Hexamethylmelamine as consolidation treatment for patients with advanced epithelial ovarian cancer in complete response after first-line chemotherapy

Systematic literature review of efficacy and safety of first-line maintenance therapy trials in advanced ovarian cancer

Aim: To review safety and efficacy outcomes in studies of first-line maintenance therapies for advanced ovarian cancer. Methods: A systematic literature review was performed (27 February 2020) to identify clinical outcomes including progression-free survival (PFS), overall survival (OS) and Grade ≥3 adverse events. Results: Overall 50 references met prespecified criteria; 18 studies evaluated 10 different agents, including PARP inhibitors. PFS was an end point in 16 trials and OS in 12 trials. PARP inhibitors reported better PFS hazard ratios (HRs: 0.59–0.68) compared with other classes; no mature OS data were identified. Safety reporting was inconsistent. Conclusion: Reported PFS HRs were better for PARP inhibitors than for other ovarian cancer maintenance therapies; overall survival data remain immature.

Feasibility Study of a Network Meta-Analysis and Unanchored Population-Adjusted Indirect Treatment Comparison of Niraparib, Olaparib, and Bevacizumab as Maintenance Therapies in Patients with Newly Diagnosed Advanced Ovarian Cancer

Selecting a first-line (1L) maintenance option for ovarian cancer is challenging given the variety of therapies, differing trials, and the lack of head-to-head data for angiogenesis and poly(ADP-ribose) polymerase (PARP) inhibitors. Thus, indirect treatment comparisons (ITCs) can aid treatment decision making. This study assessed the feasibility of two ITCs, a network meta-analysis (NMA) and a population-adjusted ITC (PAIC), comparing the efficacy of the PARP inhibitor niraparib in the PRIMA trial (NCT02655016) with other 1L maintenance treatments. A systematic literature review was conducted to identify trials using the Cochrane Handbook for Systematic Reviews of Interventions to assess differences in trial design, population characteristics, treatment arms, and outcome measures. All 12 trials identified were excluded from the NMA due to the absence of a common comparator and differences in survival measures and/or inclusion criteria. The PAIC comparing PRIMA and PAOLA-1 trials was also not feasible due to differences in inclusion criteria, survival measures, and the previous receipt of chemotherapy/bevacizumab. Neither ITC met recommended guidelines for analysis; the results of such comparisons would not be considered appropriate evidence when selecting 1L maintenance options in ovarian cancer. ITCs in this setting should be performed cautiously, as many factors can preclude objective trial comparisons.

[1,2,4]triazines – as potential drugs in cancer chemotherapy

Cancers are a high risk for humanity. In 2018, approximately 18 million new cancer cases were diagnosed in the world. The choice of treatment depends on the type of cancer and its stage at diagnosis. The treatment of cancer consists mainly of surgical methods, radiotherapy, immunotherapy, hormone therapy and chemotherapy. Cytotoxic drugs can be used both in monotherapy and combination therapy. In 2009-2018, the US. Food and Drug Administration (FDA) approved about 356 new drugs for cancer therapy. However, it should be noted that despite the increasing availability of modern drugs, this disease is the second leading cause of death in the world. Research on the development of a cytotoxic drug is aimed at designing a compound structure, whose action is directed at cancer cells while not affecting normal cells. Triazine derivatives might be the chemical structure with potential anticancer activity. This scaffold has been used in oncological therapy since 1965. Depending on the location of the nitrogen atoms in the ring, three isomers can be distinguished: [1,2,3]triazines, [1,2,4]triazines, [1,3,5]triazines. Modification of the structure of the [1,2,4]triazine derivatives should provide stronger cytotoxic properties and reduce the side effects of the novel drug. Designing new preparations also aims to improve the patient’s quality of life. This review will briefly present how the modification of the chemical structure of [1,2,4]triazine derivatives increases their cytotoxic activity against cancer and why these compounds may be better tolerated than current therapy.