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Matsukuma K, Nishio S, Tasaki S, Park J, Nasu H, Yoshimitsu T, Tasaki K, Katsuda T, Terada A, Tsuda N, Sanada S, Ushijima K. Association of Chemotherapy Response Score with Multidrug Resistance 1 and CA125 ELIMination Rate Constant K in Patients with Advanced Ovarian Cancer Treated with Neoadjuvant Chemotherapy. Kurume Med J 2024:MS7012004. [PMID: 38556270 DOI: 10.2739/kurumemedj.ms7012004] [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: 04/02/2024]
Abstract
AIM The relationship between chemotherapy response score (CRS), a widely used response predictor of neoadjuvant chemotherapy-interval debulking surgery (NAC-IDS), and multidrug resistance 1 (MDR1) and CA125 ELIMination rate constant K (KELIM), is undetermined. We evaluated CRS in advanced ovarian cancer patients undergoing NAC and looked for associations between CRS and MDR1 and CA125 KELIM. Our aim was to predict the therapeutic effect of NAC before interval debulking surgery (IDS) by examining its association with CRS. METHODS This retrospective cohort study included patients who underwent NAC-IDS (first-line treatment) at Kurume University Hospital, Japan, between 2004 and 2017. CRS association with MDR1 and CA125 KELIM was examined using Cox proportional hazard regression analyses. Survival curves used Kaplan-Meier method, and survival differences between groups used log-rank test. RESULTS Overall, 55 patients were classified into CRS1 (n=22), CRS2 (n=19), and CRS3 (n=14). The CRS3 group had a significantly better prognosis than the CRS1 or CRS2 group. CRS, age, and IDS status were clinical prognostic factors for ovarian cancer. MDR1 positivity for excision repair cross-complementing group 1, β-tubulin, and Y-box binding protein-1 occurred in 15, 17, and 11 patients, respectively, but these were not associated with CRS. CA125 KELIM was <0.5 (n=8), 0.5-1.0 (n=30), and ≥ 1.0 (n=17) but not associated with CRS. CONCLUSION CRS is reconfirmed as a treatment response predictor for NAC-IDS, but its association with drug resistance factors remains unconfirmed.
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Affiliation(s)
- Ken Matsukuma
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Shin Nishio
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Shingo Tasaki
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Jongmyung Park
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Hiroki Nasu
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Teruyuki Yoshimitsu
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Kazuto Tasaki
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Takahiro Katsuda
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Atsumu Terada
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Naotake Tsuda
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Sakiko Sanada
- Department of Pathology, Kurume University School of Medicine
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
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Marchetti C, Giannarelli D, Vizzielli G, Ferrandina G, Tortorella L, Fanfani F, Costantini B, Pasciuto T, Scambia G, Fagotti A. Quality of life in patients with advanced ovarian cancer after primary debulking surgery versus neoadjuvant chemotherapy: Results from the randomised SCORPION trial (NCT01461850). BJOG 2023; 130:1579-1588. [PMID: 37334772 DOI: 10.1111/1471-0528.17558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To investigate the effect of treatment with neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS), versus primary debulking surgery (PDS), on quality of life (QoL) in patients with advanced epithelial ovarian cancer (EOC). DESIGN Randomised trial conducted in a single institution. SETTING Division of Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. SAMPLE Patients with stage-IIIC/IV EOC and high tumour load. METHODS Patients were randomised (1:1) to undergo either PDS (PDS group) or NACT followed by IDS (NACT/IDS group). MAIN OUTCOME MEASURES Quality-of-life (QoL) data, assessed using the European Organization for Research and Treatment of Cancer core QoL questionnaire (QLQ-C30) and ovarian cancer module (OV28); co-primary outcomes were the QLQ-C30 global health score at 12 months (cross-sectional analysis) and the difference in mean QLQ-C30 global health score over time between treatment groups (longitudinal analysis). RESULTS From October 2011 to May 2016, 171 patients were enrolled (PDS = 84; NACT/IDS = 87). We observed no clinical or statistically significant difference between treatment groups in any of the QoL functioning scales at 12 months, including QLQ-C30 global health score (NACT/IDS group vs PDS group, mean difference 4.7, 95% CI -4.99 to 14.4, p = 0.340). Over time, we found lower global health scores for those undergoing PDS than for those receiving NACT (difference in mean score 6.27, 95% CI 0.440-12.11, p = 0.035), albeit this was not clinically relevant. CONCLUSIONS We found no difference in global QoL related to treatment approach at 12 months, even though patients in the NACT/IDS group reported better global health scores across the 12-month period compared with the PDS group; these findings further confirm that NACT/IDS might be a feasible option for patients unsuitable for PDS.
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Affiliation(s)
- Claudia Marchetti
- Division Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diana Giannarelli
- Biostatistics Unit, Scientific Directorate, IRCCS, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Giuseppe Vizzielli
- Division Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - GabriellaM Ferrandina
- Division Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucia Tortorella
- Division Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Fanfani
- Division Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Barbara Costantini
- Division Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Tina Pasciuto
- Statistical Technology Archiving Research (STAR) Centre, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giovanni Scambia
- Division Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Fagotti
- Division Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Pálsdóttir K, Salehi S, Johansson H, Groes-Kofoed N, Falconer H, Joneborg U. Incidence of and survival after surgical intervention for bowel obstruction in women with advanced ovarian cancer. Acta Obstet Gynecol Scand 2023; 102:1653-1660. [PMID: 37681645 PMCID: PMC10619610 DOI: 10.1111/aogs.14674] [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: 03/31/2023] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Women with advanced ovarian cancer commonly present with peritoneal disease both at primary diagnosis and relapse, with risk of subsequent bowel obstruction. The aims of this study were to assess the cumulative incidence of and survival after intervention for bowel obstruction in women with advanced ovarian cancer, to identify factors predictive of survival and the extent to which the intended outcome of the intervention was achieved. MATERIAL AND METHODS Women diagnosed with advanced ovarian cancer stages III and IV in 2009-2011 and 2014-2016 in the Stockholm-Gotland Region in Sweden were identified in the Swedish Quality Registry for Gynecologic Cancer. Through hospital records, types of intended and executed interventions for bowel obstruction were assessed, and as well as when in the course of oncologic treatment, the intervention was performed. Time from first intervention to death was analyzed with survival methodology and proportional hazard regression was used. RESULTS Of 751 identified women, 108 had an intervention for bowel obstruction. Laparotomy was the most prevalent intervention and was used in 87% (94/108) of all women, with a success rate of 87% (82/94). An intervention for bowel obstruction was performed before or during first line treatment in 32% (35/108) with a cumulative incidence in the whole cohort of 14% (108/751, 95% confidence interval [CI] 11-16). Median survival after intervention for bowel obstruction was 4 months (95% CI 3-6). The hazard of death increased when the intervention was performed after completion of primary treatment (HR 4.46, 95% CI 1.61-12.29, P < 0.01), with a median survival of 3 months. In women subjected to radical surgery during primary treatment, the hazard of death after intervention for bowel obstruction decreased (hazard ratio [HR] 0.54, 95% CI 0.32-0.91, P = 0.02). CONCLUSIONS Women with advanced ovarian cancer undergoing intervention for bowel obstruction have a dismal prognosis, regardless of which line of oncologic treatment the intervention was performed. In the majority of women an intervention for bowel obstruction was performed in a relapse situation with an even worse survival. Our findings emphasize the importance of a holistic approach in the decision-making before an intervention for bowel obstruction in women with advanced ovarian cancer.
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Affiliation(s)
- Kolbrún Pálsdóttir
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Sahar Salehi
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Nina Groes-Kofoed
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Falconer
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Joneborg
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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Mansoor M, Shakil F, Jalal U, Shahid F, Jamal M, Ali AS, Abbasi FA, Hijazi H, Imran H, Hirani S, Javaid A, Abu Bakar A, Shah AA, Varrassi G, Khatri M, Kumar S. Comparison of the Efficacy of Cisplatin/Paclitaxel Versus Carboplatin/Paclitaxel in Improving Survival and Quality of Life in the Advanced Ovarian Cancer Patient Population: A Systematic Review and Meta-Analysis of Randomized Control Trials. Cureus 2023; 15:e51011. [PMID: 38264391 PMCID: PMC10803949 DOI: 10.7759/cureus.51011] [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: 11/01/2023] [Accepted: 12/23/2023] [Indexed: 01/25/2024] Open
Abstract
Ovarian cancer, being one of the prevalent gynecological cancers, warrants a therapy that's both effective and well tolerated. After extensive drug testing, combination regimens with paclitaxel plus platinum-based agents such as cisplatin/carboplatin and taxanes, have shown promising results for advanced ovarian cancer. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of two treatment regimens for advanced ovarian cancer: cisplatin/paclitaxel and carboplatin/paclitaxel. PubMed (Medline), Science Direct, and Cochrane Library were searched from inception to March 2023. The meta-analysis included patients with histologically verified International Federation of Gynaecology and Obstetrics (FIGO) stages IIB to IV ovarian carcinoma who received either carboplatin/paclitaxel or cisplatin/paclitaxel. The primary outcomes were progression-free survival (PFS), overall survival (OS), quality of life (QOL), complete response rate (CRR), and partial response rate (PRR). The revised Cochrane Risk of Bias Tool 2.0 was used to assess the quality of the RCTs The five RCTs chosen for this statistical analysis consisted of a total of 2239 participants, with 1109 receiving paclitaxel/cisplatin for treatment and the remaining 1130 receiving carboplatin/paclitaxel. Among all included outcomes, these reported significant findings: QoL (p-value=0.0002), thrombocytopenia (p=<0.00001), neurological toxicity (p-value=0.003), nausea/vomiting (p-value=<0.00001), myalgia/arthralgia (p-value=0.02), and febrile neutropenia (p-value=0.01). We concluded that the carboplatin/paclitaxel doublet endows a better quality of life (QOL) to patients along with significantly fewer gastrointestinal and neurological toxicities when compared with the cisplatin/paclitaxel combination. However, the myelosuppressive effects of carboplatin/paclitaxel remain a point of concern and may require clinical management.
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Affiliation(s)
- Marium Mansoor
- Medicine and Surgery, Allama Iqbal Medical College, Lahore, PAK
| | - Firzah Shakil
- Allergy and Immunology, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Urba Jalal
- Medical School, Allama Iqbal Medical College, Lahore, PAK
| | - Fatimah Shahid
- Medical School, Rawalpindi Medical University, Rawalpindi, PAK
| | - Maira Jamal
- Pediatrics, Hamdard College of Medicine and Dentistry, Karachi, PAK
| | - Alishba S Ali
- Medical School, Rawalpindi Medical University, Rawalpindi, PAK
| | - Fatima A Abbasi
- Cardiology, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Hamna Hijazi
- Medical School, Khyber Medical College, Peshawar, PAK
| | - Hamza Imran
- Medical School, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Sapna Hirani
- Medical School, Peoples University of Medical and Health Science, Nawabshah, PAK
| | - Aima Javaid
- Medical School, Fatimah Jinnah Medical University, Lahore, PAK
| | - Ahshum Abu Bakar
- Medical School, Shalamar Medical and Dental College, Lahore, PAK
| | - Abdul Ahad Shah
- Medical School, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | | | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
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Climent MT, Serra A, Balaguer C, Llueca A. Should We Abandon Intraperitoneal Chemotherapy in the Treatment of Advanced Ovarian Cancer? A Meta-Analysis. J Pers Med 2023; 13:1636. [PMID: 38138863 PMCID: PMC10745120 DOI: 10.3390/jpm13121636] [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: 10/17/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Ovarian cancer is the gynaecological malignancy with the highest mortality and diagnosis often occurs in its advanced stages. Standard treatment in these cases is based on complete cytoreductive surgery with adjuvant intravenous chemotherapy. Other types of treatment are being evaluated to improve the prognosis of these patients, including intraperitoneal chemotherapy and antiangiogenic therapy. These may improve survival or time to relapse in addition to intravenous chemotherapy. OBJECTIVE The aim of this meta-analysis is to determine whether treatment with intravenous chemotherapy remains the gold standard, or whether the addition of intraperitoneal chemotherapy has a benefit in overall survival (OS) and disease-free interval (DFS). MATERIALS AND METHODS A literature search was carried out in Pubmed and Cochrane, selecting clinical studies and systematic reviews published in the last 10 years. Statistical analysis was performed using the hazard ratio measure in the RevMan tool. RESULTS Intraperitoneal chemotherapy shows a benefit in OS and DFS compared with standard intravenous chemotherapy. The significant differences in OS (HR: 0.81 CI 95% 0.74-0.88) and in DFS (HR: 0.81 CI 95% 0.75-0.87) are statistically significant (p < 0.00001). There were no clinical differences in toxicity and side-effects. CONCLUSION Intraperitoneal chemotherapy is an option that improves OS and DFS without significant toxicity regarding the use of intravenous chemotherapy alone. However, prospective studies are needed to determine the optimal dose and treatment regimen that will maintain the benefits while minimising side effects and toxicity and the profile of patients who will benefit most from this treatment.
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Affiliation(s)
- Maria Teresa Climent
- Multidisciplinary Unit of Abdominopelvic Oncological Surgery (MUAPOS), Department of Obstetrics and Gynaecology, Hospital General Universitario de Castellón, 12004 Castellón, Spain; (A.S.); (A.L.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12004 Castellón, Spain
| | - Anna Serra
- Multidisciplinary Unit of Abdominopelvic Oncological Surgery (MUAPOS), Department of Obstetrics and Gynaecology, Hospital General Universitario de Castellón, 12004 Castellón, Spain; (A.S.); (A.L.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12004 Castellón, Spain
| | - Carolina Balaguer
- Department of Medicine, University Jaume I (UJI), 12004 Castellón, Spain;
| | - Antoni Llueca
- Multidisciplinary Unit of Abdominopelvic Oncological Surgery (MUAPOS), Department of Obstetrics and Gynaecology, Hospital General Universitario de Castellón, 12004 Castellón, Spain; (A.S.); (A.L.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12004 Castellón, Spain
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Llueca A, Ibañez MV, Cascales P, Gil-Moreno A, Bebia V, Ponce J, Fernandez S, Arjona-Sanchez A, Muruzabal JC, Veiga N, Diaz-Feijoo B, Celada C, Gilabert-Estelles J, Aghababyan C, Lacueva J, Calero A, Segura JJ, Maiocchi K, Llorca S, Villarin A, Climent MT, Delgado K, Serra A, Gomez-Quiles L, Llueca M. Neoadjuvant Chemotherapy plus Interval Cytoreductive Surgery with or without Hyperthermic Intraperitoneal Chemotherapy (NIHIPEC) in the Treatment of Advanced Ovarian Cancer: A Multicentric Propensity Score Study. Cancers (Basel) 2023; 15:4271. [PMID: 37686547 PMCID: PMC10486645 DOI: 10.3390/cancers15174271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/30/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Epithelial ovarian cancer (EOC) is primarily confined to the peritoneal cavity. When primary complete surgery is not possible, neoadjuvant chemotherapy (NACT) is provided; however, the peritoneum-plasma barrier hinders the drug effect. The intraperitoneal administration of chemotherapy could eliminate residual microscopic peritoneal tumor cells and increase this effect by hyperthermia. Intraperitoneal hyperthermic chemotherapy (HIPEC) after interval cytoreductive surgery could improve outcomes in terms of disease-free survival (DFS) and overall survival (OS). MATERIALS AND METHODS A multicenter, retrospective observational study of advanced EOC patients who underwent interval cytoreductive surgery alone (CRSnoH) or interval cytoreductive surgery plus HIPEC (CRSH) was carried out in Spain between 07/2012 and 12/2021. A total of 515 patients were selected. Progression-free survival (PFS) and OS analyses were performed. The series of patients who underwent CRSH or CRSnoH was balanced regarding the risk factors using a statistical analysis technique called propensity score matching. RESULTS A total of 170 patients were included in each subgroup. The complete surgery rate was similar in both groups (79.4% vs. 84.7%). The median PFS times were 16 and 13 months in the CRSH and CRSnoH groups, respectively (Hazard ratio (HR) 0.74; 95% CI, 0.58-0.94; p = 0.031). The median OS times were 56 and 50 months in the CRSH and CRSnoH groups, respectively (HR, 0.88; 95% CI, 0.64-1.20; p = 0.44). There was no increase in complications in the CRSH group. CONCLUSION The addition of HIPEC after interval cytoreductive surgery is safe and increases DFS in advanced EOC patients.
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Affiliation(s)
- Antoni Llueca
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | | | - Pedro Cascales
- Department of General Surgery, Hospital Universitario Virgen de la Arrixaca, El Palmar, 30120 Murcia, Spain;
| | - Antonio Gil-Moreno
- Gynecologic Oncology Unit, Department of Gynecology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (A.G.-M.); (V.B.)
| | - Vicente Bebia
- Gynecologic Oncology Unit, Department of Gynecology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (A.G.-M.); (V.B.)
| | - Jordi Ponce
- Department of Gynecology, University Hospital of Bellvitge, 08907 Barcelona, Spain; (J.P.); (S.F.)
| | - Sergi Fernandez
- Department of Gynecology, University Hospital of Bellvitge, 08907 Barcelona, Spain; (J.P.); (S.F.)
| | - Alvaro Arjona-Sanchez
- Unit of Surgical Oncology and Pancreatic Surgery, University Hospital Reina Sofia, 14004 Cordoba, Spain;
| | - Juan Carlos Muruzabal
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain; (J.C.M.); (N.V.)
| | - Nadia Veiga
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain; (J.C.M.); (N.V.)
| | - Berta Diaz-Feijoo
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (B.D.-F.); (C.C.)
| | - Cristina Celada
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (B.D.-F.); (C.C.)
| | - Juan Gilabert-Estelles
- Department of Obstetrics and Gynecology, University General Hospital of Valencia, 46014 Valencia, Spain; (J.G.-E.); (C.A.)
| | - Cristina Aghababyan
- Department of Obstetrics and Gynecology, University General Hospital of Valencia, 46014 Valencia, Spain; (J.G.-E.); (C.A.)
| | - Javier Lacueva
- Unit of Peritoneal Carcinomatosis, Department of General Surgery, University General Hospital of Elche, 03203 Elche, Spain; (J.L.); (A.C.)
| | - Alicia Calero
- Unit of Peritoneal Carcinomatosis, Department of General Surgery, University General Hospital of Elche, 03203 Elche, Spain; (J.L.); (A.C.)
| | - Juan Jose Segura
- Hepatobiliopancreatic Surgery and Peritoneal Oncology Surgery Unit, General Surgery and Digestive System Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain;
| | - Karina Maiocchi
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Sara Llorca
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Alvaro Villarin
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Maria Teresa Climent
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | - Katty Delgado
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | - Anna Serra
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | - Luis Gomez-Quiles
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Maria Llueca
- Department of Obstetrics and Gynecology, Joan XXIII University Hospital of Tarragona, 43005 Tarragona, Spain;
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Sghaier S, Corbaux P, Ray-Coquard I, Lim MC, Hasegawa K, Nieuwenhuysen EV, Gonzalez A, Raspagliesi F, Freyer G. NIRVANA-1: maintenance therapy with niraparib versus niraparib-bevacizumab in patients with advanced ovarian cancer. Future Oncol 2023; 19:1715-1727. [PMID: 37650734 DOI: 10.2217/fon-2023-0167] [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: 09/01/2023] Open
Abstract
Following the results of the PRIMA and PAOLA-1 trials, the most effective maintenance strategy for International Federation of Gynecology and Obstetrics stage III patients is still debated, raising the question which of those two maintenance strategies is the most effective: PARP inhibitors alone or PARP inhibitors in combination with bevacizumab. The ongoing NIRVANA-1 study will try to answer this question by assessing the efficacy and safety of niraparib + bevacizumab in comparison with niraparib alone after adjuvant chemotherapy for completely resected stage III patients. Stratification factors include tumor BRCA status, International Federation of Gynecology and Obstetrics stage (IIIA vs IIIB/IIIC) and the use of hyperthermic intraperitoneal chemotherapy during surgery - within the OVHIPEC-2 trial. The primary end point will be progression-free survival rate at 24 months. Safety, median progression-free survival and overall survival will also be studied.
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Affiliation(s)
- Syrine Sghaier
- Department of Medical Oncology, HCL Cancer Institute & Lyon 1 University, GINECO, Lyon, France
- Department of Medical Oncology, University Hospital of Saint-Étienne, Saint-Étienne, GINECO, France
| | - Pauline Corbaux
- Department of Medical Oncology, HCL Cancer Institute & Lyon 1 University, GINECO, Lyon, France
- Department of Medical Oncology, University Hospital of Saint-Étienne, Saint-Étienne, GINECO, France
| | | | - Myong Cheol Lim
- Gynecologic Cancer Branch & Center for Uterine Cancer, National Cancer Center Korea, KGOG, Gyeonggi-do, Republic of Korea
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, GOTIC, Hidaka, Saitama, Japan
| | | | - Antonio Gonzalez
- Department of Medical Oncology, Clinical University of Navarre, GEICO, Pamplona, Spain
| | - Francesco Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale deiTumori di Milano, MANGO, Milan, Italy
| | - Gilles Freyer
- Department of Medical Oncology, HCL Cancer Institute & Lyon 1 University, GINECO, Lyon, France
- Department of Medical Oncology, University Hospital of Saint-Étienne, Saint-Étienne, GINECO, France
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8
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Gebbia V, Martorana F, Scandurra G, Valerio MR, Cufari S, Vigneri P, Sanò MV, Scollo P. A retrospective, real-life analysis of metronomic oral single-agent cyclophosphamide for the treatment of platinum-pretreated advanced ovarian carcinoma in Italy. J Oncol Pharm Pract 2023:10781552231189867. [PMID: 37501558 DOI: 10.1177/10781552231189867] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Metronomic oral cyclophosphamide (MOC) presents many potential advantages, such as significantly less severe side effects than standard regimens, ease of administration, and the delivery of a dose-dense but not necessarily dose-intense treatment. These observations prompted us to evaluate in a retrospective, multicenter study the efficacy and toxicity of MOC in a real-life series of pretreated cancer patients. METHODS The study is a multicenter, retrospective analysis of the activity of single-agent MOC in patients with recurrent or residual epithelial ovarian, fallopian tube, or primary. Eligible patients were continuously treated with MOC at 50 mg/day until progression, toxicity, or death. Overall response rate (ORR), stable disease (SD), and disease control rate (DCR) were reported. RESULTS The study included 62 patients. Three patients reached a complete response rate (5%), 11 had a partial response rate (18), and 15 had stabilization of disease (24) for an ORR of 23% and a DCR of 47%. Patients with low-grade indolent tumors showed an ORR and an SD rate higher than that observed in non-indolent ones (33% vs. 18% and 28% vs. 14%, respectively). Overall, progression-free survival was 3.5 months (range 1-9 months). CONCLUSION Single-agent MOC is active and very well tolerated in a significant fraction of patients with refractory, recurrent, or residual epithelial ovarian, fallopian tube, or primary peritoneal cancer. In the vision of a practical approach, single-agent MOC may be a useful palliative treatment option for patients with poor tolerance to high-dose regimens or widely pretreated. Further studies are needed better to characterize the role of such an approach in clinical practice.
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Affiliation(s)
- Vittorio Gebbia
- Casa di Cura Torina, Palermo, Italy
- Faculty of Medicine and Surgery, Kore University, Enna, Italy
| | - Federica Martorana
- Medical Oncology Unit, Humanitas Istituto Clinico Catanese, Catania, Italy
- Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, University of Catania, Catania, Italy
| | | | | | | | - Paolo Vigneri
- Medical Oncology Unit, Humanitas Istituto Clinico Catanese, Catania, Italy
- Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, University of Catania, Catania, Italy
| | - Maria Vita Sanò
- Medical Oncology Unit, Humanitas Istituto Clinico Catanese, Catania, Italy
| | - Paolo Scollo
- Faculty of Medicine and Surgery, Kore University, Enna, Italy
- Gynecological Oncology Unit, Ospedale Cannizzaro, Catania, Italy
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9
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Zhang S, Kim D, Park M, Yin JH, Park J, Chung YJ. Suppression of Metastatic Ovarian Cancer Cells by Bepridil, a Calcium Channel Blocker. Life (Basel) 2023; 13:1607. [PMID: 37511982 PMCID: PMC10381520 DOI: 10.3390/life13071607] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Although surgery followed by platinum-based therapy is effective as a standard treatment in the early stages of ovarian cancer, the majority of cases are diagnosed at advanced stages, leading to poor prognosis. Thus, the identification of novel therapeutic drugs is needed. In this study, we assessed the effectiveness of bepridil-a calcium channel blocker-in ovarian cancer cells using two cell lines: SKOV-3, and SKOV-3-13 (a highly metastatic clone of SKOV-3). Treatment of these cell lines with bepridil significantly reduced cell viability, migration, and invasion. Notably, SKOV-3-13 was more sensitive to bepridil than SKOV-3. The TGF-β1-induced epithelial-mesenchymal transition (EMT)-like phenotype was reversed by treatment with bepridil in both cell lines. Consistently, expression levels of EMT-related markers, including vimentin, β-catenin, and Snail, were also substantially decreased by the treatment with bepridil. An in vivo mouse xenograft model was used to confirm these findings. Tumor growth was significantly reduced by bepridil treatment in SKOV-3-13-inoculated mice, and immunohistochemistry showed consistently decreased expression of EMT-related markers. Our findings are the first to report anticancer effects of bepridil in ovarian cancer, and they suggest that bepridil holds significant promise as an effective therapeutic agent for targeting metastatic ovarian cancer.
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Affiliation(s)
- Songzi Zhang
- Precision Medicine Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Dokyeong Kim
- Precision Medicine Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Minyoung Park
- Precision Medicine Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jing Hu Yin
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Junseong Park
- Precision Medicine Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yeun-Jun Chung
- Precision Medicine Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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10
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Chan JK, Liu J, Song J, Xiang C, Wu E, Kalilani L, Hurteau JA, Thaker PH. Real-world Outcomes Associated With Poly(ADP-ribose) Polymerase Inhibitor Monotherapy Maintenance in Patients With Primary Advanced Ovarian Cancer. Am J Clin Oncol 2023; 46:314-322. [PMID: 37106485 PMCID: PMC10281176 DOI: 10.1097/coc.0000000000001010] [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: 04/29/2023]
Abstract
OBJECTIVE This study used real-world population data to assess the trends of first-line (1L) poly(ADP-ribose) polymerase inhibitor (PARPi) maintenance treatment uptake and outcomes in patients with primary advanced ovarian cancer (AOC). METHODS Patients diagnosed with AOC between January 1, 2017, and June 30, 2021, who completed 1L chemotherapy were selected from a real-world database. Descriptive analyses were performed to evaluate patient demographics, clinicopathological characteristics, and 1L treatment patterns. Time to next treatment or death was used as a proxy for real-world progression-free survival (rwPFS). Kaplan-Meier methods and Cox models were used for statistical analyses. RESULTS Of 705 patients who completed 1L chemotherapy, 166 received PARPi monotherapy and 539 underwent active surveillance (AS). Median follow-up was 10.9 months for PARPi monotherapy and 20.6 months for AS. PARPi monotherapy use increased from 6% in 2017 to 53% in 2021. Overall, patients receiving PARPi monotherapy had longer rwPFS than those who underwent AS (not reached vs 9.53 mo) respectively. rwPFS was also longer in patients who received PARPi monotherapy compared with AS in patients with BRCA- mutated disease (not reached vs 11.4 mo), BRCA- wild-type disease (13.5 vs 9.1 mo), homologous recombination-deficient tumors (not reached vs 10.2 mo), and homologous recombination-proficient or unknown status tumors (13.5 vs 9.3 mo). CONCLUSIONS Our real-world analysis suggested that 47% of patients with primary AOC did not receive PARPi maintenance in the year 2021. PARPi use was associated with significantly improved outcomes compared with AS.
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Affiliation(s)
- John K. Chan
- California Pacific/Palo Alto Medical Foundation/Sutter Health, Palo Alto
| | | | | | | | | | | | | | - Premal H. Thaker
- Department of Gynecologic Oncology, Washington University School of Medicine, St Louis, MO
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11
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Generali M, Annunziata G, Pirillo D, D’Ippolito G, Ciarlini G, Aguzzoli L, Mandato VD. The role of minimally invasive surgery in epithelial ovarian cancer treatment: a narrative review. Front Med (Lausanne) 2023; 10:1196496. [PMID: 37387787 PMCID: PMC10301737 DOI: 10.3389/fmed.2023.1196496] [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: 03/29/2023] [Accepted: 05/23/2023] [Indexed: 07/01/2023] Open
Abstract
Objectives The aim of this narrative review is to summarize the available evidence on the use of minimal invasive surgery (MIS) in the management of epithelial ovarian cancer (EOC). Background MIS is currently performed to stage and treat EOC at different stage of presentation. We will evaluate risks and benefits of minimally invasive surgery for early stage EOC treatment, then potential advantages provided by staging laparoscopy in identifying patients suitable for primary cytoreductive surgery (PDS) will be discussed. Finally we will investigate the growing role of MIS in the treatment of advanced EOC after neoadjuvant chemotherapy (NACT) and in the treatment of EOC recurrence. Methods An electronic database search was performed on PubMed, Medline, and Google Scholar for relevant studies up to December 2022. Conclusion LPS represents a feasible surgical procedure for the staging and treatment in early, advanced and EOC relapse in selected patients treated in high-volume oncological centers by surgeons with adequate experience in advanced surgical procedures. Despite the increasing use of MIS over the last few years, randomized clinical trials are still needed to prove its effectiveness.
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12
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Ray-Coquard I, Leary A, Pignata S, Cropet C, González-Martin A, Marth C, Nagao S, Vergote I, Colombo N, Mäenpää J, Selle F, Sehouli J, Lorusso D, Alia EMG, Bogner G, Yoshida H, Lefeuvre-Plesse C, Buderath P, Mosconi AM, Lortholary A, Burges A, Medioni J, El-Balat A, Rodrigues M, Park-Simon TW, Dubot C, Denschlag D, You B, Pujade-Lauraine E, Harter P. Olaparib plus bevacizumab first-line maintenance in ovarian cancer: final overall survival results from the PAOLA-1/ENGOT-ov25 trial. Ann Oncol 2023:S0923-7534(23)00686-5. [PMID: 37211045 DOI: 10.1016/j.annonc.2023.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [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: 03/09/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND In the PAOLA-1/ENGOT-ov25 primary analysis, maintenance olaparib plus bevacizumab demonstrated a significant progression-free survival (PFS) benefit in newly diagnosed advanced ovarian cancer patients in clinical response after first-line platinum-based chemotherapy plus bevacizumab, irrespective of surgical status. Prespecified, exploratory analyses by molecular biomarker status showed substantial benefit in patients with a BRCA1/BRCA2 mutation (BRCAm) or homologous recombination deficiency (HRD; BRCAm and/or genomic instability). We report the prespecified final overall survival (OS) analysis, including analyses by HRD status. PATIENTS AND METHODS Patients were randomized 2:1 to olaparib (300 mg bid; up to 24 months) plus bevacizumab (15 mg/kg q3w; 15 months total) or placebo plus bevacizumab. Analysis of OS, a key secondary endpoint in hierarchical testing, was planned for ∼60% maturity or 3 years after the primary analysis. RESULTS After median follow-up of 61.7 and 61.9 months in the olaparib and placebo arms, respectively, median OS was 56.5 versus 51.6 months in the ITT (hazard ratio [HR]=0.92, 95% CI 0.76-1.12; P=0.4118). Subsequent poly(ADP-ribose) polymerase (PARP) inhibitor therapy was received by 105 (19.6%) olaparib patients versus 123 (45.7%) placebo patients. In the HRD-positive population, OS was longer with olaparib plus bevacizumab (HR=0.62, 95% CI 0.45-0.85; 5-year OS rate, 65.5% versus 48.4%); at 5 years, updated PFS also showed a higher proportion of olaparib plus bevacizumab patients without relapse (HR=0.41, 95% CI 0.32-0.54; 5-year PFS rate, 46.1% versus 19.2%). Myelodysplastic syndrome, acute myeloid leukemia, aplastic anemia, and new primary malignancy incidence remained low and balanced between arms. CONCLUSIONS Olaparib plus bevacizumab provided clinically meaningful OS improvement for first-line patients with HRD-positive ovarian cancer. These prespecified exploratory analyses demonstrated improvement despite a high proportion of patients in the placebo arm receiving PARP inhibitors post-progression, confirming the combination as one of the standards of care in this setting with the potential to enhance cure.
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Affiliation(s)
- I Ray-Coquard
- Department of Medical Oncology, Centre Léon BERARD, Lyon, and GINECO, France;.
| | - A Leary
- Gynecological Cancer Unit, Department of Medicine, Institut Gustave Roussy, Villejuif, and GINECO, France
| | - S Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori 'Fondazione G Pascale', IRCCS, Napoli, and MITO, Italy
| | - C Cropet
- Department of Biostatistics Centre Léon BERARD, Lyon, and GINECO, France
| | - A González-Martin
- Department of Medical Oncology, Clínica Universidad de Navarra, Program in Solid Tumors (CIMA), Pamplona, and GEICO, Spain
| | - C Marth
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, and AGO Austria, Austria
| | - S Nagao
- Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, and GOTIC, Japan
| | - I Vergote
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven Cancer Institute, Leuven, and BGOG, Belgium, European Union
| | - N Colombo
- University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS Milan, and MANGO, Italy
| | - J Mäenpää
- Department of Obstetrics and Gynecology and Cancer Center, Tampere University and University Hospital, Tampere, and NSGO, Finland
| | - F Selle
- Department of Medical Oncology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, and GINECO, France
| | - J Sehouli
- Charité - Department of Gynecology with Center of Oncological Surgery, Universitätsmedizin Berlin, Berlin, and AGO, Germany
| | - D Lorusso
- (3)Gynecologic Oncology Unit, Catholic University of Sacred Heart and Fondazione Policlinico Gemelli IRCCS, Rome, and MITO, Italy
| | - E M Guerra Alia
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, and GEICO, Spain
| | - G Bogner
- Department of Obstetrics and Gynecology, Paracelsus Medical University Salzburg, Salzburg, and AGO Austria, Austria
| | - H Yoshida
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, and GOTIC, Japan
| | - C Lefeuvre-Plesse
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, and GINECO, France
| | - P Buderath
- Universitätsklinikum Essen, University Hospital Essen, West German Cancer Center, Department of Gynecology and Obstetrics, Essen and AGO, Germany
| | - A M Mosconi
- S.C. di Oncologia Medica Osp. S. Maria della Misericordia - AO di Perugia, and MITO, Italy
| | - A Lortholary
- Centre Catherine de Sienne Hopital privé du Confluent, Nantes, and GINECO, France
| | - A Burges
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, and AGO, Germany
| | - J Medioni
- Hôpital Européen Georges Pompidou, Universite de Paris Cite, Paris, and GINECO, France
| | - A El-Balat
- Spital Uster, Frauenklinik, Uster, Switzerland, and Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt, and AGO, Germany
| | - M Rodrigues
- Department of Medical Oncology, Institut Curie, Hopital Claudius Régaud, PSL Research University, Paris, France, and GINECO, France
| | - T-W Park-Simon
- Department of Gynaecology and Obstetrics, Hannover Medical School, Hannover, and AGO, Germany
| | - C Dubot
- Oncologie Médicale, Institut Curie, Hôpital René Huguenin, Saint Cloud, Paris, and GINECO, France
| | - D Denschlag
- Hochtaunuskliniken, Bad Homburg, and AGO, Germany
| | - B You
- HCL - Hospices Civils de Lyon IC-HCL, CITOHL, Université Claude Bernard Lyon 1, CICLY,Lyon, and GINECO, France
| | | | - P Harter
- Department of Gynaecology & Gynaecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, and AGO, Germany
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DeClue RW, Szamreta EA, Gautam S, Fisher MD, Monberg MJ. Comparison of advanced ovarian cancer patients treated with or without bevacizumab in the US Community Oncology Clinics. Future Oncol 2023. [PMID: 37170823 DOI: 10.2217/fon-2022-0955] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Aim: Real-world data on treatment patterns and outcomes of advanced ovarian cancer (OC) patients since bevacizumab approval in first-line (1L) OC treatment were assessed. Materials & methods: In this descriptive retrospective study using the ConcertAI Oncology Dataset, patient characteristics, treatment patterns and real-world progression-free survival (rwPFS) from start of 1L were evaluated among patients diagnosed with advanced OC between 2011-2020. Treatment data from structured sources were confirmed and/or supplemented by human review of unstructured data. Results: Median rwPFS for bevacizumab and non bevacizumab cohorts was 17.3 months (95% CI: 14.9, 20.4) and 15.7 months (95% CI: 12.3, 29.1), respectively. Patients with ≥10 doses during 1L had higher median rwPFS compared with patients receiving 3-9 doses. Conclusion: This real-world study suggests benefits of bevacizumab treatment in advanced OC were primarily experienced by patients who received ≥10 doses in 1L.
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Jeong MJ, Yoon YN, Kang YK, Kim CJ, Nam HS, Lee YS. A Novel Score Using Lymphocyte-to-Monocyte Ratio in Blood and Malignant Body Fluid for Predicting Prognosis of Patients with Advanced Ovarian Cancer. Cancers (Basel) 2023; 15:cancers15082328. [PMID: 37190256 DOI: 10.3390/cancers15082328] [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: 03/09/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: The lymphocyte-to-monocyte ratio (LMR), one of the systemic inflammatory markers, has been shown to be associated with prognosis of various solid tumors. However, no study has reported clinical utility of the LMR of malignant body fluid (mLMR) (2) Methods: We retrospectively analyzed clinical data of the final 92 patients of a total of 197 patients with advanced ovarian cancer newly diagnosed from November 2015 and December 2021 using our institute big data. (3) Results: Patients were divided into three groups according to their combined bLMR and mLMR scores (bmLMR score): 2, both bLMR and mLMR were elevated; 1, bLMR or mLMR was elevated; and 0, neither bLMR nor mLMR was elevated. A multivariable analysis confirmed that the histologic grade (p = 0.001), status of residual disease (p < 0.001), and bmLMR score (p < 0.001) were independent predictors of disease progression. A low combined value of bLMR and mLMR was strongly associated with a poor prognosis in patients with ovarian cancer. (4) Conclusions: Although further studies are required to apply our results clinically, this is the first study to validate the clinical value of mLMR for predicting prognosis of patients with advanced ovarian cancer.
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Affiliation(s)
- Min Jin Jeong
- Department of Obstetrics and Gynecology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Yeo Nyeong Yoon
- Department of Obstetrics and Gynecology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Yeon Kyung Kang
- Department of Obstetrics and Gynecology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Chan Joo Kim
- Department of Obstetrics and Gynecology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 11765, Republic of Korea
| | - Hae Seong Nam
- Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon 22332, Republic of Korea
| | - Yong Seok Lee
- Department of Obstetrics and Gynecology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
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15
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Goon KC, Alldredge J. Tolerance of Olaparib in a Patient With Unresectable Serous Gynecologic Cancer and End-Stage Renal Disease. Cureus 2023; 15:e36505. [PMID: 37090414 PMCID: PMC10119740 DOI: 10.7759/cureus.36505] [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] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Poly (adenosine diphosphate-ribose) polymerase enzyme (PARP) inhibitors have risen in popularity for the treatment of gynecologic cancers, largely due to an expansion of applications with the discovery of more genetic mutations that manifest as homologous recombination deficiency. PARP inhibitors further represent an appealing management option as oral maintenance or monotherapy. While dose adjustments exist for mild kidney dysfunction, little is published about the use of PARP inhibitors in patients with severe renal dysfunction. We present a case of advanced, serous gynecologic cancer in a patient who was ineligible for surgery due to cardiac and renal comorbidities and treated with olaparib for nine months without direct adverse effects, despite a paucity of literature supporting the use or dosing of olaparib in patients requiring dialysis. Further studies are needed to better establish the safety, efficacy, and appropriate dose modification for patients with end-stage renal disease.
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Affiliation(s)
- Kelsey C Goon
- Obstetrics and Gynecology, University of Colorado Hospital, Aurora, USA
| | - Jill Alldredge
- Obstetrics and Gynecology/Gynecologic Oncology, University of Colorado Hospital, Aurora, USA
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Liu Y, Ni M, Huang F, Gu Q, Xiao Y, Du X. Neoadjuvant chemotherapy in advanced epithelial ovarian cancer by histology: A SEER based survival analysis. Medicine (Baltimore) 2023; 102:e32774. [PMID: 36705377 PMCID: PMC9875958 DOI: 10.1097/md.0000000000032774] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
To evaluate the prognostic effect of neoadjuvant chemotherapy (NACT) in advanced epithelial ovarian cancer (EOC) patients with different histological subtype. Stage III/IV EOC patients diagnosed between 2010 and 2018 were identified from the surveillance, epidemiology, and end results database (SEER) database and stratified by histological subtype. Kaplan-Meier analysis was used for the assessment of overall survival (OS) cause-specific survival (CSS) before and after matching for baseline characteristics between NACT and primary debulking surgery (PDS) groups. Cox proportional risk model was conducted to identify independent prognostic factors. A total of 13,582 patients were included in the analysis. Of them, 9505 (74.50%) received PDS and 3253 (25.50%) received NACT. Overall, an inferior OS and CSS was observed among patients with high-grade serous carcinoma (HGSC) receiving NACT, while NACT served as a protective factor in clear cell carcinoma and carcinosarcoma in both original cohorts and adjusted cohorts. For other histo-subtypes, PDS showed survival benefit over NACT in certain cohorts of models. Prognostic effect of NACT in advanced EOC differed from pathological subtypes. Although it served as a risk factor for HGSC, patients with less common subtypes may benefit from NACT.
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Affiliation(s)
- Yuexi Liu
- Department of Obstetrics and Gynecology, The first Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Yuexi Liu, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China (e-mail: )
| | - Meng Ni
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Fanfan Huang
- Department of Ophthalmology, The first Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiuying Gu
- Department of Obstetrics and Gynecology, The first Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yao Xiao
- Department of Obstetrics and Gynecology, The first Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyue Du
- Department of Cardiovascular medicine, The first Affiliated Hospital of Chongqing Medical University, Chongqing, China
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17
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Marrelli D, Ansaloni L, Federici O, Asero S, Carbone L, Marano L, Baiocchi G, Vaira M, Coccolini F, Di Giorgio A, Framarini M, Gelmini R, Palopoli C, Accarpio F, Fagotti A. Cytoreductive Surgery (CRS) and HIPEC for Advanced Ovarian Cancer with Peritoneal Metastases: Italian PSM Oncoteam Evidence and Study Purposes. Cancers (Basel) 2022; 14. [PMID: 36497490 DOI: 10.3390/cancers14236010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Ovarian cancer is the eighth most common neoplasm in women with a high mortality rate mainly due to a marked propensity for peritoneal spread directly at diagnosis, as well as tumor recurrence after radical surgical treatment. Treatments for peritoneal metastases have to be designed from a patient's perspective and focus on meaningful measures of benefit. Hyperthermic intraperitoneal chemotherapy (HIPEC), a strategy combining maximal cytoreductive surgery with regional chemotherapy, has been proposed to treat advanced ovarian cancer. Preliminary results to date have shown promising results, with improved survival outcomes and tumor regression. As knowledge about the disease process increases, practice guidelines will continue to evolve. In this review, we have reported a broad overview of advanced ovarian cancer management, and an update of the current evidence. The future perspectives of the Italian Society of Surgical Oncology (SICO) are discussed conclusively.
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18
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Muacevic A, Adler JR, Ganguly S, Biswas B, Bhaumik J. First-line Rucaparib Plus Bevacizumab Maintenance Completed One-Year in Germline BRCA1-Mutated Advanced Ovarian Cancer. Cureus 2022; 14:e32493. [PMID: 36644062 PMCID: PMC9837332 DOI: 10.7759/cureus.32493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
The present case study showed the novel approach of Rucaparib and Bevacizumab as first-line maintenance therapy in germline BRCA 1 mutated advanced high-grade serous carcinoma of the ovary. A 56-year-old female with high-grade serous carcinoma of the ovary (ECOG PS1) was treated with carboplatin and paclitaxel in combination with Bevacizumab (CPB), followed by interval debulking surgery. Since the patient was germline BRCA 1 positive, after completion of adjuvant chemotherapy, she was kept on Rucaparib along with Bevacizumab. The patient achieved a complete response and has been leading a disease-free life for the past one year with maintenance therapy of Rucaparib + Bevacizumab, though the patient did experience a few adverse events, including one episode of grade 3 anaemia, occasional grade 3 asthenia, and grade 2 diarrhoea (CTCAE V-4) which was managed by gradual dose reduction of Rucaparib from 600 mg twice daily dose to 300mg twice daily dose. With dose alteration of rucaparib along with bevacizumab as maintenance, the patient continues to tolerate rucaparib and stay relapse-free from disease.
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19
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Yang Z, Wang X, Hong W, Zhang S, Yang Y, Xia Y, Yang R. The pharmacological mechanism of Chinese herbs effective in treating advanced ovarian cancer: Integrated meta-analysis and network pharmacology analysis. Front Pharmacol 2022; 13:1040641. [PMID: 36438791 PMCID: PMC9682081 DOI: 10.3389/fphar.2022.1040641] [Citation(s) in RCA: 2] [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: 09/09/2022] [Accepted: 10/17/2022] [Indexed: 11/15/2023] Open
Abstract
Background: Advanced ovarian cancer (AOC) develops rapidly, adding to difficulties in treatment. Traditional Chinese medicine (TCM) plays a significant role in the treatment of AOC, and so to explore the efficacy and safety of TCM in the treatment of AOC and its effective targets, we performed the following review. Methods: The major databases were searched for randomized controlled trials of TCM for the treatment of AOC. A meta-analysis of the efficacy of Chinese herbs on AOC was conducted using RevMan 5.4 software. Active compounds and target genes were acquired using the TCMSP database. The main targets of AOC were obtained through the GenCards, OMIM, TTD, and DrugBank databases. A protein-protein interaction network carried out on the STRING platform was used to select core genes. The Metascape platform was applied to achieve GO and KEGG enrichment analysis. Results: A total of 24 studies were included. Meta-analysis shows the TCM group improved the overall response rate (OR = 2.71; 95% CI = [2.14, 3.44], Z = 8.25, p < 0.00001), overall survival (OR = 2.93, 95% CI = [2.03, 4.24], Z = 5.72, p < 0.00001), and progression-free survival (OR = 5.36, 95% CI = [5.03, 5.69], Z = 31.88, p < 0.00001) of AOC patients, as well as reducing many adverse events. There were 120 compounds, 246 herb target genes, and 1503 disease targets extracted. The 10 most important components were quercetin, kaempferol, 7-methoxy-2-methyl isoflavone, formononetin, isorhamnetin, hederagenin, stigmasterol, luteolin, 7-O-methylisomucronulatol, and calycosin. The 20 core targets were TP53, STAT3, JUN, AKT1, MAPK3, RELA, MAPK1, ESR1, IL6, FOS, MAPK14, TNF, CDKN1A, RB1, CCND1, EGFR, STAT1, MDM2, MAPK8, and CAV1. KEGG enrichment analysis showed that there are many pathways directly related to different types of tumors, such as in pathway cancer and prostate cancer. Conclusion: Our article reveals TCM is effective and safe against AOC and that Chinese herbs exert effects on the disease through multi-target, multi-component, and multi-pathway mechanisms. Systematic Review Registration: (www.crd.york.ac.uk/PROSPERO/), identifier (CRD42022369731).
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Affiliation(s)
- Ze Yang
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiang Wang
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Wei Hong
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shiyi Zhang
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yang Yang
- Department of Traditional Chinese Medicine, Neighborhood Good Doctor No. 6 Street Clinic, Hangzhou, China
| | - Yongliang Xia
- Health Management Center, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Ruiwen Yang
- Health Management Center, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
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20
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Barakat A, Ismail A, Chattopadhyay S. Management of advanced ovarian cancer in Leicester: The benefits of a paradigm shift in surgical approach. J Obstet Gynaecol Res 2022; 48:3233-3241. [PMID: 36151704 PMCID: PMC10087665 DOI: 10.1111/jog.15433] [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: 06/02/2022] [Revised: 08/27/2022] [Accepted: 09/04/2022] [Indexed: 11/30/2022]
Abstract
AIM Surgery for advanced ovarian cancer (AOC) has evolved over the past decade to ingeminate the need to offer maximum effort surgery (MES). The aim of this study is to analyze the implementation of a paradigm shift in the surgical management of women with AOC at the University Hospitals of Leicester NHS Trust (UHL) in 2015, until 2020, compared to 2011-2014. METHODS Retrospective cohort study of women with AOC who underwent cytoreductive surgery (CRS) in the UHL. The two groups were: 153 women from January 2011 to December 2014 (group 1), 136 women from January 2015 to January 2020 (group 2). RESULTS In group 1, the 1, 3, and 5 years overall survival rates (OS) were, 90.4%, 33.7%, and 19.3%, compared to 90.2%, 55.4%, and 29.7%, respectively, in group 2 (p = 0.012). Significantly more women had CRS in group 2: 45-Primary debulking surgery (PDS) and 57-interval debulking surgery (IDS) versus 17-PDS & 67-IDS in group 1 (p < 0.001). Surgical complexity score (modified Aletti score) was higher in group 2 compared to group 1 (p = <0.001). No significant difference was noted in the postoperative complications, in group 2, in women who underwent PDS versus IDS, yet PDS was associated with higher OS. CONCLUSIONS MES/CRS in women with AOC significantly improves OS. Our data highlights the importance of a dedicated team to implement this change in cancer centers. Where possible, suitable women with AOC likely to have complete cytoreduction based on preoperative assessment, should be offered PDS.
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Affiliation(s)
- Anas Barakat
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK.,Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Aemn Ismail
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Supratik Chattopadhyay
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK.,Leicester Cancer Research Centre, University of Leicester, Leicester, UK
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21
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Fan L, Zhang Y, Maguire P, Muston D, Monberg M, Earla JR, Mihai A, Gulati P. Cost comparison of adverse event management among breast and ovarian cancer patients treated with poly (ADP-ribose) polymerase inhibitors: analysis based on phase 3 clinical trials. J Mark Access Health Policy 2022; 10:2078474. [PMID: 35693379 PMCID: PMC9186353 DOI: 10.1080/20016689.2022.2078474] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The economic impact of adverse events (AEs) for poly (ADP-ribose) polymerase inhibitors (PARPis) in ovarian or breast cancer has not been widely evaluated. OBJECTIVE Compare PARPi-related AE management costs from a US payer perspective. METHODS The frequency of treatment-related grade 3-4 AEs was obtained from published clinical trials of PARPis for the treatment of advanced ovarian cancer (AOC), platinum-sensitive recurrent ovarian cancer (PSROC), and metastatic breast cancer (MBC). AE management costs per patient (2020 USD) per treatment course were calculated by multiplying the AE unit costs by the frequency of AEs for each arm of each trial. Sensitivity analyses were conducted according to the lower and upper limits of the 95% confidence interval for AE rates and unit costs, respectively. Scenarios were also performed to explore the uncertainty of outcomes. RESULTS Total AE management costs in AOC were: $3,904, olaparib; $5,595, olaparib plus bevacizumab; and $12,215, niraparib. In PSROC, total costs were: $3,894, olaparib; $6,001, rucaparib; and $11,492, niraparib, and in MBC: $3,574, olaparib; and $9,489, talazoparib. Hematological toxicities were the key drivers of AE management costs for PARPis. CONCLUSIONS The main AEs among PARPis were hematological. Olaparib was associated with lower AE costs compared to other PARPis.
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Affiliation(s)
- Lin Fan
- Health Economics and Decision Science, Merck & Co., Inc, Rahway, NJ, USA
| | - Yuanyuan Zhang
- Health Economics and Evidence Generation, Wickenstones Ltd, Milton Park, Oxfordshire, UK
| | - Peter Maguire
- Health Economics and Evidence Generation, Wickenstones Ltd, Milton Park, Oxfordshire, UK
| | - Dominic Muston
- Health Economics and Decision Science, Merck & Co., Inc, Rahway, NJ, USA
| | - Matthew Monberg
- Center for Observational and Real-World Evidence, Merck & Co., Inc, Rahway, NJ, USA
| | | | - Adela Mihai
- Global Health Economics and Payer Evidence, AstraZeneca PLC, Cambridge, UK
| | - Poonam Gulati
- Global Regulatory Affairs, AstraZeneca PLC, Cambridge, UK
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22
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Khatib G, Köse S, Bağır E, Küçükgöz Güleç Ü, Güzel AB, Vardar MA. Cardiophrenic and costophrenic lymph node resection via subxiphoid approach only. J Turk Ger Gynecol Assoc 2022; 23:124-125. [PMID: 35263836 PMCID: PMC9161008 DOI: 10.4274/jtgga.galenos.2022.2021-9-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
When enlarged cardiophrenic lymph nodes (CPLN) are resected the impact on survival is still uncertain, but resection contributes to accurate staging and complete gross resection in advanced ovarian cancer. CPLN resection can be performed via video-assisted thoracic surgery or transabdominally through the subxiphoid or transdiaphragmatic routes. The subxiphoid approach is used to reach the prepericardiac nodes located in the anterior mediastinum. The transdiaphragmatic route is used to remove the costophrenic and supradiaphragmatic paracaval lymph nodes located in the middle and posterior mediastinum, respectively. However, the transdiaphragmatic approach necessitates diaphragm opening and, in most cases, liver mobilization. Costophrenic nodes can be resected through the subxiphoid route in appropriate patients without opening the diaphragm. Thus, the subxiphoid approach may be preferred to remove the costophrenic lymph nodes, in cases in whom diaphragm resection is not anticipated, and especially when the resection procedure is planned to include the prepericardiac nodes. In this video article, we present the method of resecting both prepericardiac and costophrenic lymph nodes using only the subxiphoid approach in a case of advanced ovarian cancer. The subxiphoid virtual space between the pericardium and diaphragm was developed. The observed and palpated CPLNs were dissected and excised from the prepericardiac and right latero-cardiac spaces. Thereafter, diaphragm peritoneum beneath the right costophrenic nodes was dissected. After identifying any enlarged costophrenic nodes by palpation, the sternal and costal diaphragmatic attachments were incised and the right latero-cardiac space was extended. When the single enlarged node was reached, it was grasped and pulled with curved-ring forceps and ultimately resected.
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Affiliation(s)
- Ghanim Khatib
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Sevgül Köse
- Department of Radiology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Emine Bağır
- Department of Pathology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ümran Küçükgöz Güleç
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ahmet Barış Güzel
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Mehmet Ali Vardar
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Çukurova University Faculty of Medicine, Adana, Turkey
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23
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Staropoli N, Arbitrio M, Salvino A, Scionti F, Ciliberto D, Ingargiola R, Labanca C, Agapito G, Iuliano E, Barbieri V, Cucè M, Zuccalà V, Cannataro M, Tassone P, Tagliaferri P. A Prognostic and Carboplatin Response Predictive Model in Ovarian Cancer: A Mono-Institutional Retrospective Study Based on Clinics and Pharmacogenomics. Biomedicines 2022; 10:1210. [PMID: 35625946 PMCID: PMC9138265 DOI: 10.3390/biomedicines10051210] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
Carboplatin is the cornerstone of ovarian cancer (OC) treatment, while platinum-response, dependent on interindividual variability, is the major prognostic factor for long-term outcomes. This retrospective study was focused on explorative search of genetic polymorphisms in the Absorption, Distribution, Metabolism, Excretion (ADME) genes for the identification of biomarkers prognostic/predictive of platinum-response in OC patients. Ninety-two advanced OC patients treated with carboplatin-based therapy were enrolled at our institution. Of these, we showed that 72% of patients were platinum-sensitive, with a significant benefit in terms of OS (p = 0.001). We identified an inflammatory-score with a longer OS in patients with lower scores as compared to patients with the maximum score (p = 0.001). Thirty-two patients were genotyped for 1931 single nucleotide polymorphisms (SNPs) and five copy number variations (CNVs) by the DMET Plus array platform. Among prognostic polymorphisms, we found a potential role of UGT2A1 both as a predictor of platinum-response (p = 0.01) and as prognostic of survival (p = 0.05). Finally, we identified 24 SNPs related to OS. UGT2A1 correlates to an "inflammatory-score" and retains a potential prognostic role in advanced OC. These data provide a proof of concept that warrants further validation in follow-up studies for the definition of novel biomarkers in this aggressive disease.
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Affiliation(s)
- Nicoletta Staropoli
- Medical Oncology Unit, AOU Mater Domini, 88100 Catanzaro, Italy; (A.S.); (D.C.); (M.C.); (P.T.)
| | - Mariamena Arbitrio
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 88100 Catanzaro, Italy
| | - Angela Salvino
- Medical Oncology Unit, AOU Mater Domini, 88100 Catanzaro, Italy; (A.S.); (D.C.); (M.C.); (P.T.)
| | - Francesca Scionti
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98125 Messina, Italy;
| | - Domenico Ciliberto
- Medical Oncology Unit, AOU Mater Domini, 88100 Catanzaro, Italy; (A.S.); (D.C.); (M.C.); (P.T.)
| | - Rossana Ingargiola
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (R.I.); (C.L.); (E.I.)
| | - Caterina Labanca
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (R.I.); (C.L.); (E.I.)
| | - Giuseppe Agapito
- Department of Law, Economics and Sociology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
- Data Analytics Research Center, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Eleonora Iuliano
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (R.I.); (C.L.); (E.I.)
| | - Vito Barbieri
- Medical Oncology Unit, “Pugliese-Ciaccio” Hospital, 88100 Catanzaro, Italy;
| | - Maria Cucè
- Medical Oncology Unit, AOU Mater Domini, 88100 Catanzaro, Italy; (A.S.); (D.C.); (M.C.); (P.T.)
| | - Valeria Zuccalà
- Pathology Unit, “Pugliese-Ciaccio” Hospital, 88100 Catanzaro, Italy;
| | - Mario Cannataro
- Data Analytics Research Center, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Pierfrancesco Tassone
- Medical Oncology Unit, AOU Mater Domini, 88100 Catanzaro, Italy; (A.S.); (D.C.); (M.C.); (P.T.)
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (R.I.); (C.L.); (E.I.)
| | - Pierosandro Tagliaferri
- Medical Oncology Unit, AOU Mater Domini, 88100 Catanzaro, Italy; (A.S.); (D.C.); (M.C.); (P.T.)
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (R.I.); (C.L.); (E.I.)
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24
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Tao Y, Tang XT, Li X, Wu AS, Zhou HS, Zhou CF. Comparison of Neoadjuvant Chemotherapy Efficiency in Advanced Ovarian Cancer Patients Treated With Paclitaxel Plus Carboplatin and Intraperitoneal Bevacizumab vs. Paclitaxel With Carboplatin. Front Med (Lausanne) 2022; 9:807377. [PMID: 35355595 PMCID: PMC8959569 DOI: 10.3389/fmed.2022.807377] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/17/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study evaluated the role of neoadjuvant chemotherapy (NACT) with bevacizumab intraperitoneal perfusion in advanced ovarian cancer (AOC). Methods In this study, 80 patients with advanced epithelial ovarian cancer (stage IIIc or IV) who received NACT at the Central Hospital of Zhuzhou between February 2019 and October 2020 were enrolled. Patients were randomized to receive paclitaxel plus carboplatin (TC) or TC plus intraperitoneal perfusion of bevacizumab (TCB). The effect of chemotherapy was assessed following two cycles of chemotherapy. Cancer antigen 125 (CA125), tumor size, ascites volume, bleeding volume, duration of operation, surgical satisfaction rate, complication rate, and residual tumor were assessed to monitor response to chemotherapy. Results Treatment with TCB regimen significantly reduced serum levels of CA125 and ascites volume (p < 0.001). Meanwhile, the TCB group had significantly lower intraoperative blood loss and shorter operation time (p < 0.001). Most importantly, patients treated with TCB regimen had a higher surgical satisfaction rate (p < 0.01). Moreover, the incidence of postoperative wound infection, hypoproteinemia, abdominal distension, and fever was lower in the TCB group compared with the TC group. Assessment of adverse reactions during chemotherapy showed no severe complications between the two groups. Conclusions The results demonstrated that the TCB regimen is superior to the TC regimen alone in the treatment of AOC. These findings could help improve the surgical satisfaction rate, provide more effective treatment strategies to prolong progression-free survival and reduce postoperative complications, and promote surgical recovery in AOC.
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Affiliation(s)
- Yin Tao
- Zhuzhou Central Hospital, Zhuzhou, China
| | - Xue-Ting Tang
- Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, Hengyang Medical College, Institute of Neuroscience, University of South China, Hengyang, China
| | - Xing Li
- School of Basic Medical Sciences, Shaoyang University, Shaoyang, China
| | - An-Shan Wu
- Zhuzhou Central Hospital, Zhuzhou, China
| | | | - Cheng-Fang Zhou
- Zhuzhou Central Hospital, Zhuzhou, China.,The First Affiliated Hospital of Army Medical University, Chongqing, China
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25
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Diaz-Feijoo B, Agusti-Garcia N, Sebio R, López-Hernández A, Sisó M, Glickman A, Carreras-Dieguez N, Fuste P, Marina T, Martínez-Egea J, Aguilera L, Perdomo J, Pelaez A, López-Baamonde M, Navarro-Ripoll R, Gimeno E, Campero B, Torné A, Martinez-Palli G, Arguis MJ. Feasibility of a Multimodal Prehabilitation Programme in Patients Undergoing Cytoreductive Surgery for Advanced Ovarian Cancer: A Pilot Study. Cancers (Basel) 2022; 14:cancers14071635. [PMID: 35406407 PMCID: PMC8997099 DOI: 10.3390/cancers14071635] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 02/03/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Multimodal prehabilitation programmes represent an innovative approach to promoting surgical recovery by improving the physiological and psychological baseline resilience in conjunction with nutritional optimisation in order to reduce the stress to which the patient is subjected during surgery. These programmes are becoming widespread in different fields of surgery, but in major gynaecological surgery for ovarian cancer, there is still no clear consensus. In this study, we aimed to assess the feasibility of these interventions and their impact on postoperative outcomes in women with advanced ovarian cancer. All patients received perioperative care in accordance with Enhanced Recovery After Surgery guidelines. This pilot study showed that multimodal prehabilitation before surgery is feasible and safe, since we observed good adherence without any major adverse effects in this vulnerable population. Additionally, we found that prehabilitation reduced hospital length of stay and the time from surgery to adjuvant chemotherapy. Abstract Introduction: Treatment for advanced ovarian cancer (AOC) comprises cytoreductive surgery combined with chemotherapy. Multimodal prehabilitation programmes before surgery have demonstrated efficacy in postoperative outcomes in non-gynaecological surgeries. However, the viability and effects of these programmes on patients with AOC are unknown. We aimed to evaluate the feasibility and postoperative impact of a multimodal prehabilitation programme in AOC patients undergoing surgery. Methods: This single-centre, before-and-after intervention pilot study included 34 patients in two cohorts: the prehabilitation cohort prospectively included 15 patients receiving supervised exercise, nutritional optimisation, and psychological preparation from December 2019 to January 2021; the control cohort included 19 consecutive patients between January 2018 and November 2019. Enhanced Recovery After Surgery guidelines were followed. Results: The overall adherence to the multimodal prehabilitation programme was 80%, with 86.7% adherence to exercise training, 100% adherence to nutritional optimisation, and 80% adherence to psychological preparation. The median hospital stay was shorter in the prehabilitation cohort (5 (IQR, 4–6) vs. 7 days (IQR, 5–9) in the control cohort, p = 0.04). Differences in postoperative complications using the comprehensive complication index (CCI) were not significant (CCI score: 9.3 (SD 12.12) in the prehabilitation cohort vs. 16.61 (SD 16.89) in the control cohort, p = 0.08). The median time to starting chemotherapy was shorter in the prehabilitation cohort (25 (IQR, 23–25) vs. 35 days (IQR, 28–45) in the control cohort, p = 0.03). Conclusions: A multimodal prehabilitation programme before cytoreductive surgery is feasible in AOC patients with no major adverse effects, and results in significantly shorter hospital stays and time to starting chemotherapy.
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Affiliation(s)
- Berta Diaz-Feijoo
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
- Correspondence: ; Tel.: +34-93-227-5400; Fax: +34-93-2275454
| | - Nuria Agusti-Garcia
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Raquel Sebio
- Department of Rehabilitation, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (R.S.); (E.G.)
| | - Antonio López-Hernández
- Anesthesiology and Intensive Care, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.L.-H.); (J.P.); (A.P.); (M.L.-B.); (R.N.-R.); (G.M.-P.); (M.J.A.)
| | - Marina Sisó
- Nutrition and Clinical Dietetics, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (M.S.); (B.C.)
| | - Ariel Glickman
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Nuria Carreras-Dieguez
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Pere Fuste
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Tiermes Marina
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Judit Martínez-Egea
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Laura Aguilera
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Juan Perdomo
- Anesthesiology and Intensive Care, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.L.-H.); (J.P.); (A.P.); (M.L.-B.); (R.N.-R.); (G.M.-P.); (M.J.A.)
| | - Amaia Pelaez
- Anesthesiology and Intensive Care, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.L.-H.); (J.P.); (A.P.); (M.L.-B.); (R.N.-R.); (G.M.-P.); (M.J.A.)
| | - Manuel López-Baamonde
- Anesthesiology and Intensive Care, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.L.-H.); (J.P.); (A.P.); (M.L.-B.); (R.N.-R.); (G.M.-P.); (M.J.A.)
| | - Ricard Navarro-Ripoll
- Anesthesiology and Intensive Care, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.L.-H.); (J.P.); (A.P.); (M.L.-B.); (R.N.-R.); (G.M.-P.); (M.J.A.)
| | - Elena Gimeno
- Department of Rehabilitation, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (R.S.); (E.G.)
| | - Betina Campero
- Nutrition and Clinical Dietetics, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (M.S.); (B.C.)
| | - Aureli Torné
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (N.A.-G.); (A.G.); (N.C.-D.); (P.F.); (T.M.); (J.M.-E.); (L.A.); (A.T.)
| | - Graciela Martinez-Palli
- Anesthesiology and Intensive Care, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.L.-H.); (J.P.); (A.P.); (M.L.-B.); (R.N.-R.); (G.M.-P.); (M.J.A.)
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - María J. Arguis
- Anesthesiology and Intensive Care, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.L.-H.); (J.P.); (A.P.); (M.L.-B.); (R.N.-R.); (G.M.-P.); (M.J.A.)
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Acs M, Piso P, Prader S. Current Status of Metastatic Cardiophrenic Lymph Nodes (CPLNs) in Patients With Ovarian Cancer: A Review. Anticancer Res 2022; 42:13-24. [PMID: 34969704 DOI: 10.21873/anticanres.15452] [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: 09/18/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND One of the most common sites of extra-abdominal disease spread of advanced stage ovarian cancer is the cardiophrenic lymph node (CPLN) region. The role and impact of extra-abdominal cytoreduction is not obvious in patients with cardiophrenic lymph node metastases. MATERIALS AND METHODS We examined the relevant and currently available literature to determine the prognostic value and management of enlarged CPLNs in ovarian cancer patients. RESULTS Transdiaphragmatic excision of CPLNs or via video-assisted thoracoscopic surgery (VATS) is achievable without major complications. The most common postoperative complications were pleural effusion, pneumothorax and pneumonia. On preoperative CT scan, the cut-off size of suspicious CPLNs is not uniform and is indicated as 5 to 10 mm short-axis dimension. CONCLUSION CPLNs were detected in up to 60% of patients and malignancy was pathologically confirmed in 45-95% of the cases. The presence of enlarged CPLNs was found to be a negative prognostic factor, although its impact on progression-free and overall survival is not yet clarified and needs further investigation.
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Affiliation(s)
- Miklos Acs
- Department of General and Visceral Surgery, Krankenhaus Barmherzige Brüder, Regensburg, Germany;
| | - Pompiliu Piso
- Department of General and Visceral Surgery, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - Sonia Prader
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology and Gynecologic Oncology, Krankenhaus Brixen, Brixen, Italy
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Liontos M, Timotheadou E, Papadopoulos EI, Zafeiriou Z, Lampropoulou DI, Aravantinos G, Mavroudis D, Christodoulou C, Nikolaidi A, Somarakis A, Papadimitriou C, Papandreou C, Bamias A. Real-World Data on Treatment Management and Outcomes of Patients with Newly Diagnosed Advanced Epithelial Ovarian Cancer in Greece (The EpOCa Study). Curr Oncol 2021; 28:5266-5277. [PMID: 34940079 PMCID: PMC8699844 DOI: 10.3390/curroncol28060440] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/18/2021] [Accepted: 12/08/2021] [Indexed: 01/02/2023] Open
Abstract
New treatment modalities have been recently introduced in the management of ovarian cancer (OC). Herein, we sought to investigate their implementation in routine clinical practice and examine the real-world management of OC in Greece. EpOCa was a non-interventional, multicenter, retrospective study in patients with advanced epithelial OC. The primary outcome was to estimate the proportions of the different treatment regimens used per line of therapy, while progression-free survival (PFS) and overall survival (OS) were the key secondary endpoints. A total of 154 patients were enrolled in the study, among whom, 40% were tested for BRCA mutations and 30% were found to be positive. Nearly 90% of patients underwent debulking surgery at diagnosis, with few operations being also recorded upon relapse. Platinum-based chemotherapy (CT) was predominantly used in the first line with half of patients also receiving angiogenesis inhibitor (AI), while non-platinum-based CT was preferred in later lines. The median PFS was 18.2 and 8.8 months in the first- and second-line setting, respectively, whereas the median OS was approximately 50 months. Our study adds to the available, but limited, real world data on the management of ovarian cancer providing evidence regarding the applied treatment strategies and outcomes of patients in Greece.
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Affiliation(s)
- Michalis Liontos
- Department of Clinical Therapeutics, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Eleni Timotheadou
- Department of Medical Oncology, Papageorgiou Hospital, School of Medicine, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (E.T.); (C.P.)
| | | | - Zafeiris Zafeiriou
- Second Department of Medical Oncology, Theageneion Anticancer Hospital, 54007 Thessaloniki, Greece;
| | - Dimitra Ioanna Lampropoulou
- Second Department of Medical Oncology, General Oncology Hospital of Kifissia “Agioi Anargiroi”, 14564 Athens, Greece; (D.I.L.); (G.A.)
| | - Gerasimos Aravantinos
- Second Department of Medical Oncology, General Oncology Hospital of Kifissia “Agioi Anargiroi”, 14564 Athens, Greece; (D.I.L.); (G.A.)
| | - Dimitrios Mavroudis
- Department of Medical Oncology, University General Hospital of Heraklion, 71500 Heraklion Crete, Greece;
- Laboratory of Translational Oncology, Medical School, University of Crete, 71110 Heraklion Crete, Greece
| | | | | | | | - Christos Papadimitriou
- Oncology Unit, 2nd Department of Surgery, ARETAIEIO University Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Christos Papandreou
- Department of Medical Oncology, Papageorgiou Hospital, School of Medicine, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece; (E.T.); (C.P.)
| | - Aristotelis Bamias
- 2nd Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence:
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Huang H, Wei R, Long Y, Mo Y, Xie Y, Yao D. Hepatic Hilar Lymph Node Resection in Cytoreductive Surgery for Advanced Ovarian Cancer: A Necessity or Not? Cancer Manag Res 2021; 13:7981-7988. [PMID: 34707404 PMCID: PMC8542736 DOI: 10.2147/cmar.s334658] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This review aims to clarify the necessity of hepatic hilar lymph node resection on advanced ovarian cancer patients. Background PARP inhibitors and surgery have significantly improved the survival of patients with ovarian cancer. However, for patients with advanced ovarian cancer, there are often extensive epigastric disseminated metastatic lesions, especially the lymph nodes in the hepatic hilar area. Because of the complicated anatomical relationship and lack of experience in this area, this is easily ignored by gynecological oncologists. Methods Through the retrieval and analysis of the current database, namely PubMed, Medline, Web of Science, EMBASE, Cochrane Library, and Wangfang, etc., the literature regarding this topic published before March 2021 were thoroughly investigated. Conclusion For the hepatic hilar regional lymph node surgery, through careful preoperative evaluation, surgical-indication clarification, appropriate case selection, standardized surgical operations and multidisciplinary cooperation with general surgeons, the prognosis of patients is significantly improved. Postoperative complications are also safe and controllable and convincing. To conclude, the application of hilar region lymph node cytoreductive surgery for patients with advanced ovarian cancer is a feasible and preferred choice.
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Affiliation(s)
- Honglian Huang
- Hechi People's Hospital, Hechi City, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Renjie Wei
- Hechi People's Hospital, Hechi City, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Ying Long
- Gynecologic Oncology Department, Guangxi Medical University Affiliated Cancer Hospital, Nanning City, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Yu Mo
- Hechi People's Hospital, Hechi City, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Yu Xie
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
| | - Desheng Yao
- Gynecologic Oncology Department, Guangxi Medical University Affiliated Cancer Hospital, Nanning City, Guangxi Zhuang Autonomous Region, People's Republic of China
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Kraus F, El Hajj H, Le Deley MC, Aissaoui O, Gachon B, Chevalier A, Abdeddaim C, Lemaire AS, Ben Haj Amor M, Sylla D, Leblanc E, Narducci F, Hudry D. A New Paradigm in Managing Advanced Ovarian Cancer: Differentiating Patients Requiring Neoadjuvant Treatment from Primary Cytoreduction. Cancers (Basel) 2021; 13:4925. [PMID: 34638409 DOI: 10.3390/cancers13194925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 01/22/2023] Open
Abstract
Simple Summary This study evaluates the comparability of patients treated with primary cytoreduction and patients undergoing neoadjuvant chemotherapy for advanced stages high grade serous ovarian carcinoma by comparing the preoperative and postoperative characteristics after a propensity score matching analysis during ten years in a tertiary cancer center. Abstract Our study aims to evaluate the comparability of primary debulking surgery (PDS) and neoadjuvant chemotherapy (NACT) patients. This single-center retrospective study includes all patients treated for advanced stages high-grade serous ovarian carcinomas (HGSOC) between 2007 and 2017. Preoperative characteristics and postoperative outcomes were compared after a propensity score matching analysis. Of the 221 patients included, 38% underwent PDS, and 62% received NACT. There was no age difference at diagnosis; however, CA125 levels, PCI score levels, and rates of stage IV were higher in the NACT group. There were no differences concerning the rate and the severity of complications (p = 0.29). The propensity score distribution showed a broad distinction between PDS patients and NACT patients with no significant overlap. Survival analyses demonstrate, after a median follow-up of 66.5 months, an overall survival (OS) of 105.9 and progression-free survival (PFS) of 29.2 months in the PDS group, compared to OS of 52.8 and PFS of 18.9 months in the NACT group. Advanced HGSOC is a heterogeneous population, in which inoperable patients should be differentiated from PDS patients based on many factors, primarily tumor burden.
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Banerjee S, Gonzalez-Martin A, Harter P, Lorusso D, Moore KN, Oaknin A, Ray-Coquard I. First-line PARP inhibitors in ovarian cancer: summary of an ESMO Open - Cancer Horizons round-table discussion. ESMO Open 2021; 5:e001110. [PMID: 33310779 PMCID: PMC7783599 DOI: 10.1136/esmoopen-2020-001110] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 10/11/2020] [Revised: 11/16/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022] Open
Abstract
Poly(ADP-ribose) polymerase (PARP) inhibitor maintenance therapy is the latest breakthrough in the management of newly diagnosed advanced ovarian cancer. The results of the SOLO-1 trial in 2018 led to European Medicines Agency and Food and Drug Administration approval of olaparib as first-line maintenance therapy in patients with BRCA1/2 mutation, establishing a new standard of care. Subsequently, the results of three phase III trials (PRIMA, PAOLA-1, VELIA) evaluating the use of first-line PARP inhibitors beyond patients with BRCA1/2 mutations and as combination strategies were presented in 2019, leading to the recent approval of maintenance niraparib irrespective of biomarker status and olaparib in combination with bevacizumab in homologous recombination deficiency-positive-associated advanced ovarian cancer. An ESMO Open - Cancer Horizons round-table expert panel discussed the four phase III trials of first-line PARP inhibitor therapy and how they are changing the clinical management of advanced ovarian cancer.
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Affiliation(s)
- Susana Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK.
| | | | - Philipp Harter
- Department of Gynaecology and Gynaecological Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Domenica Lorusso
- Scientific Directorate and Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Kathleen N Moore
- Stephenson Cancer Center, University of Oklahoma, Norman, Oklahoma, USA
| | - Ana Oaknin
- Medical Oncology Department, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Liao YC, Ou YC, Wu CH, Fu HC, Tsai CC, Lin H. CA125 normalization within 60 days as an independent prognostic factor for patients with advanced epithelial ovarian cancer. Cancer Biomark 2021; 32:559-567. [PMID: 34397404 DOI: 10.3233/cbm-210156] [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: 11/15/2022]
Abstract
BACKGROUND CA125 level normalization at different chemotherapy cycles has been reported to be a prognosticator in advanced epithelial ovarian cancer. OBJECTIVE In the present study, we investigated whether the time (in days) to CA125 normalization or nadir during treatment could be used as markers to predict survival. METHODS Patients with FIGO stage III-IV epithelial ovarian cancer treated with cytoreductive surgery followed by adjuvant chemotherapy between 2008 and 2016 were enrolled in this retrospective study. Clinicopathological characteristics, changes in CA125 level during treatment, and survival outcomes were analyzed. Time-dependent receiver operating characteristic curve analysis was used to determine the optimal cut-off values of the time to normalization and time to nadir of CA125 levels to predict survival. Univariate and multivariate Cox regression analysis were used to examine the impact of each variable on survival. RESULTS A total of 106 patients were included in the analysis. The optimal cut-off values for the time to normalization and nadir for predicting survival were 60 and 194 days, respectively. In Kaplan-Meier survival analysis, CA125 level normalization ⩽ 60 days and CA125 ⩽ 35 u/mL after the third cycle, and CA125 level ⩽ 10 u/mL after the sixth cycle of chemotherapy were associated with significantly better 5-year progression-free survival (PFS) and overall survival (OS). In multivariate analysis, only CA125 level normalization > 60 days was significantly associated with poor survival outcomes (PFS, HR 2.62 [95% CI: 1.54, 4.45], p= 0.004; OS, HR 2.40 [95% CI: 1.19, 4.81], p= 0.014). CONCLUSIONS Normalization of CA125 level within 60 days after cytoreductive surgery followed by adjuvant chemotherapy in patients with advanced ovarian epithelial cancer could be used as a marker to predict survival.
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Affiliation(s)
- Yi-Chiao Liao
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Che Ou
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Chen-Hsuan Wu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-Chun Fu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Chou Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Martinez-Useros J, Martin-Galan M, Florez-Cespedes M, Garcia-Foncillas J. Epigenetics of Most Aggressive Solid Tumors: Pathways, Targets and Treatments. Cancers (Basel) 2021; 13:3209. [PMID: 34198989 PMCID: PMC8267921 DOI: 10.3390/cancers13133209] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 02/06/2023] Open
Abstract
Highly aggressive tumors are characterized by a highly invasive phenotype, and they display chemoresistance. Furthermore, some of the tumors lack expression of biomarkers for target therapies. This is the case of small-cell lung cancer, triple-negative breast cancer, pancreatic ductal adenocarcinoma, glioblastoma, metastatic melanoma, and advanced ovarian cancer. Unfortunately, these patients show a low survival rate and most of the available drugs are ineffective. In this context, epigenetic modifications have emerged to provide the causes and potential treatments for such types of tumors. Methylation and hydroxymethylation of DNA, and histone modifications, are the most common targets of epigenetic therapy, to influence gene expression without altering the DNA sequence. These modifications could impact both oncogenes and tumor suppressor factors, which influence several molecular pathways such as epithelial-to-mesenchymal transition, WNT/β-catenin, PI3K-mTOR, MAPK, or mismatch repair machinery. However, epigenetic changes are inducible and reversible events that could be influenced by some environmental conditions, such as UV exposure, smoking habit, or diet. Changes in DNA methylation status and/or histone modification, such as acetylation, methylation or phosphorylation, among others, are the most important targets for epigenetic cancer therapy. Therefore, the present review aims to compile the basic information of epigenetic modifications, pathways and factors, and provide a rationale for the research and treatment of highly aggressive tumors with epigenetic drugs.
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Affiliation(s)
- Javier Martinez-Useros
- Translational Oncology Division, OncoHealth Institute, Fundacion Jimenez Diaz University Hospital, Avenida Reyes Catolicos 2, 28040 Madrid, Spain;
| | - Mario Martin-Galan
- Translational Oncology Division, OncoHealth Institute, Fundacion Jimenez Diaz University Hospital, Avenida Reyes Catolicos 2, 28040 Madrid, Spain;
| | | | - Jesus Garcia-Foncillas
- Translational Oncology Division, OncoHealth Institute, Fundacion Jimenez Diaz University Hospital, Avenida Reyes Catolicos 2, 28040 Madrid, Spain;
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He M, Lai Y, Peng H, Tong C. Role of Lymphadenectomy During Interval Debulking Surgery Performed After Neoadjuvant Chemotherapy in Patients With Advanced Ovarian Cancer. Front Oncol 2021; 11:646135. [PMID: 33842358 PMCID: PMC8034395 DOI: 10.3389/fonc.2021.646135] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/02/2021] [Indexed: 11/13/2022] Open
Abstract
Objective The role of lymphadenectomy in interval debulking surgery (IDS) performed after neoadjuvant chemotherapy (NACT) in advanced ovarian cancer remains unclear. We aimed to investigate the clinical significance of lymphadenectomy in IDS. Methods We retrospectively reviewed and analyzed the data of patients with advanced ovarian cancer who underwent NACT followed by IDS. Results In 303 patients receiving NACT-IDS, lymphadenectomy was performed in 127 (41.9%) patients. One hundred and sixty-three (53.8%) patients achieved no gross residual disease (NGRD), and 69 (22.8%) had residual disease < 1 cm, whereas 71 (23.4%) had residual disease ≥ 1cm. No significant difference in progression-free survival (PFS) and overall survival (OS) was observed between the lymphadenectomy group and the no lymphadenectomy group in patients with NGRD, residual disease < 1 cm, and residual disease ≥ 1 cm, respectively. The proportions of pelvic, para-aortic and distant lymph node recurrence were 7.9% (10/127), 4.7% (6/127) and 5.5% (7/127) in the lymphadenectomy group, compared with 5.7% (10/176, P = 0.448), 4.5% (8/176, P = 0.942) and 5.1% (9/176, P = 0.878), respectively, in no lymphadenectomy group. Multivariate analysis identified residual disease ≥ 1 cm [hazard ratios (HR), 4.094; P = 0.008] and elevated CA125 levels after 3 cycles of adjuvant chemotherapy (HR, 2.883; P = 0.004) were negative predictors for OS. Conclusion Lymphadenectomy may have no therapeutic value in patients with advanced ovarian cancer underwent NACT-IDS. Our findings may help to better the therapeutic strategy for advanced ovarian cancer. More clinical trials are warranted to further clarify the real role of lymphadenectomy in IDS.
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Affiliation(s)
- Minjun He
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Yuerong Lai
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Hongyu Peng
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Chongjie Tong
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
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Abstract
Ovarian cancer is known as the second most common cause of death among gynecologic cancers. Survival outcome has been reported to be significantly associated with the efforts to minimize residual disease after cytoreductive surgery. As ovarian cancer often invades the small and large bowel without boundary, bowel surgery has been a crucial part of the cytoreductive surgery to achieve complete tumor removal. The scope of surgical resections has progressively expanded to include small and large bowel resections, making advanced surgical skills essential for gynecologic oncologists. In this review, we discuss the extra-pelvic bowel resection in cytoreductive surgery, with a focus on the regional anatomy and surgical techniques.
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Affiliation(s)
- Joo-Hyuk Son
- Division of Gynecologic Oncology, Ajou University School of Medicine, Suwon, Korea.,Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Suk-Joon Chang
- Division of Gynecologic Oncology, Ajou University School of Medicine, Suwon, Korea.,Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
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35
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Son JH, Chang SJ. Cholecystectomy, porta hepatis stripping, and omental bursectomy. Gland Surg 2021; 10:1230-1234. [PMID: 33842269 DOI: 10.21037/gs-2019-ursoc-02] [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: 11/06/2022]
Abstract
As ovarian cancer commonly involves the visceral organs without boundary, more aggressive procedures are adopted during cytoreductive surgery. One of the most difficult aspect of the operation involves the procedure for the gall bladder, porta hepatis, and omental bursa. As the upper abdominal surgical field is not familiar to the gynecologic surgeon, and the vital organs or vessels are densely positioned, these procedures can be challenging for achieving the optimal cytoreductive surgery. The surgical approaches for advanced ovarian cancer that are required in the upper abdomen have evolved with the progress in surgical techniques. This article will discuss the surgical approach by focusing on cholecystectomy, porta hepatis debulking, and omental bursectomy, as well as the regional anatomy in patients with advanced ovarian cancer.
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Affiliation(s)
- Joo-Hyuk Son
- Division of Gynecologic Oncology, Ajou University School of Medicine, Suwon, Korea.,Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Suk-Joon Chang
- Division of Gynecologic Oncology, Ajou University School of Medicine, Suwon, Korea.,Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
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Abstract
Ovarian cancer remains the most lethal gynecological malignant tumor, with relapse
occurring in approximately 70% of advanced cases. Anlotinib is an oral small-molecule
multi-targeted tyrosine kinase inhibitor that can resist neoangiogenesis and inhibit tumor
growth. Previous research demonstrated clinical antitumor activity of anlotinib in various
cancers. We report the case of an elderly woman with advanced ovarian cancer who received
anlotinib after failure of multiple-line chemotherapy. A partial response was observed
after six cycles of anlotinib monotherapy, with a reduction in the size of the metastases
and significantly decreased serum CA125 levels from 1832.7 U/mL to 118.7 U/mL. She
continued to take anlotinib, with a progression-free survival time of more than 4 months.
Only mild hypertension was observed during the treatment. Anlotinib monotherapy may be a
novel therapeutic option for patients with advanced ovarian cancer.
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Affiliation(s)
- Ping Zhang
- Department of Oncology, Dezhou People's Hospital, Dezhou, P.R. China
| | - Liangliang Ma
- Department of Oncology, Dezhou People's Hospital, Dezhou, P.R. China
| | - Xiaojie Wang
- Department of Oncology, Dezhou People's Hospital, Dezhou, P.R. China
| | - Ruijie Zhang
- Department of Radiology, Dezhou People's Hospital, Dezhou, P.R. China
| | - Yuting Dong
- Department of Oncology, Dezhou People's Hospital, Dezhou, P.R. China
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Zhang J, Mei L, Wang F, Li Y. Ten years' disease-free survival of advanced epithelial ovarian cancer treated by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: A case report and literature review. Medicine (Baltimore) 2020; 99:e23404. [PMID: 33285729 PMCID: PMC7717790 DOI: 10.1097/md.0000000000023404] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE One of the most distinctive features of epithelial ovarian cancer is tendency to disseminate into peritoneal cavity to form peritoneal carcinomatosis, indicating advanced disease with poor prognosis. PATIENT CONCERNS A fifty-year-old patient had a chief complaint of an abdominal distension lasting 1 month. DIAGNOSES The patient was diagnosed with advanced epithelial ovarian cancer with peritoneal carcinomatosis by computed tomography scan, tumor markers, endoscopy examination, and pathology. INTERVENTIONS The patient was treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy followed by 8 cycles of systemic chemotherapy. OUTCOMES Till March 9, 2020, the patient has disease-free survival over 10 years. LESSONS The application of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy combined with systematic chemotherapy may improve survival dramatically for the patients with epithelial ovarian cancer and peritoneal carcinomatosis and should be considered as an option of a relatively new regime.
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Affiliation(s)
- Jue Zhang
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, PR. China
| | - Liejun Mei
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR. China
| | - Fubing Wang
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR. China
| | - Yan Li
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, PR. China
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38
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Zhao DX, Chen P, Su CH, Zhao YY, Sun LD, He H, Feng XN. Efficacy of weekly paclitaxel for the treatment of advanced ovarian cancer: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20537. [PMID: 32569173 PMCID: PMC7310853 DOI: 10.1097/md.0000000000020537] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aims to assess the efficacy and safety of weekly paclitaxel (WP) for the treatment of advanced ovarian cancer (AOC). METHODS This study will systematically search bibliographic databases (MEDLINE, EMBASE, Cochrane Library, Web of Science, CINAHL, PSYCINFO, Allied and Complementary Medicine Database, CNKI, WANGFANG, and Chinese Biomedical Literature Database) and other literature sources from inception to the March 1, 2020 without language and publication time limitations. Two authors will independently complete all literature selection, data collection, and study quality evaluation. Any disagreements will be solved by a third author through discussion. We will analyze data by RevMan V.5.3 software. RESULTS This study will systematically generate a comprehensive summary on the efficacy and safety of WP for the treatment of AOC. CONCLUSION This study may provide beneficial evidence of WP for the treatment of AOC. SYSTEMATIC REVIEW REGISTRATION INPLASY202040193.
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Affiliation(s)
- Dong-xu Zhao
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Jiamusi University, Jiamusi
| | - Ping Chen
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Jiamusi University, Jiamusi
| | - Cui-hong Su
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Jiamusi University, Jiamusi
| | - Yan-yan Zhao
- Department of Obstetrics and Gynecology, Shenzhen Sami Medical Center, Shenzhen, China
| | - Li-dan Sun
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Jiamusi University, Jiamusi
| | - Hong He
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Jiamusi University, Jiamusi
| | - Xiao-na Feng
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Jiamusi University, Jiamusi
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Harter P, Heitz F, Ataseven B, Schneider S, Baert T, Prader S, du Bois A. How to manage lymph nodes in ovarian cancer. Cancer 2020; 125 Suppl 24:4573-4577. [PMID: 31967675 DOI: 10.1002/cncr.32514] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 07/16/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 01/16/2023]
Abstract
The indication for staging lymphadenectomy in patients with ovarian cancer (both early- and late-stage disease) has been a major topic of debate in the last decades. Because the Lymphadenectomy in Ovarian Neoplasms (LION) study has recently demonstrated that systematic lymphadenectomy is not beneficial to patients with advanced ovarian cancer, the discussion has become more complex for patients with early-stage ovarian cancer. Further factors, such as differences in the lymph node metastasis rates of different histologic subtypes, which were not known in the past, need to be taken into account. This review is focused on the available evidence concerning lymphadenectomy in patients with newly diagnosed ovarian cancer.
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Affiliation(s)
- Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen Mitte, Essen, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen Mitte, Essen, Germany.,Department of Obstetrics and Gynecology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen Mitte, Essen, Germany
| | - Thais Baert
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen Mitte, Essen, Germany.,Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, Department of Oncology, Catholic University of Leuven, Leuven, Belgium
| | - Sonia Prader
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen Mitte, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen Mitte, Essen, Germany
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40
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Hall JP, Chang J, Moon R, Higson O, Byrne K, Doherty JP, Cappelleri JC. Real-world treatment patterns in patients with advanced (stage III-IV) ovarian cancer in the USA and Europe. Future Oncol 2020; 16:1013-1030. [PMID: 32326746 DOI: 10.2217/fon-2020-0083] [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: 12/24/2022] Open
Abstract
Aim: To analyze real-world data relating to treatment decision-making in stage III-IV ovarian cancer (OC). Materials & methods: Real world data were collected from a survey of physicians and their patients (n = 2413) across Europe and the USA in 2017-2018. Results: 49% had stage IVb disease. 39, 54 and 7% of patients received first-line (1L), second-line, or 7% third-line or later treatment. In the 1L (ongoing or completed), 93% received platinum-containing regimens, 26% bevacizumab-containing regimens and 1% a PARP inhibitor-containing regimen. In 1L maintenance treatment, 81% received bevacizumab, 17% platinum-containing treatments and 6% a PARP inhibitor. Conclusion: The most common 1L treatment for advanced ovarian cancer was platinum-containing chemotherapy. Of those receiving 1L maintenance therapy, 70-99% (across countries) received targeted therapy.
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Dai Y, Zhao XJ, Li F, Yuan Y, Yan DM, Cao H, Huang XY, Hu Z, Ma D, Gao QL. Truncated Bid Regulates Cisplatin Response via Activation of Mitochondrial Apoptosis Pathway in Ovarian Cancer. Hum Gene Ther 2020; 31:325-338. [PMID: 32024383 DOI: 10.1089/hum.2019.206] [Citation(s) in RCA: 10] [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] [Indexed: 12/30/2022] Open
Abstract
Refractoriness to conventional chemotherapy is a major challenge in the treatment of advanced ovarian cancer (OC). There is increasing evidence that mitochondrial priming correlates with cisplatin response in various cancers. Notably, Bim and Bid, two of the proapoptotic BH3-only proteins, are recognized as the most effective inducers of mitochondrial priming in OC. In this study, we constructed two tumor-specific oncolytic adenoviruses (Ads) coding for Bim (Ad-Bim) or truncated Bid (Ad-tBid), respectively, and performed gain-of-function assays in nine OC cell lines. Ad-tBid exhibited significant antitumor efficacy than the controls. On addition of Ad-tBid pretreatment, mito-primed cells displayed more sensitivity to cisplatin both in vitro and ex vivo. We also found that Ad-tBid induced mitochondrial apoptosis in a Bak-dependent manner. Furthermore, a combined cisplatin plus Ad-tBid therapy markedly inhibited tumor growth in a subcutaneous xenotransplanted tumor model. In mice bearing peritoneal disseminated OC, intraperitoneal administration of Ad-tBid potentiated the antitumor effect of cisplatin. Our findings suggest that Ad-tBid enhances cisplatin response in OC cells, establishing the potential treatment of advanced OC via a combination of cisplatin and Ad-tBid.
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Affiliation(s)
- Yun Dai
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan, People's Republic of China
| | - Xue-Jiao Zhao
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan, People's Republic of China
| | - Fei Li
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan, People's Republic of China
| | - Yuan Yuan
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan, People's Republic of China
| | - Dan-Mei Yan
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan, People's Republic of China
| | - Heng Cao
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan, People's Republic of China
| | - Xiao-Yuan Huang
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan, People's Republic of China
| | - Zheng Hu
- Department of Obstetrics and Gynecology, Precision Medicine Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Ding Ma
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan, People's Republic of China
| | - Qing-Lei Gao
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan, People's Republic of China
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42
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Wang Y, Ren F, Song Z, Wang X, Zhang C, Ouyang L. Prognostic Significance of Systematic Lymphadenectomy in Patients With Optimally Debulked Advanced Ovarian Cancer: A Meta-Analysis. Front Oncol 2020; 10:86. [PMID: 32117740 PMCID: PMC7026262 DOI: 10.3389/fonc.2020.00086] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/16/2020] [Indexed: 01/11/2023] Open
Abstract
Background: The effect of systematic lymphadenectomy (SL) on survival in patients with optimally debulked advanced ovarian cancer remains unclear. We evaluated the therapeutic value of SL in advanced ovarian cancer patients who underwent primary optimal debulking surgery. Methods: A meta-analysis was carried out using articles retrieved from the PubMed, Embase, and Cochrane databases. Overall survival (OS) and progression-free survival (PFS) were compared between patients who underwent SL and those who underwent unsystematic lymphadenectomy (USL). Results: Seven studies that included 2,425 patients with advanced ovarian cancer were included in the meta-analysis. The overall analyses indicated significantly improved OS [hazard ratio (HR) = 0.64, 95% confidence interval (CI): 0.49–0.84, P < 0.01] but not PFS (HR = 0.89, 95% CI: 0.69–1.15, P = 0.38) in patients who underwent SL compared to those who underwent USL. Subgroup analyses based on study type, study quality, total numbers of patients, and International Federation of Gynecology and Obstetrics (FIGO) stage provided similar results. However, subgroup analysis of patients with no residual tumor revealed that SL was not associated with improved OS (HR = 0.81, 95% CI: 0.66–1.00, P = 0.05) or PFS (HR = 1.09, 95% CI: 0.91–1.30, P = 0.33). Conclusions: In patients with optimally debulked advanced ovarian cancer, SL may improve OS but not PFS. However, SL does not provide a survival advantage when macroscopically complete resection of all visible tumors is achieved.
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Affiliation(s)
- Yizi Wang
- Department of the Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fang Ren
- Department of the Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zixuan Song
- Department of the Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoying Wang
- Department of the Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chiyuan Zhang
- Department of the Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Ouyang
- Department of the Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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43
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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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44
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Pokhriyal R, Hariprasad R, Kumar L, Hariprasad G. Chemotherapy Resistance in Advanced Ovarian Cancer Patients. Biomark Cancer 2019; 11:1179299X19860815. [PMID: 31308780 PMCID: PMC6613062 DOI: 10.1177/1179299x19860815] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 05/08/2019] [Indexed: 12/26/2022]
Abstract
Ovarian cancer is the seventh most common gynaecologic malignancy seen in women. Majority of the patients with ovarian cancer are diagnosed at the advanced stage making prognosis poor. The standard management of advanced ovarian cancer includes tumour debulking surgery followed by chemotherapy. Various types of chemotherapeutic regimens have been used to treat advanced ovarian cancer, but the most promising and the currently used standard first-line treatment is carboplatin and paclitaxel. Despite improved clinical response and survival to this combination of chemotherapy, numerous patients either undergo relapse or succumb to the disease as a result of chemotherapy resistance. To understand this phenomenon at a cellular level, various macromolecules such as DNA, messenger RNA and proteins have been developed as biomarkers for chemotherapy response. This review comprehensively summarizes the problem that pertains to chemotherapy resistance in advanced ovarian cancer and provides a good overview of the various biomarkers that have been developed in this field.
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Affiliation(s)
- Ruchika Pokhriyal
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Hariprasad
- Division of Clinical Oncology, National Institute of Cancer Prevention and Research, Noida, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Gururao Hariprasad
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
- Gururao Hariprasad, Department of Biophysics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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45
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Garziera M, Roncato R, Montico M, De Mattia E, Gagno S, Poletto E, Scalone S, Canzonieri V, Giorda G, Sorio R, Cecchin E, Toffoli G. New Challenges in Tumor Mutation Heterogeneity in Advanced Ovarian Cancer by a Targeted Next-Generation Sequencing (NGS) Approach. Cells 2019; 8:cells8060584. [PMID: 31197119 PMCID: PMC6627128 DOI: 10.3390/cells8060584] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/06/2019] [Accepted: 06/13/2019] [Indexed: 12/12/2022] Open
Abstract
Next-generation sequencing (NGS) technology has advanced knowledge of the genomic landscape of ovarian cancer, leading to an innovative molecular classification of the disease. However, patient survival and response to platinum-based treatments are still not predictable based on the tumor genetic profile. This retrospective study characterized the repertoire of somatic mutations in advanced ovarian cancer to identify tumor genetic markers predictive of platinum chemo-resistance and prognosis. Using targeted NGS, 79 primary advanced (III-IV stage, tumor grade G2-3) ovarian cancer tumors, including 64 high-grade serous ovarian cancers (HGSOCs), were screened with a 26 cancer-genes panel. Patients, enrolled between 1995 and 2011, underwent primary debulking surgery (PDS) with optimal residual disease (RD < 1 cm) and platinum-based chemotherapy as first-line treatment. We found a heterogeneous mutational landscape in some uncommon ovarian histotypes and in HGSOC tumor samples with relevance in predicting platinum sensitivity. In particular, we identified a poor prognostic signature in patients with HGSOC harboring concurrent mutations in two driver actionable genes of the panel. The tumor heterogeneity described, sheds light on the translational potential of targeted NGS approach for the identification of subgroups of patients with distinct therapeutic vulnerabilities, that are modulated by the specific mutational profile expressed by the ovarian tumor.
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Affiliation(s)
- Marica Garziera
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Rossana Roncato
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Marcella Montico
- Scientific Directorate, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Elena De Mattia
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Sara Gagno
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Elena Poletto
- Medical Oncology, "Santa Maria della Misericordia" University Hospital, ASUIUD, 33100 Udine, Italy.
| | - Simona Scalone
- Medical Oncology Unit C, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Vincenzo Canzonieri
- Pathology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy.
| | - Giorgio Giorda
- Gynecological Oncology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Roberto Sorio
- Medical Oncology Unit C, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Erika Cecchin
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Giuseppe Toffoli
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
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46
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Llueca A, Serra A, Delgado K, Maiocchi K, Jativa R, Gomez L, Escrig J. A radiologic-laparoscopic model to predict suboptimal (or complete and optimal) debulking surgery in advanced ovarian cancer: a pilot study. Int J Womens Health 2019; 11:333-342. [PMID: 31239786 PMCID: PMC6554528 DOI: 10.2147/ijwh.s198355] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/25/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: Medical models assist clinicians in making diagnostic and prognostic decisions in complex situations. In advanced ovarian cancer, medical models could help prevent unnecessary exploratory surgery. We designed two models to predict suboptimal or complete and optimal cytoreductive surgery in patients with advanced ovarian cancer. Methods: We collected clinical, pathological, surgical, and residual tumor data from 110 patients with advanced ovarian cancer. Computed tomographic and laparoscopic data from these patients were used to determine peritoneal cancer index (PCI) and lesion size score. These data were then used to construct two-by-two contingency tables and our two predictive models. Each model included three risk score levels; the R4 model also included operative PCI, while the R3 model did not. Finally, we used the original patient data to validate the models (narrow validation). Results: Our models predicted suboptimal or complete and optimal cytoreductive surgery with a sensitivity of 83% (R4 model) and 69% (R3 model). Our results also showed that PCI>20 was a major risk factor for unresectability. Conclusion: Our medical models successfully predicted suboptimal or complete and optimal cytoreductive surgery in 110 patients with advanced ovarian cancer. Our models are easy to construct, based on readily available laboratory test data, simple to use clinically, and could reduce unnecessary exploratory surgery in this patient group.
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Affiliation(s)
- Antoni Llueca
- Department of Obstetrics and Gynecology, University General Hospital of Castellon, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Medicine, University Jaume I(UJI), Castellon, Spain
| | - Anna Serra
- Department of Obstetrics and Gynecology, University General Hospital of Castellon, Castellón, Spain.,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Medicine, University Jaume I(UJI), Castellon, Spain
| | - Katty Delgado
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Radiology, University General Hospital of Castellon, Castellón, Spain
| | - Karina Maiocchi
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
| | - Rosa Jativa
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Anesthesiology, University General Hospital of Castellon, Castellón, Spain
| | - Luis Gomez
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
| | - Javier Escrig
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain.,Department of Medicine, University Jaume I(UJI), Castellon, Spain.,Department of General Surgery, University General Hospital of Castellon, Castellón, Spain
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Song N, Gao Y. Therapeutic value of selective lymphadenectomy in interval debulking surgery for stage IIIc and IV epithelial ovarian cancer. Int J Gynecol Cancer 2019; 29:761-767. [PMID: 30850437 DOI: 10.1136/ijgc-2018-000200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/03/2019] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The role of selective lymphadenectomy at the time of interval debulking surgery in patients with advanced ovarian cancer remains a topic of debate. This study aimed to evaluate the value of selective lymphadenectomy during interval debulking surgery in patients with radiologic evidence of lymph node metastasis at initial diagnosis that ultimately become negative on imaging after neoadjuvant chemotherapy. METHODS A retrospective analysis including patients with stage IIIC-IV epithelial ovarian cancer and suspicious pelvic or para-aortic lymph node metastasis by imaging at diagnosis that resolved after neoadjuvant chemotherapy. The study was conducted from January 1996 to June 2016 with R0 interval debulking surgery. The patients with disease progression after neoadjuvant chemotherapy were excluded. Suspicious metastatic lymph nodes at initial diagnosis by computed tomography/magnetic resonance imaging were excised by selective lymphadenectomy. Survival curves were constructed by the Kaplan-Meier method, and a multivariate analysis was performed using Cox regression. RESULTS There were a total of 330 patients included in the analysis. Selective lymphadenectomy of suspicious nodes (Group 1) was performed in 145 patients. Systematic lymphadenectomy (Group 2) was performed in 118 patients. Sixty-seven patients did not undergo lymphadenectomy (Group 3). There were no significant differences in clinicopathologic features among the groups. Median progression-free survival was 28, 30.5, and 22 months in Groups 1, 2, and 3, respectively (log-rank, p=0.049). No-lymphadenectomy was an independent factor affecting progression-free survival (Cox analysis, HR=1.729, 95% CI 1.213 to 2.464, p=0.002), with no difference between Groups 1 and 2 (Cox analysis, HR=1.097, 95% CI 0.815 to 1.478, p=0.541). Median overall survival was 50, 59, and 57 months in Groups 1, 2, and 3, respectively (Cox analysis, p=0.566). Patients who underwent selective lymphadenectomy had lower 1-year frequencies of lower extremity lymphedema and lymphocysts than those with systematic lymphadenectomy (6.2% vs 33.1%, p<0.001, and 6.2 % vs 27.1%, p<0.001, respectively). CONCLUSIONS Extent of lymphadenectomy (systematic or selective) had no significant impact on progression-free survival or overall survival. In addition, the risks of lower extremity lymphedema and lymphocysts were lower in patients who underwent selective lymphadenectomy.
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Affiliation(s)
- Nan Song
- Department of Gynecology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yunong Gao
- Department of Gynecology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
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Llueca A, Serra A, Maiocchi K, Delgado K, Jativa R, Gomez L, Escrig J. Predictive model for major complications after extensive abdominal surgery in primary advanced ovarian cancer. Int J Womens Health 2019; 11:161-167. [PMID: 30881145 PMCID: PMC6410758 DOI: 10.2147/ijwh.s190493] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 12/23/2022] Open
Abstract
Background Surgery for advanced ovarian cancer (AOC) frequently results in serious complications. The present study aimed to determine the importance of various factors and complications in cytoreductive surgery for AOC. Patients and methods The present study included 90 patients with AOC who underwent primary cytoreductive surgery in a single institution from January 2013 to August 2017. Demographic and clinicopathologic characteristics, surgical procedures, residual disease, and follow-up data were analyzed. Cytoreductive surgery was defined as complete (no residual tumor), optimal (residual tumor <1 cm in diameter), and suboptimal (residual tumor >1 cm in diameter). Grade III–IV complications were considered major. Patients were evaluated every 3–6 months. Results Surgical outcome was complete in 75 (82%), optimal in 5 (6%), and suboptimal in 11 (12%) patients. Major complications occurred in 28 (31%) patients. Independent risk factors for major complications were ≥five visceral resections, rectosigmoid resection, glissectomy, and pelvic peritonectomy. A score created by weighing the multivariate OR for each risk factor correctly predicted major complications in 67% of cases. A score cut-off of >2 discriminated between patients with and without complications in 79% of cases (95% CI: 70%–86%, P<0.001). Adjuvant chemotherapy was performed as planned in 67 patients (74%), including 50 (75%) without major complications and 17 (25%) with major complications. Conclusion Risk factors for major complications in cytoreductive surgery for AOC are ≥five visceral resections, rectosigmoid resection, glissectomy, and pelvic peritonectomy. Our model predicts morbidity based on major and minor classifications of complications.
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Affiliation(s)
- Antoni Llueca
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, Castellon, Spain, .,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellon, Spain, .,Department of Medicine, University Jaume I (UJI), Castellon, Spain,
| | - Anna Serra
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, Castellon, Spain, .,Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellon, Spain, .,Department of Medicine, University Jaume I (UJI), Castellon, Spain,
| | - Karina Maiocchi
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellon, Spain, .,Department of General Surgery, University General Hospital of Castellon, Castellon, Spain
| | - Katty Delgado
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellon, Spain, .,Department of Radiology
| | - Rosa Jativa
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellon, Spain, .,Department of Anaesthesiology, University General Hospital of Castellon, Castellon, Spain
| | - Luis Gomez
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellon, Spain, .,Department of General Surgery, University General Hospital of Castellon, Castellon, Spain
| | - Javier Escrig
- Department of Medicine, University Jaume I (UJI), Castellon, Spain, .,Department of General Surgery, University General Hospital of Castellon, Castellon, Spain.,Department of Radiology
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Son JH, Kong TW, Paek J, Chang SJ, Ryu HS. Perioperative outcomes of extensive bowel resection during cytoreductive surgery in patients with advanced ovarian cancer. J Surg Oncol 2019; 119:1011-1015. [PMID: 30737795 DOI: 10.1002/jso.25403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/13/2018] [Revised: 01/15/2019] [Accepted: 01/27/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES To achieve optimal cytoreduction, extensive bowel resections are sometimes required in patients with advanced ovarian cancer. Few studies have focused on the extent or number of resections of bowel surgeries and their feasibility. METHODS We retrospectively reviewed the medical records of patients with advanced ovarian cancer who underwent bowel surgery as part of debulking procedures at Ajou University Hospital from 2006 to 2018. Patients who received extensive bowel resections (two-segment resections or subtotal colectomy) were identified, and their perioperative outcomes were evaluated. RESULTS A total of 172 patients underwent bowel surgery. Of them, 128 (74.4%) underwent one-segment bowel resection, 25 (14.5%) underwent two-segment bowel resections, and 19 (11.1%) underwent subtotal colectomy. Although the operative time, transfusion rate, and postoperative bleeding events were higher in patients who underwent extensive bowel resection, the rates of perioperative complications were not significantly higher in this group. Anastomotic leakage occurred in two (1.5%) patients in the one-segment resection group, one (4.2%) patient in the multiple resection group, and two (10.5%) patients in the subtotal colectomy group. CONCLUSIONS Multiple bowel resections (up to two segments) are feasible and can be safely performed with an acceptable complication rate in patients with advanced ovarian cancer.
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Affiliation(s)
- Joo-Hyuk Son
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Tae-Wook Kong
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jiheum Paek
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Suk-Joon Chang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hee-Sug Ryu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
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Cerne K, Hadzialjevic B, Skof E, Verdenik I, Kobal B. Potential of osteopontin in the management of epithelial ovarian cancer. Radiol Oncol 2019; 53:105-115. [PMID: 30712025 PMCID: PMC6411016 DOI: 10.2478/raon-2019-0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/27/2018] [Indexed: 02/07/2023] Open
Abstract
Background Osteopontin (sOPN) is a promising blood tumour marker for detecting epithelial ovarian cancer (EOC). However, other clinical uses of sOPN as a tumour marker in EOC are still lacking. Since sOPN concentrations in serum are not associated with those in ascites, we compared clinical value of sOPN concentrations in the two body fluids. Patients and methods The study included 31 women with advanced EOC and 34 women with benign gynaecological pathology. In the EOC group, serum for sOPN analysis was obtained preoperatively, after primary debulking surgery and after chemotherapy. In the control group, serum was obtained before and after surgery. Ascites and peritoneal fluid were obtained during surgery. sOPN concentrations were determined by flow cytometry bead-based assay. Results The sensitivity and specificity of sOPN in detecting EOC was 91.2% and 90.3% (cut-off = 47.4 ng/ml) in serum, and 96.8% and 100% (cut-off = 529.5 ng/ml) in ascites. Kaplan-Meier analysis showed a significant association between higher serum sOPN concentration and overall survival (p = 0.018) or progression free survival (p = 0.008). Higher ascites sOPN concentrations were associated with suboptimally debulked tumour and unresectable disease. Higher serum sOPN concentrations were associated with refractory disease or incomplete response to platinum-based chemotherapy. Conclusions The study showed that ascites sOPN level mirrors present disease and is superior to serum level for diagnostic purposes and surgical planning, although the end result of treatment is the response of the whole body in fighting the disease. The preoperative sOPN concentration in serum thus better reflects disease outcome.
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Affiliation(s)
- Katarina Cerne
- Institute of Pharmacology and Experimental Toxicology, Faculty of Medicine, University Ljubljana, Ljubljana, Slovenia
| | - Benjamin Hadzialjevic
- Institute of Pharmacology and Experimental Toxicology, Faculty of Medicine, University Ljubljana, Ljubljana, Slovenia
| | - Erik Skof
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Gynaecology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University Ljubljana, Ljubljana, Slovenia
| | - Borut Kobal
- Department of Gynaecology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University Ljubljana, Ljubljana, Slovenia
- Prof. Borut Kobal, M.D., Ph.D, Department of Gynaecology and Obstetrics, Faculty of Medicine, University Ljubljana, Šlajmarjeva 3, SI-1000 Ljubljana, Slovenia. Phone: +386 1 522 6060
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