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Taguchi A, Kato K, Furusawa A, Hara K, Sone K, Yamada K, Kajiyama H, Shimada M, Okamoto A. Heterogeneous treatment effect of dose-dense paclitaxel plus carboplatin therapy for advanced ovarian cancer. Int J Cancer 2024; 155:1068-1077. [PMID: 38712630 DOI: 10.1002/ijc.34996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/22/2024] [Accepted: 04/09/2024] [Indexed: 05/08/2024]
Abstract
A Japanese clinical trial (JGOG3016) showed that dose-dense weekly paclitaxel in combination with carboplatin extensively prolonged overall survival (OS) in patients with advanced ovarian cancer. However, in other clinical trials, dose-dense paclitaxel regimens were not superior to triweekly paclitaxel regimens. In this study, causal tree analysis was applied to explore subpopulations with different treatment effects of dose-dense paclitaxel in a data-driven approach. The 587 participants with stage II-IV ovarian cancer in the JGOG3016 trial were used for model development. The primary endpoint was treatment effect in terms of 3-year OS in patients receiving dose-dense vs. conventional paclitaxel therapies. In patients <50 years, the 3-year OS was similar in both groups; however, it was higher in the dose-dense group in patients ≥50 years. Dose-dense paclitaxel showed strong positive treatment effects in patients ≥50 years with stage II/III disease, BMI <23 kg/m2, non-CC/MC, and residual tumor ≥1 cm. In contrast, although there was no significant difference in OS; the 3-year OS rate was 23% lower in dose-dense paclitaxel than conventional paclitaxel in patients ≥60 years with stage IV cancer. Patients in this group had a particularly lower performance status than other groups. Our causal tree analysis suggested that poor prognosis groups represented by residual tumor tissue ≥1 cm benefit from dose-dense paclitaxel, whereas elderly patients with advanced disease and low-performance status are negatively impacted by dose-dense paclitaxel. These subpopulations will be of interest to future validation studies. Personalized treatments based on clinical features are expected to improve advanced ovarian cancer prognosis.
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Affiliation(s)
- Ayumi Taguchi
- Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Laboratory of Human Single Cell Immunology, WPI Immunology Frontier Research Center Osaka University, Suita-shi, Osaka, Japan
| | - Kosuke Kato
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Akiko Furusawa
- Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
- Department of Gynecology, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka, Japan
| | - Konan Hara
- Department of Economics, University of Arizona, Tucson, Arizona, USA
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kyosuke Yamada
- Department of Obstetrics and Gynecology, Daisan Hospital, The Jikei University School of Medicine, Komae, Tokyo, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Muneaki Shimada
- Advanced Research Center for Innovations in Next-Generation Medicine, Tohoku University, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
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Merry E, Kesmez RT, Yu T, Flynn M, Ledermann J, Lockley M, Macdonald N, McCormack M, Nicum S, Crusz S, Miller R. A multicenter retrospective study to assess feasibility, safety and efficacy of first-line carboplatin-paclitaxel versus carboplatin monotherapy in a frail, elderly epithelial ovarian cancer population. Int J Gynecol Cancer 2024:ijgc-2024-005394. [PMID: 39231541 DOI: 10.1136/ijgc-2024-005394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024] Open
Abstract
OBJECTIVE Underrepresentation of elderly ovarian cancer patients in clinical trials has led to lack of clarity regarding optimal first-line chemotherapy in this cohort. The Elderly Women with Ovarian Cancer (EWOC)-1 trial demonstrated that 3-weekly carboplatin (3wC) resulted in worse survival and feasibility compared with standard 3-weekly carboplatin-paclitaxel (3wCP) in frail, elderly ovarian cancer patients. Our retrospective study compares feasibility, safety, and efficacy of first-line 3wCP and 3wC in a frail ovarian cancer cohort. METHODS Clinical data were retrospectively analyzed for newly-diagnosed, International Federation of Gynecology and Obstetrics (FIGO) stage III/IV, ≥70-year-old epithelial ovarian cancer patients, treated by clinician choice with 3wC or 3wCP at two London cancer centers over a 2 year period. Charlson Comorbidity Index (CCI) and Eastern Cooperative Oncology Group (ECOG) performance status provided surrogate markers of frailty. Common Terminology Criteria for Adverse Events v5.0 graded toxicity. RESULTS A total of 107 patients were treated with 3wC (n=30) and 3wCP (n=77). Age, performance status, and CCI were significantly different between cohorts, with 3wC patients older (84 vs 75 years, p<0.001), with more comorbidities (median CCI 4 vs 3, p<0.001) and worse performance status (47% vs 17% PS ≥2, p=0.015). Surgical outcomes differed significantly between cohorts, with 20 (67%) 3wC patients not undergoing surgery, compared with 22 (29%) 3wCP patients (p<0.001). Median follow-up was 45.8 months (IQR 38.7-56.3 months). While we observed improved progression-free (HR 0.55, 95% CI 0.33 to 0.90, p=0.017) and overall survival (HR 0.44, 95% CI 0.27 to 0.73, p=0.001, log-rank test) in a univariate cox proportional hazards comparison between 3wCP and 3wC, this was not significant on multivariate analysis. Completion of six planned chemotherapy cycles was achieved by the majority, with similar discontinuation rates between groups (13% 3wC vs 8% 3wCP, p>0.05). Overall grade ≥3 hematological toxicity rates were similar between regimens (33% 3wC vs 44% 3wCP, p=0.37) with grade ≥3 neutropenia (p=0.019) and grade ≥3 thrombocytopenia (p=0.006) more common with 3wCP and 3wC, respectively. No treatment-related deaths occurred. CONCLUSION Our data demonstrates that standard 3wCP is a well-tolerated, feasible first-line treatment for frail, elderly ovarian cancer patients. Improved survival with 3wCP was not significant when corrected for established clinical prognostic factors.
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Affiliation(s)
- Eve Merry
- Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Tamara Yu
- Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Michael Flynn
- Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jonathan Ledermann
- Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
- UCL Cancer Institute, London, UK
| | - Michelle Lockley
- Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
- Bart's Cancer Institute, Queen Mary University of London, London, UK
| | - Nicola Macdonald
- Gynaecological Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mary McCormack
- Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shibani Nicum
- Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Rowan Miller
- Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
- Medical Oncology, Barts Health NHS Trust, London, UK
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Wijaya ST, Ngoi NY, Loh JW, Tan TZ, Lim D, Khan IS, Thian YL, Lai A, Ang BW, Tong P, Ng J, Low JJ, Ilancheran A, Lim SE, Lim YW, Tan DS. Comprehensive characterization of genomic features and clinical outcomes following targeted therapy and secondary cytoreductive surgery in OCCC: a single center experience. J Gynecol Oncol 2024; 35:e69. [PMID: 38606821 PMCID: PMC11390249 DOI: 10.3802/jgo.2024.35.e69] [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: 05/07/2023] [Revised: 11/03/2023] [Accepted: 02/11/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE Ovarian clear cell carcinoma (OCCC) is associated with chemoresistance. Limited data exists regarding the efficacy of targeted therapies such as immune checkpoint inhibitors (ICI) and bevacizumab, and the role of secondary cytoreductive surgery (SCS). METHODS We retrospectively analyzed genomic features and treatment outcomes of 172 OCCC patients treated at our institution from January 2000 to May 2022. Next-generation sequencing (NGS) was performed where sufficient archival tissue was available. RESULTS 64.0% of patients were diagnosed at an early stage, and 36.0% at an advanced stage. Patients with advanced/relapsed OCCC who received platinum-based chemotherapy plus bevacizumab followed by maintenance bevacizumab had a median first-line progression-free survival (PFS) of 12.2 months, compared with 9.3 months for chemotherapy alone (hazard ratio=0.69; 95% confidence interval [CI]=0.33, 1.45). In 27 patients who received an ICI, the overall response rate was 18.5% and median duration of response was 7.4 months (95% CI=6.5, 8.3). In 17 carefully selected patients with fewer than 3 sites of relapse, median PFS was 35 months (95% CI=0, 73.5) and median overall survival was 96.8 months (95% CI=44.6, 149.0) after SCS. NGS on 58 tumors revealed common mutations in ARID1A (48.3%), PIK3CA (46.6%), and KRAS (20.7%). Pathogenic alterations in PIK3CA, FGFR2, and NBN were associated with worse survival outcomes. Median tumor mutational burden was 3.78 (range, 0-16). All 26 patients with available loss of heterozygosity (LOH) scores had LOH <16%. CONCLUSION Our study demonstrates encouraging outcomes with bevacizumab and ICI, and SCS in select relapsed OCCC patients. Prospective trials are warranted.
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Affiliation(s)
- Silvana Talisa Wijaya
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Natalie Yl Ngoi
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Jerold Wz Loh
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Tuan Zea Tan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
- Genomics and Data Analytics Core (GeDaC), Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Diana Lim
- Department of Pathology, National University Health System, Singapore
| | - Irfan Sagir Khan
- Department of Pathology, National University Health System, Singapore
| | - Yee Liang Thian
- Department of Diagnostic Imaging, National University Health System, Singapore
| | - Alexa Lai
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Bertrand Wl Ang
- Department of Diagnostic Imaging, National University Health System, Singapore
| | - Pearl Tong
- Division of Gynaecologic Oncology, Department of Obstetrics & Gynaecology, National University Hospital, Singapore
| | - Joseph Ng
- Division of Gynaecologic Oncology, Department of Obstetrics & Gynaecology, National University Hospital, Singapore
| | - Jeffrey Jh Low
- Division of Gynaecologic Oncology, Department of Obstetrics & Gynaecology, National University Hospital, Singapore
| | - Arunachalam Ilancheran
- Division of Gynaecologic Oncology, Department of Obstetrics & Gynaecology, National University Hospital, Singapore
| | - Siew Eng Lim
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Yi Wan Lim
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - David Sp Tan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- NUS Centre for Cancer Research (N2CR), National University of Singapore, Singapore.
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Moss E, Taylor A, Andreou A, Ang C, Arora R, Attygalle A, Banerjee S, Bowen R, Buckley L, Burbos N, Coleridge S, Edmondson R, El-Bahrawy M, Fotopoulou C, Frost J, Ganesan R, George A, Hanna L, Kaur B, Manchanda R, Maxwell H, Michael A, Miles T, Newton C, Nicum S, Ratnavelu N, Ryan N, Sundar S, Vroobel K, Walther A, Wong J, Morrison J. British Gynaecological Cancer Society (BGCS) ovarian, tubal and primary peritoneal cancer guidelines: Recommendations for practice update 2024. Eur J Obstet Gynecol Reprod Biol 2024; 300:69-123. [PMID: 39002401 DOI: 10.1016/j.ejogrb.2024.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 07/15/2024]
Affiliation(s)
- Esther Moss
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | | | - Adrian Andreou
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Christine Ang
- Northern Gynaecological Oncology Centre, Gateshead, UK
| | - Rupali Arora
- Department of Cellular Pathology, University College London NHS Trust, 60 Whitfield Street, London W1T 4E, UK
| | | | | | - Rebecca Bowen
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Lynn Buckley
- Beverley Counselling & Psychotherapy, 114 Holme Church Lane, Beverley, East Yorkshire HU17 0PY, UK
| | - Nikos Burbos
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital Colney Lane, Norwich NR4 7UY, UK
| | | | - Richard Edmondson
- Saint Mary's Hospital, Manchester and University of Manchester, M13 9WL, UK
| | - Mona El-Bahrawy
- Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | | | - Jonathan Frost
- Gynaecological Oncology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, Bath BA1 3NG, UK; University of Exeter, Exeter, UK
| | - Raji Ganesan
- Department of Cellular Pathology, Birmingham Women's Hospital, Birmingham B15 2TG, UK
| | | | - Louise Hanna
- Department of Oncology, Velindre Cancer Centre, Whitchurch, Cardiff CF14 2TL, UK
| | - Baljeet Kaur
- North West London Pathology (NWLP), Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Ranjit Manchanda
- Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London and Barts Health NHS Trust, UK
| | - Hillary Maxwell
- Dorset County Hospital, Williams Avenue, Dorchester, Dorset DT1 2JY, UK
| | - Agnieszka Michael
- Royal Surrey NHS Foundation Trust, Guildford GU2 7XX and University of Surrey, School of Biosciences, GU2 7WG, UK
| | - Tracey Miles
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Claire Newton
- Gynaecology Oncology Department, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Shibani Nicum
- Department of Oncology, University College London Cancer Institute, London, UK
| | | | - Neil Ryan
- The Centre for Reproductive Health, Institute for Regeneration and Repair (IRR), 4-5 Little France Drive, Edinburgh BioQuarter City, Edinburgh EH16 4UU, UK
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham and Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham B18 7QH, UK
| | - Katherine Vroobel
- Department of Cellular Pathology, Royal Marsden Foundation NHS Trust, London SW3 6JJ, UK
| | - Axel Walther
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Jason Wong
- Department of Histopathology, East Suffolk and North Essex NHS Foundation Trust, Ipswich Hospital, Heath Road, Ipswich IP4 5PD, UK
| | - Jo Morrison
- University of Exeter, Exeter, UK; Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton TA1 5DA, UK.
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5
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How JA, Dang M, Lee S, Fellman B, Westin SN, Sood AK, Fleming ND, Shafer A, Yuan Y, Liu J, Zhao L, Celestino J, Hajek R, Morgan MB, Parra ER, Laberiano Fernandez CD, Arrechedera CA, Solis Soto LM, Schmeler KM, Nick A, Lu KH, Coleman R, Wang L, Jazaeri AA. Pembrolizumab plus chemotherapy in frontline treatment of advanced ovarian cancer: Clinical and translational results from a phase 2 trial. MED 2024:S2666-6340(24)00303-9. [PMID: 39151421 DOI: 10.1016/j.medj.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/05/2024] [Accepted: 07/23/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND The efficacy and feasibility of pembrolizumab combined with chemotherapy in frontline management of advanced high-grade epithelial ovarian cancer (EOC) is unknown. Additionally, modification of the tumor microenvironment following neoadjuvant therapy is not well understood. METHODS In this single-arm phase 2 trial (this study was registered at ClinicalTrials.gov: NCT02520154), eligible patients received up to 4 cycles of neoadjuvant chemotherapy followed by interval cytoreduction, 3 cycles of adjuvant intravenous carboplatin/weekly paclitaxel/pembrolizumab, and finally maintenance pembrolizumab until progression or toxicity (maximum 20 cycles). The primary endpoint was progression-free survival (PFS). Secondary endpoints included feasibility, toxicity, and overall survival (OS). PD-L1 staining, multiplex immunofluorescence staining, RNA sequencing, reverse-phase protein array analyses were performed on pre- and post-chemotherapy samples. FINDINGS Thirty-one eligible patients were enrolled. Median PFS and OS was 14.88 (95% CI 12.39-23.00) and 57.43 months (95% CI 30.88-not reached), respectively. Among those with PD-L1 combined positive score (CPS) ≥10, the median PFS and OS were not reached compared to those with CPS <10 (10.50 and 30.90 months, respectively). Feasibility was met, with all patients completing their planned adjuvant cycles. Treatment discontinuation due to immune-related toxicity occurred in 6 patients (20%). Chemotherapy resulted in an infiltration of anti-tumor immune cells in the tumor microenvironment. Samples of patients with the best PFS demonstrated increased expression of NF-κB, TGF-β, and β-catenin signaling. CONCLUSIONS Pembrolizumab with chemotherapy was feasible and resulted in PFS within the historical range for this EOC population. Patients with CPS ≥10 may benefit more from this regimen, and future studies should investigate this potential biomarker. FUNDING This investigator-initiated trial was funded by Merck.
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Affiliation(s)
- Jeffrey A How
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Minghao Dang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanghoon Lee
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bryan Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicole D Fleming
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aaron Shafer
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ying Yuan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jinsong Liu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Li Zhao
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph Celestino
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard Hajek
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Margaret B Morgan
- Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Edwin R Parra
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caddie D Laberiano Fernandez
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Claudio A Arrechedera
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luisa Maren Solis Soto
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Linghua Wang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amir A Jazaeri
- Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Malandrini F, Meregaglia M, Di Maio M, Pinto C, De Lorenzo F, Ciani O. The development of an archive of patient-reported outcome measures (PROMs) in oncology: The Italian PRO4All project. Eur J Cancer 2024; 207:114161. [PMID: 38870746 DOI: 10.1016/j.ejca.2024.114161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Choosing the most adequate measure of patient-reported outcomes (PROs) for a specific medical condition is not straightforward. This study aimed to develop a comprehensive archive of patient-reported outcome measures (PROMs), observer-reported outcome measures (ObsROMs) and caregiver-reported outcome measures (CROMs) in oncology and identify their main characteristics and target outcome domains. MATERIALS AND METHODS As part of the Italian PRO4All Project, we retrieved questionnaires through an extensive search of online databases. We developed a data extraction form to collect information on cancer type, questionnaire variant(s), recall period, and scoring system. We performed a content analysis of the questionnaires to assign each item a specific outcome domain according to a predefined 38-item taxonomy. RESULTS A total of 386 PROMs (n = 356), ObsROMs (n = 13) and CROMs (n = 17) were identified and described; of these, 358 were also analyzed in their content. 47.3 % of the instruments were cancer type-specific, 45.1 % were generic for cancer and 7.9 % were developed for the general population but also recommended in oncology. The great majority (92.2 %) were patient-reported. In 50.3 % the recall period was "last week". The mean number of items per questionnaire was 22.0 (range: 1-130). 7794 items were assigned an outcome domain, the most frequent being emotional functioning/wellbeing (22 %), physical functioning (15.7 %), general outcomes (10.1 %) and delivery of care (8.9 %). CONCLUSIONS There are a variety of patient and caregiver-reported measures in oncology. This archive can guide researchers and practitioners in selecting the most suitable measures and fostering a patient-centered approach in clinical trials, clinical practice, and regulatory activities.
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Affiliation(s)
- Francesco Malandrini
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management, Milan, Italy
| | - Michela Meregaglia
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management, Milan, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy; Italian Association of Medical Oncology (AIOM), Italy
| | - Carmine Pinto
- Medical Oncology Unit, Comprehensive Cancer Center, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Federation of Italian Cooperative Oncology Groups (FICOG), Florence, Italy
| | | | - Oriana Ciani
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management, Milan, Italy.
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7
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Pierre ME, Manneh R, Hernández A, Rodríguez J, Fletcher AV, Ramírez HM, Niño OM, Gómez DA, Sanabria D, Contreras F, Pieschacón JR, Calderón PH. Expert consensus: Profiling and management of advanced or metastatic epithelial ovarian cancer. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2024; 75:4094. [PMID: 39013199 PMCID: PMC11210286 DOI: 10.18597/rcog.4094] [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: 07/23/2023] [Accepted: 04/30/2024] [Indexed: 07/18/2024]
Abstract
Introduction and objective: The approach to patients with advanced or metastatic high-grade epithelial ovarian cancer (EOC) has evolved over time with the advent of new therapies and multimodal strategies. The objective of this consensus of experts is to generate national recommendations for the profiling and management of advanced or metastatic high-grade OEC, defined as stages III and IV of the “The International Federation of Gynecology and Obstetrics (FIGO) classification at the time of diagnosis to base on the literature review that included international evidence-based clinical practice guidelines (CPG). Material and methods: Eleven panelists (oncologists and gynecological oncologists) answered 8 questions about the profiling and management of advanced or metastatic ovarian epithelial carcinoma. The panelists were chosen for their academic profile and influence in national health institutions. Guidelines from the “ESMO Standardized Operating Procedures Consensus Conference” were used to develop the consensus. It was agreed that the level of agreement to accept a recommendation should be ≥ 80%. The document was peer reviewed. Results: Eight general recommendations are made, which are presented into five domains. Some of these recommendations are subdivided into specific recommendations. Initial treatment Recommendation 1.1 Complete primary cytoreduction (PCS) surgery is suggested as the initial therapy of choice for patients with high-grade or metastatic EOC, which should ideally be carried out in centers with experience, followed by adjuvant therapy. 1.2 Neoadjuvant chemotherapy followed by interval cytoreduction surgery (ICS) is suggested in those who are unlikely to achieve a complete cytoreduction in PCS either due to unresectable metastatic disease or who present unresectability criteria (imaging, laparoscopic and/or by laparotomy) and that have been defined by a gynecological oncologist and patients with poor functional status and comorbidities according to the criteria of the multidisciplinary team (clinical oncology, gynecological oncology, radiology, etc.). Recommendation 2. In patients with high-grade epithelial ovarian cancer (EOC), in stage III locally advanced or metastatic, who received neoadjuvant chemotherapy and achieved a complete or partial response (cytoreduction with tumor residue < 2.5 mm), the use of Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) could be considered as an alternative to standard platinum-based adjuvant intravenous chemotherapy during interval cytoreductive surgery, after discussion in a multidisciplinary tumor board, at a center experienced in treating this type of patients. Use of genetic testing. Recommendation 3. It is suggested at the time of diagnosis to offer molecular genetic testing to all patients with high-grade advanced or metastatic EOC regardless of family history. Recommendation 4. It is suggested to offer genetic counseling, by qualified personnel, to all patients with high-grade advanced or metastatic EOC who are ordered genetic testing. Recommendation 5. It is suggested that all patients with advanced or metastatic high-grade EOC undergo a germ panel that includes the Breast Cancer Susceptibility Genes 1/2 genes (BRCA 1/2) and the other susceptibility genes according to with institutional protocols and the availability of genetic testing panels; If it is negative, then somatic testing should be performed that includes the homologous recombination deficiency (HRD) status, regardless of family history. Adjuvant Therapy Recommendation 6. 6.1. It is suggested that all patients with advanced stage III/IV EOC, with PSC of (0-2), got adjuvant intravenous chemotherapy as standard treatment within six weeks after Prc. It is suggested paclitaxel/carboplatin. Recommendation 6.2. It is suggested to use standard chemotherapy base on platinum plus Bevacizumab as adjuvant chemotherapy to patients with high-risk disease (EOC stage IV or stage III with suboptimal tumor cytoreduction), following by bevacizumab as maintenance. The use of bevacizumab as maintenance therapy is not recommended if bevacizumab was not included in the first line of treatment. We suggested the dose used in GOG-0218 and ICON7 trials. Recommendation 6.3 It is suggested combined intravenous/intraperitoneal chemotherapy only for selected patients, with optimal cytoreduction (residual lesions < 1 cm), especially those without residual disease (R0) and who are evaluated in a multidisciplinary meeting. It is not considered standard treatment. Recommendation 6.4. 6.4.1 It is suggested to use Poly ADP ribose polymerase (PARP) inhibitors such as olaparib or niraparib as maintenance after receiving first-line chemotherapy in patients with stage III/IV BRCA1/2 positive EOC who received platinumbased chemotherapy and obtained complete response/partial response (CR/PR), 6.4.2 It is suggested to use olaparib alone or in combination with bevacizumab or niraparib in patients with stage III/IV BRCA1/2 positive EOC who received platinum-based chemotherapy plus bevacizumab and achieved CR/PR. 6.4.3 It is suggested to use niraparibin patients with stage III/IV BRCA1/2 negative or unknown EOC who received platinum-based chemotherapy and achieved CR/PR. 6.4.4 It is suggested to use bevacizumab or olaparib plus bevacizumab in patients with EOC stage III/IV BRCA1/2 negative or unknown (HRD positive) who received platinum-based chemotherapy plus bevacizumab and obtained CR/PR. Treatment of disease relapse Recommendation 7. Secondary cytoreductive surgery followed by chemotherapy is suggested for selected patients with high-grade advanced EOC in first relapse, platinum-sensitive (platinum-free interval ≥ 6 months), positive “Arbeitsgemeinschaft Gynäkologische Onkologie – AGO” score or “I-model” positive (< 4.7) with a potential resection to R0 in centers with access to optimal surgical and postoperative support. Note: Platinum-free interval and AGO score have only been developed as positive predictors of complete resection and not to exclude patients from surgery. Recommendation 8. 8.1 For patients with relapse advanced high-grade EOC platinum-sensitive, the following is suggested: Platinum-based combination chemotherapy: carboplatin/liposomal doxorubicin or carboplatin/paclitaxel or carboplatin/nab-paclitaxel or carboplatin/docetaxel or carboplatin/gemcitabine) for six cycles. If combination therapy is not tolerated, give carboplatin or cisplatin alone. Combination chemotherapy (carboplatin/gemcitabine or carboplatin/paclitaxel or carboplatin/doxorubicin liposomal) plus bevacizumab followed by bevacizumab as maintenance (until progression or toxicity). Recommendation 8.2 For patients with relapsed advanced high-grade EOC platinum-resistant, it is suggested: Sequential treatment with chemotherapy, preferably with a non-platinum single agent (weekly paclitaxel or pegylated liposomal doxorubicin or docetaxel or oral etoposide or gemcitabine or trabectidine or, topotecan). Weekly paclitaxel or pegylated liposomal doxorubicin or topotecan could be administrate with or without bevacizumab. Other agents are considered potentially active (capecitabine, cyclophosphamide, ifosfamide, irinotecan, oxaliplatin, pemetrexed, vinorelbine, cyclophosphamide) could be recommended for later lines. Hormone receptor-positive patients who do not tolerate or have no response to cytotoxic regimens may receive hormone therapy with tamoxifen or other agents, including aromatase inhibitors (anastrozole and letrozole) or leuprolide acetate, or megestrol acetate. Patients with a performance score ≥ 3 should be considered only for best supportive care. Recommendation 8.3 Maintenance therapy with PARP inhibitors: It is suggested in patients with relapse advanced high-grade EOC stage III/IV BRCA1/2 (positive, negative or unknown) who have received two or more lines of platinum-based chemotherapy and have achieved CR/PR, use olaparib, niraparib or rucaparib. Niraparib could be useful in BRCA 1/2 +/-/unknown patients, as rucaparib, however, the latter does not yet have approval from the regulatory office in Colombia. Conclusions: It is expected that the recommendations issued in this consensus will contribute to improving clinical care, oncological impact, and quality of life of these women.
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Affiliation(s)
- Marc E. Pierre
- Centro de tratamiento e investigación sobre el Cáncer Luis Carlos Sarmiento (CTIC), Bogotá, Colombia, ,Centro de tratamiento e investigación sobre el Cáncer Luis Carlos Sarmiento (CTIC)BogotáColombia
| | - Ray Manneh
- Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia, ,Sociedad de Oncología y Hematología del CesarValleduparColombia
| | - Abraham Hernández
- Centro hospitalario Serena del Mar, Cartagena, Colombia, Centro hospitalario Serena del MarCartagenaColombia
| | - Juliana Rodríguez
- Fundación Santafé de Bogotá, Bogotá, Colombia. Departamento de obstetricia y ginecología Universidad Nacional de Colombia, Bogotá, Colombia. Instituto Nacional de Cancerología, Bogotá, Colombia, ,Universidad Nacional de ColombiaUniversidad Nacional de ColombiaBogotáColombia
| | - Angélica V. Fletcher
- Centro de Investigaciones Oncológicas Clínica San Diego (CIOSAD), Bogotá, Colombia, ,Centro de Investigaciones Oncológicas Clínica San Diego (CIOSAD)BogotáColombia
| | - Heydi M. Ramírez
- Fundación Valle de Lili, Cali, Colombia, ,Fundación Valle de LiliCaliColombia
| | - Oscar M. Niño
- Hospital San Ignacio, Bogotá, Colombia, ,Hospital San IgnacioBogotáColombia
| | - Diego A. Gómez
- . Hospital Internacional de Colombia, Bucaramanga, Colombia, ,Hospital Internacional de ColombiaBucaramangaColombia
| | - Daniel Sanabria
- Fundación Santafé de Bogotá, Bogotá, Colombia, ,Fundación Santafé de BogotáBogotáColombia
| | - Fernando Contreras
- Instituto Nacional de Cancerología, Bogotá, Colombia, ,Instituto Nacional de CancerologíaBogotáColombia
| | | | - Pedro H. Calderón
- Instituto Nacional de Cancerología, Bogotá, Colombia, Instituto Nacional de CancerologíaBogotáColombia
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8
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Xu Y, Chen YJA, Wu Y, Saverimuthu A, Jadhav A, Bhuiyan R, Sandler J, Yio J, Kumar V. The prognostic and predictive value of homologous recombination deficiency status in patients with advanced stage epithelial ovarian carcinoma after first-line platinum-based chemotherapy. Front Oncol 2024; 14:1372482. [PMID: 38915363 PMCID: PMC11194312 DOI: 10.3389/fonc.2024.1372482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/23/2024] [Indexed: 06/26/2024] Open
Abstract
Objective Homologous recombination (HR) comprises series of interrelated pathways that repair double-stranded DNA breaks and inter-strand crosslinks. It provides support for DNA replication to recover stalled or broken replication forks. Compared with homologous recombination proficiency (HRP), cancers with homologous recombination deficiency (HRD) are more likely to undergo cell death when treated with DNA-damaging agents, such as platinum agents, and have better disease control. Methods Patients diagnosed with stage III/IV ovarian cancer, early stages with recurrence, who received adjuvant chemotherapy after debulking surgery, and who also had known HR status were eligible. Results Forty-four patients were included, with 21 in the HRD group (including 8 with germline mutations) and 23 in the HRP group. The HRD group was composed predominantly of serous carcinoma (95.2%), while mucinous (n=3) and clear cell (n=1) cases were all found in the HRP group. Stage III/IV disease was 66.7% and 91.3% in HRD and HRP groups, respectively (p=0.064). Patients who were optimally debulked to no residual disease was 90.0% and 72.7% (p=0.243), respectively. Late line use of PARP inhibitors was 33.3% and 17.4% (p=0.303). Median PFS was 22.5 months (95% CI, 18.5 - 66.6) and 21.5 months (95% CI, 18.3-39.5) (p=0.49) in HRD and HRP respectively. Median platinum free interval (PFI) was 15.8 months (95% CI 12.4-60.4) and 15.9 months (95% CI 8.3-34.1) (p=0.24), respectively. Median OS was 88.2 months (95% CI 71.2-NA) and 49.7 months (95% CI 35.1-NA) (p=0.21). The PFS of the patients with germline BRCA mutations (n=5) was 54.3 months (95% CI 23.1-NA) and 21.5 months (95% CI 18.3-39.5) in the HRP group (p=0.095); the PFI difference was 47.7 months (95% CI 17.6-NA) in the BRCA mutation group, and 15.9 months (95% CI 12.4-60.4) in HRP, showing statistical significance (p=0.039); while the median OS was NA and 49.7 months (95% CI 35.1-NA) respectively (p=0.051). When adding two additional patients with somatic BRCA mutations to the germline BRCA mutation carriers, the median OS is NA (95% CI 73, NA) versus 49.7 months (95% CI 35.1, NA) for HRP (p=0.045). Conclusions HRD status was not associated with longer PFS or PFI in advanced ovarian cancer who received first line adjuvant platinum-based chemotherapy. Its role as a prognostic marker for overall survival is suggested, particularly in the subgroup with germline and somatic BRCA mutations.
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Affiliation(s)
- Yiqing Xu
- Division of Hematologic Oncology, Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, United States
| | - Yi-Ju Amy Chen
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Weill Cornell Medical College and New York Presbyterian/Queens Hospital, Flushing, NY, United States
| | - Yunhong Wu
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, United States
| | - Angela Saverimuthu
- Division of Hematologic Oncology, Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, United States
| | - Archana Jadhav
- Division of Hematologic Oncology, Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, United States
| | - Rehana Bhuiyan
- Division of Hematologic Oncology, Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, United States
| | - Jason Sandler
- Division of Hematologic Oncology, Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, United States
| | - Jiang Yio
- Division of Hematologic Oncology, Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, United States
| | - Vivek Kumar
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
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9
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Li R, Zhang H, Li Q, Yuan G, Zhou Y, Yin R, Wang H, Wang C, Huang Y, Wang W, Yan X, Wu L, Zhou Q. Efficacy and safety of paclitaxel liposome versus paclitaxel in combination with carboplatin in the first-line chemotherapy for ovarian cancer: a multicenter, open-label, non-inferiority, randomized controlled trial. JOURNAL OF THE NATIONAL CANCER CENTER 2024; 4:135-141. [PMID: 39282588 PMCID: PMC11390682 DOI: 10.1016/j.jncc.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 09/19/2024] Open
Abstract
Background The paclitaxel liposome formulation, encapsulating paclitaxel within a phospholipid bilayer, addresses the insolubility of traditional paclitaxel formulations, thereby reducing toxicity without compromising its antitumor efficacy. Methods This multicenter, open-label, non-inferiority randomized controlled trial (ChiCTR2000038555) evaluates the efficacy and safety of paclitaxel liposome in comparison to the standard regimen of paclitaxel combined with carboplatin (PLC vs. PC) as first-line therapy in patients with epithelial ovarian cancer. Results An analysis of median progression-free survival (PFS) revealed non-inferior outcomes between 263 patients in the PLC group and 260 patients in the PC group (32.3 vs. 29.9 months, hazard ratio [HR], 0.89 [95% CI, 0.64-1.25]), using a non-inferior margin of 1.3. Although the overall incidence of treatment-related adverse events was comparable between groups, the PLC group experienced significantly fewer non-hematologic toxicities than those treated with the PC regimen. Conclusion The findings affirm the non-inferiority of paclitaxel liposome compared to the combination of paclitaxel and carboplatin regarding therapeutic efficacy, with an enhanced safety profile marked by reduced non-hematologic toxicities.
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Affiliation(s)
- Rong Li
- The Gynecologic Oncology Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Hongping Zhang
- Department of Gynecologic, Yunnan Cancer Hospital, Kunming, China
| | - Qingshui Li
- Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan, China
| | - Guangwen Yuan
- Department of Gynecologic Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanjie Zhou
- Department of Gynecologic Oncology, Hunan Cancer Hospital, Changsha, China
| | - Rutie Yin
- Department of Tumor Radiotherapy and Chemotherapy, West China Second University Hospital of Sichuan University, Chengdu, China
| | - He Wang
- Department of Gynecologic, Guangxi Cancer Institute, Nanning, China
| | - Chunyan Wang
- Department of Gynecologic Oncology, Liaoning Cancer Hospital, Shenyang, China
| | - Yi Huang
- Department of Gynecologic Oncology, Hubei Cancer Hospital, Wuhan, China
| | - Wei Wang
- The Gynecologic Oncology Center, Peking Union Medical College Hospital, Beijing, China
| | - Xiaojian Yan
- Department of Gynecologic, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lingying Wu
- Department of Gynecologic Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Zhou
- The Gynecologic Oncology Center, Chongqing University Cancer Hospital, Chongqing, China
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10
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Upadhyay AK, Kumar M, Prakash A, Kumar A. Diagnostic and therapeutic challenges in a recurrent endometrial carcinoma in lung, 15 years after primary treatment. BMJ Case Rep 2024; 17:e259008. [PMID: 38782427 DOI: 10.1136/bcr-2023-259008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Endometrial carcinoma (EC) is the sixth most common cancer in females. Most ECs are detected in stage 1 and have a 5-year survival rate of more than 90%. Recurrence rates are highest within 5 years after treatment and are exceptionally rare after 10 years. Here, we describe a woman in her late 70s with endometrial cancer who was treated in 2008 and was diagnosed with a relapse in her left lung in 2023. Due to her advanced age and comorbidities, she was deemed inoperable. However, she received sequential chemotherapy and radiotherapy with a good partial response. She has now been started on hormonal therapy with an alternate megestrol and tamoxifen regime. There is a lack of follow-up imaging guidelines to detect late relapse, a dilemma in preferred treatment sequencing at relapse and an enigma in selecting chemotherapy or hormonal therapy.
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Affiliation(s)
| | - Manoj Kumar
- Medical Oncology, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Aaditya Prakash
- Radiation Oncology, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Abhishek Kumar
- Nuclear Medicine, Tata Main Hospital, Jamshedpur, Jharkhand, India
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11
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Ouali K, Michels J, Blanc-Durand F, Leary A, Kfoury M, Genestie C, Morice P, Zaccarini F, Scherrier S, Gouy S, Maulard A, Pautier P. [Current post-surgical treatment strategies in first-line ovarian cancer]. Bull Cancer 2024; 111:267-276. [PMID: 36863923 DOI: 10.1016/j.bulcan.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/18/2022] [Accepted: 01/29/2023] [Indexed: 03/04/2023]
Abstract
Although the management of epithelial ovarian cancer has evolved significantly over the past few years, it remains a public health issue, as most patients are diagnosed at an advanced stage and relapse after first line treatment. Chemotherapy remains the standard adjuvant treatment for International Federation of Gynecology and Obstetrics (FIGO) stage I and II tumors, with some exceptions. For FIGO stage III/IV tumors, carboplatin- and paclitaxel-based chemotherapy are the standard of care, in combination with targeted therapies, especially bevacizumab and/or poly-(ADP-ribose) polymerase inhibitors, that have become a key milestone of first-line treatment. Our decision making for the maintenance therapy is based on the FIGO stage, tumor histology, timing of surgery (i.e. primary or interval debulking surgery), residual tumor, response to chemotherapy, BRCA mutation and homologous recombination (HR) status.
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Affiliation(s)
- Kaïssa Ouali
- Institut Gustave-Roussy, Département d'innovations thérapeutiques et essais précoces (DITEP), 114, avenue Édouard-Vaillant, 94805 Villejuif, France; Institut Gustave-Roussy, Département de médecine, 114, avenue Édouard-Vaillant, 94805 Villejuif, France.
| | - Judith Michels
- Institut Gustave-Roussy, Département de médecine, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Felix Blanc-Durand
- Institut Gustave-Roussy, Département de médecine, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Alexandra Leary
- Institut Gustave-Roussy, Département de médecine, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Maria Kfoury
- Institut Gustave-Roussy, Département de médecine, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Catherine Genestie
- Institut Gustave-Roussy, Département de biologie et pathologie médicale, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Philippe Morice
- Institut Gustave-Roussy, Département d'anesthésie, chirurgie et imagerie interventionnelle, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - François Zaccarini
- Institut Gustave-Roussy, Département d'anesthésie, chirurgie et imagerie interventionnelle, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Stéphanie Scherrier
- Institut Gustave-Roussy, Département d'anesthésie, chirurgie et imagerie interventionnelle, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Sebastien Gouy
- Institut Gustave-Roussy, Département d'anesthésie, chirurgie et imagerie interventionnelle, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Amandine Maulard
- Institut Gustave-Roussy, Département d'anesthésie, chirurgie et imagerie interventionnelle, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
| | - Patricia Pautier
- Institut Gustave-Roussy, Département de médecine, 114, avenue Édouard-Vaillant, 94805 Villejuif, France
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12
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Danziger M, Noble H, Roque DM, Xu F, Rao GG, Santin AD. Microtubule-Targeting Agents: Disruption of the Cellular Cytoskeleton as a Backbone of Ovarian Cancer Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1452:1-19. [PMID: 38805122 DOI: 10.1007/978-3-031-58311-7_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Microtubules are dynamic polymers composed of α- and β-tubulin heterodimers. Microtubules are universally conserved among eukaryotes and participate in nearly every cellular process, including intracellular trafficking, replication, polarity, cytoskeletal shape, and motility. Due to their fundamental role in mitosis, they represent a classic target of anti-cancer therapy. Microtubule-stabilizing agents currently constitute a component of the most effective regimens for ovarian cancer therapy in both primary and recurrent settings. Unfortunately, the development of resistance continues to present a therapeutic challenge. An understanding of the underlying mechanisms of resistance to microtubule-active agents may facilitate the development of novel and improved approaches to this disease.
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Affiliation(s)
- Michael Danziger
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Helen Noble
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dana M Roque
- Division of Gynecologic Oncology, Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Fuhua Xu
- Division of Gynecologic Oncology, Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gautam G Rao
- Division of Gynecologic Oncology, Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
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13
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Brezis MR, Shachar E, Peleg Hasson S, Laskov I, Michaan N, Levy B, Wolf I, Safra T. Effectiveness and safety of standard chemotherapy in older patients with ovarian cancer: a retrospective analysis by age group and treatment regimen. Front Oncol 2023; 13:1289379. [PMID: 38152363 PMCID: PMC10751294 DOI: 10.3389/fonc.2023.1289379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023] Open
Abstract
Objective To evaluate the effectiveness and safety of standard chemotherapy administered to patients >70 years with advanced ovarian cancer (OC). Methods Medical records of 956 advanced-stage patients with OC treated between 2002-2020 with standard surgery and paclitaxel-carboplatin chemotherapy in a three-weekly (PC-3W) or weekly (PC-1W) regimen were reviewed. Treatment response and tolerability were compared between patients ≤70 years (N=723) and >70 years (N=233) with stratification to septuagenarians (>70-80 years) and octogenarians (>80 years). Results Median overall survival (mOS) in patients >70 was 41.26 months (95% confidence interval [Cl], 37.22-45.14) and median progression-free survival (mPFS) was 11.04 months (95% Cl, 8.97-15.74). No statistically significant differences in mPFS and mOS were observed between septuagenarians and octogenarians. Patients >70 treated with PC-1W versus PC-3W had significantly longer mOS (57.17 versus 30.00 months) and mPFS (19.09 versus 8.15 months). Toxicity rates were mostly similar between younger and older patients. Among patients >70 treated with PC-1W, the rate of neutropenia (75.7% versus 51.8%, p=0.0005), thrombocytopenia (41.0% versus 22.2%, p=0.0042) and anemia (78.1% versus 51.9%, p<0.0001) were significantly higher and the rate of grade 2 alopecia was statistically significantly lower compared with those >70 treated with PC-3W. Significantly more patients treated with PC-1W completed ≥6 chemotherapy cycles, suggesting better tolerability of this regimen. Conclusions Older patients with OC may benefit from improved OS with reasonable toxicity if treated with standard chemotherapy. Older patients treated with PC-1W are more likely to complete the full chemotherapy course and survive longer compared with those treated with conventional PC-3W.
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Affiliation(s)
- Miriam R. Brezis
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eliya Shachar
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Peleg Hasson
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Laskov
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Michaan
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bar Levy
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Wolf
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Safra
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Wu S, Xiong T, Guo S, Zhu C, He J, Wang S. An up-to-date view of paclitaxel-induced peripheral neuropathy. J Cancer Res Ther 2023; 19:1501-1508. [PMID: 38156915 DOI: 10.4103/jcrt.jcrt_1982_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 07/12/2023] [Indexed: 01/03/2024]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN),referring to the damage to the peripheral nerves caused by exposure to a neurotoxic chemotherapeutic agent, is a common side effect amongst patients undergoing chemotherapy. Paclitaxel-induced peripheral neuropathy (PIPN) can lead to dose reduction or early cessation of chemotherapy, which is not conducive to patients'survival. Even after treatment is discontinued, PIPN symptoms carried a greater risk of worsening and plagued the patient's life, leading to long-term morbidity in survivors. Here, we summarize the research progress for clinical manifestations, risk factors, pathogenesis, prevention and treatment of PIPN, so as to embark on the path of preventing PIPN with prolongation of patient's life quality on a long-term basis.
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Affiliation(s)
- Shan Wu
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Pharmacy, People's Hospital of Leshan, Shizhong, Leshan, China
| | - Tu Xiong
- Department of Radiology, People's Hospital of Leshan, Shizhong, Leshan, China
| | - Shenglan Guo
- Department of Pharmacy, Huadu District People's Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Cuiyi Zhu
- Department of Pharmacy, People's Hospital of Leshan, Shizhong, Leshan, China
| | - Jing He
- Department of Pharmacy, People's Hospital of Leshan, Shizhong, Leshan, China
| | - Shurong Wang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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15
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Veneziani AC, Gonzalez-Ochoa E, Alqaisi H, Madariaga A, Bhat G, Rouzbahman M, Sneha S, Oza AM. Heterogeneity and treatment landscape of ovarian carcinoma. Nat Rev Clin Oncol 2023; 20:820-842. [PMID: 37783747 DOI: 10.1038/s41571-023-00819-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/04/2023]
Abstract
Ovarian carcinoma is characterized by heterogeneity at the molecular, cellular and anatomical levels, both spatially and temporally. This heterogeneity affects response to surgery and/or systemic therapy, and also facilitates inherent and acquired drug resistance. As a consequence, this tumour type is often aggressive and frequently lethal. Ovarian carcinoma is not a single disease entity and comprises various subtypes, each with distinct complex molecular landscapes that change during progression and therapy. The interactions of cancer and stromal cells within the tumour microenvironment further affects disease evolution and response to therapy. In past decades, researchers have characterized the cellular, molecular, microenvironmental and immunological heterogeneity of ovarian carcinoma. Traditional treatment approaches have considered ovarian carcinoma as a single entity. This landscape is slowly changing with the increasing appreciation of heterogeneity and the recognition that delivering ineffective therapies can delay the development of effective personalized approaches as well as potentially change the molecular and cellular characteristics of the tumour, which might lead to additional resistance to subsequent therapy. In this Review we discuss the heterogeneity of ovarian carcinoma, outline the current treatment landscape for this malignancy and highlight potentially effective therapeutic strategies in development.
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Affiliation(s)
- Ana C Veneziani
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Eduardo Gonzalez-Ochoa
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Husam Alqaisi
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ainhoa Madariaga
- Medical Oncology Department, 12 De Octubre University Hospital, Madrid, Spain
| | - Gita Bhat
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Marjan Rouzbahman
- Department of Laboratory Medicine and Pathobiology, Toronto General Hospital, Toronto, Ontario, Canada
| | - Suku Sneha
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Amit M Oza
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Nam SH, Lee SW, Lee YJ, Kim YM. Safety and Tolerability of Weekly Genexol-PM, a Cremophor-Free Polymeric Micelle Formulation of Paclitaxel, with Carboplatin in Gynecologic Cancer: A Phase I Study. Cancer Res Treat 2023; 55:1346-1354. [PMID: 37189263 PMCID: PMC10582543 DOI: 10.4143/crt.2022.1436] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/12/2023] [Indexed: 05/17/2023] Open
Abstract
PURPOSE This phase I study was conducted to determine the maximum tolerated dose and the recommended phase II dose of weekly administered Genexol-PM combined with carboplatin in patients with gynecologic cancer. MATERIALS AND METHODS This open-label, phase I, dose-escalation study of weekly Genexol-PM included 18 patients with gynecologic cancer, who were equally divided into three cohorts of dose levels. Cohort 1 received 100 mg/m2 Genexol-PM and 5 area under the curve (AUC) carboplatin, cohort 2 received 120 mg/m2 Genexol-PM and 5 AUC carboplatin, and cohort 3 received 120 mg/m2 Genexol-PM and 6 AUC carboplatin. The safety and efficacy of each dose were analyzed for each cohort. RESULTS Of the 18 patients, 11 patients were newly diagnosed and seven patients were recurrent cases. No dose-limiting toxicity was observed. The maximum tolerated dose was not defined, but a dose up to 120 mg/m2 of Genexol-PM in combination with AUC 5-6 of carboplatin could be recommended for a phase II study. In this intention-to-treat population, five patients dropped out of the study (carboplatin-related hypersensitivity, n=1; refusal of consent, n=4). Most patients (88.9%) with adverse events recovered without sequelae, and no treatment-related death occurred. The overall response rate of weekly Genexol-PM in combination with carboplatin was 72.2%. CONCLUSION Weekly administered Genexol-PM with carboplatin demonstrated an acceptable safety profile in gynecologic cancer pati-ents. The recommended phase II dose of weekly Genexol-PM is up to 120 mg/m2 when combined with carboplatin.
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Affiliation(s)
- So Hyun Nam
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin-Wha Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Jae Lee
- Department of Obstetrics and Gynecology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Yong Man Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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González-Martín A, Harter P, Leary A, Lorusso D, Miller RE, Pothuri B, Ray-Coquard I, Tan DSP, Bellet E, Oaknin A, Ledermann JA. Newly diagnosed and relapsed epithelial ovarian cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2023; 34:833-848. [PMID: 37597580 DOI: 10.1016/j.annonc.2023.07.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/21/2023] Open
Affiliation(s)
- A González-Martín
- Department of Medical Oncology and Program in Solid Tumors Cima-Universidad de Navarra, Cancer Center Clínica Universidad de Navarra, Madrid and Pamplona, Spain
| | - P Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - A Leary
- Department of Medical Oncology, Gustave Roussy Cancer Center, INSERM U981, Université Paris-Saclay, Paris, France
| | - D Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome; Department of Woman, Child and Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - R E Miller
- Department of Medical Oncology, University College Hospital, London; Department of Medical Oncology, St Bartholomew's Hospital, London, UK
| | - B Pothuri
- Department of Obstetrics and Gynecology, Perlmutter Cancer Center, NYU Langone Health, New York University School of Medicine, New York, USA
| | - I Ray-Coquard
- Department of Medical Oncology, Centre Leon Bernard and Université Claude Bernard Lyon I, Lyon, France
| | - D S P Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University of Singapore (NUS) Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Cancer Science Institute, National University of Singapore, Singapore, Singapore; Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - E Bellet
- ACTO-Alleanza contro il Tumore Ovarico, Milan, Italy
| | - A Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - J A Ledermann
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
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Rousseau F, Ranchon F, Bardin C, Bakrin N, Lavoué V, Bengrine-Lefevre L, Falandry C. Ovarian cancer in the older patient: where are we now? What to do next? Ther Adv Med Oncol 2023; 15:17588359231192397. [PMID: 37724138 PMCID: PMC10505350 DOI: 10.1177/17588359231192397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 07/19/2023] [Indexed: 09/20/2023] Open
Abstract
In recent years, major advances have been made toward the individualization of epithelial ovarian cancer care, leading to an overall improvement of patient outcomes. However, real-life data indicate that the oldest populations do not benefit from this, due to aspects related to cancer (more aggressive histopathological features), treatment (i.e. frequently suboptimal), and the host (increased toxicities in patients with lower physiological reserve). A specific risk-benefit perspective should therefore be taken when considering surgery, chemotherapy, and maintenance treatments: the decision for cytoreductive surgery should include geriatric vulnerability and surgical complexity, neo-adjuvant chemotherapy being an option when primary surgery appears at high risk; carboplatin paclitaxel association remains the standard even in vulnerable older patients; and bevacizumab and poly(ADP-ribose) polymerase inhibitors maintenance are interesting options provided they are prescribed according to their indications with a close monitoring of their toxicities. Future studies should aim to individualize care without limiting access of older patients to innovation. A specific focus is needed on age-specific translational analyses (focusing on tumor mutational burden and impaired biological pathways), a better patient stratification according to geriatric parameters, an adaptation of both oncological treatment and geriatric interventions, and treatment adaptations not a priori but according to formal pharmacokinetic data.
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Affiliation(s)
- Frédérique Rousseau
- Institut Paoli Calmettes Institute, Marseille, France
- Société Francophone d'OncoGériatrie (SOFOG)
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
| | - Florence Ranchon
- Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Hospices Civils de Lyon, Pierre-Bénite, France
- CICLY Centre pour l’Innovation en Cancérologie de Lyon, Oullins, France
- Société Française de Pharmacie Oncologique (SFPO)
| | - Christophe Bardin
- Service de Pharmacie Clinique, Hôpital Cochin AP-HP Centre Université Paris Cité, Paris, France
- Société Française de Pharmacie Oncologique (SFPO)
| | - Naoual Bakrin
- Hospices Civils de Lyon, Service de Chirurgie Digestive, CHU Hôpital Lyon-Sud, Pierre-Bénite Cedex, France
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
| | - Vincent Lavoué
- Service de Gynécologie, CHU de Rennes, Hôpital Sud, Rennes, France
- UMR S1085, IRSET-INSERM, Université de Rennes, Rennes, France
- Groupe Français de chirurgie Oncologique et Gynécologique (FRANCOGYN)
| | - Leila Bengrine-Lefevre
- Département d’Oncologie Médicale, Centre Georges-Francois Leclerc, Dijon, France
- Société Francophone d'OncoGériatrie (SOFOG)
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
| | - Claire Falandry
- Hospices Civils de Lyon, Unité de Gériatrie, Centre Hospitalier de la Croix Rousse, 103, Grande Rue de la Croix-Rousse, Lyon 69004, France
- Université de Lyon, CarMeN Laboratory, INSERM U.1060/Université Lyon 1/INRA U1397/INSA Lyon/Hospices Civils Lyon Bâtiment CENS-ELI 2D; Hôpital Lyon Sud Secteur 2; Pierre-Bénite 69310, France
- Université Claude Bernard Lyon 1, Pierre-Bénite 69310, France Société Francophone d'OncoGériatrie (SOFOG)
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
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Konstantinopoulos PA, Matulonis UA. Clinical and translational advances in ovarian cancer therapy. NATURE CANCER 2023; 4:1239-1257. [PMID: 37653142 DOI: 10.1038/s43018-023-00617-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023]
Abstract
Ovarian cancer is an aggressive disease that is frequently detected at advanced stages and is initially very responsive to platinum-based chemotherapy. However, the majority of patients relapse following initial surgery and chemotherapy, highlighting the urgent need to develop new therapeutic strategies. In this Review, we outline the main therapeutic principles behind the management of newly diagnosed and recurrent epithelial ovarian cancer and discuss the current landscape of targeted and immune-based approaches.
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Korzun T, Moses AS, Diba P, Sattler AL, Olson B, Taratula OR, Pejovic T, Marks DL, Taratula O. Development and Perspectives: Multifunctional Nucleic Acid Nanomedicines for Treatment of Gynecological Cancers. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023:e2301776. [PMID: 37518857 PMCID: PMC10827528 DOI: 10.1002/smll.202301776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/11/2023] [Indexed: 08/01/2023]
Abstract
Gynecological malignancies are a significant cause of morbidity and mortality across the globe. Due to delayed presentation, gynecological cancer patients are often referred late in the disease's course, resulting in poor outcomes. A considerable number of patients ultimately succumb to chemotherapy-resistant disease, which reoccurs at advanced stages despite treatment interventions. Although efforts have been devoted to developing therapies that demonstrate reduced resistance to chemotherapy and enhanced toxicity profiles, current clinical outcomes remain unsatisfactory due to treatment resistance and unfavorable off-target effects. Consequently, innovative biological and nanotherapeutic approaches are imperative to strengthen and optimize the therapeutic arsenal for gynecological cancers. Advancements in nanotechnology-based therapies for gynecological malignancies offer significant advantages, including reduced toxicity, expanded drug circulation, and optimized therapeutic dosing, ultimately leading to enhanced treatment effectiveness. Recent advances in nucleic acid therapeutics using microRNA, small interfering RNA, and messenger RNA provide novel approaches for cancer therapeutics. Effective single-agent and combinatorial nucleic acid therapeutics for gynecological malignancies have the potential to transform cancer treatment by giving safer, more tailored approaches than conventional therapies. This review highlights current preclinical studies that effectively exploit these approaches for the treatment of gynecological malignant tumors and malignant ascites.
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Affiliation(s)
- Tetiana Korzun
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 SW Bond Avenue Portland, Portland, OR, 97239, USA
- Medical Scientist Training Program, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
- Papé Family Pediatric Research Institute, Oregon Health & Science University, SW Sam Jackson Park Rd, Mail Code L481, Portland, OR, 97239, USA
| | - Abraham S Moses
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Parham Diba
- Medical Scientist Training Program, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
- Papé Family Pediatric Research Institute, Oregon Health & Science University, SW Sam Jackson Park Rd, Mail Code L481, Portland, OR, 97239, USA
| | - Ariana L Sattler
- Papé Family Pediatric Research Institute, Oregon Health & Science University, SW Sam Jackson Park Rd, Mail Code L481, Portland, OR, 97239, USA
- Knight Cancer Institute, Oregon Health & Science University, 2720 S Moody Avenue, Portland, Oregon, 97201, USA
- Brenden-Colson Center for Pancreatic Care, Oregon Health & Science University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Brennan Olson
- Mayo Clinic Department of Otolaryngology-Head and Neck Surgery, 200 First St. SW, Rochester, MN, 55905, USA
| | - Olena R Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Tanja Pejovic
- Departments of Obstetrics and Gynecology and Pathology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Daniel L Marks
- Papé Family Pediatric Research Institute, Oregon Health & Science University, SW Sam Jackson Park Rd, Mail Code L481, Portland, OR, 97239, USA
- Knight Cancer Institute, Oregon Health & Science University, 2720 S Moody Avenue, Portland, Oregon, 97201, USA
- Brenden-Colson Center for Pancreatic Care, Oregon Health & Science University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Oleh Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 SW Bond Avenue Portland, Portland, OR, 97239, USA
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Gong W, Yu R, Cao C, Fang Y, Zhao X, Gao Q. Dose-dense regimen versus conventional three-weekly paclitaxel combination with carboplatin chemotherapy in first-line ovarian cancer treatment: a systematic review and meta-analysis. J Ovarian Res 2023; 16:136. [PMID: 37430376 DOI: 10.1186/s13048-023-01216-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/20/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Paclitaxel dose-dense regimen has been controversial in clinical trials in recent years. This systematic review and meta-analysis tried to evaluate the efficacy and safety of paclitaxel dose-dense chemotherapy in primary epithelial ovarian cancer. METHODS An electronic search following PRISMA guidelines was conducted (Prospero registration number: CRD42020187622), and then a systematic review and meta-analysis of included literature were initiated to determine which regimen was better. RESULTS Four randomized controlled trials were included in the qualitative evaluation, and 3699 ovarian cancer patients were included in the meta-analysis. The meta-analysis revealed that the dose-dense regimen could prolong PFS (HR0.88, 95%CI 0.81-0.96; p = 0.002) and OS (HR0.90, 95%CI 0.81-1.02; p = 0.09), but it also increased the overall toxicity (OR = 1.102, 95%CI 0.864-1.405; p = 0.433), especially toxicity of anemia (OR = 1.924, 95%CI 1.548-2.391; p < 0.001), neutropenia (OR = 2.372, 95%CI 1.674-3.361; p < 0.001). Subgroup analysis indicated that the dose-dense regimen could significantly prolong not only PFS (HR0.76, 95%CI 0.63-0.92; p = 0.005 VS HR0.91, 95%CI 0.83-1.00; p = 0.046) but also OS (HR0.75, 95%CI 0.557-0.98; p = 0.037 VS HR0.94, 95%CI 0.83-1.07; p = 0.371) in Asian, and overall toxicity was significantly increased in Asians (OR = 1.28, 95%CI: 0.877-1.858, p = 0.202) compared to non-Asians (OR = 1.02, 95%CI 0.737-1.396, p = 0.929). CONCLUSION Paclitaxel dose-dense regimen could prolong PFS and OS, but it also increased the overall toxicity. Therapeutic benefits and toxicity of dose-dense are more obvious in Asians compared to non-Asians, which need to be further confirmed in clinical trials.
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Affiliation(s)
- Wenjian Gong
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Ruidi Yu
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Canhui Cao
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Yong Fang
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Xuejiao Zhao
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, People's Republic of China.
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
| | - Qinglei Gao
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, People's Republic of China.
- National Clinical Research Center for Obstetrics and Gynecology, Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
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Andreika L, Vankevičienė K, Plioplytė M, Bitinaitytė M, Rudaitis V. Multiple Rare Primary Malignancies: A Mixed Squamous Neuroendocrine Adenocarcinoma of the Cervix, Metastasized Carcinosarcoma and Extramammary Vulvar Paget's Disease Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050995. [PMID: 37241226 DOI: 10.3390/medicina59050995] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023]
Abstract
The occurrence of more than one primary malignant tumor in a single patient is rare. Multiple primary malignancies can pose difficulties in differential diagnosis between primary tumors and metastasis. Here, we present a case report with multiple primary malignancies. The patient is a 45-year-old female who was diagnosed with cervical mixed squamous neuroendocrine adenocarcinoma, metastasized carcinosarcoma and extramammary vulvar Paget's disease. The patient was first diagnosed with a microinvasive squamous cervical carcinoma in situ. After a few months, the amputation of a small residual tumor and histological evaluation revealed an IA1-stage poorly differentiated (G3) mixed squamous and neuroendocrine cervical adenocarcinoma. After two years, the disease had progressed and biopsies from altered sites were taken. Histological diagnosis from an ulcerated vulvar region revealed extramammary vulvar Paget's disease. A biopsy from vagina polyp revealed an earlier diagnosed mixed squamous and neuroendocrine cervical adenocarcinoma. However, histological diagnosis from an inguinal lymph node biopsy was unexpected and revealed carcinosarcoma. It indicated either the development of another primary malignancy, or an unusual spread of metastasis. Clinical presentation as well as diagnostic and treatment challenges are discussed in this case report. This case report shows that multiple primary malignancy cases are difficult to manage both for clinicians and the patient because the therapeutic options can become limited. This complex case was managed by a multidisciplinary team.
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Affiliation(s)
- Linas Andreika
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio Str. 21/27, LT-03101 Vilnius, Lithuania
| | - Karolina Vankevičienė
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio Str. 21/27, LT-03101 Vilnius, Lithuania
| | - Marija Plioplytė
- Faculty of Medicine, Lithuanian University of Health Sciences, A.Mickevičiaus Str. 9, LT-44307 Kaunas, Lithuania
| | - Monika Bitinaitytė
- Faculty of Medicine, Lithuanian University of Health Sciences, A.Mickevičiaus Str. 9, LT-44307 Kaunas, Lithuania
| | - Vilius Rudaitis
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio Str. 21/27, LT-03101 Vilnius, Lithuania
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Wang L, Li S, Zhu D, Qin Y, Wang X, Hong Z, Han Z. Effectiveness and safety of nab-paclitaxel and platinum as first-line chemotherapy for ovarian cancer: a retrospective study. J Gynecol Oncol 2023:34.e44. [PMID: 36807747 DOI: 10.3802/jgo.2023.34.e44] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/03/2023] [Accepted: 01/18/2023] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness and safety of nab-paclitaxel plus platinum as first-line chemotherapy for ovarian cancer (OC). METHODS Patients administered platinum combined with nab-paclitaxel as first-line chemotherapy for epithelial OC, fallopian tube cancer, or primary peritoneal cancer from July 2018 to December 2021 were retrospectively evaluated. The primary outcome was progression-free survival (PFS). Adverse events (AEs) were examined. Subgroup analysis was performed. RESULTS Seventy-two patients (median age, 54.5 years; range, 20.0-79.0 years) were evaluated, including 12 and 60 administered neoadjuvant therapy and primary surgery with subsequent chemotherapy, respectively. The median follow-up duration was 25.6 months, and the median PFS was 26.7 (95% confidence interval [CI]=24.0-29.3) months in the whole patient population. In the neoadjuvant subgroup, the median PFS was 26.7 (95% CI=22.9-30.5) months vs. 30.1 (95% CI=23.1-37.1) months in the primary surgery subgroup. Twenty-seven patients were administered nab-paclitaxel plus carboplatin and had a median PFS of 30.3 (95% CI=not available [NA]-NA) months. The commonest grade 3-4 AEs included anemia (15.3%), white blood cell decreased (11.1%), and neutrophil count decreased (20.8%). No drug-related hypersensitivity reactions occurred. CONCLUSION Nab-paclitaxel plus platinum as first-line treatment in OC was associated with a favorable prognosis and was tolerable in patients with OC.
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Affiliation(s)
- Liangliang Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuangying Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Da Zhu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Qin
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoli Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenya Hong
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Zhiqiang Han
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Survival Outcomes of Epithelial Ovarian Cancer Patients Following Dose-dense Versus 3-Weekly Platinum-Paclitaxel Chemotherapy: A Meta-Analysis. Clin Oncol (R Coll Radiol) 2023; 35:e189-e198. [PMID: 36357255 DOI: 10.1016/j.clon.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 09/26/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
AIMS Dose-dense chemotherapy has proven its value in several cancer fields. The purpose of the present systematic review is to evaluate the impact of dose-dense chemotherapy on survival outcomes of epithelial ovarian cancer patients. MATERIALS AND METHODS Medline, Scopus, the Cochrane Central Register of Controlled Trials CENTRAL, Google Scholar and Clinicaltrials.gov databases were searched for relevant articles. Effect sizes were calculated in Rstudio using the meta and metafor functions. A sensitivity analysis was carried out to evaluate the possibility of small study effects and P-hacking. The methodological quality of the included studies was assessed using Risk of Bias 2 (RoB2) and Risk of Bias in non-Randomized Trials (RoBINS) tools. RESULTS Overall, 12 studies were included in the present systematic review, involving 4979 epithelial ovarian cancer patients. The risk of recurrence was substantially improved in patients receiving dose-dense chemotherapy (hazard ratio 0.82, 95% confidence interval 0.70, 0.96); however, the result of the meta-analysis may be attributed to the effect size of smaller studies as following adjustment for small study effects the outcome becomes non-significant (hazard ratio 0.91, 95% confidence interval 0.81, 1.02, P = 0.123). Overall survival rates were not improved by dose-dense chemotherapy (hazard ratio 0.79, 95% confidence interval 0.60, 1.04). Thirty-five types of adverse effect were identified following retrieval of data from the original studies. Dose-dense chemotherapy did not increase significantly the rates of severe adverse effects, although thrombosis, severe diarrhoea and severe nausea were more prevalent in this group of patients. CONCLUSION Dose-dense chemotherapy is associated with comparable side-effects to those of standard chemotherapy; however, data related to survival outcomes are not positive; hence, its use outside the setting of clinical trials should be discouraged.
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Comparative Survival Outcomes of Hyperthermic Intraperitoneal Chemotherapy, Intraperitoneal Chemotherapy and Intravenous Chemotherapy for Primary Advanced Ovarian Cancer: A Network Meta-Analysis. J Clin Med 2023; 12:jcm12031111. [PMID: 36769760 PMCID: PMC9917421 DOI: 10.3390/jcm12031111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/16/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE We aimed to compare the survival outcomes and adverse events of hyperthermic intraperitoneal chemotherapy (HIPEC), intraperitoneal chemotherapy (IP)and intravenous chemotherapy (IP)for primary advanced ovarian cancer. METHODS PubMed, CENTRAL (Cochrane Central Registry of Controlled Trials), Embase, Web of Science and Scopus were searched using multiple terms for primary advanced ovarian cancer, including randomized controlled trials and comparative studies in both Chinese and English (up to date 15 August 2022). Outcomes include overall survival, progression-free survival and adverse events. The data were pooled and reported as hazard ratio (HRs) with 95% confidence intervals. The Newcastle-Ottawa Scales were used to assess the risk of bias in the included comparative study. The Cochrane Collaboration's Risk of Bias Tool was used for randomized controlled trials. RESULTS In total, 32 studies, including 6347 patients and 8 different platinum-based chemotherapy regimens, were included in this network meta-analysis. Our analysis results showed that HIPEC2 (carboplatin with area under the curve 10) exhibited a statistically significant OS benefit compared to IV, weekly dose-dense chemotherapy and HIPEC1 (cisplatin with 75/100 mg/m2). Intraperitoneal plus intravenous chemotherapy was associated with a statistically significantly better likelihood of overall survival compared to IV. For progression-free survival, our statistical results only suggest a better progression-free survival in ovarian cancer patients treated with HIPEC1 compared with weekly dose-dense chemotherapy. No evidence of difference was observed between the other comparison groups. Compared with the non-HIPEC group, HIPEC may had a higher incidence of electrolyte disturbances (≥grade 3). CONCLUSION Our statistical analysis suggests that the groups receiving HIPEC2 had a better OS than the groups receiving IV, weekly dose-dense chemotherapy and HIPEC1. For PFS, our analysis only showed HIPEC1 is better than IV. Moreover, HIPEC may lead to a higher incidence of electrolyte disturbances (≥grade 3). HIPEC therapy for advanced ovarian cancer is currently controversial.
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Marrelli D, Ansaloni L, Federici O, Asero S, Carbone L, Marano L, Baiocchi G, Vaira M, Coccolini F, Di Giorgio A, Framarini M, Gelmini R, Palopoli C, Accarpio F, Fagotti A. Cytoreductive Surgery (CRS) and HIPEC for Advanced Ovarian Cancer with Peritoneal Metastases: Italian PSM Oncoteam Evidence and Study Purposes. Cancers (Basel) 2022; 14:6010. [PMID: 36497490 PMCID: PMC9740463 DOI: 10.3390/cancers14236010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Ovarian cancer is the eighth most common neoplasm in women with a high mortality rate mainly due to a marked propensity for peritoneal spread directly at diagnosis, as well as tumor recurrence after radical surgical treatment. Treatments for peritoneal metastases have to be designed from a patient's perspective and focus on meaningful measures of benefit. Hyperthermic intraperitoneal chemotherapy (HIPEC), a strategy combining maximal cytoreductive surgery with regional chemotherapy, has been proposed to treat advanced ovarian cancer. Preliminary results to date have shown promising results, with improved survival outcomes and tumor regression. As knowledge about the disease process increases, practice guidelines will continue to evolve. In this review, we have reported a broad overview of advanced ovarian cancer management, and an update of the current evidence. The future perspectives of the Italian Society of Surgical Oncology (SICO) are discussed conclusively.
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Affiliation(s)
- Daniele Marrelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Luca Ansaloni
- Unit of General Surgery San Matteo Hospital, 27100 Pavia, Italy
| | - Orietta Federici
- Surgical Oncology, Peritoneum and Abdomen Pathologies, National Cancer Institute Regina Elena, 00144 Rome, Italy
| | - Salvatore Asero
- Unit of Surgical Oncology, Soft Tissue Tumors, Department of Oncology, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, 95123 Catania, Italy
| | - Ludovico Carbone
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Luigi Marano
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Gianluca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy
| | - Marco Vaira
- Candiolo Cancer Institute, FPO–IRCCS, Candiolo, 10060 Torino, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56122 Pisa, Italy
| | - Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli–IRCCS, 00168 Rome, Italy
| | - Massimo Framarini
- Surgery and Advanced Oncological Therapy Unit, Ospedale GB. Morgagni-L. Pierantoni, AUSL Forlì, 47121 Forlì-Cesena, Italy
| | - Roberta Gelmini
- Unit of Emergency General Surgery and Surgical Oncology, AOU Policlinico di Modena, 41125 Modena, Italy
| | - Carmen Palopoli
- Unit of PSG and OBI, Azienda Ospedaliera Universitaria G. Martino, 98124 Messina, Italy
| | - Fabio Accarpio
- CRS and HIPEC Unit, Pietro Valdoni, Umberto I Policlinico di Roma, 00161 Roma, Italy
| | - Anna Fagotti
- Unit of Ovarian Carcinoma, Fondazione Policlinico Universitario A. Gemelli–IRCCS, 00168 Rome, Italy
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Zamwar UM, Anjankar AP. Aetiology, Epidemiology, Histopathology, Classification, Detailed Evaluation, and Treatment of Ovarian Cancer. Cureus 2022; 14:e30561. [DOI: 10.7759/cureus.30561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022] Open
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Epithelial ovarian cancer: Review article. Cancer Treat Res Commun 2022; 33:100629. [PMID: 36127285 DOI: 10.1016/j.ctarc.2022.100629] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
Epithelial ovarian cancer is the second commonest cause of death amongst all gynaecological cancers. Treatment is challenging because almost 75% of cases are diagnosed in advanced stages. Front line treatment with aggressive cytoreduction and adjuvant treatment decides the outcome. Despite the complete response to primary treatment majority will relapse with disease. Treatment options of recurrent disease depends on platinum free interval. Systemic therapy is the mainstay of treatment and secondary cytoreduction may be beneficial in selected patients Newer therapeutic agents are being added in the front line and recurrent setting to improve outcome.
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Armstrong DK, Alvarez RD, Backes FJ, Bakkum-Gamez JN, Barroilhet L, Behbakht K, Berchuck A, Chen LM, Chitiyo VC, Cristea M, DeRosa M, Eisenhauer EL, Gershenson DM, Gray HJ, Grisham R, Hakam A, Jain A, Karam A, Konecny GE, Leath CA, Leiserowitz G, Liu J, Martin L, Matei D, McHale M, McLean K, Miller DS, Percac-Lima S, Remmenga SW, Schorge J, Stewart D, Thaker PH, Vargas R, Hendrickson AW, Werner TL, Zsiros E, Dwyer MA, Hang L. NCCN Guidelines® Insights: Ovarian Cancer, Version 3.2022. J Natl Compr Canc Netw 2022; 20:972-980. [PMID: 36075393 DOI: 10.6004/jnccn.2022.0047] [Citation(s) in RCA: 123] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States, with less than half of patients living >5 years following diagnosis. The NCCN Guidelines for Ovarian Cancer provide recommendations for the diagnosis, evaluation, treatment, and follow-up for patients with ovarian, fallopian tube, and primary peritoneal cancers. These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines, including revised guidance on alternative chemotherapy regimens for patients with advanced age and/or comorbidities, a new algorithm for recurrent low-grade serous carcinoma based on developing research and novel therapeutic agents, and updated language regarding tumor molecular analysis applications in ovarian cancer.
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Affiliation(s)
| | | | - Floor J Backes
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | - Lee-May Chen
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | - Heidi J Gray
- University of Washington/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | | | - Joyce Liu
- Dana-Farber/Brigham and Women's Cancer Center
| | - Lainie Martin
- Abramson Cancer Center at the University of Pennsylvania
| | - Daniela Matei
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | - John Schorge
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Premal H Thaker
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Roberto Vargas
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Lisa Hang
- National Comprehensive Cancer Network
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Coffman LG, Orellana TJ, Liu T, Frisbie LG, Normolle D, Griffith K, Uppal S, McLean K, Berger JL, Boisen M, Courtney-Brooks M, Edwards RP, Lesnock J, Mahdi H, Olawaiye A, Sukumvanich P, Taylor SE, Buckanovich R. Phase I trial of ribociclib with platinum chemotherapy in recurrent ovarian cancer. JCI Insight 2022; 7:160573. [PMID: 35972817 DOI: 10.1172/jci.insight.160573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND New therapeutic combinations to improve the outcome of ovarian cancer patients are clearly needed. Preclinical studies with ribociclib (LEE-011), a CDK4/6 cell cycle checkpoint inhibitor, demonstrate a synergistic effect with platinum chemotherapy and efficacy as a maintenance therapy after chemotherapy. We tested the safety and initial efficacy of ribociclib in combination with platinum-based chemotherapy in recurrent ovarian cancer. METHODS This phase I trial combined weekly carboplatin and paclitaxel chemotherapy with ribociclib followed by ribociclib maintenance in patients with recurrent platinum-sensitive ovarian cancer. Primary objectives were safety and maximum tolerated dose (MTD) of ribociclib when given with platinum and taxane chemotherapy. Secondary endpoints were response rate (RR) and progression-free survival (PFS). RESULTS Thirty-five patients were enrolled. Patients had a mean 2.5 prior lines of chemotherapy, and 51% received prior maintenance therapy with Poly (ADP-ribose) polymerase inhibitors (PARPi) and/or Bevacizumab. The MTD was 400mg. The most common AEs included anemia (82.9%), neutropenia (82.9%), fatigue (82.9%), and nausea (77.1%). Overall RR was 79.3% with a stable disease (SD) rate of 18% resulting in a clinical benefit rate of 96.6%. The PFS was 11.4 months. RR and PFS did not differ based on number of lines of prior chemotherapy or prior maintenance therapy. CONCLUSIONS This work demonstrates the combination of ribociclib with chemotherapy in ovarian cancer is feasible and safe. With a clinical benefit rate of 97%, this work provides encouraging evidence of clinical efficacy in patients with recurrent platinum-sensitive disease. TRIAL REGISTRATION CLINICALTRIALS gov NCT03056833. FUNDING This investigator-initiated trial was supported by Novartis who provided drug and funds for trial execution.
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Affiliation(s)
- Lan G Coffman
- Department of Medicine, University of Pittsburgh, Pittsburgh, United States of America
| | - Taylor J Orellana
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, United States of America
| | - Tianshi Liu
- Department of Medicine, University of Pittsburgh, Pittsburgh, United States of America
| | - Leonard G Frisbie
- Department of Integrative Systems Biology, University of Pittsburgh, Pittsburgh, United States of America
| | - Daniel Normolle
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, United States of America
| | - Kent Griffith
- Center for Cancer Data Sciences, University of Michigan, Ann Arbor, United States of America
| | - Shitanshu Uppal
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, United States of America
| | - Karen McLean
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, United States of America
| | - Jessica L Berger
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, United States of America
| | - Michelle Boisen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, United States of America
| | - Madeleine Courtney-Brooks
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, United States of America
| | - Robert P Edwards
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, United States of America
| | - Jamie Lesnock
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, United States of America
| | - Haider Mahdi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, United States of America
| | - Alexander Olawaiye
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, United States of America
| | - Paniti Sukumvanich
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, United States of America
| | - Sarah E Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, United States of America
| | - Ronald Buckanovich
- Department of Medicine, University of Pittsburgh, Pittsburgh, United States of America
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Vergote I, Gonzalez-Martin A, Lorusso D, Gourley C, Mirza MR, Kurtz JE, Okamoto A, Moore K, Kridelka F, McNeish I, Reuss A, Votan B, du Bois A, Mahner S, Ray-Coquard I, Kohn EC, Berek JS, Tan DSP, Colombo N, Zang R, Concin N, O'Donnell D, Rauh-Hain A, Herrington CS, Marth C, Poveda A, Fujiwara K, Stuart GCE, Oza AM, Bookman MA. Clinical research in ovarian cancer: consensus recommendations from the Gynecologic Cancer InterGroup. Lancet Oncol 2022; 23:e374-e384. [PMID: 35901833 PMCID: PMC9465953 DOI: 10.1016/s1470-2045(22)00139-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/13/2022]
Abstract
The Gynecologic Cancer InterGroup (GCIG) sixth Ovarian Cancer Conference on Clinical Research was held virtually in October, 2021, following published consensus guidelines. The goal of the consensus meeting was to achieve harmonisation on the design elements of upcoming trials in ovarian cancer, to select important questions for future study, and to identify unmet needs. All 33 GCIG member groups participated in the development, refinement, and adoption of 20 statements within four topic groups on clinical research in ovarian cancer including first line treatment, recurrent disease, disease subgroups, and future trials. Unanimous consensus was obtained for 14 of 20 statements, with greater than 90% concordance in the remaining six statements. The high acceptance rate following active deliberation among the GCIG groups confirmed that a consensus process could be applied in a virtual setting. Together with detailed categorisation of unmet needs, these consensus statements will promote the harmonisation of international clinical research in ovarian cancer.
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Affiliation(s)
- Ignace Vergote
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven, Belgium; University Hospitals Leuven, Leuven, Belgium.
| | - Antonio Gonzalez-Martin
- Grupo Español de Cáncer de Ovario (GEICO), Madrid, Spain; Clinica Universidad de Navarra, Madrid, Spain; Program for Solid Tumors at Madrid, and Center for Applied Medical Research (CIMA), Universidad de Navarra, Pamplona, Spain
| | - Domenica Lorusso
- Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Naples, Italy; Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Charlie Gourley
- Scottish Gynaecological Cancer Trials Group (SGCTG), Cancer Research UK, Edinburgh, UK; Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Mansoor Raza Mirza
- Nordic Society of Gynecologic Oncology Clinical Trial Unit (NSGO-CTU), Copenhagen, Denmark; Rigshospitalet, Copenhagen, Denmark
| | - Jean-Emmanuel Kurtz
- Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein (GINECO), Paris, France; Strasbourg Cancer Institute, Strasbourg, France
| | - Aikou Okamoto
- Japanese Gynecologic Oncology Group (JGOG), Tokyo, Japan; The Jikei University School of Medicine, Tokyo, Japan
| | - Kathleen Moore
- Gynecologic Oncology Group-Foundation (GOG-F), Philadelphia, PA, USA; OU Health Stephenson Cancer Center, Oklahoma City, OH, USA
| | - Frédéric Kridelka
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven, Belgium; Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Iain McNeish
- National Cancer Research Institute (NCRI), London, UK; Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alexander Reuss
- Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Study Group, Munich, Germany; Coordinating Center for Clinical Trials, Philipps University, Marburg, Germany
| | - Bénédicte Votan
- Association de Recherche Cancers Gynécologiques (ARCAGY)-GINECO, Paris, France
| | - Andreas du Bois
- Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Study Group, Munich, Germany; Kliniken Essen Mitte (KEM), Essen, Germany
| | - Sven Mahner
- Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Study Group, Munich, Germany; University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Isabelle Ray-Coquard
- Groupe d'Investigateurs National des Etudes des Cancers Ovariens et du Sein (GINECO), Paris, France; Centre Leon Berard and University Claude Bernard Lyon I, Lyon, France
| | - Elise C Kohn
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan S Berek
- Women's Cancer Research Network-Cooperative Gynecologic Oncology Investigators (WCRN-COGI), Fresno, CA; Stanford Cancer Institute, Stanford, CA, USA
| | - David S P Tan
- Asia Pacific Gynecologic Oncology Trials Group (APGOT), Seoul, South Korea; Gynecologic Cancer Group Singapore (GCGS), Singapore; Cancer Science Institute, National University of Singapore, Singapore
| | - Nicoletta Colombo
- Mario Negri Gynecologic Oncology (MaNGO), Milan, Italy; European Institute of Oncology, Milan, Italy; University of Milano-Bicocca, Milan, Italy
| | - Rongyu Zang
- Shanghai Gynecologic Oncology Group (SGOG), Shanghai, China; Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nicole Concin
- AGO -Austria, Innsbruck, Austria; Kliniken Essen Mitte (KEM), Essen, Germany; Medical University of Innsbruck, Innsbruck, Austria
| | - Dearbhaile O'Donnell
- Cancer Trials Ireland (CTI), Dublin, Ireland; St James's Hospital, Dublin, Ireland
| | - Alejandro Rauh-Hain
- Global Gynecologic Oncology Consortium (G-GOC), Houston, TX, USA; MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - C Simon Herrington
- Scottish Gynaecological Cancer Trials Group (SGCTG), Cancer Research UK, Edinburgh, UK; Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Christian Marth
- AGO -Austria, Innsbruck, Austria; Medical University of Innsbruck, Innsbruck, Austria
| | - Andres Poveda
- Grupo Español de Cáncer de Ovario (GEICO), Madrid, Spain; Hospital Quironsalud, Valencia, Spain
| | - Keiichi Fujiwara
- Gynecologic Cancer Clinical Trials and Investigation Consortium (GOTIC), North Kanto, Japan; Saitama Medical University International Medical Center, Saitama, Japan
| | - Gavin C E Stuart
- Canadian Cancer Trials Group (CCTG), Kingston, ON, Canada; University of British Columbia, Vancouver, BC, Canada
| | - Amit M Oza
- Princess Margaret Hospital Consortium (PMHC), Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Michael A Bookman
- Gynecologic Oncology Group-Foundation (GOG-F), Philadelphia, PA, USA; San Francisco Medical Center, San Francisco, CA, USA
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The Potential of Novel Lipid Agents for the Treatment of Chemotherapy-Resistant Human Epithelial Ovarian Cancer. Cancers (Basel) 2022; 14:cancers14143318. [PMID: 35884379 PMCID: PMC9322924 DOI: 10.3390/cancers14143318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Disease recurrence and chemotherapy resistance are the major causes of mortality for the majority of epithelial ovarian cancer (EOC) patients. Standard of care relies on cytotoxic drugs that induce a form of cell death called apoptosis. EOC cells can evolve to resist apoptosis. We developed drugs called glycosylated antitumor ether lipids (GAELs) that kill EOC cells by a mechanism that does not involve apoptosis. GAELs most likely induce cell death through a process called methuosis. Importantly, we showed that GAELs are effective at killing chemotherapy-resistant EOC cells in vitro and in vivo. Our work shows that the EOC community should begin to investigate methuosis-inducing agents as a novel therapeutic platform to treat chemotherapy-resistant EOC. Abstract Recurrent epithelial ovarian cancer (EOC) coincident with chemotherapy resistance remains the main contributor to patient mortality. There is an ongoing investigation to enhance patient progression-free and overall survival with novel chemotherapeutic delivery, such as the utilization of antiangiogenic medications, PARP inhibitors, or immune modulators. Our preclinical studies highlight a novel tool to combat chemotherapy-resistant human EOC. Glycosylated antitumor ether lipids (GAELs) are synthetic glycerolipids capable of killing established human epithelial cell lines from a wide variety of human cancers, including EOC cell lines representative of different EOC histotypes. Importantly, GAELs kill high-grade serous ovarian cancer (HGSOC) cells isolated from the ascites of chemotherapy-sensitive and chemotherapy-resistant patients grown as monolayers of spheroid cultures. In addition, GAELs were well tolerated by experimental animals (mice) and were capable of reducing tumor burden and blocking ascites formation in an OVCAR-3 xenograft model. Overall, GAELs show great promise as adjuvant therapy for EOC patients with or without chemotherapy resistance.
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Clamp AR, James EC, McNeish IA, Dean A, Kim JW, O'Donnell DM, Gallardo-Rincon D, Blagden S, Brenton J, Perren TJ, Sundar S, Lord R, Dark G, Hall M, Banerjee S, Glasspool RM, Hanna CL, Williams S, Scatchard KM, Nam H, Essapen S, Parkinson C, McAvan L, Swart AM, Popoola B, Schiavone F, Badrock J, Fananapazir F, Cook AD, Parmar M, Kaplan R, Ledermann JA. Weekly dose-dense chemotherapy in first-line epithelial ovarian, fallopian tube, or primary peritoneal cancer treatment (ICON8): overall survival results from an open-label, randomised, controlled, phase 3 trial. Lancet Oncol 2022; 23:919-930. [PMID: 35690073 PMCID: PMC9630160 DOI: 10.1016/s1470-2045(22)00283-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Standard-of-care first-line chemotherapy for epithelial ovarian cancer is carboplatin and paclitaxel administered once every 3 weeks. The JGOG 3016 trial reported significant improvement in progression-free and overall survival with dose-dense weekly paclitaxel and 3-weekly (ie, once every 3 weeks) carboplatin. However, this benefit was not observed in the previously reported progression-free survival results of ICON8. Here, we present the final coprimary outcomes of overall survival and updated progression-free survival analyses of ICON8. METHODS In this open-label, randomised, controlled, phase 3 trial (ICON8), women aged 18 years or older with newly diagnosed stage IC-IV epithelial ovarian, primary peritoneal, or fallopian tube carcinoma (here collectively termed ovarian cancer, as defined by International Federation of Gynecology and Obstetrics [FIGO] 1988 criteria) and an Eastern Cooperative Oncology Group performance status of 0-2 were recruited from 117 hospitals with oncology departments in the UK, Australia and New Zealand, Mexico, South Korea, and Ireland. Patients could enter the trial after immediate primary surgery (IPS) or with planned delayed primary surgery (DPS) during chemotherapy, or could have no planned surgery. Participants were randomly assigned (1:1:1), using the Medical Research Council Clinical Trials Unit at University College London randomisation line with stratification by Gynecologic Cancer Intergroup group, FIGO disease stage, and outcome and timing of surgery, to either 3-weekly carboplatin area under the curve (AUC)5 or AUC6 and 3-weekly paclitaxel 175 mg/m2 (control; group 1), 3-weekly carboplatin AUC5 or AUC6 and weekly paclitaxel 80 mg/m2 (group 2), or weekly carboplatin AUC2 and weekly paclitaxel 80 mg/m2 (group 3), all administered via intravenous infusion for a total of six 21-day cycles. Coprimary outcomes were progression-free survival and overall survival, with comparisons done between group 2 and group 1, and group 3 and group 1, in the intention-to-treat population. Safety was assessed in all patients who started at least one chemotherapy cycle. The trial is registered on ClinicalTrials.gov, NCT01654146, and ISRCTN registry, ISRCTN10356387, and is closed to accrual. FINDINGS Between June 6, 2011, and Nov 28, 2014, 1566 patients were randomly assigned to group 1 (n=522), group 2 (n=523), or group 3 (n=521). The median age was 62 years (IQR 54-68), 1073 (69%) of 1566 patients had high-grade serous carcinoma, 1119 (71%) had stage IIIC-IV disease, and 745 (48%) had IPS. As of data cutoff (March 31, 2020), with a median follow-up of 69 months (IQR 61-75), no significant difference in overall survival was observed in either comparison: median overall survival of 47·4 months (95% CI 43·1-54·8) in group 1, 54·8 months (46·6-61·6) in group 2, and 53·4 months (49·2-59·6) in group 3 (group 2 vs group 1: hazard ratio 0·87 [97·5% CI 0·73-1·05]; group 3 vs group 1: 0·91 [0·76-1·09]). No significant difference was observed for progression-free survival in either comparison and evidence of non-proportional hazards was seen (p=0·037), with restricted mean survival time of 23·9 months (97·5% CI 22·1-25·6) in group 1, 25·3 months (23·6-27·1) in group 2, and 24·8 months (23·0-26·5) in group 3. The most common grade 3-4 adverse events were reduced neutrophil count (78 [15%] of 511 patients in group 1, 183 [36%] of 514 in group 2, and 154 [30%] of 513 in group 3), reduced white blood cell count (22 [4%] in group 1, 80 [16%] in group 2, and 71 [14%] in group 3), and anaemia (26 [5%] in group 1, 66 [13%] in group 2, and 24 [5%] in group 3). No new serious adverse events were reported. Seven treatment-related deaths were reported (two in group 1, four in group 2, and one in group 3). INTERPRETATION In our cohort of predominantly European women with epithelial ovarian cancer, we found that first-line weekly dose-dense chemotherapy did not improve overall or progression-free survival compared with standard 3-weekly chemotherapy and should not be used as part of standard multimodality front-line therapy in this patient group. FUNDING Cancer Research UK, Medical Research Council, Health Research Board in Ireland, Irish Cancer Society, and Cancer Australia.
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Affiliation(s)
- Andrew R Clamp
- The Christie NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Elizabeth C James
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | - Iain A McNeish
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Andrew Dean
- Oncology, St John of God Hospital, Subiaco, WA, Australia
| | - Jae-Won Kim
- Department of Obstetrics and Gynecology, Seoul National University, Seoul, South Korea
| | | | | | - Sarah Blagden
- Department of Oncology, Churchill Hospital, University of Oxford, Oxford, UK
| | - James Brenton
- Li Ka Shing Centre, Cancer Research UK Cambridge Institute, Cambridge, UK
| | - Tim J Perren
- Leeds Institute of Medical Research, St James' University Hospital, Leeds, UK
| | - Sudha Sundar
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | - Rosemary Lord
- Department of Oncology, Clatterbridge Cancer Centre, Wirral, UK
| | - Graham Dark
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK
| | - Marcia Hall
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Susana Banerjee
- Gynaecological Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | | | - C Louise Hanna
- Department of Oncology, Velindre Cancer Centre, Cardiff, UK
| | | | - Kate M Scatchard
- North Devon District Hospital, Barnstaple, UK; Exeter Oncology Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Helena Nam
- Broomfield Hospital, Chelmsford, UK; Southend University Hospital, Southend, UK
| | - Sharadah Essapen
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | | | - Lucy McAvan
- Department of Oncology, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Ann Marie Swart
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Babasola Popoola
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Francesca Schiavone
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Jonathan Badrock
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Fuad Fananapazir
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Adrian D Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Richard Kaplan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Jonathan A Ledermann
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute and UCL Hospitals, London, UK
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Sun L, Zhao P, Chen M, Leng J, Luan Y, Du B, Yang J, Yang Y, Rong R. Taxanes prodrug-based nanomedicines for cancer therapy. J Control Release 2022; 348:672-691. [PMID: 35691501 DOI: 10.1016/j.jconrel.2022.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/04/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]
Abstract
Malignant tumor remains a huge threat to human health and chemotherapy still occupies an important place in clinical tumor treatment. As a kind of potent antimitotic agent, taxanes act as the first-line broad-spectrum cancer drug in clinical use. However, disadvantages such as prominent hydrophobicity, severe off-target toxicity or multidrug resistance lead to unsatisfactory therapeutic effects, which restricts its wider usage. The efficient delivery of taxanes is still quite a challenge despite the rapid developments in biomaterials and nanotechnology. Great progress has been made in prodrug-based nanomedicines (PNS) for cancer therapy due to their outstanding advantages such as high drug loading efficiency, low carrier induced immunogenicity, tumor stimuli-responsive drug release, combinational therapy and so on. Based on the numerous developments in this filed, this review summarized latest updates of taxanes prodrugs-based nanomedicines (TPNS), focusing on polymer-drug conjugate-based nanoformulations, small molecular prodrug-based self-assembled nanoparticles and prodrug-encapsulated nanosystems. In addition, the new trends of tumor stimuli-responsive TPNS were also discussed. Moreover, the future challenges of TPNS for clinical translation were highlighted. We here expect this review will inspire researchers to explore more practical taxanes prodrug-based nano-delivery systems for clinical use.
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Affiliation(s)
- Linlin Sun
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan 250355, PR China; School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, PR China
| | - Pan Zhao
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, PR China
| | - Menghan Chen
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, PR China
| | - Jiayi Leng
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, PR China
| | - Yixin Luan
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, PR China
| | - Baoxiang Du
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, PR China
| | - Jia Yang
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, PR China
| | - Yong Yang
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan 250355, PR China.
| | - Rong Rong
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan 250355, PR China.
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Clear cell adenocarcinoma arising from anterior abdominal wall cesarean section scar endometriosis treated with excision and the addition of Trastuzumab for adjuvant chemotherapy: A case report. Gynecol Oncol Rep 2022; 41:100995. [PMID: 35574241 PMCID: PMC9096664 DOI: 10.1016/j.gore.2022.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/26/2022] [Accepted: 04/30/2022] [Indexed: 11/22/2022] Open
Abstract
Abdominal wall endometriosis with subsequent transformation to clear cell carcinoma is quite rare. The pathogenesis and pattern of this transformation is not well known; hence evaluation and management guidelines are not well established. We highlight a case of clear cell adenocarcinoma arising from the anterior abdominal wall in a previous cesarean section scar treated with excision and the unique addition of Trastuzumab for adjuvant chemotherapy.
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André L, Antherieu G, Boinet A, Bret J, Gilbert T, Boulahssass R, Falandry C. Oncological Treatment-Related Fatigue in Oncogeriatrics: A Scoping Review. Cancers (Basel) 2022; 14:2470. [PMID: 35626074 PMCID: PMC9139887 DOI: 10.3390/cancers14102470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/17/2022] Open
Abstract
Fatigue is a highly prevalent symptom in both cancer patients and the older population, and it contributes to quality-of-life impairment. Cancer treatment-related fatigue should thus be included in the risk/benefit assessment when introducing any treatment, but tools are lacking to a priori estimate such risk. This scoping review was designed to report the current evidence regarding the frequency of fatigue for the different treatment regimens proposed for the main cancer indications, with a specific focus on age-specific data, for the following tumors: breast, ovary, prostate, urothelium, colon, lung and lymphoma. Fatigue was most frequently reported using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) versions 3 to 5. A total of 324 regimens were analyzed; data on fatigue were available for 217 (67%) of them, and data specific to older patients were available for 35 (11%) of them; recent pivotal trials have generally reported more fatigue grades than older studies, illustrating increasing concern over time. This scoping review presents an easy-to-understand summary that is expected to provide helpful information for shared decisions with patients regarding the anticipation and prevention of fatigue during each cancer treatment.
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Affiliation(s)
- Louise André
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Gabriel Antherieu
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Amélie Boinet
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Judith Bret
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Thomas Gilbert
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
- Research on Healthcare Professionals and Performance RESHAPE, Inserm U1290, Lyon 1 University, 69008 Lyon, France
| | - Rabia Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de Nice, 06000 Nice, France;
- FHU OncoAge, 06000 Nice, France
- Faculty of Medicine, University of Nice Sofia Antilpolis, 06000 Nice, France
| | - Claire Falandry
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
- FHU OncoAge, 06000 Nice, France
- CarMeN Laboratory, INSERM U.1060/Université Lyon1/INRA U. 1397/INSA Lyon/Hospices Civils Lyon, Bâtiment CENS-ELI 2D, Hôpital Lyon Sud Secteur 2, 69310 Pierre-Bénite, France
- UCOGIR—Auvergne-Rhône-Alpes Ouest–Guyane, Hôpital Lyon Sud, 69495 Pierre-Bénite, France
- Faculty of Medicine and Maieutics Charles Mérieux, Lyon 1 University, 69310 Pierre-Bénite, France
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Ovarian Cancer: Treatment and Resistance to Pharmacotherapy. REPRODUCTIVE MEDICINE 2022. [DOI: 10.3390/reprodmed3020011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Despite advances in surgical techniques and chemotherapy, ovarian cancer is still a leading cause of death among gynecological cancers. In addition to the late detection of the disease, the main reason for poor prognosis is resistance to pharmacotherapy, mostly platinum compounds. About a third of patients do not respond to primary platinum-based chemotherapy treatment, and over time, eventually, 80% of other patients develop chemoresistance, which makes the recurrence of disease incurable. In this review, we describe a difficult clinical hurdle faced in ovarian cancer therapy as a result of platinum resistance, as well as resistance to newer targeted therapy with PARP inhibitors and bevacizumab. We, furthermore, give attention also to the role of the tumor microenvironment as it is less well understood than the tumor cell-intrinsic mechanism. Because a central goal in ovarian cancer research is the development of novel strategies to overcome chemoresistance, treatment for cancer is moving toward personalized therapy.
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Takahashi N, Takekuma M. Current trends in chemotherapy for advanced ovarian cancer. Jpn J Clin Oncol 2022; 52:806-815. [PMID: 35521913 DOI: 10.1093/jjco/hyac065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/07/2022] [Indexed: 12/24/2022] Open
Abstract
Chemotherapy for advanced ovarian cancer has progressed over the past several decades with the introduction of cytotoxic agents. Various methods, including single agents, combination therapy and changes in the method of administration, have been validated in many clinical trials and have been combined in an attempt to improve the prognosis of advanced ovarian cancer. In recent years, molecular-targeted agents have been added to cytotoxic agents as a treatment option for maintenance therapy; however, their efficacy has been limited, and further development of treatment options is expected. The advent of poly(ADP-ribose) polymerase inhibitors has considerably improved prognosis and has affected treatment strategies for advanced ovarian cancer over the past few years. With the addition of the recently introduced immune checkpoint inhibitors, future treatment strategies for advanced ovarian cancer may become more complex. In this review, we introduce the latest advances in chemotherapy for advanced ovarian cancer and discuss future perspectives.
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Kweon S, Jeong YS, Chung SW, Lee H, Lee HK, Park SJ, Choi JU, Park J, Chung SJ, Byun Y. Metronomic dose-finding approach in oral chemotherapy by experimentally-driven integrative mathematical modeling. Biomaterials 2022; 286:121584. [DOI: 10.1016/j.biomaterials.2022.121584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/02/2022]
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Leal TA, Sharifi MN, Chan N, Wesolowski R, Turk AA, Bruce JY, O'Regan RM, Eickhoff J, Barroilhet LM, Malhotra J, Mehnert J, Girda E, Wiley E, Schmitz N, Andrews S, Liu G, Wisinski KB. A phase I study of talazoparib (BMN 673) combined with carboplatin and paclitaxel in patients with advanced solid tumors (NCI9782). Cancer Med 2022; 11:3969-3981. [PMID: 35396812 PMCID: PMC9636507 DOI: 10.1002/cam4.4724] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/21/2022] [Accepted: 03/13/2022] [Indexed: 11/25/2022] Open
Abstract
Background Inhibitors of poly(ADP‐ribose) polymerase (PARP) proteins potentiate antitumor activity of platinum chemotherapy. This study sought to determine the safety and tolerability of PARP inhibitor talazoparib with carboplatin and paclitaxel. Methods We conducted a phase I study of talazoparib with carboplatin AUC5‐6 and paclitaxel 80 mg/m2 days 1, 8, 15 of 21‐day cycles in patients with advanced solid tumors. Patients enrolled using a 3 + 3 design in two cohorts with talazoparib for 7 (schedule A) or 3 days (schedule B). After induction with 4–6 cycles of triplet therapy, patients received one of three maintenance options: (a) continuation of triplet (b) carboplatin/talazoparib, or (c) talazoparib monotherapy. Results Forty‐three patients were treated. The MTD for both schedules was talazoparib 250mcg daily. The main toxicity was myelosuppression including grade 3/4 hematologic treatment‐related adverse events (TRAEs). Dose modification occurred in 87% and 100% of patients for schedules A and B, respectively. Discontinuation due to TRAEs was 13% in schedule A and 10% in B. Ten out of 22 evaluable patients in schedule A and 5/16 patients in schedule B had a complete or partial response. Twelve out of 43 patients received ≥6 cycles of talazoparib after induction, with a 13‐month median duration of maintenance. Conclusion We have established the recommended phase II dose of Talazoparib at 250mcg on a 3‐ or 7‐day schedule with carboplatin AUC6 and paclitaxel 80 mg/m2 on days 1, 8, 15 of 21‐day cycles. This regimen is associated with significant myelosuppression, and in addition to maximizing supportive care, modification of the chemotherapy component would be a consideration for further development of this combination with the schedules investigated in this study.
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Affiliation(s)
| | - Marina N Sharifi
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Nancy Chan
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Robert Wesolowski
- Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Anita A Turk
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Justine Y Bruce
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Ruth M O'Regan
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Jens Eickhoff
- Department of Biostatistics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lisa M Barroilhet
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jyoti Malhotra
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Janice Mehnert
- Perlmutter Cancer Center, New York University Grossman School of Medicine, New York, New York City, USA
| | - Eugenia Girda
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Elizabeth Wiley
- Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Natalie Schmitz
- School of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA
| | - Shannon Andrews
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Glenn Liu
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Kari B Wisinski
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
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Qiu W, Fu Y, Dang Y, Cai B, Tuo S, Mao B, Lin R, Liu Q, Li Y. Effectiveness and safety of weekly therapy versus 3-weekly therapy of paclitaxel plus carboplatin in women with ovarian cancer: a protocol of systematic review and meta-analysis. BMJ Open 2022; 12:e053182. [PMID: 35296476 PMCID: PMC8928320 DOI: 10.1136/bmjopen-2021-053182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Network meta-analyses have confirmed that paclitaxel plus carboplatin could improve progression-free survival (PFS) and overall survival (OS) compared with platinum alone. However, detailed implementation schedule (weekly or 3-weekly therapy) was not specified in clinical practice guidelines. Evidence from studies is also inconsistent. We will conduct a systematic review and meta-analysis to evaluate the benefits and harms of weekly therapy and 3-weekly therapy of paclitaxel combined with carboplatin in women with ovarian cancer. METHODS We will search PubMed, EMBASE and the Cochrane Library databases to include relevant randomised controlled trials comparing weekly therapy versus 3-weekly therapy of paclitaxel combined with carboplatin for women with ovarian cancer. Random-effects model will be used to pool data for patient-reported outcomes including survival rate, OS, PFS and adverse events. Grading of Recommendation, Assessment, Development and Evaluation approach will be used to rate the quality of evidence. ETHICS AND DISSEMINATION This systematic review and meta-analysis will be based on published data and does not therefore require specific ethical approval or consent for participation. The results will be published in a peer-reviewed journal. OSF REGISTRATION NUMBER 10.17605/OSF.IO/GJUMA.
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Affiliation(s)
- Weitao Qiu
- Medical Engineering Department, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Yu Fu
- Prenatal Diagnosis Center, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Yun Dang
- Department of Gynecology and Oncology, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Bingxin Cai
- First Department of Gynecology, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Shumei Tuo
- Department of Gynecology and Oncology, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Baohong Mao
- Medical Research Center, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Ru Lin
- Endoscopy Center, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Qing Liu
- Elderly Gynecology Department with Integrated Traditional Chinese and Western Medicine, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Yilin Li
- First Department of Gynecology, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
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Falandry C, Pommeret F, Gladieff L, Tinquaut F, Lorusso D, Mouret-Reynier MA, D'Hondt V, Mollon-Grange D, Floquet A, Abadie-Lacourtoisie S, Brachet PE, Stefani L, Rousseau F, Frenel JS, Del Piano F, Komulainen M, Warkus T, Trédan O, Pujade-Lauraine E, Freyer G. Validation of the geriatric vulnerability score in older patients with ovarian cancer: an analysis from the GCIG-ENGOT-GINECO EWOC-1 study. THE LANCET. HEALTHY LONGEVITY 2022; 3:e176-e185. [PMID: 36098291 DOI: 10.1016/s2666-7568(22)00002-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Older patients with ovarian cancer represent a heterogeneous population. The French National Group of Investigators for the Study of Ovarian and Breast Cancer developed the geriatric vulnerability score (GVS) to identify geriatric parameters predictive of poor outcomes. A prospective validation of the GVS was needed. METHODS The EWOC-1 study (NCT02001272) was an international, open-label, phase 2, three-arm trial designed according to a two-step process. Patients aged 70 years or older with newly diagnosed stage III or IV ovarian cancer were identified and the GVS determined. Those with a GVS of 3 or greater were randomly assigned to the EWOC-1 trial, stratified by country and surgical outcome, to receive three different carboplatin with or without paclitaxel regimens; those not included in the EWOC-1 trial were followed up in the EWOC-1 registry. External validation of the GVS was a secondary endpoint of the trial. Three validation cohorts were identified: the total population (validation cohort 1 [V1], n=447), the registry-only population (validation cohort 2 [V2], n=327), and the carboplatin-paclitaxel-treated population (validation cohort 3 [V3], n=320). FINDINGS From Dec 11, 2013, to Nov 16, 2018, 447 patients were included in 48 academic centres in six countries; 120 in the EWOC-1 trial and 327 in the EWOC-1 registry. Median follow-up was 19·7 (95% CI 8·5-29·7) months for the total cohort; missing values were low (<2%). According to the maximum likelihood analysis, the hazard ratio (HR) of death in V1 was 1·8 (95% CI 1·1-3·1, p=0·029) for those with a GVS of 1; 2·4 (1·4-4·0, p=0·0009) with a GVS of 2; 4·1 (2·5-7·0, p<0·0001) for a GVS of 3; 5·5 (3·3-9·3, p<0·0001) for a GVS of 4; and 9·1 (4·7-17·5, p<0·0001) for a GVS of 5 compared with a score of 0. Whatever the validation cohort, GVS of 3 or more significantly segregated two groups with different overall survival: V1 (median 13·2 [95% CI: 10·8-18·7] vs 40·8 [32·0-45·6] months; HR 2·8 [95% CI 2·2-3·7]; p<0·0001); V2 (11·9 [95% CI 8·8-18·1] vs 40·8 [32·0-45·6] months, HR 3·5 [2·5-4·9]; p<0·0001); and V3 (18·1 [95% CI 15·8-31·8] vs 43·0 [40·6-49·7] months, HR 2·6 [1·9 to 3·7]; p<0·0001). INTERPRETATION The GVS has high prognostic performance for overall survival in patients with advanced ovarian cancer, independently of geographic and historic effect (V1), as well as treatment patterns (V3), validated in an international population. Even though the GVS is time consuming it will allow the stratification of populations for clinical research and might permit the orientation of the geriatric intervention to specific domains. FUNDING French National Cancer Institute. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Claire Falandry
- GINECO, Paris, France; Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.
| | - Fanny Pommeret
- GINECO, Paris, France; Institut Gustave Roussy, Villejuif, France
| | - Laurence Gladieff
- GINECO, Paris, France; Institut Claudius Regaud-IUCT Oncopole, Toulouse, France
| | - Fabien Tinquaut
- GINECO, Paris, France; Institut de Cancérologie de la Loire, St Priest en Jarez, France
| | - Domenica Lorusso
- MITO and IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Véronique D'Hondt
- GINECO, Paris, France; Institut du Cancer de Montpellier, Montpellier, France
| | | | - Anne Floquet
- GINECO, Paris, France; Institut Bergonié, Bordeaux, France
| | | | | | - Laetitia Stefani
- GINECO, Paris, France; Centre Hospitalier Annecy Genevois, Pringy, France
| | | | - Jean-Sébastien Frenel
- GINECO, Paris, France; Institut de Cancérologie de l'Ouest-site René Gauducheau, Nantes, France
| | | | | | | | | | | | - Gilles Freyer
- GINECO, Paris, France; Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
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Landry KK, Lyon JL, Victoria KE, Changizzadeh PN, Cole BF, Pulluri B, Sikov WM, Wood ME. Weekly vs Every-3-Week Carboplatin with Weekly Paclitaxel in Neoadjuvant Chemotherapy for Triple-Negative Breast Cancer: A Retrospective Analysis. BREAST CANCER: TARGETS AND THERAPY 2022; 14:63-70. [PMID: 35313558 PMCID: PMC8934152 DOI: 10.2147/bctt.s342635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/04/2022] [Indexed: 11/25/2022]
Abstract
Background Adding carboplatin to weekly paclitaxel as part of neoadjuvant chemotherapy (NACT) for stage II–III triple negative breast cancer (TNBC) has been shown to significantly increase the pathologic complete response (pCR) rate. Hematologic toxicities associated with every 3-week dosing of carboplatin have led some oncologists to explore weekly dosing as an alternative, but there are little published data comparing the two dosing schedules. Methods We performed a retrospective analysis of patients who received paclitaxel and carboplatin, usually followed by AC, as initial NACT for TNBC at two academic cancer centers between 2008 and 2018 for whom pathologic results and post-operative follow-up were available. We recorded pCR, defined as ypT0/isN0, treatment delivery and disease-free survival, censored as of the patient’s last follow-up visit. Results A total of 76 patients were identified (median age 49 years). A total of 47 received weekly carboplatin, of whom 83% received at least 11 of 12 planned doses, and 29 received every 3-week carboplatin, of whom 90% received all 4 planned doses. pCR rates were similar, 53% with weekly and 55% with every 3-week carboplatin dosing. At median follow-up of 18 months (range <1–118), 93% of patients who achieved pCR were alive and free from recurrence, compared to 74% of those who did not. Conclusion pCR rates were similar between patients receiving weekly or every 3-week carboplatin and were similar to those reported in prior trials with carboplatin. These data suggest that providers can choose either weekly or every 3-week carboplatin dosing without compromising the likelihood of achieving pCR.
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Affiliation(s)
- Kara K Landry
- Division of Hematology and Oncology, Department of Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Jessica L Lyon
- Larner College of Medicine at the University of Vermont, Burlington, VA, USA
| | - Kitty E Victoria
- Division of Hematology and Oncology, Department of Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - P Nick Changizzadeh
- Hematology and Oncology, Eastern Connecticut Hematology and Oncology, Norwich, CT, USA
| | - Bernard F Cole
- College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VA, USA
| | - Bhargavi Pulluri
- Division of Hematology and Oncology, Saint Agnes Hospital, Baltimore, MD, USA
| | - William M Sikov
- Women and Infants Hospital of Rhode Island, Program in Women’s Oncology, and Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Marie E Wood
- Division of Hematology and Oncology, Department of Medicine, University of Vermont Medical Center, Burlington, VT, USA
- Correspondence: Marie E Wood, Department of Medicine, Division of Hematology and Oncology, University of Vermont Medical Center, 111 Colchester Avenue, Burlington, VA, 05401, USA, Tel +1 802-847-8400, Email
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Lin S, Peng T, Meng Y, Cao C, Gao P, Wu P, Zhi W, Wei Y, Chu T, Liu B, Wei J, Huang X, Ding W, Cheng C. Comparison of one-week versus three-week paclitaxel for advanced pan-carcinomas: systematic review and meta-analysis. Aging (Albany NY) 2022; 14:1959-1982. [PMID: 35218640 PMCID: PMC8908930 DOI: 10.18632/aging.203919] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
Abstract
Paclitaxel remains the first-line chemotherapy regimen for many malignant tumors. However, prognosis and adverse events under different dosing regimens (one-week versus three-week treatment) remain contradictory in many randomized controlled trials (RCTs). Here, we performed a comprehensive meta-analysis to measure the efficacy and toxicities of these two dosing regimens. Four databases were systematically retrieved. RCTs comparing two paclitaxel dosing regimens for advanced malignant tumors with assessable outcomes (e.g., overall survival (OS), progression-free survival (PFS), toxicities, response rates) were included. In total, 19 eligible RCTs involving 9 674 patients were included. Meta-analysis of pan-cancers revealed that weekly paclitaxel treatment was more beneficial regarding PFS compared to three-week paclitaxel treatment (hazard ratio (HR) = 0.90, 95% confidence interval (CI) = 0.82–0.99, P = 0.02). Nevertheless, there was no significant difference in terms of OS between the two dosing regimens (HR = 0.98, 95%CI = 0.91–1.06, P = 0.62) or other tested subgroups. In terms of serious adverse events, grade 3 or 4 (G3/4) neutropenia, G3/4 febrile neutropenia, G3/4 arthritis, and G3/4 alopecia occurred less often under weekly paclitaxel treatment. In summary, Weekly paclitaxel treatment demonstrates better PFS and fewer chemotherapy-induced hematological and non-hematological toxicities compared to the three-week paclitaxel regimen.
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Affiliation(s)
- Shitong Lin
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Gynecologic Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ting Peng
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Gynecologic Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yifan Meng
- Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Canhui Cao
- Department of Reproductive Medicine, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Peipei Gao
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Gynecologic Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ping Wu
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Gynecologic Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenhua Zhi
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Gynecologic Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ye Wei
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Gynecologic Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tian Chu
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Gynecologic Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Binghan Liu
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Gynecologic Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Juncheng Wei
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Gynecologic Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoyuan Huang
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Gynecologic Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wencheng Ding
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Gynecologic Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Cai Cheng
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Egawa-Takata T, Ueda Y, Ito K, Hori K, Shoji T, Nagasawa T, Nishio S, Ushijima K, Nishino K, Enomoto T, Kikuchi A, Honma S, Oishi T, Shimada M, Takei Y, Fujiwara H, Tanabe H, Okamoto A, Nishio Y, Yamada T, Kimura T. The ACE trial: A randomized phase II study for advanced endometrial carcinoma. Cancer Sci 2022; 113:1693-1701. [PMID: 35218673 PMCID: PMC9128191 DOI: 10.1111/cas.15310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/26/2022] Open
Abstract
This study evaluated the feasibility and efficacy of three postoperative adjuvant chemotherapy regimens for endometrial cancer. Endometrioid cancer patients with intermediate-risk stage I and II or high-risk stage III and IV disease were randomly assigned to receive six cycles of either Paclitaxel-Epirubicin-Carboplatin (TEC), Paclitaxel-Anthracycline (Doxorubicin)-Carboplatin (TAC), or dose-dense paclitaxel-carboplatin (ddTC). The primary endpoint was the completion rate (CRate) of six cycles of treatment. The secondary endpoints were progression-free survival (PFS) and overall survival (OS). One hundred and one patients were treated as follows: 33 received TEC, 33 TAC, and 35 ddTC. The CRates for TEC, TAC and ddTC were 94%, 64% and 69%, respectively (p=0.005). The TEC CRate was significantly higher than for the other two groups. However, the PFS and OS outcomes were not statistically different between the three groups. The two-year survival rates were 94%, 97%, and 97% for TEC, TAC, and ddTC, respectively. When compared to the current standard treatments for endometrial cancer, TEC is a promising candidate for a phase III trial based on its significantly superior CRate and equivalent PFS and OS. This study is registered with UMIN Clinical Trials Registry (UMIN000008911).
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Affiliation(s)
- Tomomi Egawa-Takata
- Dept. Obstetrics and Gynecology, Kansai Rosai Hospital, 3-1-69 Inabasou, Amagasaki, Hyogo, 660-8511, Japan.,Dept. Obstetrics and Gynecology, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-ku, Osaka, 543-0035, Japan
| | - Yutaka Ueda
- Dept. Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kimihiko Ito
- Dept. Obstetrics and Gynecology, Kansai Rosai Hospital, 3-1-69 Inabasou, Amagasaki, Hyogo, 660-8511, Japan
| | - Kensuke Hori
- Dept. Obstetrics and Gynecology, Kansai Rosai Hospital, 3-1-69 Inabasou, Amagasaki, Hyogo, 660-8511, Japan
| | - Tadahiro Shoji
- Dept. Obstetrics and Gynecology, Iwate Medical University, 2-1-1 Nishitokuta, Yanaba-cho, Shiwa, Iwate, 028-3694, Japan
| | - Takayuki Nagasawa
- Dept. Obstetrics and Gynecology, Iwate Medical University, 2-1-1 Nishitokuta, Yanaba-cho, Shiwa, Iwate, 028-3694, Japan
| | - Shin Nishio
- Dept. Obstetrics and Gynecology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Kimio Ushijima
- Dept. Obstetrics and Gynecology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Koji Nishino
- Dept. Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Takayuki Enomoto
- Dept. Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Akira Kikuchi
- Dept. Obstetrics and Gynecology, Niigata Cancer Center 2-15-3 Kawagishi-chou, Chuou-ku, Niigata, 951-8566, Japan
| | - Shigeru Honma
- Dept. Obstetrics and Gynecology, Niigata Cancer Center 2-15-3 Kawagishi-chou, Chuou-ku, Niigata, 951-8566, Japan.,Niigata Association of Occupational Health, Nishi-ku, Japan
| | - Tetsuro Oishi
- Dept. Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan
| | - Muneaki Shimada
- Dept. Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan.,Dept. Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Yuji Takei
- Dept. Obstetrics and Gynecology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hiroyuki Fujiwara
- Dept. Obstetrics and Gynecology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hiroshi Tanabe
- Dept. Obstetrics and Gynecology, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan.,Dept. Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, 163-1, Kashiwashita, Kashiwa, Chiba, Japan.,Dept. Gynecology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, Japan
| | - Aikou Okamoto
- Dept. Obstetrics and Gynecology, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Yukihiro Nishio
- Dept. Obstetrics and Gynecology, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-ku, Osaka, 543-0035, Japan
| | - Tomomi Yamada
- Dept. Medical Innovation Data Coordinating Center, Osaka University Hospital, Yamadaoka, Suita, Osaka, 543-0035, Japan
| | - Tadashi Kimura
- Dept. Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
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Lee MX, Wong ALA, Ow S, Sundar R, Tan DSP, Soo RA, Chee CE, Lim JSJ, Yong WP, Lim SE, Goh BC, Wang L, Lee SC. Phase Ib Dose-Finding Study of Varlitinib Combined with Weekly Paclitaxel With or Without Carboplatin ± Trastuzumab in Advanced Solid Tumors. Target Oncol 2022; 17:141-151. [PMID: 35195837 PMCID: PMC8995271 DOI: 10.1007/s11523-022-00867-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 11/25/2022]
Abstract
Background Varlitinib is a highly potent, small-molecule, pan-HER inhibitor targeting HER1, HER2, and HER4. It has demonstrated activity in gastric, biliary tract, and breast cancers. Objective We conducted a phase Ib dose confirmation study to determine safety and early efficacy signals of varlitinib in combination with chemotherapy (paclitaxel ± carboplatin) ± subcutaneous trastuzumab. Methods Eligible patients had advanced or metastatic solid tumors. A 3+3 dose de-escalation study design was used and pharmacokinetic analyses of varlitinib and paclitaxel were performed. Results Thirty-seven patients were enrolled into eight cohorts with median 4 (0–14) prior lines of palliative systemic therapies. Carboplatin area under the curve 1.5 and paclitaxel 80 mg/m2 weekly with varlitinib 500 mg twice daily continuously was de-escalated over four dose levels to 300 mg twice daily intermittently (4 days on, 3 days off) due to dose-limiting toxicities, most commonly neutropenia, febrile neutropenia, and electrolyte disturbances, with the triplet combination deemed intolerable and unable to be developed further. Varlitinib was then combined with paclitaxel alone; the recommended phase II dose of varlitinib was 300 mg twice daily intermittently. The addition of subcutaneous trastuzumab 600 mg was safe with no dose-limiting toxicities. Thirty-one patients were evaluable for response: 35.5% partial response, 41.9% stable disease. Twenty patients had HER2+ metastatic breast cancer with a median of 4 (0–14) treatment lines, 8/20 continued on single-agent varlitinib after completing chemotherapy for a median of 5.1 (range 2.0–13.3) months. A pharmacokinetic analysis showed that plasma exposure of varlitinib was dose dependent. Varlitinib administration did not significantly affect the maximum concentration or area under the curve of paclitaxel. Conclusions The recommended phase II dose of varlitinib with paclitaxel is 300 mg twice daily intermittently dosed. This is active in HER2+ metastatic breast cancer. Subcutaneous trastuzumab can be added safely to varlitinib and paclitaxel. This combination is currently being evaluated as neoadjuvant therapy in HER2+ breast cancer (NCT02396108). Clinical Trial Registration: NCT02396108, date of registration: 25 March, 2015. Supplementary Information The online version contains supplementary material available at 10.1007/s11523-022-00867-0.
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Affiliation(s)
- Matilda Xinwei Lee
- Department of Haematology-Oncology, National University Cancer Institute, Level 7, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Andrea L A Wong
- Department of Haematology-Oncology, National University Cancer Institute, Level 7, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Samuel Ow
- Department of Haematology-Oncology, National University Cancer Institute, Level 7, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Raghav Sundar
- Department of Haematology-Oncology, National University Cancer Institute, Level 7, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - David S P Tan
- Department of Haematology-Oncology, National University Cancer Institute, Level 7, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Ross A Soo
- Department of Haematology-Oncology, National University Cancer Institute, Level 7, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Cheng Ean Chee
- Department of Haematology-Oncology, National University Cancer Institute, Level 7, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Joline S J Lim
- Department of Haematology-Oncology, National University Cancer Institute, Level 7, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Wei Peng Yong
- Department of Haematology-Oncology, National University Cancer Institute, Level 7, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Siew Eng Lim
- Department of Haematology-Oncology, National University Cancer Institute, Level 7, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Boon Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute, Level 7, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Lingzhi Wang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Soo Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, Level 7, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.
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Ngoi NY, Syn NL, Goh RM, Goh BC, Huang RYJ, Soon YY, James E, Cook A, Clamp A, Tan DS. Weekly versus tri-weekly paclitaxel with carboplatin for first-line treatment in women with epithelial ovarian cancer. Cochrane Database Syst Rev 2022; 2:CD012007. [PMID: 35188221 PMCID: PMC8859866 DOI: 10.1002/14651858.cd012007.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Epithelial ovarian cancer is the sixth most common cancer worldwide: 295,414 new cases were diagnosed in 2018, with 184,799 deaths. The lack of an effective screening strategy has led to the majority of women being diagnosed at an advanced stage. For these women, intravenous carboplatin combined with paclitaxel for six cycles is widely accepted as the standard first-line treatment for epithelial ovarian cancer, in combination with debulking surgery. However, there is conflicting evidence regarding the optimal dosing schedule of paclitaxel when combined with carboplatin in this setting. OBJECTIVES To compare the efficacy and tolerability of intravenous weekly paclitaxel with that of tri-weekly paclitaxel, in combination with intravenous carboplatin, as first-line treatment for epithelial ovarian cancer (defined as epithelial ovarian, primary peritoneal and fallopian tube cancer). SEARCH METHODS We searched CENTRAL, MEDLINE, and Embase databases for relevant studies up to 15 November 2021, using keywords and MeSH terms. We additionally handsearched conference libraries, online clinical trial databases and screened through lists of retrieved references. SELECTION CRITERIA We Included randomised controlled trials (RCTs) comparing weekly paclitaxel in combination with carboplatin versus tri-weekly paclitaxel in combination with carboplatin, for treatment of newly-diagnosed epithelial ovarian cancer. DATA COLLECTION AND ANALYSIS We used the hazard ratio (HR) to estimate the primary efficacy outcomes progression-free (PFS) and overall survival (OS). We used the risk ratio (RR) to estimate the primary toxicity outcome of severe neutropenia and secondary outcomes of quality of life (QoL) and treatment-related adverse events. Two review authors independently selected studies, extracted data, and assessed risk of bias, using standard Cochrane methodological procedures. We included individual participant data (IPD) from one of the included studies, ICON-8, provided by the study team. We analysed data using a random-effects model in Review Manager 5.4 software. Additionally, we reconstructed IPD for PFS and OS data from published Kaplan-Meier curves from all studies and subsequently pooled these to analyse the two primary efficacy outcomes. MAIN RESULTS From 2469 records, we identified four eligible RCTs with data for 3699 participants. All eligible studies were included in the main meta-analysis and reported on PFS and OS. There was likely a slight improvement in PFS when paclitaxel was dosed weekly compared to tri-weekly (HR 0.89, 95% confidence interval (CI) 0.81 to 0.98; 4 studies, 3699 participants; moderate-certainty evidence). We found little to no improvement in OS when paclitaxel was dosed weekly compared to tri-weekly (HR 0.92, 95% CI 0.79 to 1.06; 4 studies, 3699 participants; high-certainty evidence). There was likely little to no difference in high-grade (grade 3 or 4) neutropenia when paclitaxel was dosed weekly compared to tri-weekly (RR 1.11, 95% CI 0.86 to 1.43; 4 studies, 3639 participants; moderate-certainty evidence). However, weekly paclitaxel increased high-grade (grade 3 or 4) anaemia when compared to tri-weekly dosing (RR 1.57, 95% CI 1.12 to 2.20; 4 studies, 3639 participants; high-certainty evidence). There may be little to no difference in high-grade neuropathy when paclitaxel was dosed weekly compared to tri-weekly (RR 1.12, 95% CI 0.64 to 1.94; 4 studies, 3639 participants; low-certainty evidence). The overall risk of detection bias and performance bias was low for OS, but was unclear for other outcomes, as treatments were not blinded. The risk of bias in other domains was low or unclear. We note that OS data were immature for three of the included studies (GOG-0262, ICON-8 and MITO-7). AUTHORS' CONCLUSIONS Weekly paclitaxel combined with carboplatin for first-line treatment of epithelial ovarian cancer likely improves PFS slightly (moderate-certainty evidence) but not OS (high-certainty evidence), compared to tri-weekly paclitaxel combined with carboplatin. However, this was associated with increased risk for high-grade anaemia, treatment discontinuation, dose delays and dose omissions (high- to low-certainty evidence). Our findings may not apply to women receiving bevacizumab in first-line therapy, those receiving treatment in the neo-adjuvant setting, or those with rare subtypes of clear cell or mucinous ovarian cancer.
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Affiliation(s)
- Natalie Yl Ngoi
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Nicholas Lx Syn
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Robby M Goh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Boon Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Ruby Yun-Ju Huang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Elizabeth James
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Adrian Cook
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Andrew Clamp
- Department of Medical Oncology, The Christie NHS Foundation Trust and University of Manchester, Manchester, UK
| | - David Sp Tan
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
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Suminokura J, Miyamoto M, Yoshikawa T, Kouta H, Kikuchi Y, Hada T, Ishibashi H, Ito T, Iwahashi H, Kakimoto S, Suzuki R, Matsuura H, Kishimoto N, Takano M. Potential efficacy of weekly low-dose administration of bevacizumab as a combination therapy for platinum-resistant ovarian carcinoma: a retrospective analysis. BMC Cancer 2022; 22:176. [PMID: 35172766 PMCID: PMC8849038 DOI: 10.1186/s12885-022-09271-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Bevacizumab (Bev) plays the central role of the adjuvant therapy for patients with ovarian carcinoma. The aim of our study was to examine whether differences in the administration of Bev influence the prognosis of patients. Methods Patients with ovarian carcinoma who received treatment at two hospitals between 1999 and 2020 were identified. Patients treated with weekly low-dose administration of Bev (100 mg Bev on days 1 and 8 and 200 mg Bev on day 15, monthly) at one hospital (group A) and those with monthly high-dose administration of Bev (15 mg/kg of Bev on day 1, monthly) at another hospital (group B) were retrospectively compared. Results Among the total patients, 44 were assigned to group A and 33 were assigned to group B. More patients in group A had advanced disease (p = 0.03) and a lower dose of Bev at the first time during the first cycle administration (p < 0.01) than in group B. Progression-free survival (PFS) was better in group A than in group B (p < 0.01). Multivariate analysis revealed that group A was a better prognostic factor for PFS (hazard ratio 0.53, p = 0.03). Stable duration was longer in group A than in group B (p < 0.01). The incidences of adverse effects, including hematological toxicities such as neutropenia (p = 0.01) and nonhematological toxicities such as hypertension (p < 0.01), intestinal obstruction (p < 0.01), and thromboembolic events (p < 0.01), were lower in group A than in group B. Conclusions Weekly low-dose administration of Bev might improve prognosis and decrease the frequency of adverse effects associated with this drug although the prospective study was needed to get corroboration.
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Affiliation(s)
- Jin Suminokura
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Morikazu Miyamoto
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Tomoyuki Yoshikawa
- Department of Clinical Oncology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hiroko Kouta
- Department of Gynecology, Ohki Memorial Kikuchi Cancer Clinic for Women, 111-1, Arahata, Tokorozawa, Saitama, 359-1133, Japan
| | - Yoshihiro Kikuchi
- Department of Gynecology, Ohki Memorial Kikuchi Cancer Clinic for Women, 111-1, Arahata, Tokorozawa, Saitama, 359-1133, Japan
| | - Taira Hada
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hiroki Ishibashi
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Tsubasa Ito
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hideki Iwahashi
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Soichiro Kakimoto
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Rie Suzuki
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hiroko Matsuura
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Naohisa Kishimoto
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Masashi Takano
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
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49
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Yang X, Fu C. The potential feasibility of nab-paclitaxel as the first-line chemotherapy for ovarian cancer: clinical development and future perspectives. Arch Gynecol Obstet 2022; 306:1417-1429. [PMID: 35165749 DOI: 10.1007/s00404-022-06425-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/27/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Optimal first-line chemotherapy regimens are crucial for epithelial ovarian cancer (EOC) treatment. Nab-paclitaxel has showed its considerable survival and low toxicity profiles in first-line treatment for three solid tumors and is recommended as a treatment for recurrent EOC. We focus on clinical efficacy and safety outcomes of nab-paclitaxel in current clinical studies of EOC treatment and aim to explore the potential feasibility of nab-paclitaxel as the first-line treatment for EOC. METHODS We searched for eligible studies up to January 2020 in Pubmed. Outcomes of interests included drug regimes, objective response rate (ORR), median progression free survival (PFS), median overall survival (OS) and main adverse events to determine feasibility of nab-paclitaxel. RESULTS This review included nine eligible studies. One study about nab-paclitaxel with carboplatin as first-line therapy in ten cases after hypersensitivity to paclitaxel had an ORR of 100%, median PFS of 16.7 months and median OS of 65.4 months. Evidence of nab-paclitaxel activity in platinum-sensitive EOC demonstrated an ORR of 64%, a median time to response of 1.3 months and PFS of 8.5 months. The ORR, median PFS and median OS range in patients with recurrent platinum-resistant EOC from 23%-72%, 4.0-8.5 months, 16.8-17.4 months, respectively. All studies demonstrated manageable toxicity profile in EOC patients. CONCLUSION Nab-paclitaxel presents potentials as the first-line chemotherapy for considerable survival and safety in EOC compared to conventional paclitaxel. However, there is no prospective trial in EOC so far. Therefore, more studies about nab-paclitaxel are needed.
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Affiliation(s)
- Xue Yang
- Department of Obstetrics and Gynecology, Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China
| | - Chun Fu
- Department of Obstetrics and Gynecology, Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China.
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50
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Ntemou E, Vidal PD, Alexandri C, Van den Steen G, Lambertini M, Demeestere I. Ovarian toxicity of carboplatin and paclitaxel in mouse carriers of mutation in BRIP1 tumor suppressor gene. Sci Rep 2022; 12:1658. [PMID: 35105904 PMCID: PMC8807594 DOI: 10.1038/s41598-022-05357-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/11/2022] [Indexed: 11/19/2022] Open
Abstract
More than 10% of women diagnosed with breast cancer during reproductive age carry hereditary germline pathogenic variants in high-penetrance BRCA genes or in others genes involved in DNA repair mechanisms such as PALB2, BRIP or ATM. Anticancer treatments may have an additional negative impact on the ovarian reserve and subsequently on the fertility of young patients carrying such mutations. Recently, the combination of carboplatin and paclitaxel is being recommended to these BRCA-mutated patients as neoadjuvant therapy. However, the impact on the ovary is unknown. Here, we investigated their effect of on the ovarian reserve using mice carriers of BRCA1-interacting protein C-terminal helicase-1 (BRIP1) mutation that plays an important role in BRCA1-dependent DNA repair. Results revealed that the administration of carboplatin or paclitaxel did not affect the ovarian reserve although increased DNA double-strand breaks were observed with carboplatin alone. Co-administration of carboplatin and paclitaxel resulted in a significant reduction of the ovarian reserve leading to a lower IVF performance, and an activation of the PI3K-Pten pathway, irrespective of the genetic background. This study suggests that co-administration of carboplatin and paclitaxel induces cumulative ovarian damage and infertility but a heterozygote genetic predisposition for DNA damage related to BRCA1 gene function does not increase this risk.
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Affiliation(s)
- E Ntemou
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
| | - P Diaz Vidal
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
| | - C Alexandri
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
| | - G Van den Steen
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - I Demeestere
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles, Brussels, Belgium.
- Obstetrics and Gynaecology Department, Erasme Hospital, Brussels, Belgium.
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