen RFPM, Massuger LFAG. Cytoreductive surgery followed by chemotherapy versus chemotherapy alone for recurrent platinum-sensitive epithelial ovarian cancer (SOCceR trial): a multicenter randomised controlled study. BMC Cancer 2014; 14:22. [PMID: 24422892 PMCID: PMC3897943 DOI: 10.1186/1471-2407-14-22] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 01/08/2014] [Indexed: 01/01/2023] Open
Abstract
Background Improvement in treatment for patients with recurrent ovarian cancer is needed. Standard therapy in patients with platinum-sensitive recurrent ovarian cancer consists of platinum-based chemotherapy. Median overall survival is reported between 18 and 35 months. Currently, the role of surgery in recurrent ovarian cancer is not clear. In selective patients a survival benefit up to 62 months is reported for patients undergoing complete secondary cytoreductive surgery. Whether cytoreductive surgery in recurrent platinum-sensitive ovarian cancer is beneficial remains questionable due to the lack of level I-II evidence. Methods/Design Multicentre randomized controlled trial, including all nine gynecologic oncologic centres in the Netherlands and their affiliated hospitals. Eligible patients are women, with first recurrence of FIGO stage Ic-IV platinum-sensitive epithelial ovarian cancer, primary peritoneal cancer or fallopian tube cancer, who meet the inclusion criteria. Participants are randomized between the standard treatment consisting of at least six cycles of intravenous platinum based chemotherapy and the experimental treatment which consists of secondary cytoreductive surgery followed by at least six cycles of intravenous platinum based chemotherapy. Primary outcome measure is progression free survival. In total 230 patients will be randomized. Data will be analysed according to intention to treat. Discussion Where the role of cytoreductive surgery is widely accepted in the initial treatment of ovarian cancer, its value in recurrent platinum-sensitive epithelial ovarian cancer has not been established so far. A better understanding of the benefits and patients selection criteria for secondary cytoreductive surgery has to be obtained. Therefore the 4th ovarian cancer consensus conference in 2010 stated that randomized controlled phase 3 trials evaluating the role of surgery in platinum-sensitive recurrent epithelial ovarian cancer are urgently needed. We present a recently started multicentre randomized controlled trial that will investigate the role of secondary cytoreductive surgery followed by chemotherapy will improve progression free survival in selected patients with first recurrence of platinum-sensitive epithelial ovarian cancer. Trial registration Netherlands Trial Register number: NTR3337.
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Affiliation(s)
- Rafli van de Laar
- Department of Obstetrics and Gynecology, Radboud University Medical Centre, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
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The role of surgery in the management of patients with platinum-sensitive recurrent ovarian cancer: Survey among Dutch gynecologists and medical oncologists. Gynecol Oncol 2013; 131:561-6. [DOI: 10.1016/j.ygyno.2013.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 09/12/2013] [Accepted: 09/13/2013] [Indexed: 02/06/2023]
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13
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González A. Increasing the chances for platinum-sensitive ovarian cancer patients. Future Oncol 2013; 9:29-35. [DOI: 10.2217/fon.13.204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Ovarian carcinoma is still one of the most common causes of death from cancer in the western world. Despite high sensitivity to chemotherapy, the majority of patients will relapse within 3 years. In this article the focus is centered on patients who have a late relapse (>12 months). Carboplatin-based regimens are the backbone of treatment for this group, producing clinical benefit with higher rates for progression-free and overall survival. However, not all patients can continue with platinum owing to loss of activity or toxicity (hypersensitivity, neurotoxicity and ototoxicity). In particular, hypersensitivity reactions to carboplatin are a concern and have been reported in approximately 15–20% of women receiving the drug. When expectations for a positive outcome with carboplatin are good, desensitization protocols may be useful so as to continue treatment. If platinum-based regimens are not possible then alternative forms of treatment are required; additional research efforts are being directed towards the development of nonplatinum-based therapies. Promising results have been obtained with the combination of trabectedin plus pegylated liposomal doxorubicin, providing encouragement that it will be a viable option for patients with recurrent ovarian cancer who cannot be treated with a platinum-based chemotherapeutic option.
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Sammartino P, Cornali T, Malatesta MFD, Piso P. Cytoreductive surgery after recurrent epithelial ovarian cancer and at other timepoints. World J Obstet Gynecol 2013; 2:101-107. [DOI: 10.5317/wjog.v2.i4.101] [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: 12/13/2012] [Accepted: 05/10/2013] [Indexed: 02/05/2023] Open
Abstract
In this descriptive review we look at the role of surgery for advanced ovarian cancer at other timepoints apart from the initial cytoreduction for front-line therapy or interval cytoreductive surgery after neoadjuvant chemotherapy. The chief surgical problem to face after primary treatment is recurrent ovarian cancer. Of far more marginal concern are the second-look surgical procedures or the palliative efforts intended to resolve the patient’s symptoms with no curative intent. The role of surgery in recurrent ovarian cancer remains poorly defined. Current data, albeit from non-randomized studies, nevertheless clearly support surgical cytoreduction in selected patients, a rarely curative expedient that invariably yields a marked survival advantage over chemotherapy alone. Despite these findings, some consider it too early to adopt secondary cytoreduction as the standard care for patients with recurrent ovarian cancer and a randomized study is needed. Two ongoing randomized trials (Arbeitsgemeinschaft Gynäkologische Onkologie-Desktop III and Gynecologic Oncology Group 213) intend to verify the role of secondary cytoreduction for platinum-sensitive ovarian cancer compared with chemotherapy considered as standard care for these patients. We await the results of these two trials for a definitive answer to the matter.
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Secondary cytoreduction versus chemotherapy alone in the treatment of patients with recurrent ovarian cancer: is a randomized trial worthwhile? Curr Oncol Rep 2013; 15:191. [PMID: 23443489 DOI: 10.1007/s11912-013-0302-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Weekly Administration of Bevacizumab, Gemcitabine, and Oxaliplatin in Patients With Recurrent and Refractory Ovarian Cancer. Int J Gynecol Cancer 2013; 23:355-60. [DOI: 10.1097/igc.0b013e31827de69e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Fagotti A, Costantini B, Petrillo M, Vizzielli G, Fanfani F, Margariti PA, Turco LC, Piovano E, Scambia G. Cytoreductive surgery plus HIPEC in platinum-sensitive recurrent ovarian cancer patients: a case-control study on survival in patients with two year follow-up. Gynecol Oncol 2012; 127:502-5. [PMID: 23022234 DOI: 10.1016/j.ygyno.2012.09.020] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 09/13/2012] [Accepted: 09/18/2012] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To compare survival data in platinum-sensitive recurrent ovarian cancer patients submitted to secondary cytoreduction (SCR) plus hyperthermic intraperitoneal intraoperative chemotherapy (HIPEC) (Cases) and a similar group of women not experiencing HIPEC (Controls). METHODS Case-control study, matching 30 Cases with 37 Controls, with at least 24 months of follow-up. RESULTS Groups were comparable for all characteristics, except for a higher proportion of patients with single-nodule relapses is the Controls (19 vs. 6; p=0.011). Median follow-up time was 46 months in the Cases and 36 months in the Controls. Twenty patients (66.6%) experienced secondary recurrence in the Cases and 37 women (100%) in the Controls (p=0.001). Moreover, 7 (23.3%) and 23 (62.2%) patients died of disease in the Cases and Controls respectively (p=0.003). The duration of secondary response was 26 months in the Cases and 15 months in the Controls (p=0.004). CONCLUSIONS The combination of SCR and HIPEC seems to improve survival rate in patients suffering from platinum-sensitive EOC recurrence with respect to no-HIPEC treatments. This result further supports the need of a randomized trial.
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Affiliation(s)
- Anna Fagotti
- Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
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Vergote I. Chairperson's introduction: Surgical skills, especially in the upper abdomen, remain pivotal in the treatment of advanced ovarian cancer. Eur J Cancer 2011; 47 Suppl 3:S86-7. [PMID: 21944034 DOI: 10.1016/s0959-8049(11)70151-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ignace Vergote
- University Hospitals Leuven, Leuven, Belgium, European Union
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