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Peleg Hasson S, Shachar E, Brezis MR, Saad A, Toledano B, Michaan N, Laskov I, Grisaru D, Goldstein J, Nutman A, Safra T. Medical cannabis and its effect on oncological outcomes in patients with ovarian cancer treated with PARP inhibitors. Int J Gynecol Cancer 2024; 34:559-565. [PMID: 38242547 DOI: 10.1136/ijgc-2023-004953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Poly (ADP-ribose) polymerase inhibitors (PARPi) play a pivotal role in ovarian cancer management. With medical cannabis emerging as a novel component of supportive care, this study investigated the impact of medical cannabis use on oncological outcomes in patients with ovarian cancer undergoing PARPi therapy. METHODS The study included patients from a single institution database treated for ovarian cancer between January 2014 and January 2020 who received PARPi maintenance therapy in a first-line or recurrent disease setting after a confirmed response to platinum-based treatment. The study categorized patients as cannabis users and cannabis-naïve. Univariate and multivariate Cox regression analysis and the Kaplan-Meier method were used to assess the effects of medical cannabis use on the duration of PARPi therapy, progression-free survival, and overall survival. RESULTS Among the eligible patients (n=93), most were cannabis-naïve (69%, n=64) while the rest used medical cannabis (31%, n=29). Medical cannabis use rates were comparable for patients receiving PARPi therapy post-primary treatment or for recurrence (42%, n=9, vs 27%, n=20; p=0.1). Both groups exhibited similar median duration for PARPi therapy (12.1 vs 9.5 months; p=0.89) and progression-free survival (20 vs 21 months; p=0.83). Kaplan-Meier analysis detected no differences in progression-free survival associated with cannabis use. Although cannabis users had an extended overall survival compared with the cannabis-naïve group (129.3 vs 99 months; p=0.03), cannabis use was insignificant for overall survival on multivariate analysis (p=0.10). Multivariate analysis showed stage IV at diagnosis (p=0.02) to be the sole factor associated with progression-free survival (p=0.02). CONCLUSION Medical cannabis usage in patients receiving PARPi treatment showed no association with duration of PARPi therapy, progression-free survival, or overall survival.
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Affiliation(s)
- Shira Peleg Hasson
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eliya Shachar
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Miriam R Brezis
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Akram Saad
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sheba Cancer Center and Institute of Oncology, Tel Hashomer, Tel Aviv, Israel
| | - Bar Toledano
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Michaan
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Laskov
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dan Grisaru
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jeffrey Goldstein
- Department of Radiation Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Amir Nutman
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Edith Wolfson Medical Center, Holon, Israel
| | - Tamar Safra
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Akdam A, Van Mil L, Tzur Y, Laskov I, Grisaru D, Schejter E, Michaan N. Human Papilloma Virus Typing as a Triage Tool for Women with Postcoital Bleeding: A Retrospective Cohort Study. J Womens Health (Larchmt) 2024. [PMID: 38502831 DOI: 10.1089/jwh.2023.0616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Objective: To investigate the performance of human papilloma virus (HPV) typing as a triage tool in the management of patients with postcoital bleeding (PCB). Methods: All patients referred for colposcopy at a cervical pathology clinic of a nationwide health insurance organization, due to PCB and had a preceding high-risk HPV (hrHPV) test between 2018 and 2020, were retrospectively located. Demographic and pathologic data were collected from electronic medical files. Sensitivity, specificity, and negative and positive predictive value of hrHPV test according to final pathology were calculated. Results: Three hundred ninety patients referred for colposcopy due to PCB with a preceding hrHPV test were located. HrHPV-positive patients were significantly younger (33.7 ± 10 vs. 37.2 ± 9, p < 0.006) with a higher proportion of nulliparous, nonmarried, and smokers compared with hrHPV-negative patients (75% vs. 47%, p < 0.001; 75.4% vs. 45.1%, p < 0.001; and 24.6% vs. 12.8%, p < 0.028, respectively). No case of high-grade cervical intraepithelial neoplasia (CIN2/3) was identified among hrHPV-negative patients. The sensitivity and NPV of the hrHPV test for high-grade cervical lesions were both 100%, decreasing to 36% and 95%, respectively, for any cervical dysplasia (CIN1/CIN2/CIN3). Adding cytology to HPV typing had a negligible effect on test performance. At univariate analysis, age, HPV vaccine status, nulliparity, and positive HPV typing were independently associated with cervical dysplasia. At multivariate analysis, only positive HPV typing remained significantly associated with cervical dysplasia (hazard ratio 2.75, confidence interval 1.1-6.5, p = 0.023). Conclusion: A negative HPV test even in the presence of PCB may rule out cervical dysplasia with extremely high accuracy and may save unnecessary colposcopies.
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Affiliation(s)
- Amir Akdam
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liel Van Mil
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Tzur
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Laskov
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Grisaru
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Nadav Michaan
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Laskov I, Michaan N, Zeng X, Salvador S, Lau S, Gilbert L, Gotlieb WH, Kessous R. The Impact of Intrauterine Manipulators on Outcome and Recurrence Patterns of Endometrial Cancer Patients Undergoing Minimally Invasive Surgery. J Womens Health (Larchmt) 2024; 33:355-363. [PMID: 38170184 DOI: 10.1089/jwh.2023.0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Objective: To evaluate the use of manipulators on the outcome of women who had minimally invasive surgery for endometrial cancer. Methods: Retrospective analysis of patients operated with or without an intrauterine manipulator. Results: Six hundred ninety-nine patients were included. The median follow-up was 44 months (range, 29-67). Nineteen (8.8%) patients had positive cytology in the manipulator group versus 21 (4.4%) in the comparison group (p = 0.02). Total recurrence rate was similar between the groups (12.3% vs. 11.9%; p = 0.8). Vaginal vault recurrence was the most common site of recurrence with higher incidence in the manipulator group (4.5% vs. 1.3%; p = 0.007). Subgroup analysis of low-risk patients who did not receive adjuvant treatment showed higher recurrence rate (8.3% vs. 3%; p = 0.023) and worse disease-free survival (p = 0.01) for the manipulator group. After controlling for other variables, the use of a manipulator did not affect the risk of recurrence for the whole cohort (hazard ratio [HR], 1.28; confidence interval [95% CI], 0.7-2.1, p = 0.3) and for the low-risk subgroup of patients who did not receive adjuvant treatment (HR, 2.47; 95% CI, 0.8-7, p = 0.08). Conclusion: The use of a manipulator increases the risk of positive cytology as well as vaginal vault recurrences, but it does not reduce the overall survival of patients.
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Affiliation(s)
- Ido Laskov
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Canada
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Michaan
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Xing Zeng
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oncology, McGill University and McGill University Health Centre, Montreal, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Canada
| | - Lucy Gilbert
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oncology, McGill University and McGill University Health Centre, Montreal, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Canada
| | - Roy Kessous
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Canada
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Brezis MR, Shachar E, Peleg Hasson S, Laskov I, Michaan N, Levy B, Wolf I, Safra T. Effectiveness and safety of standard chemotherapy in older patients with ovarian cancer: a retrospective analysis by age group and treatment regimen. Front Oncol 2023; 13:1289379. [PMID: 38152363 PMCID: PMC10751294 DOI: 10.3389/fonc.2023.1289379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023] Open
Abstract
Objective To evaluate the effectiveness and safety of standard chemotherapy administered to patients >70 years with advanced ovarian cancer (OC). Methods Medical records of 956 advanced-stage patients with OC treated between 2002-2020 with standard surgery and paclitaxel-carboplatin chemotherapy in a three-weekly (PC-3W) or weekly (PC-1W) regimen were reviewed. Treatment response and tolerability were compared between patients ≤70 years (N=723) and >70 years (N=233) with stratification to septuagenarians (>70-80 years) and octogenarians (>80 years). Results Median overall survival (mOS) in patients >70 was 41.26 months (95% confidence interval [Cl], 37.22-45.14) and median progression-free survival (mPFS) was 11.04 months (95% Cl, 8.97-15.74). No statistically significant differences in mPFS and mOS were observed between septuagenarians and octogenarians. Patients >70 treated with PC-1W versus PC-3W had significantly longer mOS (57.17 versus 30.00 months) and mPFS (19.09 versus 8.15 months). Toxicity rates were mostly similar between younger and older patients. Among patients >70 treated with PC-1W, the rate of neutropenia (75.7% versus 51.8%, p=0.0005), thrombocytopenia (41.0% versus 22.2%, p=0.0042) and anemia (78.1% versus 51.9%, p<0.0001) were significantly higher and the rate of grade 2 alopecia was statistically significantly lower compared with those >70 treated with PC-3W. Significantly more patients treated with PC-1W completed ≥6 chemotherapy cycles, suggesting better tolerability of this regimen. Conclusions Older patients with OC may benefit from improved OS with reasonable toxicity if treated with standard chemotherapy. Older patients treated with PC-1W are more likely to complete the full chemotherapy course and survive longer compared with those treated with conventional PC-3W.
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Affiliation(s)
- Miriam R. Brezis
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eliya Shachar
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Peleg Hasson
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Laskov
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Michaan
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bar Levy
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Wolf
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Safra
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Michaan N, Wenkert A, Even-Sapir E, Kerzhner K, Rabin T, Safra T, Peleg-Hasson S, Baruch Y, Raz Y, Grisaru D, Laskov I. Prognostic significance of delayed complete metabolic response on PET/CT after primary chemoradiation treatment of cervical cancer. Int J Gynecol Cancer 2023; 33:1695-1701. [PMID: 37657818 DOI: 10.1136/ijgc-2023-004703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVE To investigate the prognostic significance of near-complete metabolic response on initial follow-up PET/CT after primary chemoradiation treatment of cervical cancer. METHODS Survival data were retrospectively compared between patients who had complete metabolic response on first follow-up PET/CT, 3 months after chemoradiation (group 1) with those who had near-complete metabolic response on first PET/CT and later showed complete metabolic response at subsequent PET/CT, 6 months or more after treatment (group 2). RESULTS Of the 108 patients included in the final analysis, 74 (68.5%) showed complete metabolic response on initial PET/CT, 3 months after treatment, and 34 patients (31.5%) showed complete metabolic response on subsequent PET/CT, 6 months after treatment. Tumor characteristics were comparable between groups. Group 1 had higher percent of stage 1 (12% vs 0%) and lower percent of stage 4 disease (3% vs 14%) than those of group 2. Group 2 patients had significantly fewer cases of recurrences and deaths than group 1 patients (6% vs 26%, p=0.018; 0% vs 20%, p=0.003, respectively), with comparable 3-year survival rates (group 1, 90% vs group 2, 100%, p=0.31). Twelve patients had progressive disease on first follow-up PET/CT; these patients had significantly worse overall survival compared with all other patients (log-rank test, p<0.001). Younger age and delayed complete metabolic response were associated with lower chance of recurrence and death on univariate analysis. On multivariate analysis, delayed complete metabolic response remained significantly associated with no recurrence HR=0.14 (95% CI 0.25 to 0.84), p=0.031. CONCLUSIONS Survival outcome of patients with cervical cancer who show residual 18F-fluorodeoxyglucose uptake on initial PET/CT after treatment, but reach complete metabolic response on follow-up PET/CT, is not inferior compared with survival of patients who show complete metabolic response on initial PET/CT 3 months after treatment. Watchful waiting with follow-up PET/CT seems a safe option for these patients.
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Affiliation(s)
- Nadav Michaan
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Atalia Wenkert
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Kosta Kerzhner
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tatiana Rabin
- Department of Radiation Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Safra
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shira Peleg-Hasson
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yoav Baruch
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yael Raz
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dan Grisaru
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Laskov
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Michaan N, Leshno M, Fire G, Safra T, Rosenberg M, Peleg-Hasson S, Grisaru D, Laskov I. Cost-Utility Analysis of Open Radical Hysterectomy Compared to Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer. Cancers (Basel) 2023; 15:4325. [PMID: 37686601 PMCID: PMC10487066 DOI: 10.3390/cancers15174325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
We aimed to investigate the cost-effectiveness of open surgery, compared to minimally invasive radical hysterectomy for early-stage cervical cancer, using updated survival data. Costs and utilities of each surgical approach were compared using a Markovian decision analysis model. Survival data stratified by surgical approach and surgery costs were received from recently published data. Average costs were discounted at 3%. The value of health benefits for each strategy was calculated using quality-adjusted life years (QALYs). Incremental cost-effectiveness ratio, calculated using the formula (average cost minimal invasive surgery-average cost open surgery)/(average QALY minimal invasive surgery-average QALY open surgery), was used for cost-effectiveness analysis. One-way sensitivity analysis was conducted for all variables. Open radical hysterectomy was found to be cost-saving compared to minimally invasive surgery with an incremental cost-effectiveness ratio of USD -66 and USD -373 for laparoscopic and robotic surgery, respectively. The most influential parameters in the model were surgery costs, followed by the disutility involved with open surgery. Until further data are generated regarding the survival of patients with early-stage cervical cancer treated by minimally invasive surgery, at current pricing, open radical hysterectomy is cost-saving compared to minimally invasive radical hysterectomy, both laparoscopic and robotic.
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Affiliation(s)
- Nadav Michaan
- Gynecologic Oncology Department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (G.F.); (M.R.); (D.G.); (I.L.)
| | - Moshe Leshno
- Gastro-Enterology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel;
| | - Gil Fire
- Gynecologic Oncology Department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (G.F.); (M.R.); (D.G.); (I.L.)
| | - Tamar Safra
- Oncology Department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (T.S.); (S.P.-H.)
| | - Michal Rosenberg
- Gynecologic Oncology Department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (G.F.); (M.R.); (D.G.); (I.L.)
| | - Shira Peleg-Hasson
- Oncology Department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (T.S.); (S.P.-H.)
| | - Dan Grisaru
- Gynecologic Oncology Department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (G.F.); (M.R.); (D.G.); (I.L.)
| | - Ido Laskov
- Gynecologic Oncology Department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel; (G.F.); (M.R.); (D.G.); (I.L.)
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Laskov I, Zilberman A, Maltz-Yacobi L, Peleg Hasson S, Cohen A, Safra T, Grisaru D, Michaan N. Effect of BMI change on recurrence risk in patients with endometrial cancer. Int J Gynecol Cancer 2023; 33:713-718. [PMID: 37068853 DOI: 10.1136/ijgc-2022-004245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVE Our study aimed to explore the effect of body mass index (BMI) change on cancer recurrence risk during the routine surveillance of endometrial cancer patients. METHODS Data on patients with endometrial adenocarcinoma that had a staging procedure and continued follow-up was retrospectively collected. We compared patients' BMI at time of surgery and during the last clinic follow-up. Univariate and multivariate analyses were performed to examine the effect of predictors on BMI change and the risk of recurrence. RESULTS A total of 211 patients were included in the final analysis. The majority of patients had stage I disease (n=176, 89%) and endometrioid histology (n=178, 86%). Median follow-up time was 53.4 (standard deviation (SD) 40) months. The mean BMI was 30.4 kg/m2 (interquartile range (IQR) 25-34) at surgery compared with 30.9 kg/m2 (IQR 26-36) at last follow-up (p<0.001). The BMI increase was most pronounced in patients with endometroid histology that recurred, 31.6 (IQR 24-35) kg/m2 at surgery compared with 33.5 (IQR 27-36) kg/m2 at last follow-up (p=0.016). On multivariate analysis, age and BMI change were the only predictors that were significantly associated with the risk of recurrence (overall response (OR 1.07 (0.99-1.14), p=0.05, OR 1.37 (1.12-1.67), p=0.002, respectively). CONCLUSION Patients with endometroid endometrial cancer that had an increase in BMI during follow-up were at an increased risk for cancer recurrence compared with patients that did not change or had a decrease in BMI.
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Affiliation(s)
- Ido Laskov
- Gynecologic Oncology, Tel Aviv Sourasky Medical Center Ichilov, Tel Aviv, Israel
| | - Ayala Zilberman
- Obs & Gyn, Tel Aviv Sourasky Medical Center Ichilov, Tel Aviv, Israel
| | | | | | - Aviad Cohen
- Tel Aviv Sourasky Medical Center, Lis Maternity Hospital, Tel Aviv, Israel
| | - Tamar Safra
- Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dan Grisaru
- Gynecologic Oncology Servic, Tel-Aviv SouraskT Medical Cen, Tel-Aviv, Israel
| | - Nadav Michaan
- Lis maternity Hospital; Tel Aviv Sourasky Medical Center and Tel Aviv University, Tel Aviv, Israel
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Lavie M, Lavie I, Laskov I, Cohen A, Grisaru D, Grisaru-Soen G, Michaan N. Impact of COVID-19 Pandemic on Human Papillomavirus Vaccine Uptake in Israel. J Low Genit Tract Dis 2023; 27:168-172. [PMID: 36815631 PMCID: PMC10026726 DOI: 10.1097/lgt.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Isolation and school closure during the COVID-19 pandemic could decrease human papillomavirus (HPV) vaccination uptake and potentially increase future HPV-related morbidity among unvaccinated populations. The aim of our study was to investigate HPV vaccination rates in Israel during the pandemic. METHODS The HPV vaccination rates were compared before and during the COVID-19 pandemic years (2020-2021). Data regarding HPV vaccination between 2015 and 2021 were extracted from the Israeli Ministry of Health online reports. Vaccination rates were compared with other childhood vaccines, given at similar ages. Israeli HPV vaccination rates were further compared with England and Australia, which have an established vaccination infrastructure. RESULTS The average Israeli coverage of first-dose HPV vaccine was 60.2%, with significant variations from 2015 to 2021. During the pandemic years, first-dose vaccine coverage increased compared with the 3 previous years. The pandemic had also no apparent influence on other childhood vaccine uptake, even though adolescents in Israel missed many school days during this time. Average vaccine uptake in England and Australia was significantly higher than Israel ( p = .009); however, first-dose vaccination rates decreased considerably in England during 2020, to a nadir of 59%. The pandemic had little effect on HPV vaccination rates in Australia. CONCLUSIONS Despite many school days missed, the COVID-19 pandemic did not result in a decrease in HPV vaccine uptake in Israel. The pandemic could prove a good opportunity to further educate the public regarding the importance of whole-population vaccination programs. Implementing catch-up vaccination programs may bridge "vaccination gaps" that may be caused by future pandemics.
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Affiliation(s)
- Michael Lavie
- Gynecologic Oncology Department, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Inbar Lavie
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Ido Laskov
- Gynecologic Oncology Department, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Aviad Cohen
- Gynecologic Oncology Department, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Dan Grisaru
- Gynecologic Oncology Department, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Galia Grisaru-Soen
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel-Aviv, Israel
- Pediatric Infectious Disease Unit, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nadav Michaan
- Gynecologic Oncology Department, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel-Aviv, Israel
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Michaan N, Madar D, Kern G, Cohen A, Many A, Yogev Y, Grisaru D, Laskov I. Average maternal hemoglobin decline after first elective cesarean section compared to higher order cesarean sections. Int J Gynaecol Obstet 2023; 160:79-84. [PMID: 35332532 DOI: 10.1002/ijgo.14193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Lower uterine segment scarring after cesarean section can decrease intraoperative bleeding during subsequent surgery. We examined whether first elective cesarean section is associated with greater average blood loss compared to repeated surgery. METHODS Decrease in maternal hemoglobin and hematocrit after surgery was retrospectively compared between three study groups, women in their first, second and third or more cesarean section. Surgery length and need for blood transfusion were also compared. RESULTS Out of 9401 cases reviewed between January 2010 November 2020, 3917 had a first cesarean section, 3159 s cesarean section and 2325 had a third or more cesarean section. Hemoglobin and hematocrit drops were highest after first cesarean section (1.1 vs 1.0 vs 1.0 mg/dL, P < 0.001 and 3.3 vs 3.0, vs 2.9%, P < 0.001, respectively). Surgery length was significantly longer and more patients after third cesarean section required blood transfusions (2.5% vs 1.4% vs. 0.8%, P < 0.001). First cesarean section, younger age and BMI >35 were associated with increased hemoglobin drop in univariate and multivariate analysis. CONCLUSIONS Although repeated cesarean section is associated with longer surgery and higher need for blood transfusion, average hemoglobin drop after first cesarean section is higher. Scarring of the lower uterine segment can explain this paradoxical finding.
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Affiliation(s)
- Nadav Michaan
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center and Tel-Aviv University, Tel Aviv, Israel
| | - Dotan Madar
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center and Tel-Aviv University, Tel Aviv, Israel
| | | | - Aviad Cohen
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center and Tel-Aviv University, Tel Aviv, Israel
| | - Ariel Many
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center and Tel-Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center and Tel-Aviv University, Tel Aviv, Israel
| | | | - Ido Laskov
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center and Tel-Aviv University, Tel Aviv, Israel
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Cohen A, Tsur Y, Tako E, Levin I, Gil Y, Michaan N, Grisaru D, Laskov I. Incidence of endometrial carcinoma in patients with endometrial intraepithelial neoplasia versus atypical endometrial polyp. Int J Gynecol Cancer 2022; 33:ijgc-2022-003991. [PMID: 36600505 DOI: 10.1136/ijgc-2022-003991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
ObjectiveOur study's primary aim was to compare the incidence of endometrial carcinoma in patients with a presurgical diagnosis of endometrial intraepithelial neoplasia confined to the endometrium (EIN-E) versus endometrial intraepithelial neoplasia confined to a polyp (EIN-P). Our secondary aim was to examine the difference in pathological features, prognostic risk groups and sentinel lymph node involvement between the two groups. METHODS We conducted a retrospective cohort study between January 2014 and December 2020 in a tertiary university-affiliated medical center. The study considered the characteristics of women who underwent hysterectomy with sentinel lymph node dissection for endometrial intraepithelial neoplasia (EIN). We compared EIN-E diagnosed by endometrial sampling via dilatation curettage or hysteroscopic curettage vs EIN-P. A multivariate logistic regression analysis was used to assess risk factors for endometrial cancer. RESULTS Eighty-eight women were included in the study, of those, 50 were women with EIN-P (EIN-P group) and 38 were women with EIN following an endometrial biopsy (EIN-E group).The median age was 57.5 years (range; 52-68) in the EIN-P group as compared with 63 years (range; 53-71) in the EIN-E group (p=0.47). Eighty-nine percent of the women in the EIN-E group presented with abnormal uterine bleeding whereas 46% of the women in the EIN-P group were asymptomatic (p=0.001). Pathology results following hysterectomy revealed concurrent endometrial carcinoma in 26% of women in the EIN-P group compared with 47% of women in the EIN-E group (p=0.038). Multivariate analysis showed that endometrial cancer was significantly less common in the EIN-P group (overall response (OR)=0.3 95% confidence interval (CI)=0.1-0.9, p=0.03). Eighty-four percent of cancers were grade one in the EIN-P group compared with 50% in the EIN-E group (p=0.048). CONCLUSIONS Concurrent endometrial cancer is less frequent with EIN-P than with EIN-E. The high incidence of endometrial carcinoma in both groups supports the current advice to perform hysterectomy for post-menopausal women. Our data does not support performing sentinel lymph node dissection for EIN-P that was completely resected. The benefit of sentinel lymph node dissection for women with pre-operative EIN-E is yet to be determined.
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Affiliation(s)
- Aviad Cohen
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yossi Tsur
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Einat Tako
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ishai Levin
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yaron Gil
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nadav Michaan
- Gynecology Oncology, Lis Maternity Hospital; Tel Aviv Sourasky Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Dan Grisaru
- Gynecology Oncology, Lis Maternity Hospital; Tel Aviv Sourasky Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Ido Laskov
- Gynecology Oncology, Lis Maternity Hospital; Tel Aviv Sourasky Medical Center and Tel Aviv University, Tel Aviv, Israel
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Tzur Y, Berkovitz-Shperling R, Laskov I, Grisaru D, Michaan N. Recurrent Dysplasia After a Loop Electrosurgical Excision Procedure: Local Versus General Anesthesia. J Low Genit Tract Dis 2022; 26:315-318. [PMID: 35997172 DOI: 10.1097/lgt.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to compare the rates of positive specimen margins and postconization recurrent dysplasia between loop electrosurgical excision procedures (LEEPs) performed under general anesthesia (GA) and LEEP under local anesthesia (LA). METHODS This retrospective cohort study included all consecutive women who underwent LEEP between 2011 and 2019. Collected data included demographics, LEEP indication, cone dimensions, and margin involvement as well as recurrence rate. Women who had undergone previous conization, cold-knife conization, or those who were lost to follow-up during the first 2 years after the procedure were excluded. RESULTS Overall, 71 women who underwent LEEP under GA and 75 women under LA were included. Demographic characteristics were similar between the groups, as were the rates of preceding abnormal cytology and high-grade dysplasia before conization. Although cone depth and volume were higher for LEEP specimens done under GA compared with LA, the rate of positive specimen margins was comparable both for the endocervical margin (16/71 [22.5%] vs 16/75 [21.3%], respectively; p = .861) and the ectocervical margin (14/71 [19.7%] vs 11/75 [14.7%], respectively; p = .418). During the first 2 years after conization, the rates of high-grade dysplasia (cervical intraepithelial neoplasia ≥ 2) in repeat biopsy and the need for repeat conization were also not significantly different between the GA and LA groups (4.2% vs 1.3%, p = .356; 7.0% vs 9.3%, p = .614, respectively). CONCLUSIONS Anesthesia mode does not seem to affect the rate of positive LEEP margins and the need for repeat conization. Our study findings suggest that LA should be preferred instead of GA in LEEP.
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Deshet-Unger N, Horn G, Rawet-Slobodkin M, Waks T, Laskov I, Michaan N, Raz Y, Bar V, Zundelevich A, Aharon S, Turovsky L, Mallel G, Salpeter S, Neev G, Hollander KS, Katz BZ, Grisaru D, Globerson Levin A. Comparing Intraperitoneal and Intravenous Personalized ErbB2CAR-T for the Treatment of Epithelial Ovarian Cancer. Biomedicines 2022; 10:biomedicines10092216. [PMID: 36140319 PMCID: PMC9496506 DOI: 10.3390/biomedicines10092216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022] Open
Abstract
High-grade serous ovarian carcinoma (HGSOC) is the most common type of epithelial ovarian cancer. The majority of cases are diagnosed at advanced stages, when intraperitoneal (IP) spread has already occurred. Despite significant surgical and chemotherapeutic advances in HGSOC treatment over the past decades, survival rates with HGSOC have only modestly improved. Chimeric antigen receptor (CAR)-T cells enable T cells to directly bind to tumor-associated antigens in a major histocompatibility complex-independent manner, thereby inducing tumor rejection. While CAR-T cell therapy shows great promise in hematological malignancies, its use in solid tumors is limited. Therefore, innovative approaches are needed to increase the specificity of CAR-modified T cells against solid tumors. The aim of this study was to assess the efficacy and safety of intraperitoneal (IP) versus intravenous (IV) CAR-T cell therapy in the treatment of HGSOC. We constructed a CAR that targets the ErbB2/HER2 protein (ErbB2CAR), which is overexpressed in HGSOC, and evaluated the functionality of ErbB2CAR on ovarian cancer cell lines (OVCAR8, SKOV3, and NAR). Our findings show that an IP injection of ErbB2CAR-T cells to tumor-bearing mice led to disease remission and increased survival compared to the IV route. Moreover, we found that IP-injected ErbB2CART cells circulate to a lesser extent, making them safer for non-tumor tissues than IV-injected cells. Further supporting our findings, we show that the effect of ErbB2CAR-T cells on primary HGSOC tumors is correlated with ErbB2 expression. Together, these data demonstrate the advantages of an IP administration of CAR-T cells over IV administration, offering not only a safer strategy but also the potential for counteracting the effect of ErbB2CAR in HGSOC. Significance: IP-injected ErbB2CAR-T cells led to disease remission and increased survival compared to the IV route. These findings demonstrate the advantages of IP administration, offering a safe treatment strategy with the potential for counteracting the effect of ErbB2CAR in HGSOC.
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Affiliation(s)
- Naamit Deshet-Unger
- Immunology and Advanced CAR-T Therapy, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
| | - Galit Horn
- Immunology and Advanced CAR-T Therapy, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
| | - Moran Rawet-Slobodkin
- Immunology and Advanced CAR-T Therapy, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
| | - Tova Waks
- Immunology and Advanced CAR-T Therapy, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
- Department of Immunology, The Weizmann Institute, Rehovot 7610001, Israel
| | - Ido Laskov
- Department of Gynecologic Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Nadav Michaan
- Department of Gynecologic Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Yael Raz
- Department of Gynecologic Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Vered Bar
- cResponce Company, Rehovot 7670102, Israel
| | | | | | | | | | | | - Guy Neev
- cResponce Company, Rehovot 7670102, Israel
| | - Kenneth Samuel Hollander
- Immunology and Advanced CAR-T Therapy, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
| | - Ben-Zion Katz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- The Hematology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6997801, Israel
| | - Dan Grisaru
- Department of Gynecologic Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Anat Globerson Levin
- Immunology and Advanced CAR-T Therapy, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
- Dotan Center for Advanced Therapies, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel
- Correspondence: ; Tel.: +972-3-6972503
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Shachar E, Raz Y, Hasson SP, Levy B, Adar L, Honig Z, Mischan N, Laskov I, Grisaru D, Wolf I, Safra T. 543P Can we predict the long and short-term survivors with advanced ovarian cancer? Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Michaan N, Leshno M, Cohen Y, Safra T, Hasson SP, Laskov I, Grisaru D. Preimplantation genetic testing for BRCA gene mutation carriers: A cost effectiveness analysis (340). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01562-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Michaan N, Loboda N, Ochshorn Y, Tzur Y, Cohen A, Grisaru D, Laskov I. The effect of cervical conization on women’s sexual function and psychological health (341). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Laskov I, Deshet-Unger N, Waks T, Michaan N, Raz Y, Katz BZ, Grisaru D, Levin AG. Intra-peritoneal CAR-T cell therapy shows promising results in a murine model of epithelial ovarian cancer (313). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barda S, Laskov I, Grisaru D, Lehavi O, Kleiman S, Wenkert A, Azem F, Hauser R, Michaan N. The impact of COVID-19 vaccine on sperm quality. Int J Gynaecol Obstet 2022; 158:116-120. [PMID: 35128663 PMCID: PMC9087610 DOI: 10.1002/ijgo.14135] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/02/2022] [Indexed: 11/12/2022]
Abstract
Objective To examine the effect of the BNT162b, mRNA, SARS‐CoV‐2 virus vaccine on sperm quality. Methods This was a prospective cohort study conducted on sperm donors at the sperm bank of a tertiary, university affiliated medical center. All sperm donors donated sperm repeatedly and the average sperm parameters of all available samples were compared before and after receiving the SARS‐CoV‐2 vaccine. Each donor served as his own control. For all participants, at‐least one sperm sample was received 72 days after completing the second vaccine. Main outcome measures included total sperm count, total motile count and percent of motile sperm. Results A total of 898 sperm samples from 33 sperm donors that were vaccinated with the Pfizer BNT162b, mRNA, SARS‐CoV‐2 virus vaccine were analyzed, 425 samples were received before the vaccine, while 473 samples were received after vaccination. Total sperm count and total motile count increased after the second vaccine compared to samples before vaccination. Percent of motile sperm did not change after vaccine. Conclusion The Pfizer BNT162b, SARS‐CoV‐2 vaccine has no deleterious effect on sperm quality. Patients and physicians should be counseled accordingly. The Pfizer BNT162b, SARS‐CoV‐2 vaccine has no deleterious effect on sperm quality.
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Affiliation(s)
- Shimi Barda
- The Institute for the Study of Fertility, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israel Academic College in Ramat Gan
| | - Ido Laskov
- Gynecologic oncology department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Grisaru
- Gynecologic oncology department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Lehavi
- The Institute for the Study of Fertility, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sandra Kleiman
- The Institute for the Study of Fertility, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Atalia Wenkert
- Gynecologic oncology department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Hauser
- The Institute for the Study of Fertility, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Michaan
- Gynecologic oncology department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Segal R, Levin I, Many A, Michaan N, Laskov I, Amikam U, Yogev Y, Cohen A. Laparoscopic management of suspected postpartum uterine rupture: a novel approach. J Matern Fetal Neonatal Med 2022; 35:9362-9367. [PMID: 35105254 DOI: 10.1080/14767058.2022.2033721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Exploratory laparotomy is considered the gold standard treatment for women with suspected uterine rupture. We aimed to investigate the feasibility and safety of laparoscopy as an alternative for laparotomy for the management of hemodynamically stable women with suspected postpartum uterine rupture. STUDY DESIGN We conducted a case series study including all women who were diagnosed with postpartum uterine rupture following vaginal delivery in a university-affiliated tertiary hospital, between November 2012 and July 2021. Until 2016, all women with suspected post-partum uterine rupture underwent laparotomy. Following 2016, a new tailored protocol based on laparoscopy for the management of postpartum uterine rupture in hemodynamically stable women was implemented. A comparison was made between women who underwent emergent laparoscopy to laparotomy. RESULTS During the study period 17 women were diagnosed with postpartum uterine rupture. From January 2012 to January 2016, four cases of uterine rupture were diagnosed, all of whom underwent laparotomy. Since 2016, thirteen cases of uterine rupture were diagnosed, of whom seven women (54%) underwent laparoscopy and 6 (46%) laparotomy. The median time interval from delivery to surgery was 70.5 min IQR (40-179) in the laparotomy group and 202 min IQR (70-485) in the laparoscopy group. The median operative time for laparoscopic surgery was 80 min (IQR 60-114) and 78 min (IQR 58-114) for the laparotomy group. Four women who underwent laparotomy (40%) and one who underwent laparoscopy (14.2%) were admitted to the intensive care unit following surgery. Blood products transfusion was required in six women who had laparotomy (60%) and one who had laparoscopy (14.2%). Median hospitalization period was 5 d IQR (4-5) in the laparotomy group as compared to 3 d IQR (3-4) in the laparoscopy group. There were no conversions to laparotomy in the laparoscopy group. CONCLUSIONS In hemodynamic stable women laparoscopic surgery for suspected postpartum uterine rupture is feasible and safe.
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Affiliation(s)
- Roy Segal
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ishai Levin
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Many
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Michaan
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Laskov
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Amikam
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviad Cohen
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Michaan N, Loboda N, Ochshorn I, Tzur Y, Cohen A, Grisaru D, Laskov I. The Effect of Cervical Conization on Women's' Sexual Function and Psychological Health, A Prospective Observational Study. J Sex Med 2022; 19:257-262. [PMID: 34911661 DOI: 10.1016/j.jsxm.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/08/2021] [Accepted: 11/11/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diagnosis of cervical dysplasia and subsequent conization of the uterine cervix might affect women's' sexual health. AIM To assess the effect of cervical conization on women's sexual function and psychological wellbeing. METHODS Patients undergoing conization of the cervix were assessed before, and 6 months after conization. Assessment of sexual distress and function was done using the female sexual distress scale-revised (FSDS-r) and the female sexual function inventory (FSFI), respectively. Risk for anxiety and depression, was assessed using the Hospital Anxiety and Depression Scale (HADS). MAIN OUTCOME MEASURES FSDS-r, FSFI and HADS scores before and after conization RESULTS: From October 2018 to March 2021, 55 patients undergoing cervical conization were recruited. No significant differences were found in FSDS-r scores before and after conization. An equal number of patients indicated having sexual distress (29 patients, 53%, before and after conization, P=1.0). No significant changes were noticed on any FSDS domains or the total FSDS score before and after conization, (26.8 vs. 26.0, p=0.461). The percent of patients that indicated an overall sexual dysfunction, increased from 49 percent before conization, to 59 percent after conization, P=0.388. A high percent of patients indicated signs of anxiety on the HADS questionnaire, both before and after conization (49% and 47%, respectively). The median anxiety and depression scores did not change after conization, p=1.0. CLINICAL IMPLICATIONS A high percent of patients undergoing conization suffer from sexual distress, sexual dysfunction and general anxiety, both before and after conization. The conization procedure itself did not seem to effect questionnaire scores. STRENGTHS AND LIMITATIONS This was a prospective cohort, with comprehensive assessment of female sexual and psychological wellbeing after conization. Not all subjects reported sexual intercourse prior to questionnaire completion. CONCLUSION Gynecologists should be aware of the psychological and sexual effect of the diagnosis and treatment of cervical pre-cancerous lesions, patients should be counselled accordingly. Michaan N, Loboda N, Ochshorn I, et al., The Effect of Cervical Conization on Women's' Sexual Function and Psychological Health, A Prospective Observational Study. J Sex Med 2022;19:257-262.
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Affiliation(s)
- Nadav Michaan
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Noa Loboda
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ifat Ochshorn
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Tzur
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviad Cohen
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Grisaru
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Laskov
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tzur Y, Michaan N, Laskov I, Cohen A, Grisaru D, Beri A. Does Gas Insufflation during Gynecologic or Urologic Oncologic Laparoscopy Cause Dissemination of Malignant Cells. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Michaan N, Leshno M, Cohen Y, Safra T, Peleg-Hasson S, Laskov I, Grisaru D. Preimplantation genetic testing for BRCA gene mutation carriers: a cost effectiveness analysis. Reprod Biol Endocrinol 2021; 19:153. [PMID: 34620184 PMCID: PMC8499576 DOI: 10.1186/s12958-021-00827-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/06/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Gynecologic oncologists should be aware of the option of conception through IVF/PGT-M for families with high BRCA related morbidity or mortality. Our objective was to investigate the cost-effectiveness of preimplantation genetic testing for selection and transfer of BRCA negative embryo in BRCA mutation carriers compared to natural conception. METHODS Cost-effectiveness of two strategies, conception through IVF/PGT-M and BRCA negative embryo transfer versus natural conception with a 50% chance of BRCA positive newborn for BRCA mutation carriers was compared using a Markovian process decision analysis model. Costs of the two strategies were compared using quality adjusted life years (QALYs'). All costs were discounted at 3%. Incremental cost effectiveness ratio (ICER) compared to willingness to pay threshold was used for cost-effectiveness analysis. RESULTS IVF/ PGT-M is cost-effective with an ICER of 150,219 new Israeli Shekels, per QALY gained (equivalent to 44,480 USD), at a 3% discount rate. CONCLUSIONS IVF/ PGT-M and BRCA negative embryo transfer compared to natural conception among BRCA positive parents is cost effective and may be offered for selected couples with high BRCA mutation related morbidity or mortality. Our results could impact decisions regarding conception among BRCA positive couples and health care providers.
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Affiliation(s)
- Nadav Michaan
- Gynecologic Oncology Department, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weismann st., 6296317, Tel Aviv, Israel.
| | - Moshe Leshno
- Gastro-enterology, Tel Aviv Sourasky Medical Center, Coller School of Management and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoni Cohen
- In-vitro Fertilization Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Safra
- Oncology Department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Peleg-Hasson
- Oncology Department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Laskov
- Gynecologic Oncology Department, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weismann st., 6296317, Tel Aviv, Israel
| | - Dan Grisaru
- Gynecologic Oncology Department, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weismann st., 6296317, Tel Aviv, Israel
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Michaan N, Leshno M, Safra T, Sonnenblick A, Laskov I, Grisaru D. Cost Effectiveness of Whole Population BRCA Genetic Screening for Cancer Prevention in Israel. Cancer Prev Res (Phila) 2020; 14:455-462. [PMID: 33355193 DOI: 10.1158/1940-6207.capr-20-0411] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/16/2020] [Accepted: 12/16/2020] [Indexed: 11/16/2022]
Abstract
With the growing technical ease and reduction in genetic screening costs, whole population BRCA screening may be a feasible option. Our objective was to investigate the cost effectiveness of whole population screening for BRCA mutations in Israel, for varying degrees of BRCA carrier state. Lifetime costs of whole female population screening for BRCA mutation carrier state versus nonscreening were compared using a Markovian process decision analysis model. Model parameters including ovarian and breast cancer risks were obtained from previously published data. Screening and other treatment-related costs were received from the Israeli Ministry of Health pricing list according to specified codes. Quality-adjusted life years were used for cost-effectiveness analysis. Sensitivity analysis was conducted to evaluate model uncertainties, specifically varying degrees of BRCA prevalence. Results show that whole population BRCA screening in Israel is cost effective across a wide range of BRCA prevalence rates with an incremental cost-effectiveness ratio of 81,493 new Israeli Shekels for a BRCA prevalence of 2.5%, increasing to 250,000 new Israeli Shekels for a 0.75% prevalence rate, per quality-adjusted life year gained. Discount rate and population BRCA prevalence and rate of risk reduction salpingo-oophorectomy are the most influential parameters in the model. Whole population screening for BRCA mutations should be offered as part of general health screening strategies by national medical insurance providers, even for non-Ashkenazi Jews. Our algorithm can be applied for other countries, adjusting local costs of screening and treatment. PREVENTION RELEVANCE: Whole population BRCA mutation screening in Israel is cost effective across a wide prevalence rate and should be offered as part of general health screening strategies by national medical insurance providers for cancer prevention.
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Affiliation(s)
- Nadav Michaan
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Moshe Leshno
- Gastro-enterology, Tel Aviv Sourasky Medical Center, Coller School of Management and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Safra
- Oncology Department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Sonnenblick
- Oncology Department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Laskov
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Grisaru
- Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kessous R, Wissing MD, Laskov I, Abitbol J, Bitharas J, Agnihotram VR, Yasmeen A, Salvador S, Lau S, Gotlieb WH. Multiple lines of chemotherapy for patients with high-grade ovarian cancer: Predictors for response and effect on survival. Int J Cancer 2020; 148:2304-2312. [PMID: 33197273 DOI: 10.1002/ijc.33395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/05/2022]
Abstract
Guidelines for the treatment of tubo-ovarian cancer patients beyond third line are lacking. We aimed to evaluate the effect of response in each line on patient's outcome as well as identify variables that predict response for additional line of chemotherapy. A cohort study was performed including all patients with advanced high-grade ovarian cancer. Survival analysis was performed using Kaplan-Meier curves and log-rank tests. Odds ratios and hazard ratios were calculated using multilevel, mixed-effects logistic regression and Cox regression, adjusting for repeated measures within individual patients. Two-hundred thirty-eight patients were included and underwent up to 10 lines of chemotherapy. The median progression-free survival was 15.6 and overall survival (OS) was 55.6 months. Response rates dropped with each additional line and by line 5, most patients (61%) became refractory and only 16% had any type of response (complete 4% or partial 12%). By line 2, whether a patient had partial disease (PR), stable disease (SD) or progressive disease (PD) did not have an effect on the OS. From line 2, whether a patient had PR, SD or PD did not have an effect on chemotherapy-free interval. Number of previous lines and time from previous line were the only variables that significantly correlated with both outcome of patients and response to the next line. In conclusion, time interval from the previous line of chemotherapy is the major clinical factor that predicts beneficial effect of another line of treatment in patients with ovarian cancer.
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Affiliation(s)
- Roy Kessous
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Michel D Wissing
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Quebec, Canada
| | - Ido Laskov
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Jeremie Abitbol
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Joanna Bitharas
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Venkata R Agnihotram
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Quebec, Canada
| | - Amber Yasmeen
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Quebec, Canada
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Kessous R, Matanes E, Laskov I, Wainstock T, Abitbol J, Yasmeen A, Salvador S, Lau S, Gotlieb WH. Carboplatin plus paclitaxel weekly dose-dense chemotherapy for high-grade ovarian cancer: A re-evaluation. Acta Obstet Gynecol Scand 2020; 100:453-458. [PMID: 33048344 DOI: 10.1111/aogs.14023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We compared oncologic and clinical outcomes in patients with advanced ovarian cancer who received dose-dense weekly paclitaxel with 3-weekly carboplatin with those who received standard 3-weekly chemotherapy. MATERIAL AND METHODS Comparison of all consecutive patients with advanced (International Federation of Gynecology and Obstetrics stages III-IV) ovarian cancer who received a dose-dense protocol between 2010 and 2016 with an immediate historical cohort of consecutive patients who received standard chemotherapy. Patients who received less than three cycles of treatment were excluded. RESULTS In all, 246 patients were included in the study, of whom 128 received the dose-dense protocol and 118 were treated with the standard Q3-week protocol. Patients in the dose-dense group had significantly better progression-free survival than those receiving the standard protocol (median progression-free survival 22 vs 15 months; log rank = 0.026). The overall survival of patients in the dose-dense group was also better than that of the patients in the standard protocol group; however, this difference was not statistically significant (median overall survival 66 vs 54 months; log rank = 0.185). The dose-dense protocol remained significantly associated with favorable survival outcome in multivariable analysis adjusted for stage, histologic type, cytoreductive results and neoadjuvant chemotherapy. The use of the dose-dense protocol was associated with higher rates of gastrointestinal, dermatologic, neurologic and hematologic side effects. CONCLUSION Despite the limitations associated with the comparison to a historical cohort, a dose-dense chemotherapy protocol resulted in a significantly improved progression-free survival and the overall survival tended to be better, but this difference did not reach statistical significance compared with the standard chemotherapy protocol, and may be considered as a treatment alternative, albeit with some increased side effects.
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Affiliation(s)
- Roy Kessous
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Emad Matanes
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Ido Laskov
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jeremie Abitbol
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Amber Yasmeen
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Michaan N, Laskov I, Aizic A, Brautbar O, Grisaru D. Laparoscopic sentinel lymph node dissection followed by open radical hysterectomy for early stage cervical cancer: A pilot study. Int J Gynaecol Obstet 2020; 152:183-187. [PMID: 32961587 DOI: 10.1002/ijgo.13383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/19/2020] [Accepted: 09/16/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To propose a treatment algorithm, after the LACC trial, of laparoscopic sentinel lymph node biopsy with frozen section, followed by immediate open radical hysterectomy in node-negative cases, for early stage cervical cancer. METHODS We retrospectively collected all cases of cervical cancer that were surgically treated between 2019-2020. In all cases, surgery began with laparoscopic sentinel lymph node biopsy ± ovarian transposition. Node-negative cases continued with open radical hysterectomy. In node-positive cases, surgery was discontinued, sparing the patient a laparotomy incision. RESULTS Nine patients with cervical cancer were referred for surgery. Laparoscopic bilateral lymph node identification was achieved in all. In two cases, sentinel lymph nodes were positive for metastatic cancer and surgery was discontinued. For the other seven, node-negative patients, open radical hysterectomy was completed. Four patients had laparoscopic ovarian transposition. There were no cases where nodes were negative on frozen section but positive on final pathology. CONCLUSION Laparoscopic sentinel lymph node biopsy before open radical hysterectomy may spare a considerable number of laparotomies on the one hand and bi-modal treatment with surgery and radiation on the other, for node-positive patients. The oncological safety of this approach is yet to be determined.
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Affiliation(s)
- Nadav Michaan
- Gynecologic Oncology, Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Laskov
- Gynecologic Oncology, Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Asaf Aizic
- Department of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Oded Brautbar
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dan Grisaru
- Gynecologic Oncology, Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Laskov I, Alpern S, Ronel I, Segal R, Zindel O, Zoborovsky I, Michaan N, Grisaru D. Cardiac Function and Hemodynamic Changes during Minimally Invasive Hysterectomy with Pneumoperitoneum and Steep Trendelenburg Position for Patients with Endometrial Cancer Who Are Obese. J Minim Invasive Gynecol 2020; 28:1079-1085. [PMID: 33065261 DOI: 10.1016/j.jmig.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 02/01/2023]
Abstract
STUDY OBJECTIVE To assess the effect of carbon dioxide (CO2) pneumoperitoneum and steep Trendelenburg position on patients' cardiac function and hemodynamics during minimally invasive staging surgery for endometrial cancer. DESIGN Single-center prospective longitudinal study. SETTING University-affiliated tertiary hospital. PATIENTS Patients with endometrial cancer undergoing minimally invasive surgery. INTERVENTIONS After consent, the patients' hemodynamic parameters were assessed by the Non-Invasive Cardiac System (NI Medical, Petah Tikva, Israel) at 5 time points: before general anesthesia, after induction of general anesthesia, after CO2 insufflation of the peritoneum, after steep Trendelenburg position, and at the end of surgery. MEASUREMENTS AND MAIN RESULTS Twenty-three women were recruited. The median age of the patients was 68 years (interquartile range [IQR] 62-75), with a median body mass index of 34.9 kg/m2 (IQR 31.2-39.5) and an American Society of Anesthesiologists score ≥2. The initial median mean arterial pressure was 108 mmHg (IQR 101-113), and the baseline median cardiac output was 7.2 L/min (IQR 5.6-8.7). The median mean arterial pressure significantly decreased by 18% after insufflation (p = .001), again after Trendelenburg position (p = .003), and did not fully recover at the end of surgery in comparison with the preanesthesia baseline (p = .001). The median stroke volume significantly decreased by 17% after insufflation compared with the baseline (p = .01) and then gradually recovered to the baseline levels by the end of surgery. The median cardiac power significantly decreased by 35% after insufflation (0.009), remained low during Trendelenburg position (p = .009), and recovered by the end of surgery to 18% below the baseline levels (p = .035). CONCLUSION Significant hemodynamic changes occur during minimally invasive staging surgery for endometrial cancer. CO2 insufflation is accompanied by the most dramatic hemodynamic deterioration during surgery, and this does not get affected much with Trendelenburg. Knowledge of the hemodynamic values of women classified as high risk when using a noninvasive technique during surgery is obtainable and may assist both surgeon and anesthesiologist to ensure a safer procedure.
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Affiliation(s)
- Ido Laskov
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel
| | - Sharon Alpern
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel
| | - Ilai Ronel
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel
| | - Roy Segal
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel
| | - Ofra Zindel
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel
| | - Ilanit Zoborovsky
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel
| | - Nadav Michaan
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel
| | - Dan Grisaru
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel.
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Hershkovitz G, Ochshorn Y, Raz Y, Michaan N, Laskov I, Fiszer E, Grisaru D. Knowledge is power? Pap smear habits of female OB/GYNs compared to other female physicians. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tzur Y, Samueloff O, Raz Y, Bar-On S, Laskov I, Tzur T. Conception rates after medical versus surgical evacuation of early miscarriage. Fertil Steril 2020; 115:118-124. [PMID: 32811672 DOI: 10.1016/j.fertnstert.2020.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare short-term fertility rates after medical and surgical management of early miscarriage. DESIGN Observational cohort study. SETTING Academic tertiary-care medical center. PATIENT(S) A total of 203 patients were enrolled between June 2017 and May 2018, comprising 106 surgical evacuations and 97 medical evacuations. INTERVENTION(S) Either surgical or medical evacuation of the uterine cavity. MAIN OUTCOME MEASURE(S) Conception rates 6 months after miscarriage. RESULT(S) Conception rates 6 months after miscarriage among women who had attempted to become pregnant were similar between the medically and surgically evacuated groups (68.0% vs. 65.1%). There were no significant differences in background characteristics between the groups, apart from younger age and earlier gestational age among the medically treated group. There was no difference in the proportion of women using assisted reproductive technologies between the medically and surgically managed groups (15.5% vs. 12.6%, respectively). The median time-to-conception was 4 ± 2 months in both groups. Cumulative pregnancy rate 12 months after pregnancy loss, live birth rate, and repeat miscarriage rate also were similar between groups. CONCLUSION(S) Modality of uterine evacuation after early miscarriage does not affect short-term fertility outcomes.
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Affiliation(s)
- Yossi Tzur
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Ofri Samueloff
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Raz
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Shikma Bar-On
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Laskov
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Tzur
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Safra T, Waissengrin B, Levy T, Leidner E, Merose R, Matceyevsky D, Grisaru D, Laskov I, Mishaan N, Shayzaf R, Wolf I. Weekly Carboplatin and Paclitaxel: A Retrospective Comparison with the Three-Weekly Schedule in First-Line Treatment of Ovarian Cancer. Oncologist 2020; 26:30-39. [PMID: 32657524 DOI: 10.1634/theoncologist.2020-0196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/22/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Conventional first-line combination therapy for ovarian cancer comprises 6 cycles of adjuvant or neoadjuvant carboplatin (AUC5-6) with paclitaxel (175 mg/m2 ) every 3 weeks (PC-3W). Weekly scheduling of paclitaxel may maximize its antiangiogenic effect and reduce adverse effects. We compared the efficacy and safety of PC-3W with a modified protocol of weekly paclitaxel 80 mg/m2 and weekly carboplatin AUC2 administered on days 1, 8, and 15 in a 28-day cycle (i.e., with 1 week off-treatment [PC-W]). MATERIALS AND METHODS Medical records of consecutive patients treated between 2000 and 2018 were reviewed; 707 patients were analyzed for demographic and clinical characteristics, effectiveness and toxicity. RESULTS PC-3W was administered to 402 patients (median age, 60.5 years) and PC-W to 305 patients (median age, 62.5 years). Most patients (91.4%) were diagnosed at stage III-IV. Notwithstanding a higher proportion of residual disease and older patients in the PC-W group, median progression-free survival was 21.4 months and 13.2 months for PC-W and PC-3W, respectively; median overall survival was 75.2 and 54.0 months for PC-W and PC-3W, respectively. Cox proportional hazards model indicated improved survival for patients treated with PC-W (hazard ratio, 0.54). Similar results were observed for older patients diagnosed at ≥75 years. PC-W demonstrated a better safety profile, with lower incidence of neuropathy, neutropenia, and alopecia. CONCLUSION PC-W is as active and better tolerated than the standard PC-3W regimen. PC-W may serve as an alternative option for elderly or frail patients. IMPLICATIONS FOR PRACTICE Weekly scheduling of paclitaxel 80 mg/m2 and carboplatin AUC2, administered on days 1, 8, and 15 in a 28-day cycle (PC-W) for first-line therapy for advanced ovarian cancer, is as active and better tolerated than the standard regimen of carboplatin and paclitaxel (175 mg/m2 ) every 3 weeks (PC-3W). It is possible that the weekly holiday on day 21 in the PC-W regimen may ensure better completion rates (which may result in treatment delays for toxicity in PC-3W). The results of this retrospective analysis highlight the weekly regimen as a valid treatment option, especially for elderly patients and those with significant comorbidities.
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Affiliation(s)
- Tamar Safra
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barliz Waissengrin
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Talya Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Wolfson Medical Center, Holon, Israel
| | - Ellie Leidner
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Rotem Merose
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Diana Matceyevsky
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dan Grisaru
- Department of Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Laskov
- Department of Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nadav Mishaan
- Department of Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Rotem Shayzaf
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Wolf
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Piedimonte S, Kessous R, Laskov I, Abitbol J, Kogan L, Yasmeen A, Salvador S, Lau S, Gotlieb WH. Similar Overall Survival Using Neoadjuvant Chemotherapy or Primary Debulking Surgery in Patients Aged Over 75 Years with High-Grade Ovarian Cancer. J Obstet Gynaecol Can 2020; 42:1339-1345. [PMID: 32859533 DOI: 10.1016/j.jogc.2020.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To perform a hypothesis-generating evaluation of patient outcomes following neoadjuvant chemotherapy (NACT) compared with those following primary debulking surgery (PDS) in patients over age 75 with high-grade ovarian cancer. METHODS This was a retrospective cohort study of consecutive patients aged 75 years and older, with high-grade ovarian cancer. Data were analyzed in SPSS 25.0 using descriptive statistics to characterize groups based on primary treatment modality, Kaplan-Meier survival curves to estimate overall and progression-free survival, and Cox proportional hazards to analyze confounders. RESULTS Of 429 patients with stages III and IV high-grade ovarian cancer (endometrioid and serous), 71 were aged older than 75 years and met our criteria for inclusion; 58 were treated with NACT while 13 underwent primary debulking. Sixteen patients did not undergo interval debulking following NACT. There were no significant differences in demographic characteristics between the groups. Following NACT, more patients were completely debulked-36.2% versus 21% (P = 0.000)-and had a shorter length of stay (5 vs. 7 d; P = 0.018). Overall survival was similar between the NACT and PDS groups (58.7 vs. 59.7 mo; LR -0.836; P = 0.361) despite lower progression-free survival in the NACT group (25.9 vs. 47.1 mo; P = 0.042; LR 4.31). Both progression-free and overall survival were significantly higher when patients undergoing NACT achieved complete debulking (21.7 and 102.3 mo, respectively) compared with suboptimal debulking (12.03 and 14.2 mo, respectively). CONCLUSION In this select group older patients with stage III and IV high-grade ovarian cancers, neoadjuvant chemotherapy may be considered without compromising outcomes and contributes to complete debulking.
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Affiliation(s)
- Sabrina Piedimonte
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Roy Kessous
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Ido Laskov
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Jeremie Abitbol
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Liron Kogan
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Amber Yasmeen
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Shannon Salvador
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Susie Lau
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC.
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Mitric C, Matanes E, Wissing M, Amajoud Z, Abitbol J, Yasmeen A, López-Ozuna V, Eisenberg N, Laskov I, Lau S, Salvador S, Gotlieb WH, Kogan L. The impact of wait times on oncological outcome in high-risk patients with endometrial cancer. J Surg Oncol 2020; 122:306-314. [PMID: 32291783 DOI: 10.1002/jso.25929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/31/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the impact of surgical wait times on outcome of patients with grade 3 endometrial cancer. METHODS All consecutive patients surgically treated for grade 3 endometrial cancer between 2007 and 2015 were included. Patients were divided into two groups based on the time interval between endometrial biopsy and surgery: wait time from biopsy to surgery ≤12 weeks (84 days) vs more than 12 weeks. Survival analyses were conducted using log-rank tests and Cox proportional hazards models. RESULTS A total of 136 patients with grade 3 endometrial cancer were followed for a median of 5.6 years. Fifty-one women (37.5%) waited more than 12 weeks for surgery. Prolonged surgical wait times were not associated with advanced stage at surgery, positive lymph nodes, increased lymphovascular space invasion, and tumor size (P = .8, P = 1.0, P = .2, P = .9, respectively). In multivariable analysis adjusted for clinical and pathological factors, wait times did not significantly affect disease-specific survival (adjusted hazard ratio [HR]: 1.2, 95% confidence interval [CI], 0.6-2.5, P = .6), overall survival (HR: 1.1, 95% CI, 0.6-2.1, P = .7), or progression-free survival (HR: 0.9, 95% CI, 0.5-1.7, P = .8). CONCLUSION Prolonged surgical wait time for poorly differentiated endometrial cancer seemed to have a limited impact on clinical outcomes compared to biological factors.
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Affiliation(s)
- Cristina Mitric
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Emad Matanes
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Gynecologic Oncology Laboratory, Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Michel Wissing
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Zainab Amajoud
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jeremie Abitbol
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Amber Yasmeen
- Gynecologic Oncology Laboratory, Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Vanessa López-Ozuna
- Gynecologic Oncology Laboratory, Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Neta Eisenberg
- Department of Obstetrics and Gynecology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | - Ido Laskov
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Susie Lau
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Gynecologic Oncology Laboratory, Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Liron Kogan
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Gynecologic Oncology Laboratory, Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada.,Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew university of Jerusalem, Jerusalem, Israel
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Kessous R, Wissing MD, Piedimonte S, Abitbol J, Kogan L, Laskov I, Yasmeen A, Salvador S, Lau S, Gotlieb WH. CA-125 reduction during neoadjuvant chemotherapy is associated with success of cytoreductive surgery and outcome of patients with advanced high-grade ovarian cancer. Acta Obstet Gynecol Scand 2020; 99:933-940. [PMID: 31954071 DOI: 10.1111/aogs.13814] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/05/2020] [Accepted: 01/12/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective was to assess whether an early response to neoadjuvant chemotherapy in women with advanced ovarian cancer may predict short- and long-term clinical outcome. MATERIAL AND METHODS This is a retrospective study of all women with stage III-IV tubo-ovarian cancer treated with neoadjuvant chemotherapy at a single center in Montreal between 2003 and 2014. Logistic regression models were used to evaluate the association between cancer antigen 125 (CA-125) levels during neoadjuvant chemotherapy and debulking success. Cox proportional hazard models were used to estimate hazard ratios and their respective 95% CI for death and recurrence. Harrell's concordance indices were calculated to evaluate which variables best predicted the chemotherapy-free interval and overall survival in our population. RESULTS In all, 105 women were included. Following the first, second, and third cycles of neoadjuvant chemotherapy, CA-125 levels had a median reduction of 43.2%, 85.4%, and 92.9%, respectively, compared with CA-125 levels at diagnosis. As early as the second cycle, CA-125 was associated with overall survival (hazard ratio 1.03, 95% CI 1.01-1.05, per 50 U/mL increment). By the third cycle, CA-125 did not only predict overall survival (hazard ratio 1.04, 95% CI 1.01-1.08), but it predicted overall survival better than the success of debulking surgery (Harrell's concordance index 0.646 vs 0.616). Both absolute CA-125 levels and relative reduction in CA-125 levels after 2 and 3 cycles predicted the chance to achieve complete debulking (P < .05). CONCLUSIONS Reduction of CA-125 levels during neoadjuvant chemotherapy provides an early predictive tool that strongly correlates with successful cytoreductive surgery and long-term clinical outcome in women with advanced high-grade serous and endometrioid ovarian cancer.
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Affiliation(s)
- Roy Kessous
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | | | - Sabrina Piedimonte
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Jeremie Abitbol
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Liron Kogan
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Ido Laskov
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Amber Yasmeen
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Wang Q, López-Ozuna VM, Baloch T, Bithras J, Amin O, Kessous R, Kogan L, Laskov I, Yasmeen A. Biguanides in combination with olaparib limits tumorigenesis of drug-resistant ovarian cancer cells through inhibition of Snail. Cancer Med 2019; 9:1307-1320. [PMID: 31863638 PMCID: PMC7013055 DOI: 10.1002/cam4.2738] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/04/2019] [Accepted: 11/03/2019] [Indexed: 02/06/2023] Open
Abstract
Ovarian cancer is the most lethal gynecological malignancy. Currently, new chemotherapeutic strategies are required to improve patient outcome and survival. Biguanides, classic anti‐diabetic drugs, have gained importance for theiri antitumor potency demonstrated by various studies. Olaparib is a PARP inhibitor approved for maintenance therapy following platinum‐based chemotherapy. Furthermore, Snai1, a transcription factor that works as a master regulator of the epithelial/mesenchymal transition process (EMT) is involved in ovarian cancer resistance and progression. Here we aimed to demonstrate the possible cross talk between biguanides and Snail in response to olaparib combination therapy. In this study, we have shown that while in A2780CR cells biguanides reduced cell survival (single treatments ~20%; combined treatment ~44%) and cell migration (single treatments ~45%; biguanide‐olaparib ~80%) significantly, A2780PAR exhibited superior efficacy with single (~60%) and combined treatments (~80%). Moreover, our results indicate that knock‐down of Snail further enhances the attenuation of migration, inhibits EMT related‐proteins (~90%) and induces a synergistic effect in biguanide‐olaparib treatment. Altogether, this work suggests a novel treatment strategy against drug‐resistant or recurrent ovarian cancer.
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Affiliation(s)
- Qiong Wang
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada.,Department of Gynecology and Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou, China.,Division of Uterine Vascular Biology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Vanessa M López-Ozuna
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada.,Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Tahira Baloch
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada.,Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Joanne Bithras
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Oreekha Amin
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada.,Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Roy Kessous
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada.,Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Liron Kogan
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada.,Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Ido Laskov
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada.,Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Amber Yasmeen
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada.,Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Laskov I, Grisaru D, Deutsch V, Fargo N, Raz Y, Mishaan N. Evaluation of the hypercoagulable state of gynecologic cancer patients by thromboelastography: a prospective pilot study and a review of the literature. EUR J GYNAECOL ONCOL 2019. [DOI: 10.12892/ejgo5003.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Matanes E, Baloch T, Octeau D, Kessous R, Kogan L, Laskov I, Gotlieb W, Yasmeen A. Abstract NT-117: INHIBITION OF PARG, SENSITIZES OVARIAN CANCER CELLS TO PARP INHIBITORS AND DNA DAMAGING AGENTS. Clin Cancer Res 2019. [DOI: 10.1158/1557-3265.ovcasymp18-nt-117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Poly(ADP-ribose) glycohydrolase (PARG) is responsible poly(ADP-ribose) (PAR) catabolism, which is synthesized by poly(ADP-ribose) polymerases (PARPs) at the site of DNA single-strand breaks (SSB). Faulty PAR formation or disintegration inhibits SSB repair. PARP inhibitors (PARPi) exploit the synthetic lethality between SSB repair and homologous recombination (HR) double strand break (DSB) repair. The most effective PARPi traps PARP at the SSB site, causing a double strand break during DNA synthesis that the cell cannot repair. The trapping of PARP can also be achieved through PARG inhibition. Due to the high rate of HR defects in epithelial ovarian cancer, the aim of this study is to evaluate the effect of a PARG inhibitor (PARGi) on epithelial ovarian cancer cell lines, alone and in combination with PARPi or cisplatin.
METHODS: PARG protein levels were assessed in 74, unselected, snap-frozen, tumors kept in our bio-bank by western blotting and immuno-histochemistry (IHC), as well as in the TCGA database. PARG was knocked down in two cell lines resistant to PARP inhibition, OVCAR3 and SKOV3. The knockdowns were subjected to cell migration and cell proliferation assays, as well as single cell analysis. BRCA1 mutated and BRCA1 wild-type cell lines were exposed to clinically relevant doses of PARGi, PARPi, or cisplatin, separately or in various combination. Therapeutic efficacy was assessed using colony formation assay. Western Blotting was used to detect the levels of PARG and PARP proteins in the cell lines.
RESULTS: PARG mRNA was expressed in 30% of tumors in TCGA. PARG protein was also detected in 30% of the biobank tumors analyzed. PARG knockdowns exhibited reduced rates of cellular proliferation and significant G2/M cell cycle arrest. In PARG over expressed ovarian cancer cell lines, PARG inhibitor similarly reduced cell migration (OVCAR3 and SKOV3: 75% reduction, SNU-251: 48% reduction).
CONCLUSION: PARG inhibition appears to be a viable, complementary strategy to PARP inhibition in HR-deficient cancers. The effect of BRCA1 on the efficacy of PARG inhibition, as well as various treatment combinations, are currently under investigation.
Citation Format: Emad Matanes, Tahira Baloch , David Octeau, Roy Kessous, Liron Kogan, Ido Laskov, Walter Gotlieb, Amber Yasmeen. INHIBITION OF PARG, SENSITIZES OVARIAN CANCER CELLS TO PARP INHIBITORS AND DNA DAMAGING AGENTS [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr NT-117.
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Affiliation(s)
- Emad Matanes
- Lady Davis Institute of Medical Research, Jewish General Hospital , Montreal, QC, Canada
| | - Tahira Baloch
- Lady Davis Institute of Medical Research, Jewish General Hospital , Montreal, QC, Canada
| | - David Octeau
- Lady Davis Institute of Medical Research, Jewish General Hospital , Montreal, QC, Canada
| | - Roy Kessous
- Lady Davis Institute of Medical Research, Jewish General Hospital , Montreal, QC, Canada
| | - Liron Kogan
- Lady Davis Institute of Medical Research, Jewish General Hospital , Montreal, QC, Canada
| | - Ido Laskov
- Lady Davis Institute of Medical Research, Jewish General Hospital , Montreal, QC, Canada
| | - Walter Gotlieb
- Lady Davis Institute of Medical Research, Jewish General Hospital , Montreal, QC, Canada
| | - Amber Yasmeen
- Lady Davis Institute of Medical Research, Jewish General Hospital , Montreal, QC, Canada
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Baloch T, Kessous R, Octeau D, Kogan L, Laskov I, Witcher M, Gotlieb WH, Yasmeen A. Abstract NT-118: SEQUENTIAL THERAPEUTIC TARGETING OF OVARIAN CANCER HARBORING DYSFUNCTIONAL BRCA1. Clin Cancer Res 2019. [DOI: 10.1158/1557-3265.ovcasymp18-nt-118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Ovarian cancer is the most lethal gynecologic cancer. High grade serous ovarian cancer (HGSC) is the most common and deadly histological subtype. The current standard treatment protocol involves primary debulking surgery followed by platinum-based combination chemotherapy. PARP inhibitors(PARPi) are the first approved personalized treatments used in BRCA1-mutated recurrent ovarian cancer patients and have shown promising clinical results. Previously published data in collaboration with Dr. Witcher's lab, we described a significant reduction in PARP1 protein levels in patients after giving standard carboplatinum-paclitaxel chemotherapy that is effecting the clinical efficacy of PARP inhibitors in clinical trials. PARP inhibitors are currently administered after standard chemotherapy, when PARP levels are the lowest which was clearly shown in the previous published paper. Applying novel strategy and following the sequence of administration, giving PARP inhibitors first followed by standard chemotherapy might improve response rates. This study aims to evaluate this strategy (in vitro) in the pre-clinical models.
METHODS: BRCA1 mutated (UWB1.287, SNU-251), epigenetically silenced (OVCAR8), and wild-type BRCA1 (OVCAR3, SKOV3, A2780P & A2780R) cell lines were exposed to clinically relevant doses of PARPi, either followed by standard chemotherapy, or the inverse sequence. Therapeutic efficacy was assessed using colony formation assay. Apoptotic index was evaluated by cell cycle analysis and apoptotic assays using flow cytometry. Western Blotting was used to detect the levels of relevant apoptotic and cell cycle proteins.
RESULTS: Exposure to PARPi prior to standard chemotherapy sensitized BRCA1 mutated or epigenetically silenced BRCA1 cell lines to lower doses of Cisplatin (CP) or Paclitaxel (PT). Similarly, pre-treatment with PARPi prior to chemotherapy induced apoptosis more effectively in the same cell lines. Similar results were observed in BRCA1 wild-type cell lines and cell lines in which BRCA1 functionality was restored.
CONCLUSION: Pre-treatment of cell lines with PARPi followed by standard chemotherapy is more efficient (in vitro) in inhibiting growth and inducing apoptosis than the present sequence of chemotherapy followed by PARPi.
Citation Format: Tahira Baloch, Roy Kessous, David Octeau , Liron Kogan, Ido Laskov, Michael Witcher, Walter H. Gotlieb and Amber Yasmeen. SEQUENTIAL THERAPEUTIC TARGETING OF OVARIAN CANCER HARBORING DYSFUNCTIONAL BRCA1 [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr NT-118.
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Affiliation(s)
- Tahira Baloch
- 2Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada,
- 3Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada,
| | - Roy Kessous
- 1Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada,
- 2Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada,
| | - David Octeau
- 2Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada,
- 4Department of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Liron Kogan
- 1Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada,
- 2Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada,
| | - Ido Laskov
- 1Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada,
- 2Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada,
| | - Michael Witcher
- 2Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada,
- 4Department of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Walter H. Gotlieb
- 1Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada,
- 2Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada,
- 3Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada,
| | - Amber Yasmeen
- 1Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada,
- 2Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada,
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Oiknine-Djian E, Bar-On S, Laskov I, Lantsberg D, Haynes RK, Panet A, Wolf DG. Artemisone demonstrates synergistic antiviral activity in combination with approved and experimental drugs active against human cytomegalovirus. Antiviral Res 2019; 172:104639. [PMID: 31654672 DOI: 10.1016/j.antiviral.2019.104639] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/10/2019] [Accepted: 10/21/2019] [Indexed: 12/30/2022]
Abstract
We have recently shown that the artemisinin derivative artemisone, which was screened against malaria in human clinical studies, is a potent inhibitor of human cytomegalovirus (HCMV). Here we evaluated the antiviral effect of artemisone when employed in 2-drug combinations with approved and experimental anti-HCMV agents. Using the Chou-Talalay method, we found that in-vitro combination of artemisone with cidofovir, brincidofovir, or with the HCMV UL97 inhibitor maribavir resulted in antiviral synergism and the combination of artemisone with ganciclovir or with the viral terminase inhibitors letermovir and BDCRB resulted in moderate synergism. Importantly, the combination of artemisone with maribavir demonstrated synergistic antiviral activity ex-vivo, in a clinically-relevant multicellular model of human placental tissues maintained in organ culture. Our findings provide the basis for the use of artemisone in synergistically acting drug combinations, to enhance viral control and reduce antiviral drug toxicities.
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Affiliation(s)
- Esther Oiknine-Djian
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Department of Biochemistry and the Chanock Center for Virology, IMRIC, The Hebrew University Faculty of Medicine, Jerusalem, Israel; The Lautenberg Center for General and Tumor Immunology, IMRIC, The Hebrew University, Israel
| | - Shikma Bar-On
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Laskov
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lantsberg
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Richard K Haynes
- Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Amos Panet
- Department of Biochemistry and the Chanock Center for Virology, IMRIC, The Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Dana G Wolf
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel; The Lautenberg Center for General and Tumor Immunology, IMRIC, The Hebrew University, Israel.
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Michaan N, Lashno M, Safra T, Merose R, Laskov I, Grisaru D. Whole population BRCA screening is cost effective in Israel, even with varying prevalence of BRCA mutation. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Laskov I, Kessous R, Abitbol J, Kogan L, Badeghiesh A, Tagalakis V, Cohen S, Salvador S, Lau S, Gotlieb WH. Risk of Thromboembolic Disease With Cost Estimates in Patients Undergoing Robotic Assisted Surgery for Endometrial Cancer and Review of the Literature. Journal of Obstetrics and Gynaecology Canada 2018; 40:1571-1579. [DOI: 10.1016/j.jogc.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 10/28/2022]
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Michaan N, Gortzak-Uzan L, Grisario D, Laskov I. Ethnicity-related trends in gynecologic malignancies in Israel, 1993-2013. Int J Gynaecol Obstet 2018; 142:176-181. [DOI: 10.1002/ijgo.12524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/21/2018] [Accepted: 05/04/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Nadav Michaan
- Gynecologic Oncology Unit; Department of Obstetrics and Gynecology; Lis Maternity Hospital; Tel Aviv Sourasky Medical Center and Tel Aviv University; Tel Aviv Israel
| | - Limor Gortzak-Uzan
- Gynecologic Oncology Unit; Department of Obstetrics and Gynecology; Lis Maternity Hospital; Tel Aviv Sourasky Medical Center and Tel Aviv University; Tel Aviv Israel
| | - Dan Grisario
- Gynecologic Oncology Unit; Department of Obstetrics and Gynecology; Lis Maternity Hospital; Tel Aviv Sourasky Medical Center and Tel Aviv University; Tel Aviv Israel
| | - Ido Laskov
- Gynecologic Oncology Unit; Department of Obstetrics and Gynecology; Lis Maternity Hospital; Tel Aviv Sourasky Medical Center and Tel Aviv University; Tel Aviv Israel
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Kogan L, Octeau D, Amajoud Z, Abitbol J, Laskov I, Kessous R, Lau S, Gotlieb W, Salvador S. Lower uterine segment involvement in non-endometrioid endometrial cancer is correlated with a lack of driver mutations and unfavorable outcome. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kessous R, Abitbol J, Kogan L, Laskov I, Yasmeen A, Salvador S, Lau S, Gotlieb W. The predictive value of CA-125 during neoadjuvant chemotherapy. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kogan L, Octeau D, Amajoud Z, Abitbol J, Laskov I, Ferenczy A, Pelmus M, Eisenberg N, Kessous R, Lau S, Yasmeen A, Gotlieb WH, Salvador S. Impact of lower uterine segment involvement in type II endometrial cancer and the unique mutational profile of serous tumors. Gynecol Oncol Rep 2018; 24:43-47. [PMID: 29915797 PMCID: PMC6003406 DOI: 10.1016/j.gore.2018.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/04/2018] [Accepted: 03/14/2018] [Indexed: 12/15/2022] Open
Abstract
Objective Evaluation of the impact of lower uterine segment involvement (LUSI) in type II endometrial cancer, and mutational profile of uterine papillary serous carcinomas (UPSC). Methods Retrospective cohort study comparing patients with type II endometrial cancer with LUSI to patients without LUSI. Genes commonly implicated in carcinogenesis were analyzed in a subgroup of 42 patients with UPSC using next generation sequencing. Results 83 patients with type II endometrial cancer were included in the study, of these, LUSI was diagnosed in 31.3%. During a median follow-up of 45.5 months, patients with LUSI developed more local and distant recurrences (local: 19.2% vs. 3.5%, P = .03; distant: 50% vs. 17.5%, P = .004) and progression events (73.1% vs. 26.3%, P < .001), with shorter mean progression-free survival (16 months compared to 26.5 months, P < .01). In a multivariate analysis, LUSI was the only significant pathological factor, associated with a 2.9-fold increase in the risk of progression (P = .007), and a 2.6-fold increase in the risk of death (P = .02). In the subgroup of patients with UPSC, mutations were identified in 54 genes, including TP53 (80%), PPP2R1A (40%), and PTEN (22.5%). Frequent mutations in the PTEN-PI3K-AKT signaling pathway were found in patients with tumor in the upper uterine segment only (P = .04), with PTEN being mutated in 29% of the samples (P = .07). Conclusion Type II endometrial cancers presenting in the LUS have a significantly worse prognosis and this might be associated with a unique mutational profile. Lower uterine segment involvement is common in type II endometrial cancer. Type II tumors in the lower uterine segment are associated with adverse outcome. Serous type lower uterine segment tumors mapped with a unique mutational profile.
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Affiliation(s)
- Liron Kogan
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H3T 1E2, Canada.,Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - David Octeau
- Department of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Zainab Amajoud
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H3T 1E2, Canada
| | - Jeremie Abitbol
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H3T 1E2, Canada.,Department of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ido Laskov
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H3T 1E2, Canada.,Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Alex Ferenczy
- Department of Pathology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada
| | - Manuela Pelmus
- Department of Pathology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada
| | - Neta Eisenberg
- Department of Obstetrics and Gynecology, Rabin Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Roy Kessous
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H3T 1E2, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H3T 1E2, Canada
| | - Amber Yasmeen
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H3T 1E2, Canada.,Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H3T 1E2, Canada
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Kessous R, Octeau D, Klein K, Tonin PN, Greenwood CMT, Pelmus M, Laskov I, Kogan L, Salvador S, Lau S, Yasmeen A, Gotlieb WH. Distinct homologous recombination gene expression profiles after neoadjuvant chemotherapy associated with clinical outcome in patients with ovarian cancer. Gynecol Oncol 2018; 148:553-558. [PMID: 29395310 DOI: 10.1016/j.ygyno.2018.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The expression of homologous recombination (HR) genes in high grade ovarian cancer (HGOC) samples from debulking surgeries were correlated to outcomes in patients selected for chemotherapy treatment regimens. STUDY DESIGN RNA was extracted from 96 fresh frozen tumor samples from debulking surgeries from chemotherapy naïve patients with HGOC (primary derived surgeries (PDS), n = 55) or following neoadjuvant chemotherapy treatment (NACT), n = 41). The samples were selected for high tumor content by a gynecological pathologist, and cancer cell content was further confirmed using a percent tumor content covariate, and mutation score covariate analysis. Gene expression analysis was performed using a tailored NanoString-based Pancancer Pathway Panel. Cox proportional hazard regression models were used to assess the associations between the expression of 19 HR genes and survival. RESULTS In the PDS group, over-expression of six HR genes (C11orf30, NBN, FANCF, FANCC, FANCB, RAD50) was associated with improved outcome, in contrast to the NACT group where four HR genes (BRCA2, TP53, FANCB, RAD51) were associated with worse outcome. With the adding extent of debulking as a covariate, three HR genes (NBN, FANCF, RAD50), and only one HR gene (RAD51) remained significantly associated with survival in PDS and NACT groups, respectively. CONCLUSION Distinct HR expression profiles define subgroups associated with overall outcome in patients that are exposed to neoadjuvant chemotherapy and not only chemotherapy-naïve patients.
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MESH Headings
- Acid Anhydride Hydrolases
- Aged
- Antineoplastic Agents/therapeutic use
- BRCA1 Protein/genetics
- BRCA2 Protein/genetics
- CA-125 Antigen/blood
- Carcinoma, Endometrioid/blood
- Carcinoma, Endometrioid/drug therapy
- Carcinoma, Endometrioid/genetics
- Carcinoma, Endometrioid/pathology
- Cell Cycle Proteins/genetics
- Cytoreduction Surgical Procedures
- DNA Repair Enzymes/genetics
- DNA-Binding Proteins/genetics
- Fanconi Anemia Complementation Group C Protein/genetics
- Fanconi Anemia Complementation Group F Protein/genetics
- Fanconi Anemia Complementation Group Proteins/genetics
- Female
- Gene Expression Profiling
- Humans
- Membrane Proteins/blood
- Middle Aged
- Neoadjuvant Therapy
- Neoplasm Grading
- Neoplasm Proteins/genetics
- Neoplasms, Cystic, Mucinous, and Serous/blood
- Neoplasms, Cystic, Mucinous, and Serous/drug therapy
- Neoplasms, Cystic, Mucinous, and Serous/genetics
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Nuclear Proteins/genetics
- Ovarian Neoplasms/blood
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/genetics
- Ovarian Neoplasms/pathology
- Ovariectomy
- PTEN Phosphohydrolase/genetics
- Prognosis
- Proportional Hazards Models
- Rad51 Recombinase/genetics
- Recombinational DNA Repair/genetics
- Repressor Proteins/genetics
- Survival Rate
- Transcriptome
- Tumor Suppressor Protein p53/genetics
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Affiliation(s)
- Roy Kessous
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, Canada
| | - David Octeau
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, Canada
| | - Kathleen Klein
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Patricia N Tonin
- Cancer Research Program, The Research Institute of the McGill University Health Centre, Montreal, QC, Canada; Departments of Medicine and Human Genetics, McGill University, Montreal, QC, Canada
| | - Celia M T Greenwood
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Cancer Research Program, The Research Institute of the McGill University Health Centre, Montreal, QC, Canada; Departments of Medicine and Human Genetics, McGill University, Montreal, QC, Canada
| | - Manuela Pelmus
- Division of Pathology, Jewish General Hospital, Montréal, Canada
| | - Ido Laskov
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, Canada
| | - Liron Kogan
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, Canada
| | - Amber Yasmeen
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, Canada.
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, Canada.
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Philip CA, Laskov I, Beauchamp MC, Marques M, Amin O, Bitharas J, Kessous R, Kogan L, Baloch T, Gotlieb WH, Yasmeen A. Inhibition of PI3K-AKT-mTOR pathway sensitizes endometrial cancer cell lines to PARP inhibitors. BMC Cancer 2017; 17:638. [PMID: 28886696 PMCID: PMC5591502 DOI: 10.1186/s12885-017-3639-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 09/01/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Phosphatase and Tensin homolog (PTEN) is a tumor suppressor gene. Loss of its function is the most frequent genetic alteration in endometrioid endometrial cancers (70-80%) and high grade tumors (90%). We assessed the sensitivity of endometrial cancer cell lines to PARP inhibitors (olaparib and BMN-673) and a PI3K inhibitor (BKM-120), alone or in combination, in the context of their PTEN mutation status. We also highlighted a direct pathway linking PTEN to DNA repair. METHODS Using endometrial cancer cellular models with known PTEN status, we evaluated their homologous recombination (HR) functionality by RAD51 foci formation assay. The 50% Inhibitory concentration (IC50) of PI3K and PARP inhibitors in these cells was assessed, and western blotting was performed to determine the expression of proteins involved in the PI3K/mTOR pathway. Moreover, we explored the interaction between RAD51 and PI3K/mTOR by immunofluorescence. Next, the combination effect of PI3K and PARP inhibitors on cell proliferation was evaluated by a clonogenic assay. RESULTS Cells with mutated PTEN showed over-activation of the PI3K/mTOR pathway. These cells were more sensitive to PARP inhibition compared to PTEN wild-type cells. In addition, PI3K inhibitor treatment reduced RAD51 foci formation in PTEN mutated cells, and sensitized these cells to PARP inhibitor. CONCLUSION Targeting both PARP and PI3K might lead to improved personalized therapeutic approaches in endometrial cancer patients with PTEN mutations. Understanding the complex interaction of PTEN mutations with DNA repair in endometrial cancer will help to better select patients that are likely to respond to some of the new and costly targeted therapies.
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Affiliation(s)
- Charles-André Philip
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Ido Laskov
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada.,Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada.,Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Marie-Claude Beauchamp
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada.,Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Maud Marques
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Oreekha Amin
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Joanna Bitharas
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Roy Kessous
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada.,Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Liron Kogan
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada.,Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Tahira Baloch
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada.,Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada.,Department of Oncology, McGill University, Montreal, QC, Canada
| | - Amber Yasmeen
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada. .,Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada.
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Blank N, Laskov I, Kessous R, Kogan L, Lau S, Sebag IA, Gotlieb WH, Rudski L. Absence of cardiotoxicity with prolonged treatment and large accumulating doses of pegylated liposomal doxorubicin. Cancer Chemother Pharmacol 2017; 80:737-743. [DOI: 10.1007/s00280-017-3412-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
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Kogan L, Laskov I, Amajoud Z, Abitbol J, Yasmeen A, Octeau D, Fatnassi A, Kessous R, Eisenberg N, Lau S, Gotlieb WH, Salvador S. Dose dense carboplatin paclitaxel improves progression free survival in patients with endometrial cancer. Gynecol Oncol 2017; 147:30-35. [PMID: 28735629 DOI: 10.1016/j.ygyno.2017.07.134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Pilot study to assess the value of weekly paclitaxel plus carboplatin every 3weeks (dose dense regimen, DD) compared to the standard 3-weekly protocol in the adjuvant setting for endometrial cancer. METHODS Retrospective cohort study comparing consecutive patients with high and intermediate-high risk endometrial cancer, undergoing DD protocol (from 2011 to 2015) to a non-overlapping historical cohort with similar characteristics who received treatment every three weeks (2008-2011). RESULTS 122 patients with endometrial cancer were included in the study, of these, 61 patients received the dose dense protocol and 61 were treated with the standard 3-weekly protocol. After a median follow-up of 61.6months in the 3-weekly cohort, compared with 41.6months in the DD cohort, 40 progressions were recorded. 29 progressions were observed in women treated in the standard protocol, with a three years progression free survival (PFS) of 57.4%, compared to 11 progressions observed in patients in the DD schedule, with a three years PFS of 79.5% (P=0.03). Patients who were treated with the DD protocol were less likely to have progression events compared to the standard cohort with a hazard ratio of 0.4 on multivariate analysis (CI 95%, 0.2-0.8, P=0.01), had significantly less distant metastases (P=0.01), and had improved overall survival when diagnosed with advanced stage disease (P=0.02). Complaints of musculoskeletal pain were more frequent in the standard cohort (n=17, 27.9%) compared to the dose dense cohort (n=4, 6.6%), P=0.005. CONCLUSION Preliminary data suggests that dose dense chemotherapy might be a reasonable and superior option for adjuvant treatment of endometrial cancer, compared to standard chemotherapy.
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Affiliation(s)
- Liron Kogan
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Ido Laskov
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Zainab Amajoud
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Jeremie Abitbol
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Amber Yasmeen
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - David Octeau
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Asma Fatnassi
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Roy Kessous
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Neta Eisenberg
- Department of Obstetrics and Gynecology, Rabin Medical Center, Tel-Aviv university, Tel Aviv, Israel
| | - Susie Lau
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada.
| | - Shannon Salvador
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
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Kessous R, Laskov I, Abitbol J, Bitharas J, Yasmeen A, Salvador S, Lau S, Gotlieb WH. Clinical outcome of neoadjuvant chemotherapy for advanced ovarian cancer. Gynecol Oncol 2016; 144:474-479. [PMID: 28041690 DOI: 10.1016/j.ygyno.2016.12.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate clinical outcome in patients selected to receive neoadjuvant chemotherapy (NACT) compared to primary debulking surgery (PDS). METHODS Retrospective study including all consecutive patients diagnosed and treated for advanced (stages III-IV) ovarian cancers between the years 2003-2015. RESULTS 263 women were included in the study, of these, 127 patients were selected to receive NACT and 136 were treated with PDS followed by adjuvant chemotherapy. PDS was associated with longer OS in stage IIIc disease (median OS: 60.2 vs. 48.8months; p-value 0.039) compared with NACT. Patients achieved higher rates of complete cytoreduction in the NACT group compared to the PDS group (65.9% vs. 40.2%; p=0.001). Patients attaining complete cytoreduction after PDS had the best survival, (median OS 106months) followed by those with complete cytoreduction after NACT (median OS 71months), followed by those with residual disease after PDS (median OS 55months). Patients with residual disease following interval debulking after NACT had the worst outcome (median OS 36months). Platinum sensitivity following first line and second line chemotherapy was similar whether patients received neoadjuvant chemotherapy or not. CONCLUSION PDS was associated with improved outcome. NACT appears to improve survival outcome in patients that would have had residual disease after PDS, and attain complete cytoreduction at the time of interval cytoreduction. This treatment option can be used in selected patients that are not candidates for complete cytoreduction at PDS.
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Affiliation(s)
- Roy Kessous
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Ido Laskov
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Jeremie Abitbol
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Joanna Bitharas
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Amber Yasmeen
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC, H3T 1E2, Canada.
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Amin O, Beauchamp MC, Nader PA, Laskov I, Iqbal S, Philip CA, Yasmeen A, Gotlieb WH. Suppression of Homologous Recombination by insulin-like growth factor-1 inhibition sensitizes cancer cells to PARP inhibitors. BMC Cancer 2015; 15:817. [PMID: 26510816 PMCID: PMC4625613 DOI: 10.1186/s12885-015-1803-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/16/2015] [Indexed: 01/22/2023] Open
Abstract
Background Impairment of homologous recombination (HR) is found in close to 50 % of ovarian and breast cancer. Tumors with BRCA1 mutations show increased expression of the Insulin-like growth factor type 1 receptor (IGF-1R). We previously have shown that inhibition of IGF-1R results in growth inhibition and apoptosis of ovarian tumor cells. In the current study, we aimed to investigate the correlation between HR and sensitivity to IGF-1R inhibition. Further, we hypothesized that IGF-1R inhibition might sensitize HR proficient cancers to Poly ADP ribose polymerase (PARP) inhibitors. Methods Using ovarian and breast cancer cellular models with known BRCA1 status, we evaluated their HR functionality by RAD51 foci formation assay. The 50 % lethal concentration (LC50) of Insulin-like growth factor type 1 receptor kinase inhibitor (IGF-1Rki) in these cells was assessed, and western immunoblotting was performed to determine the expression of proteins involved in the IGF-1R pathway. Moreover, IGF-1R inhibitors were added on HR proficient cell lines to assess mRNA and protein expression of RAD51 by qPCR and western blot. Also, we explored the interaction between RAD51 and Insulin receptor substance 1 (IRS-1) by immunoprecipitation. Next, combination effect of IGF-1R and PARP inhibitors was evaluated by clonogenic assay. Results Cells with mutated/methylated BRCA1 showed an impaired HR function, and had an overactivation of the IGF-1R pathway. These cells were more sensitive to IGF-1R inhibition compared to HR proficient cells. In addition, the IGF-IR inhibitor reduced RAD51 expression at mRNA and protein levels in HR proficient cells, and sensitized these cells to PARP inhibitor. Conclusion Targeting IGF-1R might lead to improved personalized therapeutic approaches in cancer patients with HR deficiency. Targeting both PARP and IGF-1R might increase the clinical efficacy in HR deficient patients and increase the population of patients who may benefit from PARP inhibitors.
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Affiliation(s)
- Oreekha Amin
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, 3755 Cote Ste. Catherine Road, Montreal, H3T 1E2, QC, Canada. .,Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, H3T 1E2, QC, Canada.
| | - Marie-Claude Beauchamp
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, 3755 Cote Ste. Catherine Road, Montreal, H3T 1E2, QC, Canada. .,Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, H3T 1E2, QC, Canada.
| | - Paul Abou Nader
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, H3T 1E2, QC, Canada.
| | - Ido Laskov
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, 3755 Cote Ste. Catherine Road, Montreal, H3T 1E2, QC, Canada. .,Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, H3T 1E2, QC, Canada.
| | - Sanaa Iqbal
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, H3T 1E2, QC, Canada.
| | - Charles-André Philip
- Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, H3T 1E2, QC, Canada.
| | - Amber Yasmeen
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, 3755 Cote Ste. Catherine Road, Montreal, H3T 1E2, QC, Canada. .,Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, H3T 1E2, QC, Canada. .,Department of Oncology, McGill University, Montreal, QC, Canada.
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, 3755 Cote Ste. Catherine Road, Montreal, H3T 1E2, QC, Canada. .,Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, 3755 Cote Ste. Catherine Road, Montreal, H3T 1E2, QC, Canada. .,Department of Oncology, McGill University, Montreal, QC, Canada.
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Marques M, Beauchamp MC, Fleury H, Laskov I, Qiang S, Pelmus M, Provencher D, Mes-Masson AM, Gotlieb WH, Witcher M. Chemotherapy reduces PARP1 in cancers of the ovary: implications for future clinical trials involving PARP inhibitors. BMC Med 2015; 13:217. [PMID: 26354718 PMCID: PMC4565010 DOI: 10.1186/s12916-015-0454-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND PARP inhibitors have shown promising clinical results in cancer patients carrying BRCA1/2 mutations. Their clinical efficacy could logically be influenced by PARP1 protein levels in patient tumors. METHODS We screened three cohorts of patients with ovarian cancer, totaling 313 samples, and evaluated PARP1 protein expression by immunohistochemistry with further validation by western blotting. RESULTS We observed that up to 60 % of tumors showed little PARP1 protein expression. In serous ovarian tumors, comparing intratumoral PARP1 expression between chemo-naïve and post-chemotherapy patients revealed a decrease in intratumoral PARP1 following chemotherapy in all three cohorts (immunohistochemistry: p < 0.001, n = 239; western blot: p = 0.012, n = 74). The findings were further confirmed in a selection of matched samples from the same patients before and after chemotherapy. CONCLUSION Our data suggest that patients should be screened for PARP1 expression prior to therapy with PARP inhibitors. Further, the observed reduction of intratumoral PARP1 post-chemotherapy suggests that treating chemo-naïve patients with PARP inhibitors prior to the administration of chemotherapy, or concurrently, might increase the responsiveness to PARP1 inhibition. Thus, a change in the timing of PARP inhibitor administration may be warranted for future clinical trials.
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Affiliation(s)
- Maud Marques
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Côte Ste, Catherine Road, Montréal, QC, H3T 1E2, Canada.
| | - Marie-Claude Beauchamp
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Côte Ste, Catherine Road, Montréal, QC, H3T 1E2, Canada.
| | - Hubert Fleury
- Centre de recherche du Centre hospitalier de l'Université de Montréal/Institut du cancer de Montréal, Montréal, Canada.
| | - Ido Laskov
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Côte Ste, Catherine Road, Montréal, QC, H3T 1E2, Canada. .,Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montréal, Canada.
| | - Sun Qiang
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Côte Ste, Catherine Road, Montréal, QC, H3T 1E2, Canada.
| | - Manuela Pelmus
- Division of Pathology, Jewish General Hospital, Montréal, Canada.
| | - Diane Provencher
- Centre de recherche du Centre hospitalier de l'Université de Montréal/Institut du cancer de Montréal, Montréal, Canada. .,Department of Obstetric-Gynecology, Université de Montréal, Montreal, Canada. .,Department of Medicine, Université de Montréal, Montreal, Canada.
| | - Anne-Marie Mes-Masson
- Department of Obstetric-Gynecology, Université de Montréal, Montreal, Canada. .,Department of Medicine, Université de Montréal, Montreal, Canada.
| | - Walter H Gotlieb
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Côte Ste, Catherine Road, Montréal, QC, H3T 1E2, Canada. .,Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montréal, Canada.
| | - Michael Witcher
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Côte Ste, Catherine Road, Montréal, QC, H3T 1E2, Canada.
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