Application of three-dimensional imaging software to map carcinomatosis in recurrent ovarian cancer

The treatment of recurrent ovarian cancer has been based on systemic therapy. The role of secondary cytoreductive surgery has been addressed recently in several trials. Imaging plays a key role in helping the surgical team to decide which patients will have resectable disease and benefit from surgery. The role of staging laparoscopy and several imaging and clinical scores has been extensively debated in the field. In other surgical fields there have been reports of using 3D imaging software and 3D printed models to help surgeons better plan the surgical approach. To the best of our knowledge, we report the first case of a patient with recurrent ovarian cancer undergoing 3D modeling before secondary cytoreductive surgery. The 3D modeling was of most value to evaluate the extension of the disease in our patient who underwent a successful secondary cytoreductive surgery and is currently free of the disease.

Prognosis of polymerase epsilon (POLE) mutation in high-grade endometrioid endometrial cancer: Systematic review and meta-analysis

BACKGROUND

POLE mutated endometrial carcinomas may represent a subspecific type of tumors harboring a more favorable prognosis. Grade 3 (G3 or high-grade) endometrioid endometrial carcinomas remain a clinical dilemma, with some tumors behaving as the low-grade counterparts and others presenting a more aggressive behavior.

OBJECTIVES

To determine the association between POLE mutational status and the overall-survival (OS) and progression-free-survival (PFS) of patients with G3 endometrioid endometrial cancer (EC). We also aimed to determine the prevalence of POLE mutations in G3 endometrioid EC.

METHODS

We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO No: CRD4202340008). We searched the following electronic databases: PubMed/Medline, EMBASE, Cochrane Library, Scopus, and Web of Science. For time-to-event data, the effect of POLE mutation in G3 EC was described using hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Individual patient data for each study was investigated if available from the study authors. If individual patient data were not available, information regarding time-to-event outcomes was extracted using an appropriate methodology. OS and PFS were analyzed using both one-stage and two-stage approaches, the Kaplan-Meier method, and Cox-proportional hazards models.

RESULTS

This systematic review and meta-analysis included 19 studies with 3092 patients who had high-grade endometrioid EC. Patients with POLE mutations had lower risks of death (HR = 0.36, 95% CI 0.26 to 0.50, I2 = 0%, 10 trials) and disease progression (HR = 0.31, 95% CI 0.17 to 0.57, I2 = 33%, 10 trials). The pooled prevalence of POLE mutation was 11% (95% CI 9 to 13, I2 = 68%, 18 studies).

CONCLUSION

POLE mutations in high-grade endometrioid EC are associated with a more favorable prognosis with increased OS and PFS.

Abstract PD7-02: Trastuzumab Deruxtecan in patients with Unstable Central Nervous System Involvement from HER2-Low Advanced Breast Cancer: The DEBBRAH Trial

Background: The antibody-drug conjugate trastuzumab deruxtecan (T-DXd) significantly improved survival outcomes of HER2-low advanced breast cancer (ABC) patients (pts) compared to standard chemotherapy in the DESTINY-Breast04 trial. DEBBRAH is assessing the efficacy and safety of T-DXd in HER2[+] and HER2-low ABC pts with a history of brain metastases (BM) and/or leptomeningeal carcinomatosis (LMC); here, we report results of HER-low ABC pts. Methods: DEBBRAH (NCT04420598) is a multicenter, open-label, five-cohort, non-comparative, phase 2 study across 18 hospitals in 2 countries. A total of 39 pts aged ≥18 years with pretreated HER2[+] or HER2-low ABC with stable, progressing, or untreated BM and/or LMC, were enrolled in 5 cohorts: (1) HER2[+] ABC with non-progressing BM after radiotherapy and/or surgery; (2) HER2[+] or HER2-low ABC with asymptomatic untreated BM; (3) HER2[+] ABC with progressing BM after local treatment; (4) HER2-low ABC with progressing BM after local treatment; (5) HER2[+] or HER2-low ABC with LMC. Pts received 5.4 mg/kg T-DXd intravenously once every 21 days until disease progression, unacceptable toxicity, or consent withdrawal. Primary endpoint for cohorts 2 and 4 was intracranial overall response rate (ORR-IC) according to RANO-BM. Secondary endpoints included overall response (ORR) according to RECIST v1.1, progression-free survival (PFS), duration of response (DoR), clinical benefit rate (CBR); and safety and tolerability as per NCI-CTCAE v.5.0. Primary analysis is the estimation of ORR-IC (H0: ORR-IC ≤5%; H1: ORR-IC ≥40%) based on the one-sided binomial exact test. Sample size was planned to attain an 80% power at a nominal α level of 0.05 in each cohort. Results from cohort 2 should be considered descriptive since formal testing has to be performed in the whole cohort of pts with HER2[+] or HER2-low ABC and asymptomatic untreated BM. Results: From Oct 23, 2020, through Feb 15, 2022, 6 pts and 7 pts were allocated into cohorts 2 and 4, respectively. One patient with LMC included in cohort 4 was excluded from analysis. Median age was 54 (range 40–73) years. Median number of previous lines of therapy for advanced disease was 7 (range, 4-8) and 3 (range, 2-4) for cohorts 2 and 4, respectively. Median follow-up was 9.5 months (range, 1.6-15.7). At data cutoff (Apr 29, 2022), no patient of cohort 2 and 3 (50.0%) pts of cohort 4 remained on therapy. In cohort 2, ORR-IC was 66.7% (4 of 6 pts had intracranial partial response [PR]; 95% CI, 22.3–95.7). In cohort 4, ORR-IC was 33.3% meeting the primary endpoint (2 of 6 pts had intracranial PR; 95% CI, 4.3–77.7; P = .033). Overall, ORR-IC in all pts was 50% (6 of 12 pts; 95% CI, 21.1-78.9) and CBR was 66.7% (8 of 12 pts; 95% CI, 34.9-90.1). Combining pts with measurable intracranial or extracranial disease from cohorts 2 and 4, ORR, CBR and median DoR were 41.7% (5 of 12 pts; 95% CI, 15.2–72.3), 50.0% (6 of 12 pts; 95% CI, 21.1–78.9), and 7.2 months (95% CI, 2.5-16.4), respectively. Median PFS was 5.7 months (95% CI, 4.7-NA) among these pts. The most common treatment emergent adverse events (TEAEs) of any grade (G) were fatigue (58.3%; 8.3% G≥3) and nausea (50.0%; 0% G≥3). Two (16.7%; 0% G≥3) cases of interstitial lung disease/pneumonitis were reported. Serious unrelated TEAEs occurred in 2 (16.7%) of 12 pts; 1 case of general pain (G3) and 1 case of venous embolism (G5) that led to death. There were no drug-related deaths due to TEAEs. Conclusions: T-DXd showed a preliminary antitumor activity in pretreated HER2-low ABC pts with asymptomatic untreated or progressing BM after local treatment. The substantial response of BM to T-DXd in this setting is promising and warrants further investigation.

Citation Format: José Manuel Pérez-García, Marta Vaz Batista, Patricia Cortez-Castedo, Manuel Ruiz Borrego, Juan Miguel Cejalvo, Juan de la Haba-Rodríguez, Laia Garrigós, Fabriccio Racca, Sonia Servitja, Salvador Blanch, Maria Gión, Mónica Nave, Adela Fernández, Alejandro Martínez-Bueno, Antonio Llombart-Cussac, Miguel Sampayo-Cordero, Andrea Malfettone, Javier Cortés, Sofía Braga. Trastuzumab Deruxtecan in patients with Unstable Central Nervous System Involvement from HER2-Low Advanced Breast Cancer: The DEBBRAH Trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD7-02.

Chemotherapy-free treatment of recurrent advanced ovarian cancer: myth or reality?

Advanced ovarian cancer remains a leading cause of death from gynecologic malignancy. Surgery and, in most cases, platinum-based chemotherapy with or without maintenance with bevacizumab and/or poly-ADP ribose polymerase inhibitors (PARPi) represent the mainstay of treatment, but the disease typically recurs. The treatment of these patients represents a clinical challenge because sequential chemotherapy regimens are often used, with suboptimal outcomes and cumulative toxicity. Chemotherapy-free regimens, based on combinations of PARPi, vascular endothelial growth factor receptor inhibitors, anti-programmed cell death protein-1/programmed death-ligand 1, and anti-cytotoxic T-lymphocyte-associated protein-4 antibodies, among others, represent a valid option, with manageable toxicity profile and ease of administration. This review addresses this new strategy in the management of recurrent ovarian cancer and discusses its feasibility in the treatment landscape of the disease.

Transport-limited electrochemical formation of long nanosharp probes from tungsten

We show that electrochemical formation of long probes with nanosharp tips can be controlled by choosing an appropriate thermodynamic pathway of metal to metal oxide and hydroxide transformation. Currently, convection-limited electropolishing (CLE) is extensively used. Nanosharp probes are produced by electrochemically etching a wire until it breaks into two pieces. This process is difficult to control because of the complexity of the associated hydrodynamic flows. We introduce transport-limited electropolishing (TLE), where the electrochemical reaction results in the formation of metal oxides and hydroxides which form a porous surface layer hindering the flow of electrolyte. The developed TLE method enables one to make long tapered needles. The taper can spread over more than 6 mm while the radius of tip curvature can be decreased down to 30 nm. These needles are strong and were successfully applied for piercing single smooth vascular muscle cells.

Screening for a BRCA2 rearrangement in high-risk breast/ovarian cancer families: evidence for a founder effect and analysis of the associated phenotypes

PURPOSE

BRCA2 rearrangements are rare genetic events. A large BRCA2 genomic insertion was recurrently observed in our participants, and we sought to characterize it at the molecular and phenotypic level.

PATIENTS AND METHODS

We studied 210 high-risk breast/ovarian cancer families. Fifty-three probands were fully screened for BRCA1/2 mutations, and three of 53 had a large insertion in exon 3 of BRCA2. This finding was analyzed by polymerase chain reaction (PCR), reverse transcriptase PCR (RT-PCR), and sequencing. An additional 157 consecutive families were screened for this mutation by a three-step PCR method. Phenotype and haplotype analysis was also performed.

RESULTS

Sixteen BRCA mutations were observed in 19 of 53 patients (36% detection rate). A recurrent Alu motif insertion in position c.156_157 was observed after sequencing of an abnormal fragment obtained after the amplification of BRCA2 exon 3. RT-PCR revealed exon 3 skipping. Screening of this rearrangement identified 14 additional families (out of 157). In total, 17 (8%) of 210 high-risk families ascertained in our clinic were positive for this mutation. Segregation of a common haplotype (from D13S260 to D13S1695) confirmed a common origin, estimated to have occurred 2,400 to 2,600 years ago. The following four cancer phenotypes were observed in the 17 positive families: female breast (n = 9), male breast (n = 4), breast/ovarian (n = 2), and heterogeneous (n = 2). Male breast cancer was more frequently observed in c.156_157insAlu-positive families compared with negative families (23% v 12%, respectively), and 33% of all male breast cancer families with an identified BRCA mutation were c.156_157insAlu positive.

CONCLUSION

c.156_157insAlu is a founder mutation of Portuguese origin and is the most frequent BRCA2 rearrangement described to date.

Wound bed preparation: approaches to replacement of dermis

Cultured epidermal autograft (CEA) can provide a valuable source of protection in patients with large amounts of skin loss as a result of thermal injury. An unanswered question is: will the long-term outcome be better if a dermis is present? We have approached the problem by attempting to retain the cryopreserved allograft dermis that is originally placed as temporary wound coverage. The retained dermis provides a substantial, uniform, well-vascularized bed that accepts the CEA. The areas that are grafted with CEA have remained durable, and cosmesis is superior to that which results from meshed grafts. We report experience with our technique in three patients with total body surface area burns of 70% to 90% who had cryopreserved meshed (1:1.5) allografts placed immediately after tangential excision of their burns. Excision and application of the allografts were complete by day 14 or 15. CEA was placed on allodermis on days 24, 28, and 35, respectively. Patients 1 and 2, who survived and returned to work, had a "take" of at least a 90% of allograft and a permanent coverage CEA take of 88% and 81%, respectively. Patient 3, who died, had an allograft take of only 20% to 30% and a CEA take of less than 10%.