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Bao W, Li Z. Efficacy and safety of neoadjuvant chemotherapy containing anti-angiogenic drugs, immunotherapy, or PARP inhibitors for ovarian cancer. Crit Rev Oncol Hematol 2024; 194:104238. [PMID: 38128630 DOI: 10.1016/j.critrevonc.2023.104238] [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: 08/09/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Ovarian cancer is the most lethal gynecologic malignancy. The standard treatment involves chemotherapy with platinum-paclitaxel following cytoreductive surgery. For patients battling widespread and aggressive tumor spread, neoadjuvant chemotherapy (NACT) followed by interval debulking surgery emerges as an encouraging alternative. However, the effectiveness of this strategy is often limited by advanced-stage diagnosis and high likelihood of recurrence. The high mortality rate necessitates the exploration of targeted therapies. Present results signal promising efficacy and acceptable toxicities of anti-angiogenic drugs, immunotherapy, or PARP inhibitors used in chemotherapy. However, the potential integration of these drugs into NACT raises questions about response rates, surgical outcomes, and adverse events. This review delves into the findings from all published articles and ongoing studies, aiming to summarize the clinical use of anti-angiogenic drugs, immunotherapy, or PARP inhibitors in NACT, highlight the positive and negative aspects, and outline future perspectives.
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Affiliation(s)
- Wanying Bao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhengyu Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
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2
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Kharmach I, Malki S, Al Jarroudi O, El Harroudi T, Serji B, Afqir S. An unusual presentation of ovarian carcinoma with supraclavicular lymph node and colorectal metastases leading to spontaneous rectovaginal fistula. Int J Surg Case Rep 2023; 106:108189. [PMID: 37099988 PMCID: PMC10149384 DOI: 10.1016/j.ijscr.2023.108189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Secondary metastases to the rectum from primary ovarian cancer are a rare entity and their diagnosis and management are challenging. In this report, we discuss the findings of the case of metastatic ovarian cancer to supraclavicular lymph nodes and the rectum complicated with rectovaginal fistula. CASE PRESENTATION A 68-year-old woman was admitted for abdominal pain with rectal bleeding. Pelvic examination revealed a left latero-uterine mass. Abdominal-pelvic CT scan showed a tumor mass on the left ovary. A cytoreductive surgery and resection of a non-imaged rectal nodule identified during surgery were performed. The tumor specimens including the rectal metastasis were immunohistochemically confirming a metastatic ovarian cancer using CK7, WT1 and CK20. The patient received chemotherapy and had complete remission. However, she had a recto-vaginal fistula confirmed by imaging and had developed right supraclavicular lymphadenopathy from ovarian cancer later. CLINICAL DISCUSSION The dissemination of ovarian cancer in the digestive tract can be frequently, through direct invasion, abdominal implantation and lymphatic system. Unusually, ovarian cancer cells may spread to supra-clavicular nodes, because of the connection of the two diaphragmatic stages allowing the lymph flows through the lymphatic vessels. Moreover, rectovaginal fistula is an uncommon complication which can be seen spontaneously or due to certain patient's features. CONCLUSION In advanced ovarian carcinoma, it is required to properly assess the digestive tract during surgery because imaging can miss metastatic lesions such as our case. The use of immunohistochemistry is recommended to differentiate between primary ovarian carcinoma and secondary metastasis.
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Affiliation(s)
- Ikram Kharmach
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed I(st) University, Oujda, Morocco.
| | - Samia Malki
- Faculty of Medicine and Pharmacy, Mohammed I(st) University, Oujda, Morocco; Department of Anatomic Pathology, Mohammed VI University Hospital, Oujda, Morocco
| | - Ouissam Al Jarroudi
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed I(st) University, Oujda, Morocco
| | - Tijani El Harroudi
- Faculty of Medicine and Pharmacy, Mohammed I(st) University, Oujda, Morocco; Department of Surgical Oncology, Mohammed VI University Hospital, Oujda, Morocco
| | - Badr Serji
- Faculty of Medicine and Pharmacy, Mohammed I(st) University, Oujda, Morocco; Department of Surgical Oncology, Mohammed VI University Hospital, Oujda, Morocco
| | - Said Afqir
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed I(st) University, Oujda, Morocco
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Keyvani V, Riahi E, Yousefi M, Esmaeili SA, Shafabakhsh R, Moradi Hasan-Abad A, Mahjoubin-Tehran M, Hamblin MR, Mollazadeh S, Mirzaei H. Gynecologic Cancer, Cancer Stem Cells, and Possible Targeted Therapies. Front Pharmacol 2022; 13:823572. [PMID: 35250573 PMCID: PMC8888850 DOI: 10.3389/fphar.2022.823572] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
Gynecologic cancer is one of the main causes of death in women. In this type of cancer, several molecules (oncogenes or tumor suppressor genes) contribute to the tumorigenic process, invasion, metastasis, and resistance to treatment. Based on recent evidence, the detection of molecular changes in these genes could have clinical importance for the early detection and evaluation of tumor grade, as well as the selection of targeted treatment. Researchers have recently focused on cancer stem cells (CSCs) in the treatment of gynecologic cancer because of their ability to induce progression and recurrence of malignancy. This has highlighted the importance of a better understanding of the molecular basis of CSCs. The purpose of this review is to focus on the molecular mechanism of gynecologic cancer and the role of CSCs to discover more specific therapeutic approaches to gynecologic cancer treatment.
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Affiliation(s)
- Vahideh Keyvani
- Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran
- Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Espanta Riahi
- Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Mashhad, Iran; Department of Biology, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Meysam Yousefi
- Department of Medical Genetics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed-Alireza Esmaeili
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Rana Shafabakhsh
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Amin Moradi Hasan-Abad
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Maryam Mahjoubin-Tehran
- Department of Medical Biotechnology and Nanotechnology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Michael R. Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, South Africa
| | - Samaneh Mollazadeh
- Natural Products and Medicinal Plants Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
- *Correspondence: Samaneh Mollazadeh, ; Hamed Mirzaei, ,
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
- *Correspondence: Samaneh Mollazadeh, ; Hamed Mirzaei, ,
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Turco LC, Ferrandina G, Vargiu V, Cappuccio S, Fagotti A, Sallustio G, Scambia G, Cosentino F. Extreme complications related to bevacizumab use in the treatment of ovarian cancer: a case series from a III level referral centre and review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1687. [PMID: 33490199 PMCID: PMC7812204 DOI: 10.21037/atm-20-4448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In patients undergoing debulking surgery for ovarian cancer (OC), bevacizumab-combined chemotherapy has been reported to be associated with an increased incidence of adverse events (AEs). Reports in the literature have noted the overall morbidity of bevacizumab to be between 3.7% and 9%. The aim of this study is to report uncommon and unusual manifestations of morbidity in surgical cases performed at our third level referral centers for gynecologic oncology. Additionally, we review the rare and severe bevacizumab-related complications that have been described in the literature. We defined as "extreme", the particularly rare and/or severe complications up to determining a life-threatening condition or death, which are related to the use of bevacizumab. A case-series of extreme complications registered at our institutions were reported. In addition, a literature search of the PubMed, MEDLINE and EMBASE electronic databases was performed for this review. The studies collected included: 8 randomized controlled trials (RCT) and 5 prospective observational, 1 prospective phase-IV, 10 prospective phase-II, 2 prospective phase-I, and 20 retrospective studies, as well as 9 case reports. Bevacizumab was administered as primary treatment in adjuvant and neo-adjuvant setting in 16 and 5 studies respectively, as treatment for recurrence in 36 trials, and for secondary cytoreductive surgery (SCS) in 3 studies. The overall population administered with bevacizumab numbered 7,096 women. Extreme complications were observed in 591 patients, with a morbidity rate of the 8.3%. Overall, central nervous system (CNS), cardiovascular, gastrointestinal (GI) and primary infectious complications were seen in 22 patients (0.3%), 261 patients (3.7%), 159 patients (2.2%), and 8 patients (0.13%), respectively. Hemorrhagic and wound complications occurred in 18 women (0.25%), and 112 women (1.6%), respectively. Extreme complications related to the use of bevacizumab are rare, and often go unrecognized. The recognition and immediate management of such rare and life-threatening complications in patients treated at third level referral centers could significantly improve patient survival.
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Affiliation(s)
- Luigi Carlo Turco
- Mater Olbia Hospital, Gynaecology and Breast Unit, Olbia.,Division of Gynecologic Oncology, Gemelli-Molise, Università Cattolica del Sacro Cuore, Campobasso, Italia
| | - Gabriella Ferrandina
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Virginia Vargiu
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Serena Cappuccio
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Anna Fagotti
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Giuseppina Sallustio
- Università Cattolica del Sacro Cuore, Roma, Italia.,Department of Radiology and Diagnostic Imaging, Gemelli-Molise, Università Cattolica del Sacro Cuore, Campobasso, Italia
| | - Giovanni Scambia
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Francesco Cosentino
- Division of Gynecologic Oncology, Gemelli-Molise, Università Cattolica del Sacro Cuore, Campobasso, Italia
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Garcia Garcia Y, de Juan Ferré A, Mendiola C, Barretina-Ginesta MP, Gaba Garcia L, Santaballa Bertrán A, Bover Barcelo I, Gil-Martin M, Manzano A, Rubio Pérez MJ, Romeo Marin M, Arqueros Núñez C, García-Martínez E, Gonzalez Martin A. Efficacy and safety results from GEICO 1205, a randomized phase II trial of neoadjuvant chemotherapy with or without bevacizumab for advanced epithelial ovarian cancer. Int J Gynecol Cancer 2019; 29:1050-1056. [DOI: 10.1136/ijgc-2019-000256] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 11/04/2022] Open
Abstract
BackgroundBevacizumab is an approved treatment after primary debulking surgery for ovarian cancer. However, there is limited information on bevacizumab added to neoadjuvant chemotherapy before interval debulking surgery.ObjectiveTo evaluate neoadjuvant bevacizumab in a randomized phase II trial.MethodsPatients with newly diagnosed stage III/IV high-grade serous/endometrioid ovarian cancer were randomized to receive four cycles of neoadjuvant chemotherapy with or without ≥3 cycles of bevacizumab 15 mg/kg every 3 weeks. After interval debulking surgery, all patients received post-operative chemotherapy (three cycles) and bevacizumab for 15 months. The primary end point was complete macroscopic response rate at interval debulking surgery.ResultsOf 68 patients randomized, 64 completed four neoadjuvant cycles; 22 of 33 (67%) in the chemotherapy-alone arm and 31 of 35 (89%) in the bevacizumab arm (p=0.029) underwent surgery. The complete macroscopic response rate did not differ between treatment arms in either the intention-to-treat population of 68 patients (6.1% vs 5.7%, respectively; p=0.25) or the 55 patients who underwent surgery (8.3% vs 6.5%; p=1.00). There was no difference in complete cytoreduction rate or progression-free survival between the treatment arms. During neoadjuvant therapy, grade ≥3 adverse events were more common with chemotherapy alone than with bevacizumab (61% vs 29%, respectively; p=0.008). Intestinal (sub)occlusion, fatigue/asthenia, abdominal infection, and thrombocytopenia were less frequent with bevacizumab. The incidence of grade ≥3 adverse events was 9% in the control arm versus 16% in the experimental arm in the month after surgery.ConclusionsAdding three to four pre-operative cycles of bevacizumab to neoadjuvant chemotherapy for unresectable disease did not improve the complete macroscopic response rate or surgical outcome, but improved surgical operability without increasing toxicity. These results support the early integration of bevacizumab in carefully selected high-risk patients requiring neoadjuvant chemotherapy for initially unresectable ovarian cancer.
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Bottoni C, Scambia G, Fagotti A, Petrillo M. The safety of bevazicumab for the treatment of ovarian cancer. Expert Opin Drug Saf 2018; 17:1107-1113. [PMID: 30286624 DOI: 10.1080/14740338.2018.1532500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The safety profile of bevacizumab (BV) remains a challenging issue, in particular its role in fragile OC patients. Areas covered: In this literature review, we have analyzed safety data from Phase III trials evaluating the combination of BV plus standard chemotherapy in advanced or recurrent OC patients. In particular, our review aimed at clarifying the impact of the drug on fragile patients, and the correlation between BV and postoperative complications after cytoreductive surgery. Expert opinion: The addition of BV to standard chemotherapy regimens may cause unexpected side effects such as hypertension or proteinuria in up to 10% of women receiving the drug. BV administration is not associated with increase postoperative complications after cytoreductive surgery. Artero-venous thromboembolism and gastrointestinal perforation/fistula occurring in around 3% of OC patients treated with BV represent life-threatening events always requiring drug suspension. A closer monitoring is required in selected groups of women including: women with inflammatory bowel disease, or uncontrolled hypertension. Age itself is not a major contraindication, but older women should be carefully evaluated prior to start the drug. Finally, BV maintenance therapy should not be prematurely stopped due to minor events, since drug suspension may reduce survival.
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Affiliation(s)
- Carolina Bottoni
- a Department of Woman and Child Health , Università Cattolica del Sacro Cuore at IRCCS- Policlinico Gemelli Foundation for Personalized Medicine Rome , Rome , Italy
| | - Giovanni Scambia
- a Department of Woman and Child Health , Università Cattolica del Sacro Cuore at IRCCS- Policlinico Gemelli Foundation for Personalized Medicine Rome , Rome , Italy
| | - Anna Fagotti
- a Department of Woman and Child Health , Università Cattolica del Sacro Cuore at IRCCS- Policlinico Gemelli Foundation for Personalized Medicine Rome , Rome , Italy
| | - Marco Petrillo
- b Department of Clinical and Experimental Medicine , Gynecologic and Obstetrics Unit, University of Sassari , Sassari , Italy.,c Gynecologic and Obstetrics Unit, PhD School in Biomedical Sciences , University of Sassari , Sassari , Italy
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Abstract
INTRODUCTION Ovarian cancer is mostly diagnosed at advanced stage. Better survival is achieved through complete debulking surgery and chemotherapy. Historically, neoadjuvant chemotherapy (NAC) has been introduced for unresectable disease to decrease tumor load and perform a unique complete surgery. Four randomized control trials have compared primary debulking surgery to NAC, but there is still controversy about the use of neoadjuvant chemotherapy and questions about its modalities. Areas covered: We made a review of knowledge on benefits of NAC compared to primary debulking chemotherapy, in terms of survival and morbidity, methods of administration, new drugs in early and late phase trials, the selection of patients. Similar survival was observed after NAC and interval debulking surgery or primary debulking surgery. Morbidity of surgery was decreased after interval debulking compared primary debulking surgery. Conventional drugs are carboplatin and paclitaxel. Safety of bevacizumab was evaluated in phase 2 trials associated with conventional drugs. Immunotherapy trials are enrolling patients in phase 1 study. Expert commentary: NAC followed by debulking surgery is the best treatment for patients with advanced ovarian cancer.
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Petrillo M, Nero C, Carbone V, Bruno M, Scambia G, Fagotti A. Systematic Review of Cytoreductive Surgery and Bevacizumab-Containing Chemotherapy in Advanced Ovarian Cancer: Focus on Safety. Ann Surg Oncol 2017; 25:247-254. [PMID: 29134372 DOI: 10.1245/s10434-017-6235-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Initial experiences reported increased surgical morbidities in patients receiving cytoreductive surgery for colorectal cancer after bevacizumab-containing chemotherapy; however, more recent literature suggests a favorable toxicity profile in patients with advanced ovarian cancer (AOC). With the aim of providing a more objective point of view on this controversial issue, we present here a systematic literature review. METHODS Systematic revision of the available literature was conducted using the PubMed, MEDLINE, and EMBASE electronic databases. All studies reporting safety data regarding cytoreductive surgery performed before or after bevacizumab-containing chemotherapy have been analyzed for the purposes of this study. The study has been prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Forty-eight studies were retrieved from the electronic databases, with 23 (47.9%) being excluded due to an unsatisfactory study design. Among the remaining 25 manuscripts, 16 did not report data regarding surgical morbidities after cytoreductive surgery, therefore only 9 studies were included in the final analysis. Overall, 198 AOC patients received bevacizumab-containing neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in the context of five studies, among whom 21 women experienced grade 3/4 postoperative complications (10.6%), which appears to be in line with data reported in patients receiving IDS after carboplatin-paclitaxel NACT. Results from phase I-II clinical trials, and dataset analysis from GOG-0218, did not observe an increased incidence of complications in AOC patients receiving bevacizumab-containing adjuvant chemotherapy after cytoreductive surgery. CONCLUSIONS The incorporation of bevacizumab into first-line chemotherapy was not associated with increased morbidities before and after cytoreductive surgery in women with AOC.
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Affiliation(s)
- Marco Petrillo
- Department of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Camilla Nero
- Department of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vittoria Carbone
- Department of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Bruno
- Department of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Fagotti
- Department of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, Italy
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Loizzi V, Del Vecchio V, Gargano G, De Liso M, Kardashi A, Naglieri E, Resta L, Cicinelli E, Cormio G. Biological Pathways Involved in Tumor Angiogenesis and Bevacizumab Based Anti-Angiogenic Therapy with Special References to Ovarian Cancer. Int J Mol Sci 2017; 18:ijms18091967. [PMID: 28906427 PMCID: PMC5618616 DOI: 10.3390/ijms18091967] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/16/2017] [Accepted: 09/08/2017] [Indexed: 12/14/2022] Open
Abstract
The creation of new blood vessels from existing ones, which is a mechanism called “angiogenesis”, is essential in cancer to supply cancerous growth. Moreover, the development and the progression of the tumor and its metastases are the result of an efficient vascular response. Cancer cells release and activate different angiogenic growth factors and their receptors in the tumor microenvironment to promote the angiogenic process. The most important pro-angiogenic factor is the “Vascular Endothelial Growth Factor” (VEGF) because of its mitogen activity on vascular endothelium. Bevacizumab is a monoclonal antibody that obstructs the binding of circulating vascular endothelial growth factor to its receptors and has been approved for the treatment of primary and recurrent ovarian cancer but also for many other solid tumors.
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Affiliation(s)
- Vera Loizzi
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy.
| | - Vittoria Del Vecchio
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy.
| | - Giulio Gargano
- Gynecologic Oncology Unit, IRCCS, Istituto Tumori Giovanni Paolo II, 70142 Bari, Italy.
| | - Maria De Liso
- Gynecologic Oncology Unit, IRCCS, Istituto Tumori Giovanni Paolo II, 70142 Bari, Italy.
| | - Anila Kardashi
- Gynecologic Oncology Unit, IRCCS, Istituto Tumori Giovanni Paolo II, 70142 Bari, Italy.
| | - Emanuele Naglieri
- Gynecologic Oncology Unit, IRCCS, Istituto Tumori Giovanni Paolo II, 70142 Bari, Italy.
| | - Leonardo Resta
- Department of Pathology, University of Bari, 70121 Bari, Italy.
| | - Ettore Cicinelli
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy.
| | - Gennaro Cormio
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy.
- Gynecologic Oncology Unit, IRCCS, Istituto Tumori Giovanni Paolo II, 70142 Bari, Italy.
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10
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Daniele G, Lorusso D, Scambia G, Cecere SC, Nicoletto MO, Breda E, Colombo N, Artioli G, Cannella L, Lo Re G, Raspagliesi F, Maltese G, Salutari V, Ferrandina G, Greggi S, Baldoni A, Bergamini A, Piccirillo MC, Tognon G, Floriani I, Signoriello S, Perrone F, Pignata S. Feasibility and outcome of interval debulking surgery (IDS) after carboplatin-paclitaxel-bevacizumab (CPB): A subgroup analysis of the MITO-16A-MaNGO OV2A phase 4 trial. Gynecol Oncol 2016; 144:256-259. [PMID: 27993479 DOI: 10.1016/j.ygyno.2016.12.011] [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: 10/05/2016] [Revised: 12/07/2016] [Accepted: 12/10/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few data are available on the outcome of surgery after a bevacizumab-containing regimen. The MITO 16A- MaNGO OV2A phase 4 trial evaluates the outcomes of first-line CPB in a clinical-practice-like setting. Here we present the results of the subgroup of patients undergoing IDS after neoadjuvant treatment or suboptimal primary surgery. METHODS 400 chemonaïve epithelial ovarian cancer patients, age≥18, ECOG PS 0-2 were eligible to receive C (AUC 5 d1, q21) plus P (175mg/m2 d1, q21) and B (15mg/kg d1 q21) for 6cycles followed by B maintenance until cycle 22nd. RESULTS 79 patients (20%) underwent IDS. Overall, 74 patients received at least one administration of B before IDS. Median age was 61.2, 70% of the patients had FIGO IIIC disease. The median number of cycles before IDS was 3 both for chemotherapy and bevacizumab respectively. A residual disease ≤1cm was achieved in 64 patients (86.5%). Four percent of the patients experienced fever and 4% required blood transfusion after surgery. Surgical wound infection and/or dehiscence, pelvic abscess, intestinal sub-occlusion and fistula were experienced by one patient each. CONCLUSIONS In the MITO16A-MaNGO OV2A phase 4 trial, combined chemotherapy and bevacizumab did not hamper IDS and the rate of perioperative complications was similar to what expected without bevacizumab. These data support the hypothesis that adding bevacizumab to first line chemotherapy for ovarian cancer might not be denied to patients for whom IDS is planned.
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Affiliation(s)
- Gennaro Daniele
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale"- IRCCS, Naples, Italy
| | - Domenica Lorusso
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Giovanni Scambia
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Sabrina C Cecere
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | | | - Enrico Breda
- Medical Oncology Department, San Giovanni Calibita-Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Nicoletta Colombo
- Gynecology Department, European Institute of Oncology (IEO), Milan, Italy
| | | | - Lucia Cannella
- Department of Medical Oncology, G Rummo Hospital, Benevento, Italy
| | - Giovanni Lo Re
- Medical Oncology Department, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | | | - Giuseppa Maltese
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Vanda Salutari
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriella Ferrandina
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Greggi
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Alessandra Baldoni
- Medical Oncology Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Carmela Piccirillo
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale"- IRCCS, Naples, Italy
| | - Germana Tognon
- Obstetric and Gynaecology Azienda Ospedaliera "Spedali Civili", Brescia, Italy
| | - Irene Floriani
- Dipartimento di Oncologia, IRCCS Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | | | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale"- IRCCS, Naples, Italy
| | - Sandro Pignata
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy.
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Musella A, Vertechy L, Romito A, Marchetti C, Giannini A, Sciuga V, Bracchi C, Tomao F, Di Donato V, De Felice F, Monti M, Muzii L, Benedetti Panici P. Bevacizumab in Ovarian Cancer: State of the Art and Unanswered Questions. Chemotherapy 2016; 62:111-120. [DOI: 10.1159/000448942] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/06/2016] [Indexed: 11/19/2022]
Abstract
Ovarian cancer is a most lethal gynecologic tumor. The mainstay treatment is cytoreductive surgery followed by platinum-based chemotherapy. However, a high percentage of patients recur, thus needing multiple treatments with a frequently poor prognosis. In the last two decades, research has focused on the potential of target therapies to improve the survival of patients affected by ovarian cancer. Bevacizumab is one of the most studied target therapies, and it is approved for first- and second-line treatment of advanced epithelial ovarian, fallopian tube, and primary peritoneal tumors. Despite its widespread use with favorable results, controversy regarding patient selection and the best schedule, dosage, and timing of bevacizumab still exists. This review summarizes the state of the art on the use of bevacizumab for ovarian cancer in front-line, recurrence, and neoadjuvant settings. This study focuses on the results of pivotal trials, emerging data, ongoing research, and still unanswered questions about the most adequate dosage of bevacizumab and its potential activity after disease progression or rechallenge in previously treated patients.
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12
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Sonoda K. Molecular biology of gynecological cancer. Oncol Lett 2015; 11:16-22. [PMID: 26834851 DOI: 10.3892/ol.2015.3862] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 09/24/2015] [Indexed: 12/20/2022] Open
Abstract
Cancer is a pathological condition in which the balance between cell growth and death is disordered. Various molecules have been reported to be involved in the oncogenic process of invasion, metastasis and resistance to treatment. An exponential growth in the collection of genomic and proteomic data in the past 20 years has provided major advances in understanding the molecular mechanisms of human cancer, which has been applied to diagnostic and treatment strategies. Targeted therapies have been developed and adopted, particularly for advanced, refractory or recurrent cancers, depending on individual molecular profiles. The aim of the present review is to provide a report of the current literature regarding the molecular biology of gynecological cancers.
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Affiliation(s)
- Kenzo Sonoda
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka 812-8582, Japan
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13
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Petrillo M, Paris I, Vizzielli G, Amadio G, Cosentino F, Salutari V, Scambia G, Fagotti A. Neoadjuvant Chemotherapy Followed by Maintenance Therapy With or Without Bevacizumab in Unresectable High-Grade Serous Ovarian Cancer: A Case-Control Study. Ann Surg Oncol 2015; 22 Suppl 3:S952-8. [PMID: 26036187 DOI: 10.1245/s10434-015-4651-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to compare the toxicity, perioperative outcomes of interval debulking surgery (IDS), and duration of progression-free survival (PFS) in women with unresectable high-grade serous advanced ovarian cancer (AOC) receiving neoadjuvant chemotherapy (NACT) with or without bevacizumab. METHODS Twenty-five patients with high-grade serous AOC treated with bevacizumab-based NACT (cases) were matched according to initial disease extension assessed by laparoscopy, and age, in a 1:2 ratio, with 50 high-grade serous AOC patients treated with standard NACT without bevacizumab (controls). RESULTS Both groups received a median of four NACT cycles before IDS (p = 0.867), and the median time interval between NACT and IDS was 27 days in both groups (p = 0.547). Twenty-two cases (88.0 %) showed complete/partial radiologic response compared with 36 controls (72.3 %; p = 0.054). A higher percentage of cases showed complete serological response (48 vs. 35.1 %; p = 0.041). At IDS, complete cytoreduction was achieved in 20 cases (80.0 %) and 36 controls (72.3 %) [p = 0.260]. No differences were observed between groups in terms of surgical complexity score, perioperative outcomes, surgical complications, and chemotherapy-related adverse events. One death due to gastrointestinal perforation was observed among cases. Cases showed a longer median PFS compared with controls (18 months vs. 10 months; p = 0.001), and the administration of bevacizumab (hazard ratio 3.786; p = 0.001) retained a prognostic role for longer PFS at multivariate analysis. CONCLUSIONS The incorporation of bevacizumab in NACT prolongs PFS without affecting the safety of IDS. The risk of gastrointestinal perforation should be considered prior to attempting bevacizumab-based NACT in women with diffuse bowel involvement at initial laparoscopic evaluation.
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Affiliation(s)
- Marco Petrillo
- Division of Gynecologic Oncology, Department of Oncology, Foundation John Paul II, Catholic University of the Sacred Heart, Campobasso, Italy.,Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Ida Paris
- Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Vizzielli
- Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulia Amadio
- Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Cosentino
- Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Vanda Salutari
- Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Fagotti
- Division of Minimally Invasive Gynaecology, St. Maria Hospital, University of Perugia, Terni, Italy.
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Sato S, Itamochi H. Neoadjuvant chemotherapy in advanced ovarian cancer: latest results and place in therapy. Ther Adv Med Oncol 2014; 6:293-304. [PMID: 25364394 PMCID: PMC4206650 DOI: 10.1177/1758834014544891] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Approximately 70% of women with epithelial ovarian cancer (EOC) are diagnosed with advanced stage disease, which is associated with high morbidity and mortality. The standard approach to treating patients with advanced EOC remains primary debulking surgery (PDS) followed by chemotherapy. EOC is one of the most sensitive of all solid tumors to cytotoxic drugs, with over 80% of women showing a response to standard chemotherapy combined with taxane and platinum. Furthermore, residual disease is a major prognostic factor for survival. On the basis of the clinical features, neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is considered to be an alternative treatment option to standard treatment in patients unable to undergo complete resection during PDS. Noninferiority of NACT-IDS to PDS has been demonstrated in some randomized controlled trials and meta-analyses. NACT would also lead to improved quality of life (QOL) of patients, however there are still problems to be solved in the treatment strategy. The uncertainty of perioperative visual assessment of tumor dissemination after NACT has been reported. In addition, several papers have shown the possibility that NACT induces platinum resistance. Furthermore, a notable risk associated with NACT is that patients with significant side effects and refractory disease will lose the opportunity for debulking surgery. Appropriate selection of the patient cohort for NACT is an important issue. Bevacizumab (Bev) is active in patients with advanced EOC. However, the use of Bev is not recommended in the neoadjuvant setting. Bev has a specific adverse event profile that needs to be considered, especially for surgical management, such as gastrointestinal perforation, hemorrhage, and thromboembolic events. NACT could be an alternative treatment option in patients with stage III or IV EOC. However, further studies are needed to clarify the precise role of NACT in the management of advanced EOC.
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Affiliation(s)
- Seiya Sato
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago-City, Tottori, Japan
| | - Hiroaki Itamochi
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago-City 683-8504, Tottori, Japan
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15
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Vergote I, Oaknin A, Baurain JF, Ananda S, Wong S, Su X, Wu B, Zhong Z, Warner D, Casado A. A phase 1b, open-label study of trebananib in combination with paclitaxel and carboplatin in patients with ovarian cancer receiving interval or primary debulking surgery. Eur J Cancer 2014; 50:2408-16. [PMID: 25037684 DOI: 10.1016/j.ejca.2014.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/10/2014] [Accepted: 06/13/2014] [Indexed: 01/29/2023]
Abstract
AIM To evaluate the tolerability, pharmacokinetics and tumour response of first-line trebananib plus paclitaxel and carboplatin followed by trebananib maintenance in high-risk or advanced ovarian cancer. METHODS In this open-label phase 1b study, patients received intravenous (IV) trebananib 15 mg/kg administered weekly (QW) plus paclitaxel 175 mg/m(2) once every 3 weeks (Q3W) and carboplatin 6 mg/mL · min Q3W followed by trebananib 15 mg/kg QW monotherapy for 18 months. End-points were dose-limiting toxicities (DLTs; primary); treatment-emergent adverse events (AEs), anti-trebananib antibodies, pharmacokinetics and tumour response (secondary). RESULTS Twenty seven patients (interval debulking surgery [IDS], n=13) were enrolled. No DLTs occurred. During the combination therapy phase, AEs (>50%) in patients with IDS were nausea, diarrhoea, fatigue, decreased appetite and thrombocytopenia. In patients with primary debulking surgery (PDS), they were nausea, diarrhoea, fatigue and localised oedema. Grade 4 AEs were neutropenia (IDS, PDS; all n=3) and thrombocytopenia (IDS, PDS; all n=1). No deaths occurred. Toxicity results pertaining to trebananib maintenance were immature. The treatment combination did not markedly affect the pharmacokinetics across agents. In patients with IDS (n=14 after one patient was reassigned from PDS to IDS), 12 patients had a partial response (PR), two patients had stable disease. In patients with PDS (n=4), three patients had a complete response, one patient had a PR. CONCLUSIONS In women with ovarian cancer receiving IDS or PDS, IV trebananib 15 mg/kg QW plus paclitaxel and carboplatin appears tolerable. Results suggest that the treatment combination followed by trebananib 15 mg/kg monotherapy is associated with antitumour activity.
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Affiliation(s)
- I Vergote
- University Hospitals-KU Leuven, Leuven Cancer Institute, Department of Obstetrics and Gynecology, Herestraat 49, B-3000 Leuven, Belgium.
| | - A Oaknin
- Vall d'Hebron University Hospital, Medical Oncology Department, and Vall d'Hebron Institute of Oncology (VHIO), Head, Neck, and Gynecological Tumors Group, P. Vall d'Hebron 119-129, Barcelona 08035, Spain.
| | - J-F Baurain
- Université Catholique de Louvain, Centre du Cancer, Service d'Oncologie Médicale des Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Bruxelles 1200, Belgium.
| | - S Ananda
- Royal Women's Hospital, Oncology Unit, 20 Flemington Road, Parkville 3052, VIC, Australia.
| | - S Wong
- Western Hospital, Department of Medical Oncology, Oncology Research Level 2 South, Gordon Street, Footscray 3011, VIC, Australia.
| | - X Su
- Amgen Inc., Department of Biostatistics, One Amgen Center Drive, Thousand Oaks, CA 91320-1799, USA.
| | - B Wu
- Amgen Inc., Department of Pharmacokinetics and Drug Metabolism, One Amgen Center Drive, Thousand Oaks, CA 91320-1799, USA.
| | - Z Zhong
- Amgen Inc., Department of Clinical Immunology and Biological Sample Management, One Amgen Center Drive, Thousand Oaks, CA 91320-1799, USA.
| | - D Warner
- Amgen Inc., Department of Clinical Development, One Amgen Center Drive, Thousand Oaks, CA 91320-1799, USA.
| | - A Casado
- Hospital Universitario Clínico San Carlos, Servicio de Oncologia Medica, Calle del Professor Martín Lagos s/n, Madrid 28040, Spain.
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Abstract
Ovarian cancer is the most lethal malignancy of the female reproductive system and the fifth leading cause of cancer death in women. In the year 2012 alone, United States had 22,280 new ovarian cancer cases and 15,500 deaths were reported. About 7%-10% of ovarian cancers result from an inherited tendency to develop the disease. Ovarian cancer has the ability to escape the immune system because of its pathological interactions between cancer cells and host immune cells in the tumor microenvironment create an immunosuppressive network that promotes tumor growth, protects the tumor from immune system. The levels of immune suppressive elements like regulatory T cells, plasmacytoid dendritic cells and cytokines such as IL-10, IL-6, TNF-α, and TGF-β are elevated in the tumor microenvironment. Vascular endothelial growth factor is known to have an immune suppressing role besides its angiogenic role in the tumor microenvironment. Ovarian cancer is associated with high mortality partly due to difficulties in early diagnosis and development of metastases. These problems may overcome by developing accurate mouse models that should mimic the complexity of human ovarian cancer. Such animal models are better suited to understand pathophysiology, metastases, and also for preclinical testing of targeted molecular therapeutics. Immunotherapy is an area of active investigation and off late many clinical trials is ongoing to prevent disease progression. The main aim of dendritic cells vaccination is to stimulate tumor specific effector T cells that can reduce tumor size and induce immunological memory to prevent tumor relapse.
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Affiliation(s)
- T Sree Latha
- 1Department of Genetics & Genomics, Yogi Vemana University, Kadapa, India
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Ceelen W, Van Nieuwenhove Y, Putte DV, Pattyn P. Neoadjuvant chemotherapy with bevacizumab may improve outcome after cytoreduction and hyperthermic intraperitoneal chemoperfusion (HIPEC) for colorectal carcinomatosis. Ann Surg Oncol 2014; 21:3023-8. [PMID: 24756812 DOI: 10.1245/s10434-014-3713-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND In selected patients with colorectal peritoneal carcinomatosis (PC), cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) may improve survival. We aimed to assess whether neoadjuvant chemotherapy with or without bevacizumab is indicated in this patient population. METHODS Colorectal PC patients were treated with CRS and HIPEC using oxaliplatin (200-460 mg/m(2)) or mitomycin C (35 mg/m(2)). Postoperative outcome and long-term survival were prospectively recorded. The impact of clinical variables on overall survival (OS) was assessed using univariate and Cox multivariate analysis. RESULTS Between October 2002 and May 2012, 166 patients were treated with CRS and HIPEC. Neoadjuvant chemotherapy alone was administered to 21 % and neoadjuvant chemotherapy with bevacizumab to 16 % of patients. Postoperative mortality and major morbidity were 2.4 and 35 %, respectively. Half of the patients received adjuvant chemotherapy. After a median follow-up of 18 months, OS was 27 months (95 % confidence interval 20.8-33.2). On univariate analysis, OS was associated with extent of disease (P < 0.001), neoadjuvant chemotherapy with bevacizumab (P = 0.021), completeness of cytoreduction (CC) (P < 0.001), and adjuvant chemotherapy (P = 0.04), but not with primary disease site, synchronous presentation, or chemoperfusion drug. In multivariate Cox regression, independent predictors of OS were CC (hazard ratio 0.29, P < 0.001) and neoadjuvant therapy containing bevacizumab (hazard ratio 0.31, P = 0.019). CONCLUSIONS Long-term OS after CRS and HIPEC for colorectal cancer is associated with CC and neoadjuvant therapy containing bevacizumab. This regimen merits prospective study in patients with resectable PC of colorectal origin.
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Affiliation(s)
- Wim Ceelen
- Department of Surgery, Ghent University Hospital, Ghent, Belgium,
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