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Abstract
Epithelial ovarian cancer (EOC) is very sensitive to upfront chemotherapy. This condition is attributable to defects in the DNA damage repair system. Agents that damage DNA are the main drugs used for its treatment. Many EOC cells have DNA repair deficiencies that confer susceptibility to these agents. Platinum is the most important agent for first-line and also for relapses, together with other drugs that can be given as monotherapy or along with platinum or other drugs. Lately, the emerging role of PARP inhibitors has changed the landscape of opportunities for patients with EOC. All these strategies will be reviewed in this article.
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Affiliation(s)
- Maria-Pilar Barretina-Ginesta
- Department of Medical Oncology, Catalan Institute of Oncology (ICO) Girona, Girona Biomedical Research Institute (IDIBGI), Department of Medical Sciences, Medical School University of Girona (UdG), Spain
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Lorusso D, Marchetti C, Conte C, Giudice E, Bolomini G, Vertechy L, Ceni V, Ditto A, Ferrandina G, Raspagliesi F, Scambia G, Fagotti A. Bevacizumab as maintenance treatment in BRCA mutated patients with advanced ovarian cancer: A large, retrospective, multicenter case-control study. Gynecol Oncol 2020; 159:95-100. [PMID: 32703631 DOI: 10.1016/j.ygyno.2020.07.022] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/12/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the correlation between BRCA mutational status and response to bevacizumab in a large advanced ovarian cancer (AOC) series. METHODS This is a multicenter, retrospective case-control study including upfront AOC treated between January 2015 and June 2019. The main inclusion criteria were: having received three weekly carboplatin-paclitaxel as first-line treatment, with or without Bevacizumab maintenance, knowledge of the BRCA mutational status. RESULTS Overall, 441 patients were included; 183 (41.5%) patients received bevacizumab (Cases), and 258 (58.5%) did not receive it (Controls). The BRCA mutated patients (BRCAmut) were 58 (39%) in the Cases group and 90 (34.9%) in the Controls group (p = .77). Patients who received bevacizumab had a significant 4-months increase in median progression free survival (mPFS: 21 vs. 17 months, p = .033). Concerning BRCAmut patients, no differences were shown between those who received bevacizumab or not in terms of mPFS (24 vs. 22 months, p = .3). Conversely, in BRCA wild-type (BRCAwt) population bevacizumab administration significantly prolonged mPFS (20 vs 15 months, p = .019). At multivariate analysis, independent factors of prolonged PFS were BRCA status (OR = 0.60), having received PDS (OR = 0.69), and complete cytoreduction (OR = 0.50), but not the bevacizumab administration (OR = 0.83, p = .22). CONCLUSIONS No evidence of oncological benefit in terms of PFS and OS related to bevacizumab maintenance therapy was found in BRCAmut patients. Differently, BRCAwt patients seem to benefit from antiangiogenic treatment in terms of mPFS.
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Affiliation(s)
- D Lorusso
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Marchetti
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Conte
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Giudice
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Bolomini
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Vertechy
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - V Ceni
- Department of Obstetrics and Gynecology of Parma, Parma, Italy
| | - A Ditto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - G Ferrandina
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Raspagliesi
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - G Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - A Fagotti
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
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Tomao F, Santangelo G, Musacchio L, Di Donato V, Fischetti M, Giancotti A, Perniola G, Petrella MC, Monti M, Palaia I, Muzii L, Benedetti Panici P. Targeting cervical cancer: Is there a role for poly (ADP-ribose) polymerase inhibition? J Cell Physiol 2020; 235:5050-5058. [PMID: 31912897 DOI: 10.1002/jcp.29440] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/19/2019] [Indexed: 12/13/2022]
Abstract
Patients with metastatic and recurrent cervical cancer (CC) have a poor prognosis with limited palliative treatment options. Increasing understanding of the cellular aberrations inherent to cancer cells has allowed the development of therapies to target biological pathways, an important step toward the individualization of cancer therapy. The poly (ADP-ribose) polymerase (PARP) family of enzymes is important in several DNA repair pathways. Drugs that inhibit these PARP enzymes have been investigated in many types of cancer and their application in the treatment of gynecologic malignancies has rapidly evolved. Although the majority of data for PARPi in gynecologic malignancies has been specifically regarding ovarian cancer, their role in the treatment of uterine and CC is currently being investigated. This review will examine PARP inhibitors in CC, summarizes the critical clinical trials of PARP inhibitors that have been completed, provides an overview of the on-going trials, presents the confirmed conclusions and notes the issues that need to be addressed in future studies.
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Affiliation(s)
- Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Giusi Santangelo
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Lucia Musacchio
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Margherita Fischetti
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Maria Cristina Petrella
- AOUC Azienda Ospedaliero-Universitaria Careggi, Reparto di Oncologia Medica, Florence, Italy
| | - Marco Monti
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, University "Sapienza", Policlinico "Umberto I", Rome, Italy
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Luvero D, Plotti F, Aloisia A, Montera R, Terranova C, Carlo De Cicco Nardone, Scaletta G, Lopez S, Miranda A, Capriglione S, Gatti A, Pierluigi Benedetti Panici, Angioli R. Ovarian cancer relapse: From the latest scientific evidence to the best practice. Crit Rev Oncol Hematol 2019; 140:28-38. [PMID: 31176270 DOI: 10.1016/j.critrevonc.2019.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 12/27/2017] [Revised: 03/17/2019] [Accepted: 05/23/2019] [Indexed: 01/10/2023] Open
Abstract
Ovarian cancer (OC) is the fifth most common cause of cancer death in women worldwide. Despite treatment options have continued to improve in recent years, the recurrence rate is still high; in fact around 80% of patients relapses within 18 months. Recently, the scientific landscape is agree in asserting that the ovarian cancer is not a single disease but the outcome of patients depends from the molecular and biological characterization of tumor tissue. In this scenario, molecular targeted therapy given alone or in combination with chemotherapy is showing significant results. We review the different options for the treatment of ovarian cancer recurrence, including the role of surgery, in order to try outlining a possible treatment algorithm evaluating the recent scientific literature and the most important trials.
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Affiliation(s)
- Daniela Luvero
- University Campus Bio Medico of Rome, Department of Obstetrics and Gynecology, Via Álvaro del Portillo, 200, 00128 Rome, Italy.
| | - Francesco Plotti
- University Campus Bio Medico of Rome, Department of Obstetrics and Gynecology, Via Álvaro del Portillo, 200, 00128 Rome, Italy
| | - Alessia Aloisia
- University Campus Bio Medico of Rome, Department of Obstetrics and Gynecology, Via Álvaro del Portillo, 200, 00128 Rome, Italy
| | - Roberto Montera
- University Campus Bio Medico of Rome, Department of Obstetrics and Gynecology, Via Álvaro del Portillo, 200, 00128 Rome, Italy
| | - Corrado Terranova
- University Campus Bio Medico of Rome, Department of Obstetrics and Gynecology, Via Álvaro del Portillo, 200, 00128 Rome, Italy
| | - Carlo De Cicco Nardone
- University Campus Bio Medico of Rome, Department of Obstetrics and Gynecology, Via Álvaro del Portillo, 200, 00128 Rome, Italy
| | - Giuseppe Scaletta
- Unit of Gynecologic Oncology, Department of Women's and Children's Health. A. Gemelli University Polyclinic Foundation Rome, Italy
| | - Salvatore Lopez
- University Campus Bio Medico of Rome, Department of Obstetrics and Gynecology, Via Álvaro del Portillo, 200, 00128 Rome, Italy
| | - Andrea Miranda
- University Campus Bio Medico of Rome, Department of Obstetrics and Gynecology, Via Álvaro del Portillo, 200, 00128 Rome, Italy
| | - Stella Capriglione
- University Campus Bio Medico of Rome, Department of Obstetrics and Gynecology, Via Álvaro del Portillo, 200, 00128 Rome, Italy
| | - Alessandra Gatti
- University Campus Bio Medico of Rome, Department of Obstetrics and Gynecology, Via Álvaro del Portillo, 200, 00128 Rome, Italy
| | - Pierluigi Benedetti Panici
- University of Rome "Sapienza", Department of Gynecological-Obstetric Sciences and Urological Sciences, Umberto I Hospital, Rome, Italy
| | - Roberto Angioli
- University Campus Bio Medico of Rome, Department of Obstetrics and Gynecology, Via Álvaro del Portillo, 200, 00128 Rome, Italy
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Floquet A, Stoeckle E, Croce S, Longy M, Mc Grogan G, Barouk E, Bubien V, Garbay D, Joly E, Guyon F. [Hereditary ovarian carcinomas: clinico-biological features and treatment]. Bull Cancer 2014; 101:167-74. [PMID: 24555961 DOI: 10.1684/bdc.2014.1888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hereditary ovarian cancers account for 10% of all cases. Two major syndromes with dominant autosomal transmission are identified. The most common one is breast-ovarian cancer syndrome due to BRCA1 and BRCA2 genes mutations, and the Lynch syndrome with mutated MMR genes is the other. Alterations in homologous recombination specifically observed in ovarian cancer with BRCA defects associated to Parp inhibition create a synthetic lethality of special interest. Numerous studies are in progress to explore this promising new approach. Furthermore, it seems that carcinogenesis of these two syndromes are different, suggesting alternative therapeutic options in the near future in order to improve prognosis of ovarian carcinomas.
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Lovato A, Panasci L, Witcher M. Is there an epigenetic component underlying the resistance of triple-negative breast cancers to parp inhibitors? Front Pharmacol 2013; 3:202. [PMID: 23293602 PMCID: PMC3530734 DOI: 10.3389/fphar.2012.00202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 10/11/2012] [Accepted: 12/06/2012] [Indexed: 12/15/2022] Open
Abstract
Poly(ADP-ribose) polymerase (Parp) is an enzyme responsible for catalyzing post-translational modifications through the addition of poly(ADP-ribose) chains (known as PARylation). Modification by PARylation modulates numerous cellular processes including transcription, chromatin remodeling, apoptosis, and DNA damage repair. In particular, the role of Parp activation in response to DNA damage has been intensely studied. Tumors bearing mutations of the breast cancer susceptibility genes, Brca1/2, are prone to DNA breakages whose restoration into functional double-strand DNA is Parp dependent. This concept has been exploited therapeutically in Brca mutated breast and ovarian tumors, where acute sensitivity to Parp inhibitors is observed. Based on in vitro and clinical studies it remains unclear to what extent Parp inhibitors can be utilized beyond treating Brca mutated tumors. This review will focus on the often overlooked roles of PARylation in chromatin remodeling, epigenetics, and transcription to explain why some cancers may be unresponsive to Parp inhibition. We predict that understanding the impact of PARylation on gene expression will lead to alternative approaches to manipulate the Parp pathway for therapeutic benefit.
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Affiliation(s)
- Amanda Lovato
- The Departments of Oncology and Experimental Medicine, The Lady Davis Institute and Segal Cancer Centre of the Jewish General Hospital, McGill University Montreal QC, Canada
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