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Glajzer J, Castillo-Tong DC, Richter R, Vergote I, Kulbe H, Vanderstichele A, Ruscito I, Trillsch F, Mustea A, Kreuzinger C, Gourley C, Gabra H, Taube ET, Dorigo O, Horst D, Keunecke C, Baum J, Angelotti T, Sehouli J, Braicu EI. Impact of BRCA Mutation Status on Tumor Dissemination Pattern, Surgical Outcome and Patient Survival in Primary and Recurrent High-Grade Serous Ovarian Cancer: A Multicenter Retrospective Study by the Ovarian Cancer Therapy-Innovative Models Prolong Survival (OCTIPS) Consortium. Ann Surg Oncol 2023; 30:35-45. [PMID: 36085390 PMCID: PMC9726811 DOI: 10.1245/s10434-022-12459-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 08/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study seeks to evaluate the impact of breast cancer (BRCA) gene status on tumor dissemination pattern, surgical outcome and survival in a multicenter cohort of paired primary ovarian cancer (pOC) and recurrent ovarian cancer (rOC). PATIENTS AND METHODS Medical records and follow-up data from 190 patients were gathered retrospectively. All patients had surgery at pOC and at least one further rOC surgery at four European high-volume centers. Patients were divided into one cohort with confirmed mutation for BRCA1 and/or BRCA2 (BRCAmut) and a second cohort with BRCA wild type or unknown (BRCAwt). Patterns of tumor presentation, surgical outcome and survival data were analyzed between the two groups. RESULTS Patients with BRCAmut disease were on average 4 years younger and had significantly more tumor involvement upon diagnosis. Patients with BRCAmut disease showed higher debulking rates at all stages. Multivariate analysis showed that only patient age had significant predictive value for complete tumor resection in pOC. At rOC, however, only BRCAmut status significantly correlated with optimal debulking. Patients with BRCAmut disease showed significantly prolonged overall survival (OS) by 24.3 months. Progression-free survival (PFS) was prolonged in the BRCAmut group at all stages as well, reaching statistical significance during recurrence. CONCLUSIONS Patients with BRCAmut disease showed a more aggressive course of disease with earlier onset and more extensive tumor dissemination at pOC. However, surgical outcome and OS were significantly better in patients with BRCAmut disease compared with patients with BRCAwt disease. We therefore propose to consider BRCAmut status in regard to patient selection for cytoreductive surgery, especially in rOC.
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Affiliation(s)
- Jacek Glajzer
- Department of Gynecology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, Berlin, Germany ,Tumorbank Ovarian Cancer Network, Berlin, Germany ,Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, Erlangen, Germany
| | - Dan Cacsire Castillo-Tong
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Rolf Richter
- Department of Gynecology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Ignace Vergote
- Tumorbank Ovarian Cancer Network, Berlin, Germany ,Division of Gynecological Oncology, Department of Gynaecology and Obstetrics, Leuven Cancer Institute, Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, Herestraat 49, Leuven, Belgium
| | - Hagen Kulbe
- Department of Gynecology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, Berlin, Germany ,Tumorbank Ovarian Cancer Network, Berlin, Germany
| | - Adriaan Vanderstichele
- Tumorbank Ovarian Cancer Network, Berlin, Germany ,Division of Gynecological Oncology, Department of Gynaecology and Obstetrics, Leuven Cancer Institute, Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, Herestraat 49, Leuven, Belgium
| | - Ilary Ruscito
- Department of Gynecology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, Berlin, Germany ,Tumorbank Ovarian Cancer Network, Berlin, Germany ,Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Fabian Trillsch
- Department of Obstetrics and Gynecology, University Hospital LMU Munich, Munich, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Caroline Kreuzinger
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria ,Institute of Science and Technology Austria, Am Campus 1, Klosterneuburg, Austria
| | - Charlie Gourley
- Nicola Murray Centre for Ovarian Cancer Research, University of Edinburgh Cancer Research UK Centre, MRC Institute of Genetics and Cancer,, Western General Hospital, Crewe Road South, Edinburgh, UK
| | - Hani Gabra
- Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Eliane T. Taube
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Oliver Dorigo
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stanford University School of Medicine, Stanford, CA USA
| | - David Horst
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Carlotta Keunecke
- Department of Gynecology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, Berlin, Germany ,Tumorbank Ovarian Cancer Network, Berlin, Germany
| | - Joanna Baum
- Department of Gynecology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, Berlin, Germany ,Tumorbank Ovarian Cancer Network, Berlin, Germany
| | - Timothy Angelotti
- Department of Anesthesiology, Perioperative and Pain Medicine, 300 Pasteur Drive H3580, Stanford, CA USA
| | - Jalid Sehouli
- Department of Gynecology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, Berlin, Germany ,Tumorbank Ovarian Cancer Network, Berlin, Germany
| | - Elena Ioana Braicu
- Department of Gynecology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, Berlin, Germany ,Tumorbank Ovarian Cancer Network, Berlin, Germany ,Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stanford University School of Medicine, Stanford, CA USA
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2
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Phung MT, Webb PM, DeFazio A, Fereday S, Lee AW, Bowtell DDL, Fasching PA, Goode EL, Goodman MT, Karlan BY, Lester J, Matsuo K, Modugno F, Brenton JD, Van Gorp T, Pharoah PDP, Schildkraut JM, McLean K, Meza R, Mukherjee B, Richardson J, Grout B, Chase A, McKinnon Deurloo C, Terry KL, Hanley GE, Pike MC, Berchuck A, Ramus SJ, Pearce CL. Lifestyle and personal factors associated with having macroscopic residual disease after ovarian cancer primary cytoreductive surgery. Gynecol Oncol 2023; 168:68-75. [PMID: 36401943 PMCID: PMC10398872 DOI: 10.1016/j.ygyno.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The presence of macroscopic residual disease after primary cytoreductive surgery (PCS) is an important factor influencing survival for patients with high-grade serous ovarian cancer (HGSC). More research is needed to identify factors associated with having macroscopic residual disease. We analyzed 12 lifestyle and personal exposures known to be related to ovarian cancer risk or inflammation to identify those associated with having residual disease after surgery. METHODS This analysis used data on 2054 patients with advanced stage HGSC from the Ovarian Cancer Association Consortium. The exposures were body mass index, breastfeeding, oral contraceptive use, depot-medroxyprogesterone acetate use, endometriosis, first-degree family history of ovarian cancer, incomplete pregnancy, menopausal hormone therapy use, menopausal status, parity, smoking, and tubal ligation. Logistic regression models were fit to assess the association between these exposures and having residual disease following PCS. RESULTS Menopausal estrogen-only therapy (ET) use was associated with 33% lower odds of having macroscopic residual disease compared to never use (OR = 0.67, 95%CI 0.46-0.97, p = 0.033). Compared to nulliparous women, parous women who did not breastfeed had 36% lower odds of having residual disease (OR = 0.64, 95%CI 0.43-0.94, p = 0.022), while there was no association among parous women who breastfed (OR = 0.90, 95%CI 0.65-1.25, p = 0.53). CONCLUSIONS The association between ET and having no macroscopic residual disease is plausible given a strong underlying biologic hypothesis between this exposure and diagnosis with HGSC. If this or the parity finding is replicated, these factors could be included in risk stratification models to determine whether HGSC patients should receive PCS or neoadjuvant chemotherapy.
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Affiliation(s)
- Minh Tung Phung
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Penelope M Webb
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Anna DeFazio
- Centre for Cancer Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Gynaecological Oncology, Westmead Hospital, Sydney, NSW, Australia; The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Sian Fereday
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Alice W Lee
- Department of Public Health, California State University, Fullerton, Fullerton, CA, USA
| | - David D L Bowtell
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter A Fasching
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, Los Angeles, California, USA; Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Ellen L Goode
- Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Marc T Goodman
- Samuel Oschin Comprehensive Cancer Institute, Cancer Prevention and Genetics Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Community and Population Health Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Beth Y Karlan
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jenny Lester
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Francesmary Modugno
- Women's Cancer Research Center, Magee-Women's Research Institute and Hillman Cancer Center, Pittsburgh, PA, USA; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburg, PA, USA
| | - James D Brenton
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Toon Van Gorp
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Paul D P Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK; Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Karen McLean
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, Canada
| | - Bhramar Mukherjee
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jean Richardson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Patient Advocate
| | | | | | | | - Kathryn L Terry
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA; Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gillian E Hanley
- University of British Columbia Faculty of Medicine, Department of Obstetrics & Gynecology, Vancouver, Canada
| | - Malcolm C Pike
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Berchuck
- Division of Gynecologic Oncology, Duke University School of Medicine, Durham, NC, USA
| | - Susan J Ramus
- School of Clinical Medicine, Faculty of Medicine and Health, University of NSW, Sydney, New South Wales, Australia; Adult Cancer Program, Lowy Cancer Research Centre, University of NSW, Sydney, New South Wales, Australia
| | - Celeste Leigh Pearce
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
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3
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De Jong D, Otify M, Chen I, Jackson D, Jayasinghe K, Nugent D, Thangavelu A, Theophilou G, Laios A. Survival and Chemosensitivity in Advanced High Grade Serous Epithelial Ovarian Cancer Patients with and without a BRCA Germline Mutation: More Evidence for Shifting the Paradigm towards Complete Surgical Cytoreduction. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111611. [PMID: 36363568 PMCID: PMC9699274 DOI: 10.3390/medicina58111611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
Background and Objectives: Approximately 10−15% of high-grade serous ovarian cancer (HGSOC) cases are related to BRCA germline mutations. Better survival rates and increased chemosensitivity are reported in patients with a BRCA 1/2 germline mutation. However, the FIGO stage and histopathological entity may have been confounding factors. This study aimed to compare chemotherapy response and survival between patients with and without a BRCA 1/2 germline mutation in advanced HGSOC receiving neoadjuvant chemotherapy (NACT). Materials and Methods: A cohort of BRCA-tested advanced HGSOC patients undergoing cytoreductive surgery following NACT was analyzed for chemotherapy response and survival. Neoadjuvant chemotherapy served as a vehicle to assess chemotherapy response on biochemical (CA125), histopathological (CRS), biological (dissemination), and surgical (residual disease) levels. Univariate and multivariate analyses for chemotherapy response and survival were utilized. Results: Thirty-nine out of 168 patients had a BRCA ½ germline mutation. No differences in histopathological chemotherapy response between the patients with and without a BRCA ½ germline mutation were observed. Survival in the groups of patients was comparable Irrespective of the BRCA status, CRS 2 and 3 (HR 7.496, 95% CI 2.523−22.27, p < 0.001 & HR 4.069, 95% CI 1.388−11.93, p = 0.011), and complete surgical cytoreduction (p = 0.017) were independent parameters for a favored overall survival. Conclusions: HGSOC patients with or without BRCA ½ germline mutations, who had cytoreductive surgery, showed comparable chemotherapy responses and subsequent survival. Irrespective of BRCA status, advanced-stage HGSOC patients have a superior prognosis with complete surgical cytoreduction and good histopathological response to chemotherapy.
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Affiliation(s)
- Diederick De Jong
- ESGO Center of Excellence for Advanced Ovarian Cancer Surgery, Department of Gynaecological Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - Mohamed Otify
- ESGO Center of Excellence for Advanced Ovarian Cancer Surgery, Department of Gynaecological Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - Inga Chen
- Department of Obstetrics and Gynaecology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - David Jackson
- Department of Medical Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - Kelum Jayasinghe
- ESGO Center of Excellence for Advanced Ovarian Cancer Surgery, Department of Gynaecological Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - David Nugent
- ESGO Center of Excellence for Advanced Ovarian Cancer Surgery, Department of Gynaecological Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - Amudha Thangavelu
- ESGO Center of Excellence for Advanced Ovarian Cancer Surgery, Department of Gynaecological Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - Georgios Theophilou
- ESGO Center of Excellence for Advanced Ovarian Cancer Surgery, Department of Gynaecological Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - Alexandros Laios
- ESGO Center of Excellence for Advanced Ovarian Cancer Surgery, Department of Gynaecological Oncology, St James’s University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
- Correspondence: ; Tel.: +44-(0)-1132068251
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4
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Ataseven B, Tripon D, Schwameis R, Harter P, Rhiem K, Schneider S, Heikaus S, Baert T, Francesco AP, Heitz F, Traut A, Groeben HT, Schmutzler R, du Bois A. Clinical outcome in patients with primary epithelial ovarian cancer and germline BRCA1/2-mutation - real life data. Gynecol Oncol 2021; 163:569-577. [PMID: 34565600 DOI: 10.1016/j.ygyno.2021.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND We evaluated the clinical impact of germline (g)BRCA1/2-mutation on initial disease presentation, surgical implications, surgical morbidity and survival in patients with advanced epithelial ovarian cancer (EOC) undergoing debulking surgery (DS). METHODS Data of all consecutive EOC patients with stage III/IV, high-grade serous disease and known gBRCA1/2 status (gBRCA; non-gBRCA), who underwent DS at our department between 01/2011 and 06/2019 were analyzed. Associations between gBRCA-status and severe postoperative complications and survival were analyzed. RESULTS gBRCA-status was determined in 50.1% (612/1221) of all patients. gBRCA was present in 21.9% (134/612). Significant differences were observed in terms of median age (p = 0.001) and histology (high-grade serous histology gBRCA: 98.5%, non-gBRCA 76.2%; p < 0.001). gBRCA-status had no impact on intraoperative disease presentation, surgical complexity or complete resection rate (gBRCA: 74.4%, non-gBRCA: 69.0%; p = 0.274). gBRCA-status was not predictive for severe postoperative complication (gBRCA: 12.0%, non-gBRCA: 19.1%; p = 0.082). Median PFS and OS was 31/22 and 71/53 months in patients with/without gBRCA-mutation, respectively. gBRCA was a significant prognostic factor for PFS (HR 0.57 p < 0.001) and for OS (HR 0.64, p = 0.048) after adjusting for established prognostic factors. CONCLUSIONS gBRCA-status had no impact on initial disease presentation, surgical results or postoperative complications. gBRCA patients have a significantly longer PFS but the impact on the long term prognosis is unclear. Complete resection remains the most important prognostic factor in patients with EOC independent of gBRCA-status.
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Affiliation(s)
- Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany; Department of Obstetrics and Gynecology, University Hospital, LMU, Munich, Germany.
| | - Denise Tripon
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany; Department of Obstetrics and Gynecology, University Hospital, LMU, Munich, Germany
| | - Richard Schwameis
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany; Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Austria
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany
| | | | - Thaïs Baert
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany; Department of Oncology, Laboratory of Tumour Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium
| | | | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany; Department of Gynecology, Campus Virchow Clinic, Charité Medical University, Berlin, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany
| | - Harald-Thomas Groeben
- Department of Anesthesiology and Intensive Care, Kliniken Essen-Mitte, Essen, Germany
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Evang, Kliniken Essen-Mitte, Essen, Germany
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5
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Kim SR, Malcolmson J, Li X, Bernardini MQ, Hogen L, May T. The correlation between BRCA status and surgical cytoreduction in high-grade serous ovarian carcinoma. Gynecol Oncol 2021; 162:702-706. [PMID: 34256977 DOI: 10.1016/j.ygyno.2021.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE BRCA-associated ovarian cancers are biologically unique; it is unclear if this translates to favorable outcomes at the time of primary cytoreduction (PCS). The aim of this study was to compare the amount of residual disease after PCS in BRCA mutated (BRCAm) and wild-type (BRCAwt) high-grade serous ovarian cancers (HGSC), and to assess whether BRCA status was an independent predictor of complete cytoreduction. METHODS We conducted a retrospective analysis of patients with stage III/IV HGSC with known germline and somatic BRCA status, treated with PCS from 2000 to 2017. We compared the complete, optimal and suboptimal cytoreduction rates between the BRCAm and BRCAwt cohorts and built a predictive model to assess whether BRCA status was predictive of complete cytoreduction. RESULTS Of 303 treated with PCS, 120 were germline/somatic BRCAm (40%) and 183 were BRCAwt (60%). BRCAm women tended to be younger, but there were no differences between the two groups in preoperative CA-125, disease burden, surgical complexity, length of surgery, or perioperative complications. BRCAm group had a higher rate of complete cytoreduction to no residual disease (0 mm) [72% vs. 48%] (p < 0.001). In a multivariate model, after accounting for age, length of surgery, CA-125 level, stage, disease burden and surgical complexity, BRCAm status was predictive of 0 mm residual disease with odds ratio of 5.3 (95% CI 2.45-11.5; p < 0.001). CONCLUSIONS BRCAm status is predictive of complete cytoreduction at the time of PCS. Despite similar disease burden and surgical efforts, one is more likely to achieve complete resection in BRCAm HGSC.
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Affiliation(s)
- Soyoun Rachel Kim
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health Systems, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Janet Malcolmson
- Familial Cancer Clinic, University Health Network, Toronto, Ontario, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Xuan Li
- Department of Biostatistics, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marcus Q Bernardini
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health Systems, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Liat Hogen
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health Systems, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Taymaa May
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health Systems, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada.
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6
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Estati FL, Pirolli R, de Alencar VTL, Ribeiro ARG, Formiga MN, Torrezan GT, Carraro DM, Guimarães APG, Baiocchi G, da Costa AABA. Impact of BRCA1/2 Mutations on the Efficacy of Secondary Cytoreductive Surgery. Ann Surg Oncol 2020; 28:3637-3645. [PMID: 33221980 DOI: 10.1245/s10434-020-09366-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/10/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Phase III trials evaluating the role of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer have pointed to the importance of patient selection. Two studies showed conflicting results regarding the benefit of SCS in BRCA1/2 mutation carriers. Our aim was to evaluate the impact of SCS on recurrent ovarian cancer according to BRCA1/2 status. METHODS All patients with ovarian carcinoma with platinum-sensitive recurrent disease and tested for BRCA1/2 germline mutations were included. Cox regression and log rank test were used to evaluate the impact of SCS on progression-free survival (PFS) and the influence of BRCA1/2 mutations on the effect of SCS. RESULTS 127 patients were included, 45.6% were treated with SCS and chemotherapy and 54.3% treated with chemotherapy only. Patients treated with SCS were younger, presented better performance status, had lower CA125, and had a longer platinum-free interval. In multivariate analysis SCS was associated with longer PFS (HR 0.42, 95% CI 0.25-0.72, p = 0.002). BRCA1/2 mutations were found in 35 patients (27.5%), and 11.8% of patients were treated with PARP inhibitors. Although not statistically significant, both BRCA1/2 wild type patients (PFS: 21.6 vs 18.4 months; p = 0.114) and BRCA1/2 mutation carriers (PFS: 23.1 vs 18.2 months, p = 0.193) appeared to derive benefit from SCS. DISCUSSION The present study suggests a benefit of SCS irrespective of BRCA1/2 status among patients mostly not treated with PARP inhibitor. Further data on post hoc analysis from the phase III trials are warranted to confirm whether BRCA1/2 mutated patients should be selected for SCS.
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Affiliation(s)
| | - Rafaela Pirolli
- Department of Medical Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | - Maria Nirvana Formiga
- Department of Medical Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.,Department of Oncogenetics, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | | | - Dirce Maria Carraro
- Genomics and Molecular Biology Group, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | | | - Glauco Baiocchi
- Department of Gynecology Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
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Jiang Y, Zhao J, Zhang L, Tian S, Yang T, Wang L, Zhao M, Yang Q, Wang Y, Yang X. Evaluation of the Efficacy and Safety of PARP Inhibitors in Advanced-Stage Epithelial Ovarian Cancer. Front Oncol 2020; 10:954. [PMID: 32719741 PMCID: PMC7350528 DOI: 10.3389/fonc.2020.00954] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/15/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose: PARP inhibitors are a novel targeted anti-cancer drug and a large number of clinical studies on PARP inhibitors have been accomplished. This updated meta-analysis was conducted to evaluate the efficacy and safety of PARP inhibitors in advanced-stage epithelial ovarian cancer. Methods: Medline (PubMed), Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus were searched to identify the eligible trials up to April 2020. ClinicalTrials.gov was also screened for additional unpublished trials. Data extraction and risk of bias assessment were performed by two independent investigators, respectively. The hazard ratios (HRs) and its 95% confidence intervals (CI) for time-to-event data of progression-free survival (PFS) and overall survival (OS), and the risk ratios (RRs) with 95% CI for dichotomous data of overall response rate (ORR) and occurrence of adverse events (AEs) were calculated by Review Manager 5.3 and Stata 12.0 software. Results: A total of 12 trials with 5,347 patients were included in this meta-analysis. Compared with the control group, PARP inhibitors significantly improved PFS (HR, 0.51; 95% CI, 0.40–0.65; P < 0.00001) and ORR (RR, 1.26; 95% CI, 1.11–1.43; P = 0.0003). Specifically, PFS was improved regardless of BRCA genes mutations and homologous-recombination status. However, no difference was observed in OS between the PARP inhibitors group and the control group (95% CI, 0.73–1.01; P = 0.06). PARP inhibitors were associated with a statistically significant higher risk of hematologic events and different PARP inhibitors had different toxicities profiles. Conclusion: PARP inhibitors are an effective and well-tolerated treatment for patients with advanced-stage epithelial ovarian cancer.
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Affiliation(s)
- Yifan Jiang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Juan Zhao
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Zhang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Sijuan Tian
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ting Yang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Wang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Minyi Zhao
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qing Yang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yaohui Wang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaofeng Yang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Nahshon C, Barnett-Griness O, Segev Y, Schmidt M, Ostrovsky L, Lavie O. Five-year survival decreases over time in patients with BRCA-mutated ovarian cancer: a systemic review and meta-analysis. Int J Gynecol Cancer 2020; 32:48-54. [DOI: 10.1136/ijgc-2020-001392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 01/04/2023] Open
Abstract
IntroductionShort-term survival rates of patients with BRCA-mutated ovarian cancer have been previously shown to be longer than those of non-carriers. We aimed to study the long-term survival rates of these patients and investigate whether the 5-year advantage decreases over time.MethodsA systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyzes (PRISMA) statement. The study protocol can be assessed at PROSPERO International prospective register of systematic reviews (http://www.crd.york.ac.uk/PROSPERO, registration number CRD42019137455). We considered for inclusion studies providing Kaplan–Meier survival curves up to and including 10 years, comparing patients with ovarian cancer with and without BRCA mutations. Our main outcome was the conditional probability of surviving an additional 5 years.ResultsA total of 13 references comprising 4565 patients was analyzed, of which 1131 BRCA1/2-mutated carriers and 3434 non-carriers were included. The expected higher 5-year survival rate in BRCA-mutated patients was observed (risk difference (RD)=14.9%, p=0.0002, risk ratio (RR)=1.36, p=0.001). Ten-year survival rates were comparatively less improved in BRCA-mutated patients (RD=8.6%, p=0.042, RR=1.25, p=0.12). After already surviving 5 years, no advantage in probability of further surviving 5 additional years was observed for the BRCA-mutated group (RD=2.9%, p=0.71, RR=0.97, p=0.78).ConclusionOur results provide insight into long-term survival rates and prognosis in patients with BRCA-mutated ovarian cancer which suggest that, despite the improved 5-year prognosis, the conditional probability of surviving an additional 5 years does not show the same advantage. The relatively low long-term advantage highlights the significance of epithelial ovarian cancer recurrence prevention. In the era of poly adenosine ribose inhibitors, future studies should explore the adequate follow-up and the benefit of a longer maintenance treatment phase, aiming to prolong the long-term survival of BRCA-mutated patients.
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10
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Tomao F, Bardhi E, Di Pinto A, Sassu CM, Biagioli E, Petrella MC, Palaia I, Muzii L, Colombo N, Panici PB. Parp inhibitors as maintenance treatment in platinum sensitive recurrent ovarian cancer: An updated meta-analysis of randomized clinical trials according to BRCA mutational status. Cancer Treat Rev 2019; 80:101909. [DOI: 10.1016/j.ctrv.2019.101909] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 02/01/2023]
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11
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Madariaga A, Lheureux S, Oza AM. Tailoring Ovarian Cancer Treatment: Implications of BRCA1/2 Mutations. Cancers (Basel) 2019; 11:E416. [PMID: 30909618 PMCID: PMC6468364 DOI: 10.3390/cancers11030416] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 02/07/2023] Open
Abstract
High grade serous ovarian cancer (HGSOC) is the most common epithelial ovarian cancer, harbouring more than 20% germline or somatic mutations in the tumour suppressor genes BRCA1 and BRCA2. These genes are involved in both DNA damage repair process via homologous recombination (HR) and transcriptional regulation. BRCA mutation confers distinct characteristics, including an increased response to DNA-damaging agents, such us platinum chemotherapy and poly-ADP ribose polymerase inhibitors (PARPi). However, several mechanisms of resistance to these agents have been described, including increased HR capacity through reverse BRCA mutations, non-homologous end-joint (NHEJ) repair alterations and drug efflux pumps. Current treatments of ovarian cancer including surgery, chemotherapy, targeted treatment and maintenance strategies, as well as resistance mechanisms will be reviewed, focusing on future trends with respect to BRCA mutation carriers.
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Affiliation(s)
- Ainhoa Madariaga
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 2M9, Canada.
| | - Stephanie Lheureux
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 2M9, Canada.
| | - Amit M Oza
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 2M9, Canada.
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12
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Abstract
High grade serous ovarian cancer (HGSOC) is the most common epithelial ovarian cancer, harbouring more than 20% germline or somatic mutations in the tumour suppressor genes BRCA1 and BRCA2. These genes are involved in both DNA damage repair process via homologous recombination (HR) and transcriptional regulation. BRCA mutation confers distinct characteristics, including an increased response to DNA-damaging agents, such us platinum chemotherapy and poly-ADP ribose polymerase inhibitors (PARPi). However, several mechanisms of resistance to these agents have been described, including increased HR capacity through reverse BRCA mutations, non-homologous end-joint (NHEJ) repair alterations and drug efflux pumps. Current treatments of ovarian cancer including surgery, chemotherapy, targeted treatment and maintenance strategies, as well as resistance mechanisms will be reviewed, focusing on future trends with respect to BRCA mutation carriers.
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13
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Madariaga A, Lheureux S, Oza AM. Tailoring Ovarian Cancer Treatment: Implications of BRCA1/2 Mutations. Cancers (Basel) 2019. [PMID: 30909618 DOI: 10.3390/cancers11030416]+[] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
High grade serous ovarian cancer (HGSOC) is the most common epithelial ovarian cancer, harbouring more than 20% germline or somatic mutations in the tumour suppressor genes BRCA1 and BRCA2. These genes are involved in both DNA damage repair process via homologous recombination (HR) and transcriptional regulation. BRCA mutation confers distinct characteristics, including an increased response to DNA-damaging agents, such us platinum chemotherapy and poly-ADP ribose polymerase inhibitors (PARPi). However, several mechanisms of resistance to these agents have been described, including increased HR capacity through reverse BRCA mutations, non-homologous end-joint (NHEJ) repair alterations and drug efflux pumps. Current treatments of ovarian cancer including surgery, chemotherapy, targeted treatment and maintenance strategies, as well as resistance mechanisms will be reviewed, focusing on future trends with respect to BRCA mutation carriers.
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Affiliation(s)
- Ainhoa Madariaga
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 2M9, Canada.
| | - Stephanie Lheureux
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 2M9, Canada.
| | - Amit M Oza
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 2M9, Canada.
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14
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Cardoso FC, Goncalves S, Mele PG, Liria NC, Sganga L, Diaz Perez I, Podesta EJ, Solano AR. BRCA1 and BRCA2 mutations and clinical interpretation in 398 ovarian cancer patients: comparison with breast cancer variants in a similar population. Hum Genomics 2018; 12:39. [PMID: 30103829 PMCID: PMC6090818 DOI: 10.1186/s40246-018-0171-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/30/2018] [Indexed: 12/04/2022] Open
Abstract
Background Ovarian cancer is the leading cause of death worldwide among gynecologic malignancies. The recent approval of inhibitors of poly (ADP-ribose) polymerase (iPARP) in the treatment of ovarian cancer in the presence of a BRCA1/2 mutation has sparked the analysis of women with such diagnosis, which can further benefit from the detection of carriers in the family. Germline sequence and large rearrangements for BRCA1/2 were tested in 398 consecutive epithelial ovarian cancer (EOC) patients. The aim of this study was to identify the frequency and spectrum of germline BRCA1/2 pathogenic alterations in a cohort of patients with ovarian serous carcinoma, with a view to adequately selecting patients for prevention through family counseling and correlating this frequency with platinum sensitivity as a guidance to identify patients eligible for iPARP in our population. Results A total of 96 patients carried a pathogenic germline mutation, accounting for an overall 24.1% mutation incidence. Among mutation carriers, BRCA1 showed 62.5% incidence, BRCA2 rendered 36.5%, and one patient exhibited a mutation in both genes. Three pathogenic mutations were recurrent mutations detected five, three, and four times and represented 12.5% of the mutated samples. Worth highlighting, a 50% mutation incidence was detected when breast and ovarian cancer coexisted in the same patient. Novel mutations amounted to 9.4% of the total mutations, as compared to 4.7% in breast cancer. Forty out of 60 BRCA1 mutations were beyond the ovarian cancer cluster region (OCCR), in stark contrast with 22 out of 36 BRCA2 mutations being inside the OCCR. Taken together, germline BRCA1/2 mutations in EOC patients showed a distinct mutational spectrum compared to our previously published data on breast cancer patients. Conclusions In sum, our study provides novel data on ovarian BRCA1/2 mutation prevalence worldwide, enhances adequate patient selection for family counseling and prevention, and sheds light on the benefits of iPARP treatment. Electronic supplementary material The online version of this article (10.1186/s40246-018-0171-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florencia C Cardoso
- Genotipificación y Cáncer Hereditario, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Galván 4102, C1431FWO, Ciudad Autonoma de Buenos Aires, Argentina
| | - Susana Goncalves
- AstraZeneca Argentina MC, Vedia 3616, C1430DAH, Ciudad Autonoma de Buenos Aires, Argentina
| | - Pablo G Mele
- Instituto de Investigaciones Biomédicas (INBIOMED), Facultad de Medicina, Universidad de Buenos Aires-CONICET, Paraguay 2155 - Piso 5, C1121ABG, Ciudad Autonoma de Buenos Aires, Argentina
| | - Natalia C Liria
- Genotipificación y Cáncer Hereditario, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Galván 4102, C1431FWO, Ciudad Autonoma de Buenos Aires, Argentina
| | - Leonardo Sganga
- AstraZeneca Argentina MC, Vedia 3616, C1430DAH, Ciudad Autonoma de Buenos Aires, Argentina
| | - Ignacio Diaz Perez
- AstraZeneca Argentina MC, Vedia 3616, C1430DAH, Ciudad Autonoma de Buenos Aires, Argentina
| | - Ernesto J Podesta
- Instituto de Investigaciones Biomédicas (INBIOMED), Facultad de Medicina, Universidad de Buenos Aires-CONICET, Paraguay 2155 - Piso 5, C1121ABG, Ciudad Autonoma de Buenos Aires, Argentina
| | - Angela R Solano
- Genotipificación y Cáncer Hereditario, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Galván 4102, C1431FWO, Ciudad Autonoma de Buenos Aires, Argentina. .,Instituto de Investigaciones Biomédicas (INBIOMED), Facultad de Medicina, Universidad de Buenos Aires-CONICET, Paraguay 2155 - Piso 5, C1121ABG, Ciudad Autonoma de Buenos Aires, Argentina.
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Abstract
OBJECTIVE A meta-analysis was performed to determine if BRCA1/2 mutations are associated with improved overall survival (OS) and progression-free survival (PFS) in patients with ovarian cancer. RESEARCH DESIGN AND METHODS Studies of patients with primary or recurrent ovarian cancer that examined the relationship between BRCA1/2 mutation status and outcomes were included. MAIN OUTCOME MEASURES The primary outcomes were OS and PFS of patients with and without BRCA1 and BRCA2 mutations. The secondary outcome was treatment response: complete response, partial response, and overall response. RESULTS Overall analysis revealed BRCA1/2 mutations were associated with improved OS [hazard ratio (HR) = 0.75; 95% confidence interval (CI): 0.64, 0.88; P < .001] and PFS (HR = 0.80; 95% CI: 0.64, 0.99; P = .039). BRCA1 mutations were significantly associated with improved OS (HR = 0.75) but not PFS, and BRCA2 mutations alone were not associated with either improved OS or PFS. The presence of BCRA1/2 mutations was associated with a better overall response rate, higher complete response rate, and lower partial response rate; however, BRCA1 or BRCA2 alone was not associated with overall response rate. CONCLUSIONS BRCA1 mutations appear to be associated with improved OS in patients with ovarian cancer. However, the effect of BRCA1 mutations on PFS and BRCA2 mutations alone on OS and PFS is less clear.
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Minimal Macroscopic Residual Disease (0.1-1 cm). Is It Still a Surgical Goal in Advanced Ovarian Cancer? Int J Gynecol Cancer 2017; 26:906-11. [PMID: 27051052 DOI: 10.1097/igc.0000000000000690] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The objective of this review was to try to determine by searching in the literature what is the survival in patients with advanced ovarian cancer after a primary debulking with minimal macroscopic residual disease (MMRD; 0.1-10 mm). Additionally, this review aimed to explore the survival in patients with residual disease from 0.1 to 0.5 cm. METHODS A retrospective search was accomplished in the PubMed database looking for all English-language articles published between January 1, 2007 and December 31, 2014, under the following search strategy: "ovarian cancer and cytoreduction" or "ovarian cancer and phase III trial". We selected those articles that contain information on both percentage of MMRD (0.1-1 cm) and median overall survival (OS) in this subset of patients with stage III to stage IV ovarian cancer after primary debulking surgery. RESULTS Thirteen publications were obtained including information of a total 11,999 patients with stage III to stage IV ovarian cancer. Five thousand thirty-seven patients (42%) had MMRD after the primary debulking (0.1-1 cm). Median overall survival in patients with MMRD was 40 months and disease-free survival (DFS) was 16 months. This group of patients obtained an advantage of 10 months in OS (40 vs 30 m) and 4 months in DFS (16 vs 12 m) compared with the group with suboptimal debulking (P < 0.001). Compared with the group of complete resection, patients with minimal macroscopic residuum showed a significant inferior median OS and DFS of 30 months and 14 months, respectively (OS, 70 vs 40 m; DFS, 30 vs 16 m) (P < 0.001). The group of residual disease of 0.1 to 0.5 cm reached a median survival of 53 months. CONCLUSIONS Patients with ovarian cancer with MMRD after primary surgery obtain a modest but significant advantage in survival (10 months) over suboptimal patients. Patients with macroscopic residual disease (0.1-0.5 cm) obtain a better survival (53 months) than those with more than 0.5 to 1 cm. We propose that they should be classified as a different prognostic group.
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BRCA mutational status, initial disease presentation, and clinical outcome in high-grade serous advanced ovarian cancer: a multicenter study. Am J Obstet Gynecol 2017; 217:334.e1-334.e9. [PMID: 28549976 DOI: 10.1016/j.ajog.2017.05.036] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/08/2017] [Accepted: 05/16/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND In the last decades, there have been several efforts to clarify the role of BRCA mutational status in women with advanced ovarian cancer, demonstrating its role in cancer development, as well as the prognostic significance of BRCA genotype. OBJECTIVE Our aim is to evaluate the correlation between BRCA mutational status and disease presentation in a large series of advanced high-grade serous ovarian cancer patients. STUDY DESIGN This is a retrospective multicenter study including a consecutive series of newly diagnosed high-grade serous ovarian cancer patients with International Federation of Gynecology and Obstetrics stage IIIC-IV disease, at least 18 months of follow-up time, and tested for BRCA 1/2 germline mutation status. Disease presentation was analyzed using the following variables: laparoscopic predictive index value, incidence of bulky lymph nodes, and ovarian masses. Progression-free survival was defined as the months elapsed from initial diagnosis (staging laparoscopy) and recurrent disease or last follow-up. RESULTS In all, 324 high-grade serous ovarian cancer patients received BRCA testing, and 273 fulfilled inclusion criteria. BRCA1/2 germline mutations were observed in 107 women (39.2%). No differences were documented according to BRCA mutation status in terms of International Federation of Gynecology and Obstetrics stage, CA125 levels, or presence of ascites. In patients with BRCA1/2 mutations we observed a higher incidence of peritoneal spread without ovarian mass (25.2% vs 13.9%; P value = .018) and of bulky lymph nodes (30.8% vs 17.5%; P value = .010) compared with women showing BRCA1/2 wild type genotype. Furthermore, women with BRCA1/2 mutations showed high peritoneal tumor load (laparoscopic predictive index value ≥8; 42.1% vs 27.1%; P value = .016) more frequently. Focusing on survival, no differences in term of median progression-free survival were observed among women treated with primary debulking surgery and neoadjuvant chemotherapy in the group of patients with BRCA1/2 mutations (P value = .268). On the other hand, in women showing BRCA wild type genotype, median progression-free survival after primary debulking surgery was 8 months longer compared with patients treated with neoadjuvant chemotherapy approach (26 vs 18 months; P value = .003). CONCLUSION Women with BRCA1/2 mutations show at diagnosis higher peritoneal tumor load and increased frequency of bulky lymph nodes compared to patients without germline BRCA mutations. Primary debulking surgery seems to ensure a longer progression-free survival in women with BRCA wild type genotype compared to neoadjuvant chemotherapy. BRCA testing might be a reliable tool to personalize treatment in patients with high-grade serous ovarian cancer, thus giving novel points of discussion to the ongoing debate regarding the best initial treatment approach.
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Rosenthal AN, Fraser LSM, Philpott S, Manchanda R, Burnell M, Badman P, Hadwin R, Rizzuto I, Benjamin E, Singh N, Evans DG, Eccles DM, Ryan A, Liston R, Dawnay A, Ford J, Gunu R, Mackay J, Skates SJ, Menon U, Jacobs IJ. Evidence of Stage Shift in Women Diagnosed With Ovarian Cancer During Phase II of the United Kingdom Familial Ovarian Cancer Screening Study. J Clin Oncol 2017; 35:1411-1420. [PMID: 28240969 PMCID: PMC5455461 DOI: 10.1200/jco.2016.69.9330] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose To establish the performance of screening with serum cancer antigen 125 (CA-125), interpreted using the risk of ovarian cancer algorithm (ROCA), and transvaginal sonography (TVS) for women at high risk of ovarian cancer (OC) or fallopian tube cancer (FTC). Patients and Methods Women whose estimated lifetime risk of OC/FTC was ≥ 10% were recruited at 42 centers in the United Kingdom and underwent ROCA screening every 4 months. TVS occurred annually if ROCA results were normal or within 2 months of an abnormal ROCA result. Risk-reducing salpingo-oophorectomy (RRSO) was encouraged throughout the study. Participants were observed via cancer registries, questionnaires, and notification by centers. Performance was calculated after censoring 365 days after prior screen, with modeling of occult cancers detected at RRSO. Results Between June 14, 2007, and May 15, 2012, 4,348 women underwent 13,728 women-years of screening. The median follow-up time was 4.8 years. Nineteen patients were diagnosed with invasive OC/FTC within 1 year of prior screening (13 diagnoses were screen-detected and six were occult at RRSO). No symptomatic interval cancers occurred. Ten (52.6%) of the total 19 diagnoses were stage I to II OC/FTC (CI, 28.9% to 75.6%). Of the 13 screen-detected cancers, five (38.5%) were stage I to II (CI, 13.9% to 68.4%). Of the six occult cancers, five (83.3%) were stage I to II (CI, 35.9% to 99.6%). Modeled sensitivity, positive predictive value, and negative predictive value for OC/FTC detection within 1 year were 94.7% (CI, 74.0% to 99.9%), 10.8% (6.5% to 16.5%), and 100% (CI, 100% to 100%), respectively. Seven (36.8%) of the 19 cancers diagnosed < 1 year after prior screen were stage IIIb to IV (CI, 16.3% to 61.6%) compared with 17 (94.4%) of 18 cancers diagnosed > 1 year after screening ended (CI, 72.7% to 99.9%; P < .001). Eighteen (94.8%) of 19 cancers diagnosed < 1 year after prior screen had zero residual disease (with lower surgical complexity, P = .16) (CI, 74.0% to 99.9%) compared with 13 (72.2%) of 18 cancers subsequently diagnosed (CI, 46.5% to 90.3%; P = .09). Conclusion ROCA-based screening is an option for women at high risk of OC/FTC who defer or decline RRSO, given its high sensitivity and significant stage shift. However, it remains unknown whether this strategy would improve survival in screened high-risk women.
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Affiliation(s)
- Adam N Rosenthal
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Lindsay S M Fraser
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Susan Philpott
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Ranjit Manchanda
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Matthew Burnell
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Philip Badman
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Richard Hadwin
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Ivana Rizzuto
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Elizabeth Benjamin
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Naveena Singh
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - D Gareth Evans
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Diana M Eccles
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Andy Ryan
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Robert Liston
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Anne Dawnay
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Jeremy Ford
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Richard Gunu
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - James Mackay
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Steven J Skates
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Usha Menon
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Ian J Jacobs
- Adam N. Rosenthal, Lindsay S.M. Fraser, Susan Philpott, Ranjit Manchanda, Matthew Burnell, Philip Badman, Richard Hadwin, Ivana Rizzuto, Andy Ryan, Robert Liston, Jeremy Ford, Richard Gunu, Usha Menon, and Ian J. Jacobs, University College London Elizabeth Garrett Anderson Institute for Women's Health; Elizabeth Benjamin, University College London; Naveena Singh, Barts Health National Health Service Trust; Ranjit Manchanda, Barts Cancer Institute, Queen Mary University of London; Anne Dawnay, University College London Hospital; James Mackay, The University College London Cancer Institute, London; D. Gareth Evans, University of Manchester, St Mary's Hospital Manchester, Manchester; Diana M. Eccles, Southampton General Hospital, Southampton, United Kingdom; Steven J. Skates, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and Ian J. Jacobs, University of New South Wales Australia, Sydney, New South Wales, Australia
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Invasion Patterns of Metastatic Extrauterine High-grade Serous Carcinoma With BRCA Germline Mutation and Correlation With Clinical Outcomes. Am J Surg Pathol 2016; 40:404-9. [PMID: 26574845 DOI: 10.1097/pas.0000000000000556] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Characteristic histopathologic features have been described in high-grade serous carcinoma associated with BRCA abnormalities (HGSC-BRCA), which are known to have relatively favorable clinical outcomes. The aim of this study was to evaluate the clinical significance of invasion patterns in metastatic HGSC-BRCA cases. Of the 37 cases of advanced-stage HGSC with known BRCA1 or BRCA2 germline mutation retrieved from our institutional files, 23 patients had a germline mutation of BRCA1 and 14 had a BRCA2 mutation. The pattern of invasion at metastatic sites was recorded and classified as a pushing pattern (either predominantly or exclusively), an exclusively micropapillary infiltrative pattern, or an infiltrative pattern composed of papillae, micropapillae, glands, and nests (mixed infiltrative pattern). Histologic evaluation of metastases was performed without knowledge of genotype or clinical outcome. Clinical data were abstracted from medical records. Median age was 56 years (range, 31 to 73 y). All patients presented at stage IIIC or IV and underwent complete surgical staging followed by chemotherapy. All 37 HGSC-BRCA cases showed either pushing pattern metastases (30; 81%) or infiltrative micropapillary metastases (7; 19%). No HGSC-BRCA case exhibited metastases composed solely of mixed infiltrative patterns. Among the 7 infiltrative micropapillary cases, 6 had a BRCA1 germline mutation versus 1 with a BRCA2 mutation. The median time of follow-up was 26 months (range, 13 to 49 mo). All 7 patients with infiltrative micropapillary metastases either experienced recurrence or died of disease (5 recurrences and 2 deaths), which was significantly worse than what was seen in patients with predominantly pushing pattern metastases, of whom 16 of 30 (53%) experienced recurrence (n=14) or died of disease (n=2) (P=0.03). In conclusion, the recognition of different invasion patterns of metastatic extrauterine HGSC-BRCA has prognostic implications. The infiltrative micropapillary pattern is associated with poor outcomes and is more frequently seen in BRCA1-associated HGSC than in BRCA2 cases.
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FIGO stage IV epithelial ovarian, fallopian tube and peritoneal cancer revisited. Gynecol Oncol 2016; 142:597-607. [PMID: 27335253 DOI: 10.1016/j.ygyno.2016.06.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/13/2016] [Accepted: 06/15/2016] [Indexed: 12/14/2022]
Abstract
Epithelial ovarian, fallopian tube and peritoneal cancer (EOC) is the seventh most common cancer diagnosis among women worldwide and shows the highest mortality rate of all gynecologic tumors. Different histological and anatomic spread patterns as well as multiple gene-expression based studies have demonstrated that EOC is indeed a heterogeneous disease. The prognostic factors that best predict the survival in this disease include: age, performance status and patient's comorbidities at the time of diagnosis; tumor biology, histological type, amount of residual tumor after surgery and finally tumor stage as surrogate for pre-operative tumor burden and growth pattern. In the majority of patients, the disease is diagnosed in advanced stage, disseminated intra- and/or extra-abdominally. It is unclear whether this is a consequence of distinct tumor biology, absence of anatomic barriers between ovary and the abdominal cavity, delay of diagnosis and/or the lack of sufficient early detection methods. FIGO stage IV disease, defined as tumor spread outside the abdominal cavity (including malignant pleural effusion) and/or visceral metastases, will be present in 12-33% of the patients at initial diagnosis. Overall, median survival for patients with stage IV disease ranges from 15 to 29months, with an estimated 5-year survival of approximately 20%. Unfortunately, over the past decades the overall survival gain compared to stage III remains disappointing. The current review aims to summarize the current data published in the international literature concerning FIGO stage IV EOC and discusses the published evidence for the clinical management of these patients.
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Dimitrova D, Ruscito I, Olek S, Richter R, Hellwag A, Türbachova I, Woopen H, Baron U, Braicu EI, Sehouli J. Germline mutations of BRCA1 gene exon 11 are not associated with platinum response neither with survival advantage in patients with primary ovarian cancer: understanding the clinical importance of one of the biggest human exons. A study of the Tumor Bank Ovarian Cancer (TOC) Consortium. Tumour Biol 2016; 37:12329-12337. [DOI: 10.1007/s13277-016-5109-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/09/2016] [Indexed: 12/15/2022] Open
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Mahdi H, Gockley A, Esselen K, Marquard J, Nutter B, Yang B, Hinchcliff E, Horowitz N, Rose PG. Outcome of neoadjuvant chemotherapy in BRCA1/2 mutation positive women with advanced-stage Müllerian cancer. Gynecol Oncol 2015. [PMID: 26210778 DOI: 10.1016/j.ygyno.2015.07.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To investigate whether patients with germline BRCA1/2 mutations who received neoadjuvant chemotherapy (NAC) for advanced-stage Müllerian cancer (MC) have an improved outcome compared to patients who did not undergo genetic testing. METHODS Three hundred and two patients who received NAC for stage III-IV MC were identified from a multi-institutional study involving Cleveland Clinic and Brigham and Women's Hospital for 2000-2014 and 2010-2014 respectively. Patients were divided into 3 cohorts: patients with germline BRCA1/2 mutations (BRCA_mut+; N=30), patients with no genetic testing (BRCA_mut_unk; N=166) and patients with negative genetic testing (BRCA_mut-, N=106). RESULTS There were no differences in the clinical characteristics and rates of complete cytoreduction and bowel resection between the three groups. BRCA_mut+ had longer PFS compared to BRCA_mut_unk and BRCA_mut- (19.1 vs. 15.1 vs. 15.7months respectively. However, this difference was not statistically significant (p=0.48). Patients with BRCA2 mutation had non-significant trend toward longer PFS compared to patients with unknown BRCA or BRCA1 mutation (20.2 vs. 15.1 vs. 14.8months respectively, p=0.58). BRCA_mut+ and BRCA_mut- had longer overall survivals (OS) compared to BRCA_mut_unk patients (50.5 vs. 54.1 vs. 36.5months respectively, p=0.009). In multivariable analyses, controlling for age, stage and complete cytoreduction, BRCA_mut_unk was associated with worse PFS (HR 1.44, 95% CI 1.01-2.05, p=0.045) and OS (HR 2.67, 95% CI 1.33-5.36, p=0.006). CONCLUSIONS Patients with germline BRCA mutations had improved outcomes with NAC compared to patients with unknown BRCA status. These outcomes were more favorable compared to the outcome of NAC in prior studies.
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Affiliation(s)
- Haider Mahdi
- Division of Gynecologic Oncology, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Allison Gockley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Katherine Esselen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jessica Marquard
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Benjamin Nutter
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Bin Yang
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Emily Hinchcliff
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Neil Horowitz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter G Rose
- Division of Gynecologic Oncology, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
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Reyes MC, Arnold AG, Kauff ND, Levine DA, Soslow RA. Invasion patterns of metastatic high-grade serous carcinoma of ovary or fallopian tube associated with BRCA deficiency. Mod Pathol 2014; 27:1405-11. [PMID: 24577588 DOI: 10.1038/modpathol.2013.237] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/01/2013] [Indexed: 01/13/2023]
Abstract
High-grade serous carcinomas of the uterine adnexa with BRCA1 deficiency (high-grade serous carcinomas-BRCA) have recently been described to demonstrate characteristic histopathological features. We hypothesize that metastatic high-grade serous carcinomas-BRCA cases exhibit characteristic morphological features as well. We studied 102 high-grade serous carcinomas with known BRCA1 and BRCA2 genotype from the archives of the Department of Pathology at Memorial Sloan-Kettering Cancer Center. The primary site morphological characteristics of these cases were reported previously; we now focus solely on tumor morphology in sites other than the uterine adnexa (ie, metastatic sites). The study group consisted of the following case types: 13 BRCA1 germline mutations; 5 BRCA1 somatic mutations; 10 BRCA1 promoter methylation; 4 BRCA2 germline mutations; 1 BRCA2 somatic mutation; 11 lacking BRCA1 or BRCA2 abnormality; 58 cases lacking BRCA1 or BRCA2 germline mutation. Two observers independently scored invasion patterns and microscopic tumor architecture while blinded to genotype. Concordance between observers and correlations between metastatic patterns and the following indices were studied: genotype, primary site tumor characteristics, and BRCA1 immunohistochemistry. Concordance between observers was excellent (κ values >0.9). All cases with BRCA1 or 2 abnormalities showed either pushing pattern metastases (76%) or infiltrative metastases composed only of micropapillae (24%). In contrast, all cases lacking BRCA1 or 2 abnormalities showed infiltrative metastases that contained combinations of papillary, glandular, and, rarely, cribriform and micropapillary architecture (P<0.0001 for comparison with pushing metastasis and P<0.001 for comparison with purely micropapillary architecture). Morphological assessment of metastatic carcinomas, a highly reproducible exercise, accurately correlated with BRCA1 status in every case, unlike morphological assessment of primary site adnexal high-grade serous carcinomas or BRCA1 immunohistochemistry. Metastatic high-grade serous carcinomas-BRCAs exhibit characteristic morphological features that appear more sensitive and specific for BRCA mutations than two other morphologically based prediction systems and should be easier to apply in practice. These findings should be validated prospectively in an independent cohort.
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Affiliation(s)
- M Carolina Reyes
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Angela G Arnold
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Noah D Kauff
- 1] Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA [2] Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA [3] Weill Cornell Medical College, New York, NY, USA
| | - Douglas A Levine
- 1] Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA [2] Weill Cornell Medical College, New York, NY, USA
| | - Robert A Soslow
- 1] Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA [2] Weill Cornell Medical College, New York, NY, USA
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BRCA-associated ovarian cancer: from molecular genetics to risk management. BIOMED RESEARCH INTERNATIONAL 2014; 2014:787143. [PMID: 25136623 PMCID: PMC4129974 DOI: 10.1155/2014/787143] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 07/08/2014] [Accepted: 07/10/2014] [Indexed: 01/12/2023]
Abstract
Ovarian cancer (OC) mostly arises sporadically, but a fraction of cases are associated with mutations in BRCA1 and BRCA2 genes. The presence of a BRCA mutation in OC patients has been suggested as a prognostic and predictive factor. In addition, the identification of asymptomatic carriers of such mutations offers an unprecedented opportunity for OC prevention.
This review is aimed at exploring the current knowledge on epidemiological and molecular aspects of BRCA-associated OC predisposition, on pathology and clinical behavior of OC occurring in BRCA mutation carriers, and on the available options for managing asymptomatic carriers.
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The role of BRCA status on the prognosis of patients with epithelial ovarian cancer: a systematic review of the literature with a meta-analysis. PLoS One 2014; 9:e95285. [PMID: 24788697 PMCID: PMC4006804 DOI: 10.1371/journal.pone.0095285] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 03/26/2014] [Indexed: 12/13/2022] Open
Abstract
Objective The role of BRCA dysfunction on the prognosis of patients with epithelial ovarian cancer (EOCs) remains controversial. This systematic review tried to assess the role of BRCA dysfunction, including BRCA1/2 germline, somatic mutations, low BRCA1 protein/mRNA expression or BRCA1 promoter methylation, as prognostic factor in EOCs. Methods Studies were selected for analysis if they provided an independent assessment of BRCA status and prognosis in EOC. To make it possible to aggregate survival results of the published studies, their methodology was assessed using a modified quality scale. Results Of 35 evaluable studies, 23 identified BRCA dysfucntion status as a favourable prognostic factor. No significant differences were detected in the global score of quality assessment. The aggregated hazard ratio (HR) of overall survival (OS) of 34 evaluable studies suggested that BRCA dysfunction status had a favourable impact on OS (HR = 0.69, 95% CI 0.61–0.79), and when these studies were categorised into BRCA1/2 mutation and low protein/mRNA expression of BRCA1 subgroups, all of them demonstrated positive results (HR = 0.67, 95% CI: 0.57–0.78; HR = 0.62, 95% CI: 0.51–0.75; and HR = 0.51, 95% CI: 0.33–0.78, respectively), except for the subgroup of BRCA1 promoter methylation (HR = 1.59, 95% CI: 0.72–3.50). The meta-analysis of progression-free survival (PFS), which included 18 evaluable studies, demonstrated that BRCA dysfunction status was associated with a longer PFS in EOC (HR = 0.69, 95% CI: 0.63–0.76). Conclusions Patients with BRCA dysfunction status tend to have a better outcome, but further prospective clinical studies comparing the different BRCA statuses in EOC is urgently needed to specifically define the most effective treatment for the separate patient groups.
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Liu TW, Stewart JM, MacDonald TD, Chen J, Clarke B, Shi J, Wilson BC, Neel BG, Zheng G. Biologically-targeted detection of primary and micro-metastatic ovarian cancer. Am J Cancer Res 2013; 3:420-7. [PMID: 23781288 PMCID: PMC3677412 DOI: 10.7150/thno.6413] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 05/03/2013] [Indexed: 01/18/2023] Open
Abstract
Ovarian cancer is the leading cause of morbidity/mortality from gynecologic malignancy. Early detection of disease is difficult due to the propensity for ovarian cancer to disseminate throughout the peritoneum. Currently, there is no single accurate test to detect primary or recurrent ovarian cancer. We report a novel clinical strategy using PPF: a multimodal, PET and optical, folate receptor (FR)-targeted agent for ovarian cancer imaging. The capabilities of PPF were evaluated in primary human ovarian cancer cells, in vivo xenografts derived from primary cells and ex vivo patient omemtum, as the heterogeneity and phenotype displayed by patients is retained. Primary cells uptake PPF in a FR-dependent manner demonstrating approximately a 5- to 25-fold increase in fluorescence. By both PET and fluorescence imaging, PPF specifically delineated FR-positive, ovarian cancer xenografts, with similar tumor-to-background ratios of 8.91±0.91 and 7.94±3.94, and micro-metastatic studding (<1mm), which demonstrated a 3.5-fold increase in PPF uptake over adjacent normal tissue. Ex vivo patient omentum demonstrated selective uptake of PFF by tumor deposits. The ability of PPF to identify metastatic deposits <1mm could facilitate more complete debulking (currently, optimal debulking is <10mm residual tumor), by providing a more sensitive imaging strategy improving treatment planning, response assessment and residual/recurrent disease detection. Therefore, PPF is a novel clinical imaging strategy that could substantially improve the prognosis of patients with ovarian cancer by allowing pre-, post- and intra-operative tumor monitoring, detection and possibly treatment throughout all stages of therapy and tumor progression.
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Norquist BM, Pennington KP, Agnew KJ, Harrell MI, Pennil CC, Lee MK, Casadei S, Thornton AM, Garcia RL, Walsh T, Swisher EM. Characteristics of women with ovarian carcinoma who have BRCA1 and BRCA2 mutations not identified by clinical testing. Gynecol Oncol 2012; 128:483-7. [PMID: 23262210 DOI: 10.1016/j.ygyno.2012.12.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/06/2012] [Accepted: 12/10/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Few studies have comprehensively tested all ovarian cancer patients for BRCA1 and BRCA2 (BRCA1/2) mutations. We sought to determine if clinically identified mutation carriers differed in clinical characteristics and outcomes from mutation carriers not identified during routine clinical care. METHODS We included women with ovarian, tubal or peritoneal carcinoma. BROCA, an assay using targeted capture and massively parallel sequencing was used to identify mutations in BRCA1/2 and 19 other tumor suppressor genes. We identified subjects with BRCA1/2 mutations using BROCA that had not previously received standard genetic testing (BROCA, n=37) and compared them to subjects with BRCA1/2 mutations identified during routine clinical care (known, n=70), and to those wildtype for 21 genes using BROCA (wildtype, n=291). RESULTS BROCA mutation carriers were older than known carriers, median age of 58 (range 41-77), vs. 51 (range 33-76, p=0.003, Mann-Whitney). 58/70 (82.9%) of known carriers had a strong family history, compared with 15/37 (40.5%) of BROCA carriers, p<0.0001, (Fisher's Exact). Median overall survival was significantly worse for BROCA mutation carriers compared to known mutation carriers, (45 vs. 93months, p<0.0001, HR 3.47 (1.79-6.72), Log-rank test). The improved survival for BRCA1/2 mutation carriers (known and BROCA) compared with wildtype cases (69 vs. 44months, p=0.0001, HR 0.58 (0.43-0.77), Log-rank test) was driven by known mutation carriers. CONCLUSIONS Older age, absence of a strong family history, and poor survival are all associated with decreased clinical identification of inherited BRCA1/2 mutations in women with ovarian cancer. Using age and family history to direct genetic testing will miss a significant percentage of mutation carriers. Testing should be initiated at the time of diagnosis to maximize identification of mutations and minimize survival bias.
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Affiliation(s)
- Barbara M Norquist
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Box 356460, University of Washington School of Medicine, Seattle, WA 98195, USA.
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