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Frezzini S, Tasca G, Borgato L, Sartor L, Ferrero A, Artioli G, Modena A, Baldoni A. PARP Inhibitors in Brain Metastases from Epithelial Ovarian Cancer through a Multimodal Patient Journey: Case Reports and Literature Review. Int J Mol Sci 2024; 25:7887. [PMID: 39063128 PMCID: PMC11276770 DOI: 10.3390/ijms25147887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Epithelial ovarian cancer (EOC) is the deadliest gynecological malignancy worldwide. Brain metastasis (BM) is quite an uncommon presentation. However, the likelihood of central nervous system (CNS) metastasization should be considered in the context of disseminated disease. The therapeutic management of BMs is an unmet clinical need, to date. We identified, across different cancer centers, six cases of both BRCA wild-type and BRCA-mutated EOCs spreading to the CNS. They presented either with a single brain lesion or with multiple lesions and most of them had intracranial-only disease. All cases received Poly-ADP ribose polymerase inhibitor (PARPi) maintenance, as per clinical practice, for a long time within a multimodal treatment approach. We also provide an insight into the available body of work regarding the management of this intriguing disease setting, with a glimpse of future therapeutic challenges. Despite the lack of unanimous guidelines, multimodal care pathways should be encouraged for the optimal disease control of this unfortunate patient subset. Albeit not being directly investigated in BM patients, PARPi maintenance is deemed to have a valuable role in this setting. Prospective research, aimed to implement worthwhile strategies in the multimodal patient journey of BMs from EOC, is eagerly awaited.
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Affiliation(s)
- Simona Frezzini
- Medical Oncology 3 Unit, Veneto Institute of Oncology IOV—IRCCS, 35128 Padova, Italy
| | - Giulia Tasca
- Medical Oncology 2 Unit, Veneto Institute of Oncology IOV—IRCCS, 35128 Padova, Italy;
| | - Lucia Borgato
- Medical Oncology Unit, Ospedale San Bortolo, 36100 Vicenza, Italy;
| | - Lucia Sartor
- Medical Oncology Unit, Ospedale di Camposampiero, ULSS 6 Euganea, 35131 Padova, Italy;
| | - Annamaria Ferrero
- Academic Department Gynecologic Oncology, Mauriziano Hospital, University of Torino, 10124 Torino, Italy;
| | - Grazia Artioli
- Medical Oncology Unit, Azienda ULSS 2 Marca Trevigiana, 31100 Treviso, Italy;
| | - Alessandra Modena
- Medical Oncology Department, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy;
| | - Alessandra Baldoni
- Oncology and Hematology Department, Mirano AULSS3 Serenissima, 30035 Mirano, Italy;
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Cabitza E, Pirola M, Baldessari C, Bernardelli G, Zunarelli E, Pipitone S, Vitale MG, Nasso C, Molinaro E, Oltrecolli M, D'Agostino E, Mandato VD, Palicelli A, Dominici M, Sabbatini R. Cerebellar metastasis of ovarian cancer: a case report. J Med Case Rep 2023; 17:553. [PMID: 38115068 PMCID: PMC10731881 DOI: 10.1186/s13256-023-04211-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 10/12/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Ovarian cancer is metastatic at presentation in about 62% of cases, but brain metastases are rare, reported in 3.3-4% of patients. Brain metastasis seems to be more frequent in advanced stages at diagnosis and in patients with BRCA1/2 mutation. CASE PRESENTATION We present a case of a 47-year-old Caucasian woman, BRCA wild type, with an ovarian cancer that started with single cerebellar metastasis. CONCLUSION Brain metastases in ovarian cancer are rare and complex for diagnosis and management. This case focuses both on diagnosis and treatment, emphasizing the importance of a multimodal approach in a multidisciplinary team.
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Affiliation(s)
- Eleonora Cabitza
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Marta Pirola
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy.
| | - Cinzia Baldessari
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | | | - Elena Zunarelli
- Anatomic Pathology Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Stefania Pipitone
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | | | | | | | - Marco Oltrecolli
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Elisa D'Agostino
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | | | - Andrea Palicelli
- Pathology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Dominici
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Roberto Sabbatini
- Oncology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
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3
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Jayraj AS, Kumar S, Bhatla N, Malik PS, Mathur S, Rangarajan K, Vanamail P, Thulkar S, Kumar L. Central nervous system metastasis from epithelial ovarian cancer- predictors of outcome. Curr Probl Cancer 2023; 47:100918. [PMID: 36502584 DOI: 10.1016/j.currproblcancer.2022.100918] [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: 08/28/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 12/02/2022]
Abstract
Management of central nervous system (CNS) metastases from epithelial ovarian cancer (EOC) is an unmet need. We analyzed data on 41 such patients to evaluate predictors of outcome. Between January, 2010 and December 2020, among 1028 patients with EOC treated at our institute 41 (3.98%) developed CNS metastasis. Median age of patients was 48 years, ranging from 22 to 75 years. Primary outcome measure was progression free survival (PFS). Overall survival (OS), and analysis of prognostic factors were secondary outcome measures. An intention to treat analysis was done. We also performed review the literature (n=2253) as regards to clinicopathological and radiological features, treatment received, survival outcomes and prognostic factors. Median time from diagnosis of EOC to CNS metastasis was 27 months (range: 0 to 101 months). 33(80.5%) patients had FIGO stage III-IV at baseline and serous carcinoma (75.6%) was common pathology subtype. Thirteen (31.7%) patients had isolated CNS metastasis and 28 (68.3%) had intra-abdominal disease in addition. Nineteen (46.3%) patients achieved complete response post treatment with surgery, radiation and chemotherapy. Median PFS and OS from the time of CNS metastasis is 12 (range:1 to 51) months and 33 (range: 1 to 71) months, respectively. Absence of extracranial disease and lower serum CA-125 at diagnosis of CNS metastasis were predictive of superior PFS and OS on multivariate analysis. CNS metastasis is a late event in EOC, post multiple lines of treatment. Patients with disease limited to brain and treated with surgical resection and chemoradiation have best outcome.
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Limon D, Shachar E, Wolf I, Adar L, Peleg Hasson S, Ferro L, Safra T. Brain metastases in patients with ovarian cancer. Acta Oncol 2022; 61:757-763. [PMID: 35485453 DOI: 10.1080/0284186x.2022.2066985] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Brain metastasis (BM) are uncommon among women with epithelial ovarian cancer (EOC). The frequency, risk factors and clinical repercussions of BM in these patients are not well described. METHODS We retrospectively evaluated EOC patients treated at our center from 2002 to 2020 and assessed their clinical parameters, risk for BM development and association with overall survival (OS). This cohort has a known high frequency of BRCA mutation carriers (BRCAm) due to women of Ashkenazi Jewish descent. RESULTS Among 1035 EOC patients, 29 (2.8%) were diagnosed with BM. The prevalence of BRCA mutations was more common among women with BM (56.5% vs. 34.3%, p = 0.033). The BM rate in patients with BRCAm was higher than the BM rate in those with wildtype BRCA (BRCAw; 5.1% vs. 2.1%, OR = 2.6; 95% CI: 1.2-5.4, p = 0.013). Median time from diagnosis to BM and from disease recurrence to BM was longer among patients with BRCAm. Median OS was not significantly different among patients with BM versus those without BM (59.4 vs. 73.4 months, p = 0.243). After BM diagnosis, median OS was not statistically significantly different between patients with BRCAm and those with BRCAw (20.6 vs. 12.3 months, p = 0.441). Treatment with poly (ADP-ribose) polymerase inhibitors and bevacizumab had no impact on subsequent development of BM. CONCLUSIONS BM are rare among EOC patients. However, the risk is three-fold higher among patients with BRCAm. BM do not significantly alter OS among EOC patients. The higher rate of BM in patients with BRCAm may be related to longer OS in this subpopulation.
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Affiliation(s)
- Dror Limon
- Oncology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eliya Shachar
- Oncology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Wolf
- Oncology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lyri Adar
- Oncology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shira Peleg Hasson
- Oncology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leora Ferro
- Oncology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Safra
- Oncology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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Morales Vázquez F, López Basave HN, Méndez Herrera MDC, Peña González RR. Clinically Relevant Response to Treatment with Olaparib in a Patient with Refractory Multidrug-Resistant Ovarian Cancer and Central Nervous System Involvement: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925990. [PMID: 33226974 PMCID: PMC7704057 DOI: 10.12659/ajcr.925990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite advances in diagnosis and treatment, epithelial ovarian cancer (EOC) continues to be highly lethal. Undoubtedly, the introduction of poly(adenosine diphosphate-ribose) polymerase inhibitors such as olaparib will alter this clinical picture. Phase III studies have already documented clinically relevant outcomes, particularly among patients with BRCA mutations and homologous recombination deficiency. CASE REPORT Here we present a case report that documents the evolution of refractory multidrug-resistant, BRCA1-mutated EOC in a patient who had advanced clinical deterioration, carcinomatosis, and central nervous system (CNS) involvement that responded favorably to olaparib, resulting in a tripling of her progression-free survival. CONCLUSIONS Olaparib proved to be a safe and effective option for the treatment of a patient with multidrug-resistant, BRCA1-mutated EOC with CNS metastases. This suggests that early initiation of the drug in similar cases can be very useful.
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Brain Metastases from Ovarian Cancer: Current Evidence in Diagnosis, Treatment, and Prognosis. Cancers (Basel) 2020; 12:cancers12082156. [PMID: 32759682 PMCID: PMC7464214 DOI: 10.3390/cancers12082156] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 12/12/2022] Open
Abstract
With this review, we provide the state of the art concerning brain metastases (BMs) from ovarian cancer (OC), a rare condition. Clinical, pathological, and molecular features, treatment options, and future perspectives are comprehensively discussed. Overall, a diagnosis of high-grade serous OC and an advanced disease stage are common features among patients who develop brain metastases. BRCA1 and BRCA2 gene mutations, as well as the expression of androgen receptors in the primary tumor, are emerging risk and prognostic factors which could allow one to identify categories of patients at greater risk of BMs, who could benefit from a tailored follow-up. Based on present data, a multidisciplinary approach combining surgery, radiotherapy, and chemotherapy seem to be the best approach for patients with good performance status, although the median overall survival (<1 year) remains largely disappointing. Hopefully, novel therapeutic avenues are being explored, like PARP inhibitors and immunotherapy, based on our improved knowledge regarding tumor biology, but further investigation is warranted.
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Favier L, Truc G, Boidot R, Bengrine-Lefevre L. Long-term response to Olaparib in carcinomatous meningitis of a BRCA2 mutated ovarian cancer: A case report. Mol Clin Oncol 2020; 13:73-75. [PMID: 32454976 DOI: 10.3892/mco.2020.2035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 02/18/2020] [Indexed: 11/06/2022] Open
Abstract
PARP inhibitors are considered as a treatment revolution in ovarian cancer management. Leptomeningeal metastasis is a rare event with poor prognosis. The present report presents an exceptional history of long term survival for a young patient treated with olaparib for carcinomatous meningitis. A 54-year-old woman was diagnosed with ovarian cancer. After Paclitaxel and Carboplatin treatment, followed by a debulking surgery and several lines of chemotherapy due to progression, the patient's disease evolved into carcinomatous meningitis within 6 months after the end of treatment. During care, exome analysis on brain lesions was performed. Exome analysis was performed with a mean coverage of 80X by a paired-end sequencing on an Illumina NextSeq500 device. Following bioinformatics alignment and variant annotation, a pathogenic BRCA2 mutation, c.7617+1G>T, was observed, and this was already detected in her family. Additionally, the allelic frequency observed indicated that the mutation was present at the homozygous status in tumor cells. Due to the presence of a pathogenic mutation and a loss of wild-type BRCA2 allele, a maintenance treatment by Olaparib was initiated after radiotherapy and Cisplatin monotherapy. The patient received olaparib treatment for 14 months with a very good disease control and an excellent tolerance. Despite long control, the patient succumbed to meningeal and peritoneal progression.
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Affiliation(s)
- Laure Favier
- Department of Medical Oncology, Georges-François Leclerc Anticancer Center, UNICANCER, F-21079 Dijon, France
| | - Gille Truc
- Department of Radiotherapy, Georges-François Leclerc Anticancer Center, UNICANCER, F-21079 Dijon, France
| | - Romain Boidot
- Department of Biology and Pathology of Tumors, Georges-François Leclerc Anticancer Center, UNICANCER, F-21079 Dijon, France
| | - Leïla Bengrine-Lefevre
- Department of Medical Oncology, Georges-François Leclerc Anticancer Center, UNICANCER, F-21079 Dijon, France
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8
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da Costa AABA, Dos Santos ES, Cotrim DP, Pandolfi NC, Cesca MG, Mantoan H, Sanches SM, Ribeiro ARG, de Brot L, Bonvolim G, Sanematsu PI, de Souza RP, Maya JML, de Souza Castro F, da Nogueira Silveira Lima JP, Chen MJ, Guimarães APG, Baiocchi G. Prognostic impact of platinum sensitivity in ovarian carcinoma patients with brain metastasis. BMC Cancer 2019; 19:1194. [PMID: 31805898 PMCID: PMC6896587 DOI: 10.1186/s12885-019-6382-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 11/20/2019] [Indexed: 01/28/2023] Open
Abstract
Background Brain metastasis (BM) is a rare event in ovarian cancer patients. The current prognostic scores that have been used for other tumors do not account for specific characteristics of ovarian cancer, such as platinum sensitivity. Methods This retrospective cohort study examined patients with ovarian carcinoma and BM who were treated at a single institution from January 2007 to December 2017. Clinical data on the diagnosis of BM and follow-up were collected. Cox regression was used to evaluate prognostic factors for overall survival (OS). Results Of 560 patients, 26 presented with BM. Eight patients were treated with surgery, 15 with whole-brain radiotherapy (RT), and 5 with stereotactic RT, and 4 patients received systemic treatment at the diagnosis of BM. The median OS was 10.8 months. The following factors were associated with OS: platinum-sensitive recurrence (HR 0.34, 95% CI 0.12–0.99; p = 0.049), higher number of previous treatment lines (HR 1.57, 95% CI 1.12–2.19; p = 0.008), ECOG performance status (HR 2.52, 95% CI 1.24–5.09; p = 0.010), and longer interval from initial diagnosis to BM (p = 0.025). Notably, the number of brain metastasis, the largest tumor size, and progression outside of the CNS were not related to survival. Platinum sensitivity was not associated with any of the classic prognostic factors in brain metastasis patients such as number or size of brain metastasis or disease progression outside the CNS strengthening the hypothesis of the importance of platinum sensitivity to the prognosis of ovarian cancer patients with BM. Conclusions The factors related to the biological behavior of the ovarian cancer such as platinum sensitivity at the time of BM diagnosis, fewer number of previous treatment lines and interval from initial diagnosis were associated with survival in ovarian cancer patients with BM, while factors that are usually related to survival in BM in other cancers were not associated with survival in this cohort of ovarian cancer patients. The small number of patients did not allow us to exclude the prognostic role of these former factors that were not associated with survival in the present cohort.
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Affiliation(s)
| | - Elizabeth Santana Dos Santos
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Deborah Porto Cotrim
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Natasha Carvalho Pandolfi
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Marcelle Goldner Cesca
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Henrique Mantoan
- Gynecology Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Solange Moraes Sanches
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Adriana Regina Gonçalves Ribeiro
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Louise de Brot
- Pathology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Graziele Bonvolim
- Pathology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Paulo Issamu Sanematsu
- Neurosurgery Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Ronaldo Pereira de Souza
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Joyce Maria Lisboa Maya
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Fabrício de Souza Castro
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | | | - Michael Jenwel Chen
- Radiotherapy Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Andrea Paiva Gadelha Guimarães
- Medical Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
| | - Glauco Baiocchi
- Gynecology Oncology Department, A.C. Camargo Cancer Center, 211 Professor Antonio Prudente Street, Liberdade, São Paulo, SP, 01509-900, Brazil
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Szarszewska M, Markowska A, Jach R, Marszałek A, Filas V, Bednarek W, Olejek A, Tomczak P, Sajdak S, Nowak-Markwitz E, Jaszczyńska-Nowinka K, Stanisławiak-Rudowicz J, Gryboś A, Chudecka-Głaz A, Gryboś M, Adamska K, Ramlau R, Markowska J, Knapp P. Significance of BRCA1 expression in breast and ovarian cancer patients with brain metastasis - A multicentre study. Adv Med Sci 2019; 64:235-240. [PMID: 30822630 DOI: 10.1016/j.advms.2018.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/02/2018] [Accepted: 12/18/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Cerebral metastases develop in 10-30% of patients with breast cancer (BC) and in around 3.3 to 4% of patients with ovarian cancer (OC). The aim of the multicenter study is to investigate the correlation between the expression of estrogen alpha receptors (ERα), progesterone receptors (PR), human epidermal growth factor receptor 2 (HER2), stromal cell-derived factor 1 (SDF1) and its receptor C-X-C chemokine receptor type 4 (CXCR4), breast cancer metastasis suppressor 1 (BRMS1), astrocyte elevated gene 1 (AEG1), depending on the status of BRCA1 protein, in patients suffering from OC and BC with brain metastases. PATIENTS AND METHODS The analysis included 51 patients: 29 with BC and 22 with OC, in whom brain metastases were disclosed. RESULTS In most patients (65.5% of BC patients and 68.2% of patients with OC tumors) BRCA1 protein loss was found. No correlation was disclosed between the levels of ERα, PR receptors, HER2, SDF1, CXCR4, AEG1, BRMS1 and BRCA1 status, patient age, stage of disease advancement, grade of histological maturity of the cells, presence of metastases to lymph nodes. A statistically significant correlation was disclosed between the negative expression of PR receptors and a high expression of CXCR4 in patients with BC. High values of the AEG1 protein (linked to metastases) were detected alongside a high expression of BRMS1 (a suppressor of metastases). CONCLUSIONS Patients with BC and OC and brain metastases have a frequent loss of BRCA1 expression. The role of ERα, PR, HER2, SDF1, CXCR4, AEG1, BRMS1 in metastatic process needs further studies.
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10
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Stasenko M, Cybulska P, Feit N, Makker V, Konner J, O'Cearbhaill RE, Alektiar KM, Beal K, Gardner GJ, Long Roche KC, Sonoda Y, Chi DS, Zivanovic O, Leitao MM, Cadoo KA, Tew WP. Brain metastasis in epithelial ovarian cancer by BRCA1/2 mutation status. Gynecol Oncol 2019; 154:144-149. [PMID: 31113680 DOI: 10.1016/j.ygyno.2019.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/01/2019] [Accepted: 05/07/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate clinical outcomes of patients with BRCA-associated ovarian cancer who developed brain metastases (BM). METHODS Patients with epithelial ovarian, fallopian tube, and primary peritoneal cancer (EOC) and BM, treated at a single institution from 1/1/2008-7/1/2018, were identified from two institutional databases. Charts and medical records were retrospectively reviewed for clinical characteristics and germline BRCA mutation status. Appropriate statistics were used. RESULTS Of 3649 patients with EOC, 91 had BM (2.5%). Germline mutation status was available for 63 (69%) cases; 21 (35%) of these harbored a BRCA1/2 mutation (15 BRCA1, 6 BRCA2). Clinical characteristics were similar between groups. BM were diagnosed at a median of 31 months (95% CI, 22.6-39.4) in BRCA-mutated (mBRCA) and 32 months (95% CI, 23.7-40.3) in wild-type BRCA (wtBRCA) (p = 0.78) patients. Brain metastases were the only evidence of disease at time of BM diagnoses in 48% (n = 10) mBRCA and 19% (n = 8) wtBRCA (p = 0.02) patients. There was no difference in treatment of BM by mutation status (p = 0.84). Survival from time of BM diagnosis was 29 months (95%CI, 15.5-42.5) in mBRCA and 9 months (95% CI, 5.5-12.5) in wtBRCA patients, with an adjusted hazard ratio (HR) of 0.53, p = 0.09; 95% CI, 0.25-1.11. HR was adjusted for presence of systemic disease at time of BM diagnosis. CONCLUSION This is the largest study to date comparing outcomes in patients with EOC and BM by mutation status. mBRCA patients were more likely to have isolated BM, which may be a factor in their long survival. This supports the pursuit of aggressive treatment for mBRCA EOC patients with BM. Additional studies examining the correlation of BRCA mutational status with BM are warranted.
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Affiliation(s)
- Marina Stasenko
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Paulina Cybulska
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Noah Feit
- Weill Cornell Medical College of Cornell University, New York, NY 10065, USA
| | - Vicky Makker
- Weill Cornell Medical College of Cornell University, New York, NY 10065, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jason Konner
- Weill Cornell Medical College of Cornell University, New York, NY 10065, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Roisin E O'Cearbhaill
- Weill Cornell Medical College of Cornell University, New York, NY 10065, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kaled M Alektiar
- Weill Cornell Medical College of Cornell University, New York, NY 10065, USA; Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kathryn Beal
- Weill Cornell Medical College of Cornell University, New York, NY 10065, USA; Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ginger J Gardner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College of Cornell University, New York, NY 10065, USA
| | - Kara C Long Roche
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College of Cornell University, New York, NY 10065, USA
| | - Yukio Sonoda
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College of Cornell University, New York, NY 10065, USA
| | - Dennis S Chi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College of Cornell University, New York, NY 10065, USA
| | - Oliver Zivanovic
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College of Cornell University, New York, NY 10065, USA
| | - Mario M Leitao
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College of Cornell University, New York, NY 10065, USA
| | - Karen A Cadoo
- Weill Cornell Medical College of Cornell University, New York, NY 10065, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - William P Tew
- Weill Cornell Medical College of Cornell University, New York, NY 10065, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Keskin S, Küçücük S, Ak N, Atalar B, Sarı M, Sozen H, Ibis K, Topuz S, Saip P. Survival Impact of Optimal Surgical Cytoreduction in Recurrent Epithelial Ovarian Cancer with Brain Metastasis. Oncol Res Treat 2019; 42:101-106. [PMID: 30661076 DOI: 10.1159/000494334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 10/05/2018] [Indexed: 11/19/2022]
Abstract
AIM The aim of this study was to determine the clinicopathological characteristics, treatment details and outcome of patients with brain metastasis from epithelial ovarian carcinoma (EOC). METHODS This study included 21 patients diagnosed with brain metastasis from EOC between 1999 and 2009. RESULTS Median age was 61 years (range 38-77). The median time elapsed from EOC diagnosis to brain metastasis detection was 32 months. Single brain metastases were found in 10 (48%) cases, and there was extra-cranial disease in 11 (52%) cases. During the mean 86 months of follow-up, 18 of the patients (86%) died of the disease and 3 (14%) were alive with disease. The median survival time after the initial diagnosis of brain metastasis was 9 months. The median overall survival (OS) from initial diagnosis of EOC was 50 months. In univariate analysis, prolonged time from initial diagnosis to central nervous system metastasis (more than 32 months) (p = 0.001), treatment with radiotherapy (p < 0.001), optimal cytoreductive operation (p = 0.02) were all positively correlated with OS. CONCLUSION The prognosis of patients with brain metastasis from EOC is still poor. The significant predictors of survival in our series were whole brain radiotherapy, prolonged elapsed time from initial diagnosis to brain metastasis and optimal cytoreductive surgery.
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Sakamoto I, Hirotsu Y, Nakagomi H, Ikegami A, Teramoto K, Omata M. Durable response by olaparib for a Japanese patient with primary peritoneal cancer with multiple brain metastases: A case report. J Obstet Gynaecol Res 2018; 45:743-747. [PMID: 30565790 DOI: 10.1111/jog.13851] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/08/2018] [Indexed: 01/10/2023]
Abstract
Brain metastases (BM) from epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) are extremely rare, accounting for 1-2.5% of all cases. Although therapeutic options, such as surgery, irradiation and chemotherapy are proven to yield survival benefit, the overall prognosis of these patients remains unsatisfactory. Poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitor, olaparib is useful for patients with recurrent EOC or PPC. However, reports suggesting the efficacy of PARP inhibitors for patients with EOC or PPC with BM are limited. We report the case of a 58-year-old Japanese woman with recurrent PPC with multiple BM. After obtaining informed consent from the patient, we performed BRCA testing that detected a deleterious BRCA 1 mutation. At that time, olaparib was not yet approved in Japan, we learned about the compassionate use program of olaparib called Managed Access Program (MAP). Of note, we have established a system to enroll patients in MAP. After olaparib treatment, the patient exhibited a considerable decrease of BMs. Eighteen months since the initiation of olaparib treatment, the patient has reported no evidence of disease progression. Olaparib maintenance treatment could be effective for Japanese patients with PPC and multiple BMs.
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Affiliation(s)
- Ikuko Sakamoto
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
| | - Yosuke Hirotsu
- Genome Analysis Center, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
| | - Hiroshi Nakagomi
- Breast Surgery, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
| | - Atsushi Ikegami
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
| | - Katsuhiro Teramoto
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
| | - Masao Omata
- Genome Analysis Center, Yamanashi Prefectural Central Hospital, Yamanashi, Japan.,University of Tokyo, Tokyo, Japan
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