1
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Li P, Qian LH, Liao YN, Gai YZ, Pan H, Han L, Nie HZ. Hematological and Neurological Expressed 1 Promotes Tumor Progression Through mTOR Signaling in Ovarian Cancer. Reprod Sci 2024; 31:1868-1880. [PMID: 38263477 DOI: 10.1007/s43032-024-01456-4] [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: 10/24/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
Ovarian cancer (OV) is a highly aggressive malignancy with poor prognosis due to recurrence and drug resistance. Therefore, it is imperative to investigate the key molecular mechanisms underlying OV progression in order to develop promising diagnostic and therapeutic interventions. Although the importance of hematological and neurological expressed 1 (HN1) protein in hemopoietic cell and neurological development has been well-established, its function in cancer, particularly in OV, remains uncertain. In this study, we compared the expression of HN1 in ovarian cancers and para-tumor tissues and predicted potential related signaling pathways through enrichment analysis. In order to confirm the role of HN1 in vitro and vivo, we carried out a variety of experiments including bioinformation analysis, colony formation, flow cytometry analysis, and subcutaneous tumor models. The results demonstrated that HN1 was upregulated in OV and was negatively associated with clinical prognosis. Moreover, we observed that HN1 enhances cell proliferation, migration, and drug resistance, while suppressing apoptosis in OV cells. Notably, we discovered that HN1 functions as a novel regulator of mTOR pathways. Our findings suggest that HN1-mediated mTOR regulation facilitates OV advancement and targeting HN1 could provide a promising therapeutic approach for clinical OV treatment.
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Affiliation(s)
- Pin Li
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Li-Heng Qian
- State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Ying-Na Liao
- State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Yan-Zhi Gai
- State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Hong Pan
- State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Long Han
- Women and Children's Hospital, Qingdao University, Qingdao, 266034, China.
| | - Hui-Zhen Nie
- State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200240, China.
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2
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Chen YF, Hsu ST, Hwang SF, Sun L, Liu CK, Shih YH, Lu TF, Wang JS, Lu CH. Maintenance Chemotherapy in Patients with Platinum-Sensitive Relapsed Epithelial Ovarian Cancer after Second-Line Chemotherapy. J Clin Med 2024; 13:566. [PMID: 38256699 PMCID: PMC10816073 DOI: 10.3390/jcm13020566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/24/2023] [Accepted: 01/17/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: Our aim was to evaluate the efficacy and adverse effects of maintenance chemotherapy in platinum-sensitive recurrent epithelial ovarian cancer after second-line chemotherapy. (2) Methods: A total of 72 patients from a single institute who had been diagnosed with platinum-sensitive recurrent ovarian cancer and had experienced either complete or partial response after six cycles of second-line chemotherapy were divided into a standard group (n = 31) with six cycles or a maintenance group (n = 41) with more than six cycles. We then compared patient characteristics and survival outcomes between these two groups. (3) Results: In all patients, after primary management for the first recurrence, the maintenance group showed worse survival outcomes. Patients who had not undergone either surgery or radiotherapy were divided into complete response and partial response groups after six cycles of chemotherapy. In patients with partial response, maintenance chemotherapy led to a significant improvement in PFS (median, 3.6 vs. 6.7 months, p = 0.007), but no significant change in in OS. The median cycle number of maintenance chemotherapy was four. (4) Conclusions: Maintenance chemotherapy may still play an important role in patients with platinum-sensitive recurrent ovarian cancer, particularly in selected patient groups.
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Affiliation(s)
- Yen-Fu Chen
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-F.C.); (S.-T.H.); (S.-F.H.); (L.S.); (C.-K.L.); (Y.-H.S.); (T.-F.L.)
| | - Shih-Tien Hsu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-F.C.); (S.-T.H.); (S.-F.H.); (L.S.); (C.-K.L.); (Y.-H.S.); (T.-F.L.)
- Center for General Education, Ling Tung University, Taichung 408213, Taiwan
- School of Medicine, China Medical University, Taichung 404328, Taiwan
| | - Sheau-Feng Hwang
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-F.C.); (S.-T.H.); (S.-F.H.); (L.S.); (C.-K.L.); (Y.-H.S.); (T.-F.L.)
- Department of Palliative Care Unit, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Lou Sun
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-F.C.); (S.-T.H.); (S.-F.H.); (L.S.); (C.-K.L.); (Y.-H.S.); (T.-F.L.)
| | - Chih-Ku Liu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-F.C.); (S.-T.H.); (S.-F.H.); (L.S.); (C.-K.L.); (Y.-H.S.); (T.-F.L.)
| | - Yu-Hsiang Shih
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-F.C.); (S.-T.H.); (S.-F.H.); (L.S.); (C.-K.L.); (Y.-H.S.); (T.-F.L.)
| | - Ting-Fang Lu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-F.C.); (S.-T.H.); (S.-F.H.); (L.S.); (C.-K.L.); (Y.-H.S.); (T.-F.L.)
| | - Jun-Sing Wang
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
| | - Chien-Hsing Lu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-F.C.); (S.-T.H.); (S.-F.H.); (L.S.); (C.-K.L.); (Y.-H.S.); (T.-F.L.)
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402202, Taiwan
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3
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Corbaux P, You B, Glasspool RM, Yanaihara N, Tinker AV, Lindemann K, Ray-Coquard IL, Mirza MR, Subtil F, Colomban O, Péron J, Karamouza E, McNeish I, Kelly C, Kagimura T, Welch S, Lewsley LA, Paoletti X, Cook A. Survival and modelled cancer antigen-125 ELIMination rate constant K score in ovarian cancer patients in first-line before poly(ADP-ribose) polymerase inhibitor era: A Gynaecologic Cancer Intergroup meta-analysis. Eur J Cancer 2023; 191:112966. [PMID: 37542936 DOI: 10.1016/j.ejca.2023.112966] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND In patients with advanced ovarian cancer, the modelled CA-125 ELIMination rate constant K (KELIM) is an early indicator of the tumour intrinsic chemosensitivity. We assessed the prognostic and surrogate values of KELIM with respect to those of surgery outcome (based on post-operative residual lesions) in the Gynaecologic Cancer Intergroup (GCIG) individual patient data meta-analysis MAOV (Meta-Analysis in OVarian cancer) built before the emergence of poly(ADP-ribose) polymerase (PARP) inhibitors. METHODS The dataset was split into learning and validation cohorts (ratio 1:2). The individual modelled KELIM values were estimated, standardised by the median value, then scored as unfavourable (<1.0) or favourable (≥1.0). Overall survival (OS) and progression-free survival (PFS) analyses were performed with a two-step meta-analytic approach and surrogacy through a two-level meta-analytic model. RESULTS KELIM was assessed in 5884 patients from eight first-line trials (learning, 1962; validation, 3922). A favourable KELIM score was significantly associated with longer OS (validation set, median, 78.8 versus 28.4 months, hazard-ratios [HR] 0.46, 95% confidence interval [CI], 0.41-0.50, C-index 0.68), and longer PFS (validation set, median 30.5 versus 9.8 months, HR 0.49, 95% CI, 0.45-0.54, C-index 0.68), as were International Federation of Gynaecology and Obstetrics (FIGO) stage and debulking surgery outcome. Three prognostic groups were identified based on the surgery outcome and KELIM score, with large differences in OS (105.1, ∼45.0, and 22.1 months) and PFS (58.1, ∼15.0, and 8.0 months). Surrogacy for OS and for PFS was not established. CONCLUSION KELIM is an independent prognostic biomarker for survival, complementary to surgery outcome, representing a new determinant of first-line treatment success.
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Affiliation(s)
- Pauline Corbaux
- EA UCBL/HCL 3738, Centre pour l'lnnovation en Cancérologie de Lyon (CICLY), Faculty of Medicine Lyon-Sud, Claude Bernard University Lyon 1, Lyon, France; Medical Oncology, Institut de Cancérologie et d'Hématologie Universitaire de Saint-Étienne (ICHUSE), Centre Hospitalier Universitaire de Saint-Etienne, France
| | - Benoit You
- EA UCBL/HCL 3738, Centre pour l'lnnovation en Cancérologie de Lyon (CICLY), Faculty of Medicine Lyon-Sud, Claude Bernard University Lyon 1, Lyon, France; Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, GINECO, GINEGEPS, Lyon, France.
| | - Rosalind M Glasspool
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Nozomu Yanaihara
- Department of Obstetrics and Gynecologye, The Jikei University School of Medicine, Tokyo, Japan
| | - Anna V Tinker
- Medical Oncology, BC Cancer - Vancouver, Vancouver, Canada
| | - Kristina Lindemann
- Department of Gynaecological Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Mansoor R Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Clinical Trial Unit, Nordic Society of Gynaecological Oncology, Copenhagen, Denmark
| | - Fabien Subtil
- Department of Biostatistics, Hospices Civils de Lyon, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, CNRS UMR 5558, Claude Bernard University Lyon 1, Lyon, France
| | - Olivier Colomban
- EA UCBL/HCL 3738, Centre pour l'lnnovation en Cancérologie de Lyon (CICLY), Faculty of Medicine Lyon-Sud, Claude Bernard University Lyon 1, Lyon, France
| | - Julien Péron
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, GINECO, GINEGEPS, Lyon, France; Department of Biostatistics, Hospices Civils de Lyon, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, CNRS UMR 5558, Claude Bernard University Lyon 1, Lyon, France
| | - Eleni Karamouza
- Institut Gustave Roussy, Office of Biostatistics and Epidemiology, Université Paris-Saclay, Villejuif, France; Inserm, Université Paris-Saclay, CESP U1018, Oncostat, labelled Ligue Contre le Cancer, Villejuif, France
| | - Iain McNeish
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Caroline Kelly
- Cancer Research UK Clinical Trial Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Tatsuo Kagimura
- Foundation for Biomedical Research and Innovation at Kobe, Translational Research Center for Medical Innovation, Kobe, Japan
| | - Stephen Welch
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Liz-Anne Lewsley
- Cancer Research UK Clinical Trial Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Adrian Cook
- Medical Research Council Clinical Trials Unit, University College London, London, UK
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4
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Zhang X, Wang J, Fan Y, Zhao Z, Paraghamian SE, Hawkins GM, Buckingham L, O'Donnell J, Hao T, Suo H, Yin Y, Sun W, Kong W, Sun D, Zhao L, Zhou C, Bae-Jump VL. Asparagus officinalis combined with paclitaxel exhibited synergistic anti-tumor activity in paclitaxel-sensitive and -resistant ovarian cancer cells. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04276-8. [PMID: 36006482 DOI: 10.1007/s00432-022-04276-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Although paclitaxel is a promising first-line chemotherapeutic drug for ovarian cancer, acquired resistance to paclitaxel is one of the leading causes of treatment failure, limiting its clinical application. Asparagus officinalis has been shown to have anti-tumorigenic effects on cell growth, apoptosis, cellular stress and invasion of various types of cancer cells and has also been shown to synergize with paclitaxel to inhibit cell proliferation in ovarian cancer. METHODS Human ovarian cancer cell lines MES and its PTX-resistant counterpart MES-TP cell lines were used and were treated with Asparagus officinalis and paclitaxel alone as well as in combination. Cell proliferation, cellular stress, invasion and DMA damage were investigated and the synergistic effect of a combined therapy analyzed. RESULTS In this study, we found that Asparagus officinalis combined with low-dose paclitaxel synergistically inhibited cell proliferation, induced cellular stress and apoptosis and reduced cell invasion in paclitaxel-sensitive and -resistant ovarian cancer cell lines. The combined treatment effects were dependent on DNA damage pathways and suppressing microtubule dynamics, and the AKT/mTOR pathway and microtubule-associated proteins regulated the inhibitory effect through different mechanisms in paclitaxel-sensitive and -resistant cells. CONCLUSION These findings suggest that the combination of Asparagus officinalis and paclitaxel have potential clinical implications for development as a novel ovarian cancer treatment strategy.
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Affiliation(s)
- Xin Zhang
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, 100026, People's Republic of China.,Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr, Chapel Hill, NC, 27599, USA
| | - Jiandong Wang
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, 100026, People's Republic of China
| | - Yali Fan
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, 100026, People's Republic of China.,Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr, Chapel Hill, NC, 27599, USA
| | - Ziyi Zhao
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, 100026, People's Republic of China.,Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr, Chapel Hill, NC, 27599, USA
| | - Sarah E Paraghamian
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr, Chapel Hill, NC, 27599, USA
| | - Gabrielle M Hawkins
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr, Chapel Hill, NC, 27599, USA
| | - Lindsey Buckingham
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr, Chapel Hill, NC, 27599, USA
| | - Jillian O'Donnell
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr, Chapel Hill, NC, 27599, USA
| | - Tianran Hao
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr, Chapel Hill, NC, 27599, USA
| | - Hongyan Suo
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, 100026, People's Republic of China.,Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr, Chapel Hill, NC, 27599, USA
| | - Yajie Yin
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr, Chapel Hill, NC, 27599, USA
| | - Wenchuan Sun
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr, Chapel Hill, NC, 27599, USA
| | - Weimin Kong
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, 100026, People's Republic of China
| | - Delin Sun
- Shandong Juxinyuan Asparagus Industry Development Research Institute, HeZe, 274400, Shandong, People's Republic of China
| | - Luyu Zhao
- Shandong Juxinyuan Agricultural Technology Co. LTD, HeZe, 274400, Shandong, People's Republic of China
| | - Chunxiao Zhou
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr, Chapel Hill, NC, 27599, USA. .,Division of Gynecologic Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Dr, Chapel Hill, NC, 27599, USA.
| | - Victoria L Bae-Jump
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, 170 Manning Dr, Chapel Hill, NC, 27599, USA. .,Division of Gynecologic Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Dr, Chapel Hill, NC, 27599, USA.
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5
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Neoadjuvant and Adjuvant Systemic Therapy for Newly Diagnosed Stage II–IV Epithelial Ovary, Fallopian Tube, or Primary Peritoneal Carcinoma: A Practice Guideline. Curr Oncol 2022; 29:231-242. [PMID: 35049696 PMCID: PMC8774918 DOI: 10.3390/curroncol29010022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/14/2021] [Accepted: 01/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background: This study aims to provide guidance for the use of neoadjuvant and adjuvant systemic therapy in women with newly diagnosed stage II–IV epithelial ovary, fallopian tube, or primary peritoneal carcinoma. Methods: EMBASE, MEDLINE, and Cochrane Library were investigated for relevant systematic reviews and phase III trials. Articles focusing on consolidation and maintenance therapies were excluded. Results: For women with potentially resectable disease, primary cytoreductive surgery, followed by six to eight cycles of intravenous three-weekly paclitaxel and carboplatin is recommended. For those with a high-risk profile for primary cytoreductive surgery, neoadjuvant chemotherapy can be an option. Adjuvant chemotherapy with six cycles of dose-dense weekly paclitaxel plus three-weekly carboplatin can be considered for women of Japanese descent. In women with stage III or IV disease, the incorporation of bevacizumab concurrent with paclitaxel and carboplatin is not recommended for use as adjuvant therapy unless bevacizumab is continued as maintenance therapy. Intravenous paclitaxel plus intraperitoneal cisplatin and paclitaxel can be considered for stage III optimally debulked women who did not receive neoadjuvant chemotherapy. However, intraperitoneal administration of chemotherapy with bevacizumab should not be considered as an option for stage II–IV optimally debulked women. Discussion: The recommendations represent a current standard of care that is feasible to implement and valued by both clinicians and patients.
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6
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Hirte H, Poon R, Yao X, May T, Ethier JL, Petz L, Speakman J, Elit L. Neoadjuvant and adjuvant systemic therapy for newly diagnosed stage II- IV epithelial ovary, fallopian tube, or primary peritoneal carcinoma: A systematic review. Crit Rev Oncol Hematol 2021; 162:103324. [PMID: 33862245 DOI: 10.1016/j.critrevonc.2021.103324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/12/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To systematically review neoadjuvant and adjuvant therapy options for women with newly diagnosed stage II-IV ovarian cancer. METHODS Phase III trials were searched using MEDLINE, EMBASE, and Cochrane Library. Maintenance therapies were excluded. RESULTS Thirty-three trials were included. For women with high-risk profiles that would contraindicate upfront cytoreductive surgery, neoadjuvant chemotherapy can be an option. In the post-surgical adjuvant setting, the three-weekly regimen consisting of paclitaxel and carboplatin remains the standard of care. Docetaxel may be offered to those who are unable to tolerate paclitaxel. Intraperitoneal cisplatin and paclitaxel increased OS for stage III optimally debulked women (GOG 172). The intraperitoneal regimens in GOG 252 offered no survival benefit and some harms in terms of toxicity and quality of life. CONCLUSIONS There is no evidence to support adding a third agent to the standard carboplatin and paclitaxel. Results of the iPocc study will clarify the role of intraperitoneal chemotherapy.
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Affiliation(s)
- Hal Hirte
- Division of Medical Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Raymond Poon
- Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
| | - Xiaomei Yao
- Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), Department of Oncology, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Taymaa May
- Department of Obstetrics and Gynecology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Josee-Lyne Ethier
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Cancer Centre of Southeastern Ontario, Department of Oncology and Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lauri Petz
- Patient Representative, North Bay, Ontario, Canada
| | - Jane Speakman
- Patient Representative, Sutton West, Ontario, Canada
| | - Laurie Elit
- Department of Obstetrics and Gynecology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
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7
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Armstrong DK, Alvarez RD, Bakkum-Gamez JN, Barroilhet L, Behbakht K, Berchuck A, Chen LM, Cristea M, DeRosa M, Eisenhauer EL, Gershenson DM, Gray HJ, Grisham R, Hakam A, Jain A, Karam A, Konecny GE, Leath CA, Liu J, Mahdi H, Martin L, Matei D, McHale M, McLean K, Miller DS, O'Malley DM, Percac-Lima S, Ratner E, Remmenga SW, Vargas R, Werner TL, Zsiros E, Burns JL, Engh AM. Ovarian Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:191-226. [PMID: 33545690 DOI: 10.6004/jnccn.2021.0007] [Citation(s) in RCA: 320] [Impact Index Per Article: 106.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States and is the country's fifth most common cause of cancer mortality in women. A major challenge in treating ovarian cancer is that most patients have advanced disease at initial diagnosis. These NCCN Guidelines discuss cancers originating in the ovary, fallopian tube, or peritoneum, as these are all managed in a similar manner. Most of the recommendations are based on data from patients with the most common subtypes─high-grade serous and grade 2/3 endometrioid. The NCCN Guidelines also include recommendations specifically for patients with less common ovarian cancers, which in the guidelines include the following: carcinosarcoma, clear cell carcinoma, mucinous carcinoma, low-grade serous, grade 1 endometrioid, borderline epithelial, malignant sex cord-stromal, and malignant germ cell tumors. This manuscript focuses on certain aspects of primary treatment, including primary surgery, adjuvant therapy, and maintenance therapy options (including PARP inhibitors) after completion of first-line chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | - Lee-May Chen
- 7UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | - Heidi J Gray
- 12Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | - Joyce Liu
- 19Dana-Farber/Brigham and Women's Cancer Center
| | - Haider Mahdi
- 20Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Lainie Martin
- 21Abramson Cancer Center at the University of Pennsylvania
| | - Daniela Matei
- 22Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - David M O'Malley
- 26The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | - Roberto Vargas
- 20Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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8
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Wang Y, Chiou YS, Chong QY, Zhang M, Rangappa KS, Ma L, Zhu T, Kumar AP, Huang RYJ, Pandey V, Basappa, Lobie PE. Pharmacological Inhibition of BAD Ser99 Phosphorylation Enhances the Efficacy of Cisplatin in Ovarian Cancer by Inhibition of Cancer Stem Cell-like Behavior. ACS Pharmacol Transl Sci 2020; 3:1083-1099. [PMID: 33344891 DOI: 10.1021/acsptsci.0c00064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Indexed: 02/06/2023]
Abstract
Platinum-based chemotherapy has been the standard treatment for ovarian cancer patients for approximately four decades. However, the prognosis of patients with advanced ovarian carcinoma remains dismal, mainly attributed to both dose-limiting toxicities of cisplatin and the high rate of chemo-resistant disease recurrence. Herein, both patient-derived and experimentally generated cisplatin-sensitive and -resistant ovarian cancer cell line models were used to delineate BADSer99 phosphorylation as an actionable target in ovarian cancer. BADSer99 phosphorylation was negatively associated with cisplatin sensitivity in ovarian cancer, and the inhibition of BADSer99 phosphorylation by point mutation induced apoptosis and reduced cisplatin IC50. In addition, BAD phosphorylation was also shown to be associated with cancer stem cell-like properties. Henceforth, a novel small molecule which inhibits BAD phosphorylation specifically at Ser99 (NPB) was utilized. NPB promoted apoptosis and reduced 3D growth of bulk cancer cells and inhibited cancer stem cell-like properties in both cisplatin-sensitive and -resistant ovarian cancer cells. The combination of cisplatin with NPB exhibited synergistic effects in vitro. NPB in combination with cisplatin also achieved an improved outcome compared to either monotreatment in vivo, including suppression of the cancer stem cell population, an effect not observed with cisplatin treatment. Furthermore, NPB exhibited strong synergistic effects with the AKT inhibitor AZD5363, and significantly reduced its IC50 in cells resistant to cisplatin treatment. These findings identify BADSer99 phosphorylation as an actionable and pharmacologically relevant target to improve outcomes of cisplatin treated ovarian cancer.
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Affiliation(s)
- Yanxin Wang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 119260, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119260, Singapore
| | - Yi-Shiou Chiou
- Tsinghua Berkeley Shenzhen Institute (TBSI), Shenzhen, 518000, China
| | - Qing-Yun Chong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 119260, Singapore
| | - Mengyi Zhang
- College of Pharmacy, Nankai University, Tianjin, 300071, China
| | | | - Lan Ma
- Tsinghua Berkeley Shenzhen Institute (TBSI), Shenzhen, 518000, China.,Shenzhen Bay Laboratory, Shenzhen, 518000, China
| | - Tao Zhu
- Hefei National Laboratory for Physical Sciences at Microscale and School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Alan Prem Kumar
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 119260, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119260, Singapore
| | - Ruby Yun-Ju Huang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 119260, Singapore.,Department of Obstetrics and Gynaecology, National University Hospital of Singapore, Singapore, 119074, Singapore.,School of Medicine, College of Medicine, National Taiwan University, Taipei, 10617, Taiwan
| | - Vijay Pandey
- Tsinghua Berkeley Shenzhen Institute (TBSI), Shenzhen, 518000, China
| | - Basappa
- Department of Studies in Organic Chemistry, University of Mysore, Mysore, 570006, India
| | - Peter E Lobie
- Tsinghua Berkeley Shenzhen Institute (TBSI), Shenzhen, 518000, China.,Shenzhen Bay Laboratory, Shenzhen, 518000, China
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9
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Low junctional adhesion molecule-A expression is associated with an epithelial to mesenchymal transition and poorer outcomes in high-grade serous carcinoma of uterine adnexa. Mod Pathol 2020; 33:2361-2377. [PMID: 32514162 DOI: 10.1038/s41379-020-0586-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 12/17/2022]
Abstract
High-grade serous carcinoma of uterine adnexa (HGSC) is the most frequent histotype of epithelial ovarian cancer and has a poor 5-year survival rate due to late-stage diagnosis and the poor efficacy of standard treatments. Novel biomarkers of cancer outcome are needed to identify new targetable pathways and improve personalized treatments. Cell-surface screening of 26 HGSC cell lines by high-throughput flow cytometry identified junctional adhesion molecule 1 (JAM-A, also known as F11R) as a potential biomarker. Using a multi-labeled immunofluorescent staining coupled with digital image analysis, protein levels of JAM-A were quantified in tissue microarrays from three HGSC patient cohorts: a discovery cohort (n = 101), the Canadian Ovarian Experimental Unified Resource cohort (COEUR, n = 1158), and the Canadian Cancer Trials Group OV16 cohort (n = 267). Low JAM-A level was associated with poorer outcome in the three cohorts by Kaplan-Meier (p = 0.023, p < 0.001, and p = 0.036, respectively) and was an independent marker of shorter survival in the COEUR cohort (HR = 0.517 (0.381-703), p < 0.001). When analyses were restricted to patients treated by taxane-platinum-based chemotherapy, low JAM-A protein expression was associated with poorer responses in the COEUR (p < 0.001) and OV16 cohorts (p = 0.006) by Kaplan-Meier. Decreased JAM-A gene expression was an indicator of poor outcome in gene expression datasets including The Cancer Genome Atlas (n = 606, p = 0.002) and Kaplan-Meier plotter (n = 1816, p = 0.024). Finally, we observed that tumors with decreased JAM-A expression exhibited an enhanced epithelial to mesenchymal transition (EMT) signature. Our results demonstrate that JAM-A expression is a robust prognostic biomarker of HGSC and may be used to discriminate tumors responsive to therapies targeting EMT.
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10
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Wang W, Liu M, Ding B. Comparison of the short‐term efficacy and serum markers between lobaplatin/paclitaxel‐ And carboplatin/paclitaxel‐based adjuvant chemotherapy in patient with ovarian cancer. J Clin Pharm Ther 2020; 46:166-172. [PMID: 33098169 DOI: 10.1111/jcpt.13276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/24/2020] [Accepted: 09/07/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Wei Wang
- Department of Gynecology Shangluo Central Hospital Shanxi China
| | - Ming Liu
- Department of Anesthesiology Shangluo Central Hospital Shanxi China
| | - Boyong Ding
- Department of Oncology Shangluo Central Hospital Shanxi China
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11
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Yoo J, Jung Y, Ahn JH, Choi YJ, Lee KH, Hur S. Incidence and clinical course of septic shock in neutropenic patients during chemotherapy for gynecological cancers. J Gynecol Oncol 2020; 31:e62. [PMID: 32808493 PMCID: PMC7440980 DOI: 10.3802/jgo.2020.31.e62] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/01/2020] [Accepted: 04/10/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To identify the incidence and clinical course of septic shock combined with neutropenia during chemotherapy in gynecological cancer patients. METHODS We retrospectively reviewed the medical records of all gynecological cancer patients who received intravenous chemotherapy between March 2009 and March 2018. Patients diagnosed with neutropenic septic shock (NSS) during the course of chemotherapy were identified. We calculated the overall incidence and mortality rate of NSS, and analyzed risk factors and clinical course. RESULTS A total of 1,009 patients received 10,239 cycles of chemotherapy during the study period. Among these, 30 (3.0%) patients had 32 NSS events, of which 12 (1.2%) died. With respect to patient age during the first course of chemotherapy, the incidence of NSS after the age of 50 was significantly higher than that in patients under 50 (3.9% vs. 1.4%, p=0.034). As the number of chemotherapy courses increased, the incidence of NSS increased, and linear-by-linear association analysis showed a positive correlation (p=0.004). NSS events occurred on average 7.8 days after the last cycle of chemotherapy, and the median duration of vasopressor administration was 23.3 hours. The median age (64.0 vs. 56.5, p=0.017) and peak heart rate (149.5 min-1 vs. 123.5 min-1, p=0.015) were significantly higher in the group of patients who subsequently died of NSS than in those who survived. CONCLUSION The overall incidence of NSS in gynecological cancer patients receiving chemotherapy was 3.0%, which is higher than previously estimated. Peak heart rate during NSS events may be an indicator for predicting survival.
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Affiliation(s)
- Jigeun Yoo
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yuyeon Jung
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jung Hwan Ahn
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Youn Jin Choi
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Keun Ho Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sooyoung Hur
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
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12
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Yuan D, Zhou H, Sun H, Tian R, Xia M, Sun L, Liu Y. Identification of key genes for guiding chemotherapeutic management in ovarian cancer using translational bioinformatics. Oncol Lett 2020; 20:1345-1359. [PMID: 32724377 PMCID: PMC7377160 DOI: 10.3892/ol.2020.11672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 04/01/2020] [Indexed: 12/13/2022] Open
Abstract
The emergence of resistance to chemotherapy drugs in patients with ovarian cancer is still the main cause of low survival rates. The present study aimed to identify key genes that may provide treatment guidance to reduce the incidence of drug resistance in patients with ovarian cancer. Original data of chemotherapy sensitivity and chemoresistance of ovarian cancer were obtained from the Gene Expression Omnibus dataset GSE73935. Differentially expressed genes (DEGs) between sensitive and resistant ovarian cancer cell lines were screened by Empirical Bayes methods. Overlapping DEGs between four chemoresistant groups were identified by Venn map analysis. Protein-protein interaction networks were also constructed, and hub genes were identified. The hub genes were verified by in vitro experiments as well as The Cancer Genome Atlas data. Results from the present study identified eight important genes that may guide treatment decisions regarding chemotherapy regimens for ovarian cancer, including epidermal growth factor-like repeats and discoidin I-like domains 3, NRAS proto-oncogene, hyaluronan and proteoglycan link protein 1, activated protein C receptor, CD53, cyclin-dependent kinase inhibitor 2A, insulin-like growth factor 1 receptor and roundabout guidance receptor 2 genes. Their expressions were found to have an impact on the prognosis of different treatment groups (cisplatin, paclitaxel, cisplatin + paclitaxel, cisplatin + doxorubicin and cisplatin + topotecan). The results indicated that these genes may minimise the occurrence of ovarian cancer drug resistance and may provide effective treatment options for patients with ovarian cancer.
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Affiliation(s)
- Danni Yuan
- Key Laboratory of Pathobiology, Department of Pathophysiology, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Haohan Zhou
- Key Laboratory of Pathobiology, Department of Pathophysiology, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Hongyu Sun
- Key Laboratory of Pathobiology, Department of Pathophysiology, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Rui Tian
- Key Laboratory of Pathobiology, Department of Pathophysiology, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Meihui Xia
- Department of Obstetrics, First Hospital, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Liankun Sun
- Key Laboratory of Pathobiology, Department of Pathophysiology, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yanan Liu
- Key Laboratory of Pathobiology, Department of Pathophysiology, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, Jilin 130021, P.R. China
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13
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Yang Y, Du N, Xie L, Jiang J, Mo J, Hong J, Mao D, Ng DM, Shi H. The efficacy and safety of the addition of poly ADP-ribose polymerase (PARP) inhibitors to therapy for ovarian cancer: a systematic review and meta-analysis. World J Surg Oncol 2020; 18:151. [PMID: 32622363 PMCID: PMC7335450 DOI: 10.1186/s12957-020-01931-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/23/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to explore the efficacy and tolerability of poly ADP-ribose polymerase (PARP) inhibitors in patients with ovarian cancer. METHODS The meta-analysis searched the PubMed, Web of Science, EBSCO, and Cochrane libraries from inception to February 2020 to identify relevant studies. And the main results of this study were long-term prognosis and treatment-related adverse events. RESULTS The results showed that the addition of PARP inhibitors could significantly prolong progression-free survival (PFS) and overall survival (OS) for patients with ovarian cancer (HR 0.44, 95% CI 0.34-0.53, p < 0.001; HR, 0.79, 95% CI 0.65-0.94, p < 0.001, respectively). In the BRCA 1/2 mutation patients, the HR of PFS was 0.29 (p < 0.001), and the HR was 0.51 (p < 0.001) in the no BRCA 1/2 mutation patients. The HR of PFS was 0.40 (p < 0.001) in the homologous recombination deficiency (HRD) mutation patients, while the HR was 0.80 (p < 0.001) in the no HRD mutation patients. Moreover, the analysis found that the use of PARP inhibitors did not significantly increase the risk of all grade adverse events (AEs) (RR = 1.04, p = 0.16). But the incidence of grade 3 or higher AEs was increased (RR = 1.87, p = 0.002). In general, the AEs were mainly manifested in the blood system. CONCLUSIONS PARP inhibitors can improve the prognosis of ovarian cancer patients with and without genetic mutations (BRCA 1/2 or HRD). Furthermore, PARP inhibitors were tolerable to patients when added to their current therapy, although it inevitably adds the grade 3 and higher AEs.
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Affiliation(s)
- Yingzhu Yang
- Department of Gynecology, Ningbo Women and Children's Hospital, Liuting Street 339, Haishu District, Ningbo, Zhejiang, 315000, China
| | - Nannan Du
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Laidi Xie
- Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Jing Jiang
- Department of Gynecology, Ningbo Women and Children's Hospital, Liuting Street 339, Haishu District, Ningbo, Zhejiang, 315000, China
| | - Jiahang Mo
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiaze Hong
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Danyi Mao
- Basic Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Derry Minyao Ng
- Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Huiwei Shi
- Department of Gynecology, Ningbo Women and Children's Hospital, Liuting Street 339, Haishu District, Ningbo, Zhejiang, 315000, China.
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14
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Lee MW, Ryu H, Song IC, Yun HJ, Jo DY, Ko YB, Lee HJ. Efficacy of cisplatin combined with topotecan in patients with advanced or recurrent ovarian cancer as second- or higher-line palliative chemotherapy. Medicine (Baltimore) 2020; 99:e19931. [PMID: 32332673 PMCID: PMC7440193 DOI: 10.1097/md.0000000000019931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the outcomes of patients with advanced or recurrent ovarian cancer treated with cisplatin combined with topotecan as second- or higher-line palliative chemotherapy.We retrospectively reviewed the medical records of patients with advanced or recurrent ovarian cancer, who were treated with cisplatin (50 mg/m on day 1) and topotecan (0.75 mg/m on days 1-3). Treatment response, progression-free survival (PFS) and overall survival (OS) were analyzed, and laboratory data were reviewed to evaluate toxicities.Thirty one patients were treated with cisplatin and topotecan. The objective response rate (ORR) was 22.6%, and the disease control rate (DCR) was 61.3%. The median PFS was 3.7 months (95% confidence interval [CI], 2.3-5.2 months) and the median OS was 44.5 months (95% CI, 35.5-53.5 months). The ORR (33.3% vs. 0%; P = .012) was significantly better in the platinum-sensitive group compared to the platinum-resistant group. The median PFS was significantly longer in the platinum-sensitive group compared to the platinum-resistant group (7.7 vs 2.5 months; P < .001), and the median OS was also significantly longer in the platinum-sensitive group (46.6 vs 19.3 months; P < .001). Almost all of the patients reported some degree of hematological toxicity. A high rate of grade 3-4 neutropenia (87.1%) was observed. Grade 3-4 thrombocytopenia (41.9%) and febrile neutropenia (19.4%) were also seen.The results showed that cisplatin combined with topotecan, as second- or higher-line palliative chemotherapy for patients with advanced or recurrent ovarian cancer, might be effective, especially in the platinum-sensitive group. However, attention should be paid to the high hematological toxicity associated with this drug combination.
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Affiliation(s)
| | | | | | | | | | - Young Bok Ko
- Department of Obstetrics and Gynecology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
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15
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Paoletti X, Lewsley LA, Daniele G, Cook A, Yanaihara N, Tinker A, Kristensen G, Ottevanger PB, Aravantinos G, Miller A, Boere IA, Fruscio R, Reyners AKL, Pujade-Lauraine E, Harkin A, Pignata S, Kagimura T, Welch S, Paul J, Karamouza E, Glasspool RM. Assessment of Progression-Free Survival as a Surrogate End Point of Overall Survival in First-Line Treatment of Ovarian Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e1918939. [PMID: 31922558 PMCID: PMC6991254 DOI: 10.1001/jamanetworkopen.2019.18939] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022] Open
Abstract
Importance The Gynecologic Cancer InterGroup (GCIG) recommended that progression-free survival (PFS) can serve as a primary end point instead of overall survival (OS) in advanced ovarian cancer. Evidence is lacking for the validity of PFS as a surrogate marker of OS in the modern era of different treatment types. Objective To evaluate whether PFS is a surrogate end point for OS in patients with advanced ovarian cancer. Data Sources In September 2016, a comprehensive search of publications in MEDLINE was conducted for randomized clinical trials of systematic treatment in patients with newly diagnosed ovarian, fallopian tube, or primary peritoneal cancer. The GCIG groups were also queried for potentially completed but unpublished trials. Study Selection Studies with a minimum sample size of 60 patients published since 2001 with PFS and OS rates available were eligible. Investigational treatments considered included initial, maintenance, and intensification therapy consisting of agents delivered at a higher dose and/or frequency compared with that in the control arm. Data Extraction and Synthesis Using the meta-analytic approach on randomized clinical trials published from January 1, 2001, through September 25, 2016, correlations between PFS and OS at the individual level were estimated using the Kendall τ model; between-treatment effects on PFS and OS at the trial level were estimated using the Plackett copula bivariate (R2) model. Criteria for PFS surrogacy required R2 ≥ 0.80 at the trial level. Analysis was performed from January 7 through March 20, 2019. Main Outcomes and Measures Overall survival and PFS based on measurement of cancer antigen 125 levels confirmed by radiological examination results or by combined GCIG criteria. Results In this meta-analysis of 17 unique randomized trials of standard (n = 7), intensification (n = 5), and maintenance (n = 5) chemotherapies or targeted treatments with data from 11 029 unique patients (median age, 58 years [range, 18-88 years]), a high correlation was found between PFS and OS at the individual level (τ = 0.724; 95% CI, 0.717-0.732), but a low correlation was found at the trial level (R2 = 0.24; 95% CI, 0-0.59). Subgroup analyses led to similar results. In the external validation, 14 of the 16 hazard ratios for OS in the published reports fell within the 95% prediction interval from PFS. Conclusions and Relevance This large meta-analysis of individual patient data did not establish PFS as a surrogate end point for OS in first-line treatment of advanced ovarian cancer, but the analysis was limited by the narrow range of treatment effects observed or by poststudy treatment. These results suggest that if PFS is chosen as a primary end point, OS must be measured as a secondary end point.
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Affiliation(s)
- Xavier Paoletti
- Groupe d’investigateurs national des Etudes des Cancers Ovariens (GINECO), Paris, France
- Gustave Roussy Cancer Center and Institut National de la Santé et de la Recherche Medicale Oncostat, Villejuif, France
- Department of Biostatistics, University of Versailles St Quentin, Institut Curie, Saint-Cloud, France
| | - Liz-Anne Lewsley
- Scottish Gynaecological Cancer Trials Group (SGCTG), Cancer Research United Kingdom Clinical Trial Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Gennaro Daniele
- Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Clinical Trials Unit, Istituto Nazionale Tumori– Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, Napoli, Italia
| | - Adrian Cook
- Medical Research Counsel Clinical Trials Unit, University College London, London, United Kingdom
| | - Nozomu Yanaihara
- Japanese Gynecologic Oncology Group (JGOG), Jikei University School of Medicine, Tokyo, Japan
| | - Anna Tinker
- Canadian Cancer Trials Group (CCTG), University of British Columbia, Vancouver, British Columbia, Canada
| | - Gunnar Kristensen
- Nordic Society of Gynaecological Oncology, Norwegian Radium Hospital, Oslo, Norway
| | - Petronella B. Ottevanger
- European Organisation for Research and Treatment of Cancer, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gerasimos Aravantinos
- Hellenic Cooperative Oncology Group, General Oncology Hospital of Kifissia, Nea Kifissia, Greece
| | - Austin Miller
- Gynecologic Oncology Group (GOG), Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Ingrid A. Boere
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Robert Fruscio
- University of Milan Bicocca, San Gerardo Hospital, Monza, Italy
| | - Anna K. L. Reyners
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Eric Pujade-Lauraine
- Association de Recherche sur les Cancers dont Gynécologiques–GINECO, Université Paris Descartes, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Andrea Harkin
- Scottish Gynaecological Cancer Trials Group (SGCTG), Cancer Research United Kingdom Clinical Trial Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Sandro Pignata
- MITO, Istituto Nazionale Tumori di Napoli IRCCS Fondazione G Pascale, Napoli, Italy
| | - Tatsuo Kagimura
- JGOG, Foundation for Biomedical Research and Innovation at Kobe, Translational Research Center for Medical Innovation, Kobe, Japan
| | - Stephen Welch
- CCTG, London Health Sciences Centre, London, Ontario, Canada
| | - James Paul
- Scottish Gynaecological Cancer Trials Group (SGCTG), Cancer Research United Kingdom Clinical Trial Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | - Rosalind M. Glasspool
- SGCTG, Beatson West of Scotland Cancer Centre, NHS (National Health Service) Greater Glasgow and Clyde, Glasgow, United Kingdom
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16
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Gourley C, Bookman MA. Evolving Concepts in the Management of Newly Diagnosed Epithelial Ovarian Cancer. J Clin Oncol 2019; 37:2386-2397. [PMID: 31403859 DOI: 10.1200/jco.19.00337] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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17
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Bouberhan S, Shea M, Cannistra SA. Advanced Epithelial Ovarian Cancer: Do More Options Mean Greater Benefits? J Clin Oncol 2019; 37:1359-1364. [PMID: 31002579 DOI: 10.1200/jco.19.00500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A healthy 51-year-old woman presented with increasing abdominal and pelvic pain. Computed tomography imaging of the abdomen and pelvis showed an 11.6-cm pelvic mass, retroperitoneal lymphadenopathy, right hydronephrosis, and mesenteric tumor deposits ( Fig 1A ). A serum CA-125 was elevated at 1,149 U/mL. She underwent primary surgical cytoreduction including hysterectomy, bilateral salpingo-oophorectomy, appendectomy, resection of pelvic tumor, omentectomy, and low anterior resection with colorectal anastomosis. Intraoperatively, she was noted to have bilateral ovarian masses, pelvic and para-aortic lymphadenopathy, and a 4-cm omental tumor; in addition, both the uterus and rectosigmoid colon had adherent tumor deposits. All gross tumor was resected during the procedure. Final pathology confirmed high-grade serous carcinoma of ovarian origin ( Fig 1B ) that was determined to be stage IIIC as a result of upper abdominal involvement with greater than 2-cm tumor deposits, as well as retroperitoneal lymph node involvement. She underwent germline genetic testing, which did not identify a mutation in the BRCA1, BRCA2, BRIP1, RAD51C, or RAD51D genes. She presented for adjuvant chemotherapy after an optimal (R0) resection.
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Affiliation(s)
- Sara Bouberhan
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Meghan Shea
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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18
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Ai X, Guo X, Wang J, Stancu AL, Joslin PMN, Zhang D, Zhu S. Targeted therapies for advanced non-small cell lung cancer. Oncotarget 2018; 9:37589-37607. [PMID: 30680072 PMCID: PMC6331020 DOI: 10.18632/oncotarget.26428] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 02/24/2018] [Indexed: 12/28/2022] Open
Abstract
Lung cancer is a serious health problem and the leading cause of cancer death worldwide, due to its high incidence and mortality. 85% of lung cancers are represented by the non-small cell lung cancer (NSCLC). Traditional chemotherapy has been the main treatment option in NSCLC. However, it is often associated with limited efficacy and overall poor patient survival. In recent years, molecular targeting has achieved great progress in therapeutic treatment of cancer and plays a crucial role in the current clinical treatment of NSCLC, due to enhanced efficacy on cancer tissues and reduced toxicity for normal tissues. In this review, we summarize the current targeting treatment of NSCLC, including inhibition of the epidermal growth factor receptor (EGFR), phosphatidylinositol 3-kinase (PI3Ks), mechanistic target of rapamycin (mTOR), epidermal growth factor receptor 2 (ErbB2), vascular epidermal growth factor receptor (VEGFR), kirsten human rat sarcoma protein (KRAS), mesenchymal-epithelial transition factor or hepatocyte growth factor receptor (c-MET), anaplastic lymphoma kinase (ALK), v-Raf murine sarcoma viral oncogene homolog B (BRAF). This article may serve as a guide to clinicians and researchers alike by assisting in making therapeutic decisions. Challenges of acquired drug resistance targeted therapy and imminent newer treatment modalities against NSCLC are also discussed.
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Affiliation(s)
- Xiaojuan Ai
- National Key Discipline of Genetics, School of Life Sciences, Central South University, Changsha, China
| | | | - Jun Wang
- National Key Discipline of Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Andreea L Stancu
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Patrick M N Joslin
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dianzheng Zhang
- Department of Bio-Medical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Shudong Zhu
- National Key Discipline of Genetics, School of Life Sciences, Central South University, Changsha, China.,Argus Pharmaceuticals, Changsha, China
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Risk factors for septic adverse events and their impact on survival in advanced ovarian cancer patients treated with neoadjuvant chemotherapy and interval debulking surgery. Gynecol Oncol 2018; 151:32-38. [DOI: 10.1016/j.ygyno.2018.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 01/13/2023]
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20
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Clinical benefit of controversial first line systemic therapies for advanced stage ovarian cancer – ESMO-MCBS scores. Cancer Treat Rev 2018; 69:233-242. [DOI: 10.1016/j.ctrv.2018.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 12/22/2022]
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21
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Sjoquist KM, Lord SJ, Friedlander ML, John Simes R, Marschner IC, Lee CK. Progression-free survival as a surrogate endpoint for overall survival in modern ovarian cancer trials: a meta-analysis. Ther Adv Med Oncol 2018; 10:1758835918788500. [PMID: 30093922 PMCID: PMC6080081 DOI: 10.1177/1758835918788500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/24/2018] [Indexed: 11/15/2022] Open
Abstract
Background Progression-free survival (PFS) has been adopted as the primary endpoint in many randomized controlled trials, and can be determined much earlier than overall survival (OS). We investigated whether PFS is a good surrogate endpoint for OS in trials of first-line treatment for epithelial ovarian cancer (EOC), and whether this relationship has changed with the introduction of new treatment types. Methods In a meta-analysis, we identified summary data [hazard ratio (HR) and median time] from published randomized controlled trials. Linear regression was used to assess the association between treatment effects on PFS and OS overall, and for subgroups defined by treatment type, postprogression survival (PPS) and established prognostic factors. Results Correlation between HRs for PFS and OS, in 26 trials with 30 treatment comparisons comprising 24,870 patients, was modest (r2 = 0.52, weighted by trial sample size). The correlation diminished with recency: preplatinum/paclitaxel era, r2= 0.66; platinum/paclitaxel, r2= 0.44; triplet combinations, r2= 0.22; biologicals, r2= 0.30. The median PPS increased over time for the experimental (Ptrend = 0.03) and control arms (Ptrend = 0.003). The difference in median PPS between treatment arms strongly correlated with the difference in median OS (r2 = 0.83). In trials where the control therapy had median PPS of less than 18 months, correlation between PFS and OS was stronger (r2 = 0.64) than where the median PPS was longer (r2 = 0.48). Conclusions In EOC, correlation in the relative treatment effect between PFS and OS in first-line platinum-based chemotherapy randomized controlled trials is moderate and has weakened with increasing availability of effective salvage therapies.
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Affiliation(s)
- Katrin M Sjoquist
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, Australia New Zealand Gynaecological Oncology Group, University of Sydney, Locked Bag 77, Camperdown NSW 1450, Australia
| | - Sarah J Lord
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Michael L Friedlander
- NHMRC Clinical Trials Centre, Australia New Zealand, Gynaecological Oncology Group, University of Sydney, Camperdown, Australia
| | - Robert John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Ian C Marschner
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Chee Khoon Lee
- NHMRC Clinical Trials Centre, Australia New Zealand Gynaecological Oncology Group, University of Sydney, Camperdown, Australia
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Wilson MK, Mercieca-Bebber R, Friedlander M. A practical guide to understanding, using and including patient reported outcomes in clinical trials in ovarian cancer. J Gynecol Oncol 2018; 29:e81. [PMID: 30022641 PMCID: PMC6078895 DOI: 10.3802/jgo.2018.29.e81] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 06/25/2018] [Accepted: 07/02/2018] [Indexed: 01/01/2023] Open
Abstract
Health related quality of life (HRQOL) is a key priority for patients with ovarian cancer as there is significant morbidity associated with the disease and the treatment. It is therefore essential to include measures of HRQOL and patient reported outcomes (PROs) in all clinical trials and ideally report them in the initial manuscript. The results of these analyses help interpret the primary trial endpoints which are typically progression free survival and overall survival from the perspective of the patients, but can also assist with regulatory approval of new drugs and inform future patients regarding the potential benefits and downsides of the treatment as well as help support clinical recommendations. Including PROs in clinical trials allows patient-defined clinical benefits to be assessed in parallel to traditional survival outcomes to provide a more holistic overview and aid in the interpretation of the trial results. Given the importance of these instruments in clinical trials, greater effort is required to improve the appropriate inclusion, quality of analyses and reporting of PROs. It is also essential that all clinicians understand the intricacies of the selection, implementation and interpretation of these measures of HRQOL and PRO's and how important their contribution is to clinical trials as well as clinical practice. This review is a practical guide for clinicians to gain a better understanding of PROs and how they can be incorporated into ovarian cancer trials.
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Affiliation(s)
- Michelle K Wilson
- Department of Cancer and Blood, Auckland City Hospital, Auckland, New Zealand.
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Wilson MK, Friedlander ML, Joly F, Oza AM. A Systematic Review of Health-Related Quality of Life Reporting in Ovarian Cancer Phase III Clinical Trials: Room to Improve. Oncologist 2018; 23:203-213. [PMID: 29118265 PMCID: PMC5813744 DOI: 10.1634/theoncologist.2017-0297] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/21/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Epithelial ovarian cancer (OC) remains a significant cause of morbidity and mortality for women worldwide. Patients may experience a multitude of disease- and treatment-related symptoms that can impact quality of life (QOL) and should be measured and reported in clinical trials. This systematic review investigated the adequacy of reporting of QOL in randomized phase III trials in OC in both the first-line and recurrent disease setting. MATERIALS AND METHODS A systematic review of MEDLINE and EMBASE identified randomized clinical trials of systemic therapy in OC from 1980 to 2014. The adequacy of reporting QOL was evaluated with respect to adherence to established guidelines on reporting QOL in clinical trials and the recent recommendations on the inclusion of patient-reported outcomes in clinical trials from the Fifth Ovarian Cancer Consensus Conference. RESULTS Of 3,247 abstracts, 35 studies, including 24,664 patients, met inclusion criteria. Twenty-two trials (63%) were in the first-line setting, with 13 (37%) in the recurrent setting. The inclusion of QOL assessments increased from 2% (1980s) to 62% (2010+). Quality of life was a co-primary endpoint in only one trial.Minimal clinically important differences in QOL were defined in eight trials (23%), with results included in the abstract in 37% and article in 86%. Compliance was reported in 26 trials (74%), with 13 trials (37%) reporting specifically how they dealt with missing data. Only seven trials reported the reasons for missing data (20%).Group results were published in 29 trials (83%), with 6 (17%) reporting individual patient results. Results were more commonly reported as a mean overall score (21 trials; 60%), with specific domain scores in only 9 trials (26%). No studies reported QOL beyond progression or included predefined context-specific endpoints based on objectives of treatment (i.e., palliation/cure/maintenance) and the patient population. Duration of benefit of palliative chemotherapy was reported in only one study. CONCLUSION Inclusion and reporting of QOL as a trial endpoint has improved in phase III trials in OC, but there are still significant shortfalls that need to be addressed in future trials. IMPLICATIONS FOR PRACTICE The impact of treatment on quality of life (QOL) is an important consideration in patients with ovarian cancer for whom treatment is often given with palliative intent. Both the disease and treatment impact a patient's QOL and require careful evaluation in clinical trials. Matching the QOL questions to the patient population of interest is critical. Similar rigor to that used to assess progression-based endpoints is essential to guide clinical decisions. This systematic review demonstrated that although the inclusion and reporting of QOL as a trial endpoint has improved in phase III trials there are still significant shortfalls that need to be addressed in future trials.
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Affiliation(s)
- Michelle K Wilson
- Department of Medical Oncology, Auckland City Hospital, Auckland, New Zealand
| | | | - Florence Joly
- Department of Medical Oncology, Centre Francois Baclesse, Universite Basse Normandie, INSERM U1086, Caen, France
| | - Amit M Oza
- Princess Margaret Cancer Centre, Toronto, Canada
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24
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Provencher DM, Gallagher CJ, Parulekar WR, Ledermann JA, Armstrong DK, Brundage M, Gourley C, Romero I, Gonzalez-Martin A, Feeney M, Bessette P, Hall M, Weberpals JI, Hall G, Lau SK, Gauthier P, Fung-Kee-Fung M, Eisenhauer EA, Winch C, Tu D, MacKay HJ. OV21/PETROC: a randomized Gynecologic Cancer Intergroup phase II study of intraperitoneal versus intravenous chemotherapy following neoadjuvant chemotherapy and optimal debulking surgery in epithelial ovarian cancer. Ann Oncol 2018; 29:431-438. [PMID: 29186319 PMCID: PMC6658709 DOI: 10.1093/annonc/mdx754] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background The purpose of this multistage, adaptively, designed randomized phase II study was to evaluate the role of intraperitoneal (i.p.) chemotherapy following neoadjuvant chemotherapy (NACT) and optimal debulking surgery in women with epithelial ovarian cancer (EOC). Patients and methods We carried out a multicenter, two-stage, phase II trial. Eligible patients with stage IIB-IVA EOC treated with platinum-based intravenous (i.v.) NACT followed by optimal (<1 cm) debulking surgery were randomized to one of the three treatment arms: (i) i.v. carboplatin/paclitaxel, (ii) i.p. cisplatin plus i.v./i.p. paclitaxel, or (iii) i.p. carboplatin plus i.v./i.p. paclitaxel. The primary end point was 9-month progressive disease rate (PD9). Secondary end points included progression-free survival (PFS), overall survival (OS), toxicity, and quality of life (QOL). Results Between 2009 and 2015, 275 patients were randomized; i.p. cisplatin containing arm did not progress beyond the first stage of the study after failing to meet the pre-set superiority rule. The final analysis compared i.v. carboplatin/paclitaxel (n = 101) with i.p. carboplatin, i.v./i.p. paclitaxel (n = 102). The intention to treat PD9 was lower in the i.p. carboplatin arm compared with the i.v. carboplatin arm: 24.5% (95% CI 16.2% to 32.9%) versus 38.6% (95% CI 29.1% to 48.1%) P = 0.065. The study was underpowered to detect differences in PFS: HR PFS 0.82 (95% CI 0.57-1.17); P = 0.27 and OS HR 0.80 (95% CI 0.47-1.35) P = 0.40. The i.p. carboplatin-based regimen was well tolerated with no reduction in QOL or increase in toxicity compared with i.v. administration alone. Conclusion In women with stage IIIC or IVA EOC treated with NACT and optimal debulking surgery, i.p. carboplatin-based chemotherapy is well tolerated and associated with an improved PD9 compared with i.v. carboplatin-based chemotherapy. Clinical trial number clinicaltrials.gov, NCT01622543.
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Affiliation(s)
- D M Provencher
- Institut du Cancer de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | | | - W R Parulekar
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - J A Ledermann
- University College London Cancer Institute, London, UK
| | - D K Armstrong
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - M Brundage
- Cancer Centre of Southeastern Ontario, Kingston, Canada
| | - C Gourley
- Edinburgh Cancer Research UK Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - I Romero
- Secretaria del Área Clínica de Oncología Ginecológica, Instituto Valenciano de Oncología, València
| | | | - M Feeney
- University College London Cancer Institute, London, UK
| | - P Bessette
- Gynecologic Oncology Division, Centre Hospitalier de l'Université de Montréal, Sherbrooke, Canada
| | - M Hall
- Department of Obstetrics and Gynaecology, Mount Vernon Cancer Centre, Northwood, UK
| | - J I Weberpals
- Division of Gynaecologic Oncology, The Ottawa Hospital, Ottawa, Canada
| | - G Hall
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - S K Lau
- Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, Montréal, Canada
| | - P Gauthier
- Gynecologic Oncology Division, Centre Hospitalier de l'Université de Montréal, Sherbrooke, Canada
| | - M Fung-Kee-Fung
- Division of Gynaecologic Oncology, The Ottawa Hospital, Ottawa, Canada
| | - E A Eisenhauer
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - C Winch
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - D Tu
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - H J MacKay
- Division of Medical Oncology & Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
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25
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Provencher DM, Gallagher CJ, Parulekar WR, Ledermann JA, Armstrong DK, Brundage M, Gourley C, Romero I, Gonzalez-Martin A, Feeney M, Bessette P, Hall M, Weberpals JI, Hall G, Lau SK, Gauthier P, Fung-Kee-Fung M, Eisenhauer EA, Winch C, Tu D, MacKay HJ. OV21/PETROC: a randomized Gynecologic Cancer Intergroup phase II study of intraperitoneal versus intravenous chemotherapy following neoadjuvant chemotherapy and optimal debulking surgery in epithelial ovarian cancer. ANNALS OF ONCOLOGY : OFFICIAL JOURNAL OF THE EUROPEAN SOCIETY FOR MEDICAL ONCOLOGY 2018. [PMID: 29186319 DOI: 10.1093/annonc/mdx754] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background The purpose of this multistage, adaptively, designed randomized phase II study was to evaluate the role of intraperitoneal (i.p.) chemotherapy following neoadjuvant chemotherapy (NACT) and optimal debulking surgery in women with epithelial ovarian cancer (EOC). Patients and methods We carried out a multicenter, two-stage, phase II trial. Eligible patients with stage IIB-IVA EOC treated with platinum-based intravenous (i.v.) NACT followed by optimal (<1 cm) debulking surgery were randomized to one of the three treatment arms: (i) i.v. carboplatin/paclitaxel, (ii) i.p. cisplatin plus i.v./i.p. paclitaxel, or (iii) i.p. carboplatin plus i.v./i.p. paclitaxel. The primary end point was 9-month progressive disease rate (PD9). Secondary end points included progression-free survival (PFS), overall survival (OS), toxicity, and quality of life (QOL). Results Between 2009 and 2015, 275 patients were randomized; i.p. cisplatin containing arm did not progress beyond the first stage of the study after failing to meet the pre-set superiority rule. The final analysis compared i.v. carboplatin/paclitaxel (n = 101) with i.p. carboplatin, i.v./i.p. paclitaxel (n = 102). The intention to treat PD9 was lower in the i.p. carboplatin arm compared with the i.v. carboplatin arm: 24.5% (95% CI 16.2% to 32.9%) versus 38.6% (95% CI 29.1% to 48.1%) P = 0.065. The study was underpowered to detect differences in PFS: HR PFS 0.82 (95% CI 0.57-1.17); P = 0.27 and OS HR 0.80 (95% CI 0.47-1.35) P = 0.40. The i.p. carboplatin-based regimen was well tolerated with no reduction in QOL or increase in toxicity compared with i.v. administration alone. Conclusion In women with stage IIIC or IVA EOC treated with NACT and optimal debulking surgery, i.p. carboplatin-based chemotherapy is well tolerated and associated with an improved PD9 compared with i.v. carboplatin-based chemotherapy. Clinical trial number clinicaltrials.gov, NCT01622543.
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Affiliation(s)
- D M Provencher
- Institut du Cancer de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | | | - W R Parulekar
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - J A Ledermann
- University College London Cancer Institute, London, UK
| | - D K Armstrong
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - M Brundage
- Cancer Centre of Southeastern Ontario, Kingston, Canada
| | - C Gourley
- Edinburgh Cancer Research UK Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - I Romero
- Secretaria del Área Clínica de Oncología Ginecológica, Instituto Valenciano de Oncología, València
| | | | - M Feeney
- University College London Cancer Institute, London, UK
| | - P Bessette
- Gynecologic Oncology Division, Centre Hospitalier de l'Université de Montréal, Sherbrooke, Canada
| | - M Hall
- Department of Obstetrics and Gynaecology, Mount Vernon Cancer Centre, Northwood, UK
| | - J I Weberpals
- Division of Gynaecologic Oncology, The Ottawa Hospital, Ottawa, Canada
| | - G Hall
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - S K Lau
- Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, Montréal, Canada
| | - P Gauthier
- Gynecologic Oncology Division, Centre Hospitalier de l'Université de Montréal, Sherbrooke, Canada
| | - M Fung-Kee-Fung
- Division of Gynaecologic Oncology, The Ottawa Hospital, Ottawa, Canada
| | - E A Eisenhauer
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - C Winch
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - D Tu
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - H J MacKay
- Division of Medical Oncology & Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
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26
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Jang JYA, Yanaihara N, Pujade-Lauraine E, Mikami Y, Oda K, Bookman M, Ledermann J, Shimada M, Kiyokawa T, Kim BG, Matsumura N, Kaku T, Kuroda T, Nagayoshi Y, Kawabata A, Iida Y, Kim JW, Quinn M, Okamoto A. Update on rare epithelial ovarian cancers: based on the Rare Ovarian Tumors Young Investigator Conference. J Gynecol Oncol 2018; 28:e54. [PMID: 28541641 PMCID: PMC5447152 DOI: 10.3802/jgo.2017.28.e54] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 02/08/2023] Open
Abstract
There has been significant progress in the understanding of the pathology and molecular biology of rare ovarian cancers, which has helped both diagnosis and treatment. This paper provides an update on recent advances in the knowledge and treatment of rare ovarian cancers and identifies gaps that need to be addressed by further clinical research. The topics covered include: low-grade serous, mucinous, and clear cell carcinomas of the ovary. Given the molecular heterogeneity and the histopathological rarity of these ovarian cancers, the importance of designing adequately powered trials or finding statistically innovative ways to approach the treatment of these rare tumors has been emphasized. This paper is based on the Rare Ovarian Tumors Conference for Young Investigators which was presented in Tokyo 2015 prior to the 5th Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup (GCIG).
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Affiliation(s)
- Ji Yon Agnes Jang
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Nozomu Yanaihara
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Eric Pujade-Lauraine
- Unité Cancer de la Femme et Recherche Clinique, Hôpitaux Universitaires Paris Centre, site Hôtel-Dieu, Université Paris Descartes, Paris, France
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Katsutoshi Oda
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | | | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Takako Kiyokawa
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Byoung Gie Kim
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
| | - Tsunehisa Kaku
- Department of Health Sciences, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Takafumi Kuroda
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoko Nagayoshi
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ayako Kawabata
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasushi Iida
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University, Seoul, Korea
| | - Michael Quinn
- Women's Cancer Research Center, Royal Women's Hospital, Melbourne, Australia
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
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27
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Kim JY, Cho CH, Song HS. Targeted therapy of ovarian cancer including immune check point inhibitor. Korean J Intern Med 2017; 32:798-804. [PMID: 28823141 PMCID: PMC5583460 DOI: 10.3904/kjim.2017.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/03/2017] [Indexed: 02/08/2023] Open
Abstract
Epithelial ovarian cancer is the eighth most common cause of cancer-related deaths in women because most patients present with advanced stage disease at the time of diagnosis. Although cytoreductive surgery and platinum-based chemotherapy remain the gold standards of treatment, the recurrence rate of ovarian cancer remains high. Attempts to improve this standard two-drug chemotherapy by adding a third cytotoxic drug have failed to affect either progression-free survival or overall survival and have resulted in an increase in toxic side effects. Some anti-angiogenic agents, poly(ADP-ribose) polymerase, and immune checkpoint inhibitors have shown efficacy in early stages of development for the treatment of epithelial ovarian cancer. As demonstrated in recent clinical trials, the use of bevacizumab, cediranib, pazopanib, olaparib, and rucaparib, either alone or in combination with conventional cytotoxic agents, improves progression-free survival. Trials on immune checkpoint inhibitors such as nivolumab have revealed prolonged responses in a small set of ovarian cancer cases but require further exploration. In this review, we discuss the role of targeted therapies against ovarian cancer, including the use of immune checkpoint inhibitors.
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Affiliation(s)
- Jin Young Kim
- Division of Hematology/Oncology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
- Pain Research Center, Keimyung University School of Medicine, Daegu, Korea
- Correspondence to Jin Young Kim, M.D. Division of Hematology/Oncology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea Tel: +82-53-250-7476 Fax: +82-53-425-6476 E-mail:
| | - Chi Heum Cho
- Department of Obstetrics and Gynecology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hong Suk Song
- Division of Hematology/Oncology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
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28
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Design expert assisted nanoformulation design for co-delivery of topotecan and thymoquinone: Optimization, in vitro characterization and stability assessment. J Mol Liq 2017. [DOI: 10.1016/j.molliq.2017.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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29
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Musiol R. An overview of quinoline as a privileged scaffold in cancer drug discovery. Expert Opin Drug Discov 2017; 12:583-597. [DOI: 10.1080/17460441.2017.1319357] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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30
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Trial-level analysis of progression-free survival and response rate as end points of trials of first-line chemotherapy in advanced ovarian cancer. Med Oncol 2017; 34:87. [DOI: 10.1007/s12032-017-0939-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
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31
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Wang F, Du X, Li X, Liu N, Yu H, Sheng X. Effects of sequential paclitaxel-carboplatin followed by gemcitabine-based chemotherapy compared with paclitaxel-carboplatin therapy administered to patients with advanced epithelial ovarian cancer: A retrospective, STROBE-compliant study. Medicine (Baltimore) 2016; 95:e5696. [PMID: 28002342 PMCID: PMC5181826 DOI: 10.1097/md.0000000000005696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We aimed to compare the efficacy of paclitaxel and carboplatin followed by gemcitabine-based combination chemotherapy with paclitaxel-carboplatin for treating advanced epithelial ovarian cancer in this retrospective, STROBE-compliant study. Patients' tolerance to treatment was also assessed.We retrospectively analyzed the records of 178 women who underwent initial optimal debulking surgery between January 2003 and December 2011 to treat FIGO stage IIIc epithelial ovarian cancer. Patients in arm 1 (n = 88) received 4 cycles of paclitaxel and carboplatin followed by 2 to 4 cycles of gemcitabine-based combination chemotherapy. Patients in arm 2 (n = 90) received 6 to 8 cycles of paclitaxel and carboplatin. The granulocyte-colony stimulating factor was administered prophylactically to all patients.The median follow-up for both arms was 62 months. Medianprogression-free survival (PFS) between arms 1 and 2 (28 and 19 months [P = 0.003]) as well as 5-year OS (34.1% and 18.9% [P = 0.021]) differed significantly. The neurotoxicity rate was significantly higher in arm 2 than in arm 1 (45.2% vs 27.1%, P = 0.026). There was no significant difference between study arms in hematological toxicity.The sequential regimen significantly improved PFS and 5-year OS with tolerable toxicity compared with the single regimen, and offers an alternative for treating patients with advanced epithelial ovarian cancer.
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Affiliation(s)
- Fei Wang
- School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences
- Department of Gynecologic Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan
| | - Xuelian Du
- Department of Gynecologic Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan
| | - Xiaoxia Li
- Department of Obstetrics and Gynecology, People's Hospital of Wenshang, Jining, Shandong, China
| | - Naifu Liu
- Department of Gynecologic Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan
| | - Hao Yu
- Department of Gynecologic Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan
| | - Xiugui Sheng
- Department of Gynecologic Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan
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32
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Webber K, Friedlander M. Chemotherapy for epithelial ovarian, fallopian tube and primary peritoneal cancer. Best Pract Res Clin Obstet Gynaecol 2016; 41:126-138. [PMID: 28027849 DOI: 10.1016/j.bpobgyn.2016.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/03/2016] [Accepted: 11/11/2016] [Indexed: 01/01/2023]
Abstract
Chemotherapy plays a key role in the management of women with epithelial ovarian, fallopian tube and primary peritoneal cancer (EOC). Platinum- and taxane-based regimens are the standard of care for adjuvant treatment in early-stage EOC and first-line therapy for advanced stage disease. Efforts to define the optimal scheduling, timing and route of administration are ongoing. The majority of women with EOC will develop recurrent disease, and treatment options for these women are depend on the time that has elapsed from first-line therapy. Platinum-based doublet chemotherapy is preferred for women with platinum-sensitive recurrent cancer. In platinum-resistant relapsed EOC, options are much more limited, and careful consideration of symptoms, performance status, anticipated toxicity and quality of life is essential when recommending chemotherapy for these women.
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Affiliation(s)
- Kate Webber
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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Morphologic and Molecular Characteristics of Mixed Epithelial Ovarian Cancers. Am J Surg Pathol 2016; 39:1548-57. [PMID: 26099008 DOI: 10.1097/pas.0000000000000476] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epithelial ovarian cancer (EOC) consists of 5 major histotypes: high-grade serous carcinoma (HGSC), endometrioid carcinoma (EC), clear cell carcinoma (CCC), mucinous carcinoma (MC), and low-grade serous carcinoma (LGSC). Each can have a broad spectrum of morphologic appearances, and 1 histotype can closely mimic histopathologic features more typical of another. Historically, there has been a relatively high frequency of mixed, defined by 2 or more distinct histotypes present on the basis of routine histopathologic assessment, histotype carcinoma diagnoses (3% to 11%); however, recent immunohistochemical (IHC) studies identifying histotype-specific markers and allowing more refined histotype diagnoses suggest a much lower incidence. We reviewed hematoxylin and eosin-stained slides from 871 cases of EOC and found the frequency of mixed carcinomas to be 1.7% when modern diagnostic criteria are applied. Through international collaboration, we established a cohort totaling 22 mixed EOCs, consisting of 9 EC/CCC, 4 EC/LGSC, 3 HGSC/CCC, 2 CCC/MC, and 4 other combinations. We interrogated the molecular differences between the different components of each case using IHC, gene expression, and hotspot sequencing analyses. IHC data alone suggested that 9 of the 22 cases were not mixed tumors, as they presented a uniform immuno-phenotype throughout, and these cases most probably represent morphologic mimicry and variation within tumors of a single histotype. Synthesis of molecular data further reduces the incidence of mixed carcinomas. On the basis of these results, true mixed carcinomas with both morphologic and molecular support for the presence of >1 histotype within a given tumor represent <1% of EOCs.
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Weberpals JI, Amin MS, Chen BE, Tu D, Spaans JN, Squire JA, Eisenhauer EA, Virk S, Ma D, Duciaume M, Hoskins P, LeBrun DP. First application of the Automated QUantitative Analysis (AQUA) technique to quantify PTEN protein expression in ovarian cancer: A correlative study of NCIC CTG OV.16. Gynecol Oncol 2016; 140:486-93. [PMID: 26775196 DOI: 10.1016/j.ygyno.2016.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/09/2016] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Platinum resistance is a dominant cause of poor outcomes in advanced ovarian cancer (OC). A mechanism of platinum resistance is the inhibition of apoptosis through phosphatidylinositol 3 kinase (PI3K) pathway activation. The role of phosphatase and tensin homolog (PTEN), a negative regulator of this pathway, as a tumor biomarker is unclear. Quantitative analysis of PTEN expression as an alternative to immunohistochemistry has not been considered. PATIENTS AND METHODS In 238 patient tumors from the NCIC-CTG trial OV.16, PTEN protein expression was quantified by Automated QUantitative Analysis (AQUA). Cox model was used to study the association between PTEN expression and clinical outcomes using a minimum p-value approach in univariate analysis. Multivariate analysis was used to adjust for clinical and pathological parameters. RESULTS PTEN scores (range 13.9-192.3) of the 202 samples that passed quality control were analyzed. In univariate analysis, there was a trend suggesting an association between PTEN expression by AQUA as a binary variable (low ≤61 vs high >61) and progression free survival (HR=0.77, p=0.083), and in multivariate analysis, this association approached significance (HR=0.74, p=0.059). The relationship between quantitative PTEN expression and PFS differed (p=0.01 for interaction) by the extent of surgical debulking (residual disease (RD) <1cm or ≥1cm), with a numerically superior PFS in patients with high PTEN (23.5 vs 14.9m) only when RD<1cm (p=0.19). There was no association between PTEN levels and overall survival. CONCLUSIONS AQUA is a novel method to measure PTEN expression. Further study of PTEN as a biomarker in OC is warranted.
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Affiliation(s)
- J I Weberpals
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Canada; Division of Gynecologic Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - M S Amin
- Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - B E Chen
- NCIC-CTG, Kingston, Ontario, Canada
| | - D Tu
- NCIC-CTG, Kingston, Ontario, Canada
| | - J N Spaans
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Canada
| | - J A Squire
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - E A Eisenhauer
- NCIC-CTG, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - S Virk
- NCIC-CTG, Kingston, Ontario, Canada; Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - D Ma
- Department of Mathematics and Statistics, Queen's University, Kingston, Ontario, Canada
| | - M Duciaume
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Canada
| | - P Hoskins
- BC Cancer Centre, Vancouver, British Columbia, Canada
| | - D P LeBrun
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
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du Bois A, Kristensen G, Ray-Coquard I, Reuss A, Pignata S, Colombo N, Denison U, Vergote I, Del Campo JM, Ottevanger P, Heubner M, Minarik T, Sevin E, de Gregorio N, Bidziński M, Pfisterer J, Malander S, Hilpert F, Mirza MR, Scambia G, Meier W, Nicoletto MO, Bjørge L, Lortholary A, Sailer MO, Merger M, Harter P. Standard first-line chemotherapy with or without nintedanib for advanced ovarian cancer (AGO-OVAR 12): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet Oncol 2015; 17:78-89. [PMID: 26590673 DOI: 10.1016/s1470-2045(15)00366-6] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Angiogenesis is a target in the treatment of ovarian cancer. Nintedanib, an oral triple angiokinase inhibitor of VEGF receptor, platelet-derived growth factor receptor, and fibroblast growth factor receptor, has shown activity in phase 2 trials in this setting. We investigated the combination of nintedanib with standard carboplatin and paclitaxel chemotherapy in patients with newly diagnosed advanced ovarian cancer. METHODS In this double-blind phase 3 trial, chemotherapy-naive patients (aged 18 years or older) with International Federation of Gynecology and Obstetrics (FIGO) IIB-IV ovarian cancer and upfront debulking surgery were stratified by postoperative resection status, FIGO stage, and planned carboplatin dose. Patients were randomly assigned (2:1) via an interactive voice or web-based response system to receive six cycles of carboplatin (AUC 5 mg/mL per min or 6 mg/mL per min) and paclitaxel (175 mg/m(2)) in addition to either 200 mg of nintedanib (nintedanib group) or placebo (placebo group) twice daily on days 2-21 of every 3-week cycle for up to 120 weeks. Patients, investigators, and independent radiological reviewers were masked to treatment allocation. The primary endpoint was investigator-assessed progression-free survival analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01015118. FINDINGS Between Dec 9, 2009, and July 27, 2011, 1503 patients were screened and 1366 randomly assigned by nine study groups in 22 countries: 911 to the nintedanib group and 455 to the placebo group. 486 (53%) of 911 patients in the nintedanib group experienced disease progression or death compared with 266 (58%) of 455 in the placebo group. Median progression-free survival was significantly longer in the nintedanib group than in the placebo group (17·2 months [95% CI 16·6-19·9] vs 16·6 months [13·9-19·1]; hazard ratio 0·84 [95% CI 0·72-0·98]; p=0·024). The most common adverse events were gastrointestinal (diarrhoea: nintedanib group 191 [21%] of 902 grade 3 and three [<1%] grade 4 vs placebo group nine [2%] of 450 grade 3 only) and haematological (neutropenia: nintedanib group 180 [20%] grade 3 and 200 (22%) grade 4 vs placebo group 90 [20%] grade 3 and 72 [16%] grade 4; thrombocytopenia: 105 [12%] and 55 [6%] vs 21 [5%] and eight [2%]; anaemia: 108 [12%] and 13 [1%] vs 26 [6%] and five [1%]). Serious adverse events were reported in 376 (42%) of 902 patients in the nintedanib group and 155 (34%) of 450 in the placebo group. 29 (3%) of 902 patients in the nintedanib group experienced serious adverse events associated with death compared with 16 (4%) of 450 in the placebo group, including 12 (1%) in the nintedanib group and six (1%) in the placebo group with a malignant neoplasm progression classified as an adverse event by the investigator. Drug-related adverse events leading to death occurred in three patients in the nintedanib group (one without diagnosis of cause; one due to non-drug-related sepsis associated with drug-related diarrhoea and renal failure; and one due to peritonitis) and in one patient in the placebo group (cause unknown). INTERPRETATION Nintedanib in combination with carboplatin and paclitaxel is an active first-line treatment that significantly increases progression-free survival for women with advanced ovarian cancer, but is associated with more gastrointestinal adverse events. Future studies should focus on improving patient selection and optimisation of tolerability. FUNDING Boehringer Ingelheim.
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Affiliation(s)
| | - Gunnar Kristensen
- Department of Gynecologic Oncology and Institute for Cancer Genetics and Informatics, Oslo University Hospital, and Oslo University, Oslo, Norway
| | | | | | | | - Nicoletta Colombo
- University of Milan Bicocca, Milan, Italy; European Institute of Oncology Milan, Milan, Italy
| | - Ursula Denison
- Health + Life Gesundheitsmanagement GmbH, Vienna, Austria
| | | | | | | | - Martin Heubner
- West German Tumor Center, Department of Gynecology and Obstetrics, University of Duisburg-Essen, Essen, Germany
| | | | - Emmanuel Sevin
- Centre François Baclesse, Comité Uro-Gynécologie, Caen, France
| | | | - Mariusz Bidziński
- Faculty of Health Science, University of Jan Kochanowski, Kielce, Poland
| | | | | | - Felix Hilpert
- Universitäts-Klinik Schleswig-Holstein (UKSH) Campus Kiel, Department of Gynecology and Obstetrics, Kiel, Germany
| | - Mansoor R Mirza
- Rigshospitalet-Copenhagen University Hospital, Department of Oncology, Copenhagen, Denmark
| | - Giovanni Scambia
- Universita Cattolica del Sacro Cuore Policlinico Gemelli, Rome, Italy
| | - Werner Meier
- Evangelisches Krankenhaus, Department of Gynecology and Obstetrics, Duesseldorf, Germany
| | - Maria O Nicoletto
- Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS), Oncologia MedicaI, Padova, Italy
| | - Line Bjørge
- Haukeland Universitetssykehus, Bergen, Norway
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Hamanishi J, Mandai M, Ikeda T, Minami M, Kawaguchi A, Murayama T, Kanai M, Mori Y, Matsumoto S, Chikuma S, Matsumura N, Abiko K, Baba T, Yamaguchi K, Ueda A, Hosoe Y, Morita S, Yokode M, Shimizu A, Honjo T, Konishi I. Safety and Antitumor Activity of Anti-PD-1 Antibody, Nivolumab, in Patients With Platinum-Resistant Ovarian Cancer. J Clin Oncol 2015; 33:4015-22. [PMID: 26351349 DOI: 10.1200/jco.2015.62.3397] [Citation(s) in RCA: 846] [Impact Index Per Article: 94.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Programmed death-1 (PD-1), a coinhibitory immune signal receptor expressed in T cells, binds to PD-1 ligand and regulates antitumor immunity. Nivolumab is an anti-PD-1 antibody that blocks PD-1 signaling. We assessed the safety and antitumor activity of nivolumab in patients with platinum-resistant ovarian cancer. PATIENTS AND METHODS Twenty patients with platinum-resistant ovarian cancer were treated with an intravenous infusion of nivolumab every 2 weeks at a dose of 1 or 3 mg/kg (constituting two 10-patient cohorts) from October 21, 2011. This phase II trial defined the primary end point as the best overall response. Patients received up to six cycles (four doses per cycle) of nivolumab treatment or received doses until disease progression occurred. Twenty nivolumab-treated patients were evaluated at the end of the trial on December 7, 2014. RESULTS Grade 3 or 4 treatment-related adverse events occurred in eight (40%) of 20 patients. Two patients had severe adverse events. In the 20 patients in whom responses could be evaluated, the best overall response was 15%, which included two patients who had a durable complete response (in the 3-mg/kg cohort). The disease control rate in all 20 patients was 45%. The median progression-free survival time was 3.5 months (95% CI, 1.7 to 3.9 months), and the median overall survival time was 20.0 months (95% CI, 7.0 months to not reached) at study termination. CONCLUSION This study, to our knowledge, is the first to explore the effects of nivolumab against ovarian cancer. The encouraging safety and clinical efficacy of nivolumab in patients with platinum-resistant ovarian cancer indicate the merit of additional large-scale investigations (UMIN Clinical Trials Registry UMIN000005714).
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Affiliation(s)
- Junzo Hamanishi
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan.
| | - Masaki Mandai
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Takafumi Ikeda
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Manabu Minami
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Atsushi Kawaguchi
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Toshinori Murayama
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Masashi Kanai
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Yukiko Mori
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Shigemi Matsumoto
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Shunsuke Chikuma
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Noriomi Matsumura
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Kaoru Abiko
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Tsukasa Baba
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Ken Yamaguchi
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Akihiko Ueda
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Yuko Hosoe
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Satoshi Morita
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Masayuki Yokode
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Akira Shimizu
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Tasuku Honjo
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
| | - Ikuo Konishi
- Junzo Hamanishi, Masashi Kanai, Yukiko Mori, Shigemi Matsumoto, Shunsuke Chikuma, Noriomi Matsumura, Kaoru Abiko, Tsukasa Baba, Ken Yamaguchi, Akihiko Ueda, Yuko Hosoe, Tasuku Honjo, and Ikuo Konishi, Kyoto University Graduate School of Medicine, Kyoto, Japan; Masaki Mandai, Kinki University Faculty of Medicine, Osaka, Japan; and Takafumi Ikeda, Manabu Minami, Atsushi Kawaguchi, Toshinori Murayama, Satoshi Morita, Masayuki Yokode, and Akira Shimizu, Kyoto University Hospital, Kyoto, Japan
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Brotto L, Brundage M, Hoskins P, Vergote I, Cervantes A, Casado HA, Poveda A, Eisenhauer E, Tu D. Randomized study of sequential cisplatin-topotecan/carboplatin-paclitaxel versus carboplatin-paclitaxel: effects on quality of life. Support Care Cancer 2015; 24:1241-9. [PMID: 26304156 DOI: 10.1007/s00520-015-2873-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/27/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND A recent phase III trial compared the efficacy of cisplatin-topotecan (a topoisomerase I inhibitor) followed by carboplatin-paclitaxel (Arm 1) versus paclitaxel-carboplatin (Arm 2) in women with newly diagnosed stage IIB or greater ovarian cancer. There was a significantly lower response rate in the experimental arm compared to standard treatment, and less likelihood of normalized CA125 within the first 3 months. At 43 months follow-up, there were no significant group differences in progression-free survival. There were also significantly more side effects in the experimental arm. METHODS The current study examined quality of life (QoL) endpoints using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and the ovarian cancer module, QLQ-OV28, administered prior to randomization, at day 1 of treatment cycles 3, 5, and 7, at completion of the last cycle, and at 3 and 6 months following completion of chemotherapy. RESULTS Global QoL, physical symptoms, fatigue, and role, emotional, cognitive and social function (all from the EORTC QLQ-C30) significantly improved in both treatment arms, with no significant between-arm differences. Between-group differences in pain, insomnia, and peripheral neuropathy reported while on treatment did not differ at follow-up. Nausea and vomiting improved more with standard treatment both during and after treatment. Body image significantly differed between the groups only at cycle 5 (more deterioration in Arm 2) but group differences disappeared at follow-up. A stratified analysis of global QoL by debulking surgery status found no greater effect indicating that overall improvements in QoL were unrelated to surgical recovery. CONCLUSIONS There was no significant QoL advantage of cisplatin-topotecan. This finding, combined with no progression-free survival conferred by this combination, reaffirms carboplatin-paclitaxel as the standard of care for women with newly diagnosed ovarian cancer.
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Affiliation(s)
- Lori Brotto
- University of British Columbia, Vancouver, British Columbia, Canada.
| | - Michael Brundage
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Hoskins
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Ignace Vergote
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Andres Cervantes
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Herraez A Casado
- University of British Columbia, Vancouver, British Columbia, Canada
| | - A Poveda
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Dongsheng Tu
- University of British Columbia, Vancouver, British Columbia, Canada
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Regulatory T cells, inherited variation, and clinical outcome in epithelial ovarian cancer. Cancer Immunol Immunother 2015; 64:1495-504. [PMID: 26298430 DOI: 10.1007/s00262-015-1753-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 08/12/2015] [Indexed: 02/08/2023]
Abstract
The immune system constitutes one of the host factors modifying outcomes in ovarian cancer. Regulatory T cells (Tregs) are believed to be a major factor in preventing the immune response from destroying ovarian cancers. Understanding mechanisms that regulate Tregs in the tumor microenvironment could lead to the identification of novel targets aimed at reducing their influence. In this study, we used immunofluorescence-based microscopy to enumerate Tregs, total CD4 T cells, and CD8(+) cytotoxic T cells in fresh frozen tumors from over 400 patients with ovarian cancer (>80 % high-grade serous). We sought to determine whether Tregs were associated with survival and genetic variation in 79 genes known to influence Treg induction, trafficking, or function. We used Cox regression, accounting for known prognostic factors, to estimate hazard ratios (HRs) associated with T cell counts and ratios. We found that the ratios of CD8 T cells and total CD4 T cells to Tregs were associated with improved overall survival (CD8/Treg HR 0.84, p = 0.0089; CD4/Treg HR 0.88, p = 0.046) and with genetic variation in IL-10 (p = 0.0073 and 0.01, respectively). In multivariate analyses, the associations between the ratios and overall survival remained similar (IL-10 and clinical covariate-adjusted CD8/Treg HR 0.85, p = 0.031; CD4/Treg HR 0.87, p = 0.093), suggesting that this association was not driven by variation in IL-10. Thus, integration of novel tumor phenotyping measures with extensive clinical and genetic information suggests that the ratio of T cells to Tregs may be prognostic of outcome in ovarian cancer, regardless of inherited genotype in genes related to Tregs.
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Valdivieso M, Corn BW, Dancey JE, Wickerham DL, Horvath LE, Perez EA, Urton A, Cronin WM, Field E, Lackey E, Blanke CD. The Globalization of Cooperative Groups. Semin Oncol 2015; 42:693-712. [PMID: 26433551 DOI: 10.1053/j.seminoncol.2015.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The National Cancer Institute (NCI)-supported adult cooperative oncology research groups (now officially Network groups) have a longstanding history of participating in international collaborations throughout the world. Most frequently, the US-based cooperative groups work reciprocally with the Canadian national adult cancer clinical trial group, NCIC CTG (previously the National Cancer Institute of Canada Clinical Trials Group). Thus, Canada is the largest contributor to cooperative groups based in the United States, and vice versa. Although international collaborations have many benefits, they are most frequently utilized to enhance patient accrual to large phase III trials originating in the United States or Canada. Within the cooperative group setting, adequate attention has not been given to the study of cancers that are unique to countries outside the United States and Canada, such as those frequently associated with infections in Latin America, Asia, and Africa. Global collaborations are limited by a number of barriers, some of which are unique to the countries involved, while others are related to financial support and to US policies that restrict drug distribution outside the United States. This article serves to detail the cooperative group experience in international research and describe how international collaboration in cancer clinical trials is a promising and important area that requires greater consideration in the future.
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Affiliation(s)
- Manuel Valdivieso
- Division of Hematology/Oncology, University of Michigan; and SWOG, Executive Officer, Quality Assurance and International Initiatives, Ann Arbor, MI.
| | - Benjamin W Corn
- Institute of Radiotherapy, Tel Aviv Medical Center, Tel Aviv, Israel; and Department of Radiation Oncology, Jefferson Medical College, Philadelphia, PA
| | - Janet E Dancey
- Director, NCIC Clinical Trials Group; Scientific Director Canadian Cancer Clinical Trials Network; Program Leader, High Impact Clinical Trials, Ontario Institute for Cancer Research; Professor of Oncology, Queen's University, Kingston, Ontario, Canada
| | - D Lawrence Wickerham
- Deputy Chairman, NRG Oncology, Pittsburgh, PA; Department of Human Oncology, Pittsburgh Campus, Drexel University School of Medicine; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA
| | - L Elise Horvath
- Executive Officer, Alliance for Clinical Trials in Oncology, Chicago, IL
| | - Edith A Perez
- Deputy Director at Large, Mayo Clinic Cancer Center; Group Vice Chair, Alliance for Clinical Trials in Oncology; Hematology/Oncology and Cancer Biology Mayo Clinic, Jacksonville, FL
| | - Alison Urton
- Group Administrator, NCIC Clinical Trials Group, Queen's University, Kingston, Ontario, Canada
| | - Walter M Cronin
- Associate Director, NRG Oncology Statistics and Data Management Center (SDMC); Associate Director, Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Erica Field
- Project Specialist III, RTOG, Philadelphia, PA
| | - Evonne Lackey
- Coordinating Center Manager, SWOG Statistical Center, Seattle, WA
| | - Charles D Blanke
- Chair, SWOG; Department of Medicine, Division of Hematology and Medical Oncology, Oregon Health & Science University and Knight Cancer Institute, Portland, OR
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Abstract
PURPOSE OF REVIEW Targeted therapies are being used as maintenance therapy to improve the outcome of ovarian cancer following standard treatment in the first-line setting and in recurrent disease. We review the different approaches being used, trial design, and the impact of maintenance treatment on survival and quality of life. RECENT FINDINGS The greatest experience of maintenance therapy is with antiangiogenic agents. Several trials targeting vascular endothelial growth factor with bevacizumab or vascular endothelial growth factor receptor with oral tyrosine kinase inhibitors have demonstrated a prolongation in progression-free survival (PFS) following first or second-line treatment. Maintenance therapy with olaparib, a poly ADP ribose polymerase inhibitor given post-platinum therapy for recurrent disease, has led to a prolongation in PFS, particularly, in patients with a BRCA mutation. The results of immunotherapy maintenance studies, based on using cancer antigen 125 as an antigen, have been disappointing. A benefit in PFS often does not translate into overall survival improvement, largely because of crossover and postprogression therapies. This makes clinical interpretation of results more difficult. SUMMARY The principle of using molecular targeted therapy to prolong the control of ovarian cancer has been clearly demonstrated. The greatest effect is on prolongation of PFS and, by adding to the effects of standard treatments, maintenance therapy is likely to help incrementally extend the 5-year survival of women with ovarian cancer.
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Bryand A, Hamidou Z, Paget-Bailly S, Bonnetain F, Mathelin C, Baldauf JJ, Akladios C. [Health-related quality of life in patients treated for ovarian cancer: tools and issues]. ACTA ACUST UNITED AC 2015; 43:151-7. [PMID: 25596884 DOI: 10.1016/j.gyobfe.2014.12.011] [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: 06/22/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022]
Abstract
Health-related quality of life (QoL) in patients treated for ovarian cancer is directly and heavily impacted by the natural history of cancer, its evolution and its therapeutic modalities. The evaluation and consideration of various parameters of QoL seems to be a major issue. Indeed, on the one hand, it is essential to take into account the opinion of patients in the choice of therapeutic strategies for this cancer with a poor prognosis and, on the other hand, more and more studies show that QoL is an independent prognostic factor in ovarian cancer. Improvement in this case, in addition to being an endpoint by itself, would potentially improve the overall survival of patients. To date there are several tools to assess QOL of patients with ovarian cancer. The 2 questionnaires most commonly used are: FACT-O and the EORTC QLQ-OV28. The aim of our study was to evaluate from a review of the literature, the reciprocal effects of ovarian cancer on QoL and QoL on ovarian cancer survival, as well as specificities of each of the 2 questionnaires most commonly used in assessing the QoL.
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Affiliation(s)
- A Bryand
- CHU Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | - Z Hamidou
- Service de santé publique, faculté de médecine, 27, boulevard Jean-Moulin, 13385 Marseille cedex, France
| | - S Paget-Bailly
- CHRU de Besançon, 2, place Saint-Jacques, 25000 Besançon, France
| | - F Bonnetain
- CHRU de Besançon, 2, place Saint-Jacques, 25000 Besançon, France
| | - C Mathelin
- CHU Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - J-J Baldauf
- CHU Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - C Akladios
- CHU Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
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Ezzati M, Abdullah A, Shariftabrizi A, Hou J, Kopf M, Stedman JK, Samuelson R, Shahabi S. Recent Advancements in Prognostic Factors of Epithelial Ovarian Carcinoma. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:953509. [PMID: 27382614 PMCID: PMC4897239 DOI: 10.1155/2014/953509] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/26/2014] [Indexed: 01/03/2023]
Abstract
Ovarian cancer remains the most common cause of gynecologic cancer-related death among women in developed countries. Nevertheless, subgroups of ovarian cancer patients experience relatively longer survival. Efforts to identify prognostic factors that characterize such patients are ongoing, with investigational areas including tumor characteristics, surgical management, inheritance patterns, immunologic factors, and genomic patterns. This review discusses various demographic, clinical, and molecular factors implicating longevity and ovarian cancer survival. Continued efforts at identifying these prognosticators may result in invaluable adjuncts to the treatment of ovarian cancer, with the ultimate goal of advancing patient care.
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Affiliation(s)
- Mohammad Ezzati
- Department of Obstetrics and Gynecology, Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010, USA
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Amer Abdullah
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA
| | - Ahmad Shariftabrizi
- Department of Pathology and Laboratory Medicine, School of Medicine, Tufts University, 800 Washington Street, Boston, MA 02111, USA
| | - June Hou
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine and Montefiore Medical Center, Montefiore Centennial, 3332 Rochambeau Avenue, Bronx, NY 10467-2836, USA
| | - Michael Kopf
- Department of Medicine, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA
| | - Jennifer K. Stedman
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA
| | - Robert Samuelson
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA
| | - Shohreh Shahabi
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, 24 Hospital Avenue, Danbury, CT 06810, USA
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Castonguay V, Wilson MK, Diaz-Padilla I, Wang L, Oza AM. Estimation of expectedness: predictive accuracy of standard therapy outcomes in randomized phase 3 studies in epithelial ovarian cancer. Cancer 2014; 121:413-22. [PMID: 25278038 PMCID: PMC4755141 DOI: 10.1002/cncr.29030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/02/2014] [Accepted: 07/07/2014] [Indexed: 12/05/2022]
Abstract
BACKGROUND The anticipated clinical outcome of the standard/control arm is an important parameter in the design of randomized phase 3 (RP3) trials to properly calculate sample size, power, and study duration. Changing patterns of care or variation in the study population enrolled may lead to a deviation from the initially anticipated outcome. The authors hypothesized that recent changes in patterns of care in epithelial ovarian cancer (EOC) have led to challenges in correctly estimating the outcome of control groups. METHODS A systematic review of the literature was conducted for RP3 trials of EOC published between January 2000 and December 2010. The expected outcome of the control arm as well as the actual outcome achieved by this cohort was collected and a ratio (actual‐over‐expected ratio) was calculated. The estimation of outcome was deemed accurate if the outcome of the control arm was between 0.75 to 1.25 times the anticipated outcome. RESULTS A total of 35 trials were eligible for analysis. Fifteen trials had survival as the primary endpoint whereas 20 had a progression‐based primary endpoint. In total, 12 of 15 trials with a survival‐based endpoint significantly underestimated the outcome of the control arm, whereas only 4 of 20 trials with a progression‐based endpoint did. Studies with a survival endpoint underestimated outcome more frequently than those with a progression endpoint (P<.001). CONCLUSIONS Survival of the control arm has frequently been underestimated in recent EOC RP3 trials. This underestimation means that the initial statistical assumptions of these trials may have been inaccurate. Underestimating the outcome of the control arm may result in trials being underpowered to demonstrate the absolute benefit they were designed to show. Cancer 2015;121:413–422. © 2014 American Cancer Society. The anticipated clinical outcome of the standard/control arm is an important parameter in the design of randomized phase 3 trials for the accurate calculation of sample size, power, and study duration but is often underestimated in ovarian cancer trials. Changing patterns of care and variations in enrolled study populations may result in a deviation from the anticipated outcome and subsequent inaccurate statistical assumptions.
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Affiliation(s)
- Vincent Castonguay
- CHU-de-Québec, Quebec City, Quebec, Canada; Division of Medical Oncology and Haematology, Bras Family Drug Development Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Long-term results of a randomised phase III trial of weekly versus three-weekly paclitaxel/platinum induction therapy followed by standard or extended three-weekly paclitaxel/platinum in European patients with advanced epithelial ovarian cancer. Eur J Cancer 2014; 50:2592-601. [PMID: 25096168 DOI: 10.1016/j.ejca.2014.07.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/04/2014] [Accepted: 07/08/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Weekly paclitaxel/carboplatin might improve survival in platinum-resistant epithelial ovarian cancer (EOC). We compared efficacy of first-line weekly to three-weekly paclitaxel/cis- or carboplatin (PCw and PC3w) induction therapy, followed by either three or six PC3w cycles. PATIENTS AND METHODS In this multicentre, randomised phase III trial with 2×2 design, patients with FIGO stage IIb-IV EOC were randomised to six cycles PCw (paclitaxel 90mg/m(2), cisplatin 70mg/m(2) or carboplatin AUC 4) or three cycles PC3w (paclitaxel 175mg/m(2), cisplatin 75mg/m(2) or carboplatin AUC 6), followed by either three or six cycles PC3w. Primary endpoints were progression free survival (PFS) and overall survival (OS). Secondary endpoints were response rate (RR) and toxicity. RESULTS Of 267 eligible patients, 133 received PCw and 134 PC3w. The first 105 patients received cisplatin, after protocol amendment the subsequent 162 patients received carboplatin. Weekly cisplatin was less well tolerated than weekly carboplatin. All PC3w cycles were well tolerated. At the end of all treatments, RR was 90.8% with no differences between the treatment arms. After a follow-up of median 10.3years (range 7.1-14.8), median PFS was 18.5 (95% confidence interval (CI) 15.9-21.0) months for PCw and 16.4 (95% CI 13.5-19.2) months for PC3w (p=0.78). Median OS was 44.8 (95% CI 33.1-56.5) months for PCw and 41.1 (95% CI 34.4-47.7) months for PC3w (p=0.98). CONCLUSIONS There was no benefit in terms of OS, PFS or RR for a weekly regimen nor for extended chemotherapy as first-line treatment for EOC in European patients.
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Akin JM, Waddell JA, Solimando DA. Paclitaxel and Carboplatin (TC) Regimen for Ovarian Cancer. Hosp Pharm 2014; 49:425-31. [PMID: 24958952 PMCID: PMC4062714 DOI: 10.1310/hpj4905-425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr, President, Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203, e-mail: OncRxSvc@comcast.net; or J. Aubrey Waddell, Professor, University of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E. Lamar Alexander Parkway, Maryville, TN 37804, e-mail: waddfour@charter.net.
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Affiliation(s)
- Julie M Akin
- Dr. Akin is a pharmacy practice (PGY1) resident at Blount Memorial Hospital , Maryville, Tennessee
| | - J Aubrey Waddell
- Dr. Akin is a pharmacy practice (PGY1) resident at Blount Memorial Hospital , Maryville, Tennessee
| | - Dominic A Solimando
- Dr. Akin is a pharmacy practice (PGY1) resident at Blount Memorial Hospital , Maryville, Tennessee
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Polypeptide-based combination of paclitaxel and cisplatin for enhanced chemotherapy efficacy and reduced side-effects. Acta Biomater 2014; 10:1392-402. [PMID: 24316362 DOI: 10.1016/j.actbio.2013.11.026] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/22/2013] [Accepted: 11/26/2013] [Indexed: 12/11/2022]
Abstract
A novel methoxy poly(ethylene glycol)-b-poly(l-glutamic acid)-b-poly(l-phenylalanine) (mPEG-b-P(Glu)-b-P(Phe)) triblock copolymer was prepared and explored as a micelle carrier for the co-delivery of paclitaxel (PTX) and cisplatin (cis-diamminedichlo-platinum, CDDP). PTX and CDDP were loaded inside the hydrophobic P(Phe) inner core and chelated to the middle P(Glu) shell, respectively, while mPEG provided the outer corona for prolonged circulation. An in vitro release profile of the PTX+CDDP-loaded micelles showed that the CDDP chelation cross-link prevented an initial burst release of PTX. The PTX+CDDP-loaded micelles exhibited a high synergism effect in the inhibition of A549 human lung cancer cell line proliferation over 72 h incubation. For the in vivo treatment of xenograft human lung tumor, the PTX+CDDP-loaded micelles displayed an obvious tumor inhibiting effect with a 83.1% tumor suppression rate (TSR%), which was significantly higher than that of a free drug combination or micelles with a single drug. In addition, more importantly, the enhanced anti-tumor efficacy of the PTX+CDDP-loaded micelles came with reduced side-effects. No obvious body weight loss occurred during the treatment of A549 tumor-bearing mice with the PTX+CDDP-loaded micelles. Thus, the polypeptide-based combination of PTX and CDDP may provide useful guidance for effective and safe cancer chemotherapy.
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Aghajanian C, Goff B, Nycum LR, Wang Y, Husain A, Blank S. Independent radiologic review: bevacizumab in combination with gemcitabine and carboplatin in recurrent ovarian cancer. Gynecol Oncol 2014; 133:105-10. [PMID: 24508841 DOI: 10.1016/j.ygyno.2014.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/22/2014] [Accepted: 02/02/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE OCEANS, a randomized, placebo-controlled, phase III trial, found that adding bevacizumab to gemcitabine-carboplatin (GC) significantly improved investigator-determined progression-free survival (PFS) and objective response rate (ORR) in platinum-sensitive, recurrent ovarian cancer. To evaluate the reliability of assessment of progression and objective response per RECIST, radiologic and clinical data were assessed by an independent review committee (IRC). METHODS Radiologic images and clinical data were provided prospectively to the IRC for all randomized patients (N=484). Data were reviewed in a blinded fashion per RECIST (modified v1.0). PFS and ORR were analyzed based on the IRC assessment. Concordance between investigator- and IRC-assessed progression and objective response was assessed. RESULTS The IRC analysis demonstrated a statistically significant increase in PFS (hazard ratio [HR]=0.451; 95% confidence interval [CI]=0.351 to 0.580, p<0.0001) consistent with the benefit reported by investigators (HR=0.484; 95% CI=0.388 to 0.605, p<0.0001). The concordance rate, defined by agreement on progression status, was 74.2% overall, and comparable between treatment arms (bevacizumab, 75.2% vs. placebo, 73.1%). IRC-assessed ORR was significantly improved with bevacizumab (bevacizumab, 74.8% vs. placebo, 53.7%; p<0.0001), consistent with the investigator-assessed results. The concordance rate for objective response was 79.8% overall, and comparable between treatment arms (bevacizumab, 78.9% vs. placebo, 80.6%). CONCLUSIONS IRC-determined results were highly consistent with those determined by investigators, demonstrating that bevacizumab plus GC provides a significant improvement in PFS and ORR. These results suggest that investigators can reliably assess disease progression and objective response in recurrent ovarian cancer using RECIST, without the necessity of a full IRC review.
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Affiliation(s)
- Carol Aghajanian
- Memorial Sloan-Kettering Cancer Center, Gynecologic Medical Oncology Service, 300 East 66th Street, New York, NY 10065, USA; Weill Cornell Medical College, 445 East 69th Street, New York, NY 10021, USA.
| | - Barbara Goff
- University of Washington School of Medicine, Department of Obstetrics and Gynecology, Box 356460, Seattle, WA 98195, USA
| | - Lawrence R Nycum
- Novant Health Forsyth Medical Center, Division of Gynecologic Oncology, 3333 Silas Creek Pkwy, Winston-Salem, NC 27103, USA
| | - Yan Wang
- Genentech, Inc., Product Development, 1 DNA Way, South San Francisco, CA 94080, USA
| | - Amreen Husain
- Genentech, Inc., Product Development, 1 DNA Way, South San Francisco, CA 94080, USA
| | - Stephanie Blank
- New York University School of Medicine, Department of Obstetrics and Gynecology, 160 East 34th Street, New York, NY 10016, USA
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Abstract
ObjectiveSince the publication of International Collaborative Ovarian Neoplasm 3, various practice patterns have evolved with respect to practice patterns and survival among women with epithelial ovarian cancer in British Columbia, Canada. The objectives of this study were to evaluate different strategies for first-line chemotherapy in ovarian cancer and to determine their effect on survival at a population level.Methods and MaterialsThis was a retrospective population-based cohort study of 854 women with epithelial ovarian cancer in British Columbia from 2005 to 2008. Details were ascertained on stage, grade, histotype, performance status, surgeon type, extent of debulking, first-line chemotherapy including type and number of cycles, and cause and date of death. A Cox regression model was used to evaluate the association of covariates on overall survival.ResultsOf the 817 women eligible for chemotherapy, 729 (89.2%) received treatment, including 106 (14.5%) women who received single-agent carboplatin and 623 (85.5%) women who received combination platinum-based chemotherapy. Chemotherapy was evaluated as a time-varying covariate. Median numbers of single-agent carboplatin and combination chemotherapy cycles were 5 (range, 1–11) and 6 (range, 1–12), respectively. After adjustment for demographic, disease, and treatment factors, the covariates significantly associated with survival were stage, performance status, extent of debulking, and chemotherapy type. Single-agent carboplatin had a mortality hazards ratio of 5.15 (95% confidence interval, 2.39–11.11) relative to combination chemotherapy.ConclusionsIn this population-based study, first-line platinum-based combination chemotherapy was associated with improved survival compared with single-agent carboplatin after adjustment for covariates in ovarian cancer. Higher rates of combination chemotherapy may improve outcomes at a population level.
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Lavoué V, Foucher F, Henno S, Bauville E, Catros V, Cabillic F, Levêque J. [Immunotherapy in epithelial ovarian carcinoma: hope and reality]. ACTA ACUST UNITED AC 2013; 43:198-210. [PMID: 24230482 DOI: 10.1016/j.jgyn.2013.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 10/14/2013] [Accepted: 10/16/2013] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Epithelial ovarian carcinoma (EOC) has a worst prognosis with little progress in terms of survival for the last two decades. Immunology received little interest in EOC in the past, but now appears very important in the natural history of this cancer. This review is an EOC immunology state of art and focuses on the place of immunotherapy in future. MATERIAL AND METHODS A systematic review of published studies was performed. Medline baseline interrogation was performed with the following keywords: "Ovarian carinoma, immunotherapy, T-lymphocyte, regulator T-lymphocyte, dendritic cells, macrophage, antigen, chemotherapy, surgery, clinical trials". Identified publications (English or French) were assessed for the understanding of EOC immunology and the place of conventional treatment and immunotherapy strategy. RESULTS Intratumoral infiltration by immune cells is a strong prognotic factor in EOC. Surgery and chemotherapy in EOC decrease imunosuppression in patients. The antitumoral immunity is a part of the therapeutic action of surgery and chemotherapy. Until now, immunotherapy gave some disappointing results, but the new drugs that target the tolerogenic tumoral microenvironnement rise and give a new hope in the treatment of cancer. CONCLUSION Immunology controls the EOC natural history. The modulation of immunosuppressive microenvironment associated with the stimulation of antitumoral immunity could be the next revolution in the treatment of cancer.
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Affiliation(s)
- V Lavoué
- Service de chirurgie gynécologique, centre hospitalier universitaire de Rennes, 35000 Rennes, France; Faculté de médecine, université de Rennes 1, 35000 Rennes, France; Inserm, UMR991, 35000 Rennes, France.
| | - F Foucher
- Service de chirurgie gynécologique, centre hospitalier universitaire de Rennes, 35000 Rennes, France
| | - S Henno
- Service d'anatomo-pathologie, centre hospitalier universitaire de Rennes, 35000 Rennes, France
| | - E Bauville
- Service de chirurgie gynécologique, centre hospitalier universitaire de Rennes, 35000 Rennes, France
| | - V Catros
- Faculté de médecine, université de Rennes 1, 35000 Rennes, France; Inserm, UMR991, 35000 Rennes, France; Service de biologie cellulaire, centre hospitalier universitaire de Rennes, 35000 Rennes, France
| | - F Cabillic
- Faculté de médecine, université de Rennes 1, 35000 Rennes, France; Inserm, UMR991, 35000 Rennes, France; Service de biologie cellulaire, centre hospitalier universitaire de Rennes, 35000 Rennes, France
| | - J Levêque
- Service de chirurgie gynécologique, centre hospitalier universitaire de Rennes, 35000 Rennes, France; Faculté de médecine, université de Rennes 1, 35000 Rennes, France
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Preston CC, Maurer MJ, Oberg AL, Visscher DW, Kalli KR, Hartmann LC, Goode EL, Knutson KL. The ratios of CD8+ T cells to CD4+CD25+ FOXP3+ and FOXP3- T cells correlate with poor clinical outcome in human serous ovarian cancer. PLoS One 2013; 8:e80063. [PMID: 24244610 PMCID: PMC3828213 DOI: 10.1371/journal.pone.0080063] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/08/2013] [Indexed: 01/07/2023] Open
Abstract
Ovarian cancer is an immune reactive malignancy with a complex immune suppressive network that blunts successful immune eradication. This suppressive microenvironment may be mediated by recruitment or induction of CD4+ regulatory T cells (Tregs). Our study sought to investigate the association of tumor-infiltrating CD4+CD25+FOXP3+ Tregs, and other immune factors, with clinical outcome in serous ovarian cancer patients. We performed immunofluorescence and quantification of intraepithelial tumor-infiltrating triple positive Tregs (CD4+CD25+FOXP3+), as well as CD4+CD25+FOXP3-, CD3+ and CD8+ T cells in tumor specimens from 52 patients with high stage serous ovarian carcinoma. Thirty-one of the patients had good survival (i.e. > 60 months) and 21 had poor survival of < 18 months. Total cell counts as well as cell ratios were compared among these two outcome groups. The total numbers of CD4+CD25+FOXP3+ Tregs, CD4+CD25+FOXP3-, CD3+ and CD8+ cells were not significantly different between the groups. However, higher ratios of CD8+/CD4+CD25+FOXP3+ Treg, CD8+/CD4+ and CD8/CD4+CD25+FOXP3- cells were seen in the good outcome group when compared to the patients with poor outcome. These data show for the first time that the ratios of CD8+ to both CD4+CD25+FOXP3+ Tregs and CD4+CD25+FOXP3- T cells are associated with disease outcome in ovarian cancer. The association being apparent in ratios rather than absolute count of T cells suggests that the effector/suppressor ratio may be a more important indicator of outcome than individual cell count. Thus, immunotherapy strategies that modify the ratio of CD4+CD25+FOXP3+ Tregs or CD4+CD25+FOXP3- T cells to CD8+ effector cells may be useful in improving outcomes in ovarian cancer.
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Affiliation(s)
- Claudia C. Preston
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Matthew J. Maurer
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ann L. Oberg
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Daniel W. Visscher
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kimberly R. Kalli
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Lynn C. Hartmann
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ellen L. Goode
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail: (ELG); (KLK)
| | - Keith L. Knutson
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, United States of America
- Vaccine and Gene Therapy Institute, Port St. Lucie, Florida, United States of America
- * E-mail: (ELG); (KLK)
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