False assumptions about BMI

Body Mass Index and Chemotherapy Completion among Patients Newly Diagnosed with Ovarian Cancer

https://tinyurl.com/y9jdtek8

It has been common knowledge that obese ovarian cancer patients did not have the same therapeutic benefit from chemo, with lower blood levels of drug activity called relative drug intensity, RDI.

Often women during their course of chemo have variations of the dose, this may be due to adverse side effects prompting dose reduction. Obese women require higher doses of chemo because of their high body surface area. This sometimes meant that the adverse effects were more intense, as a result drug capping of chemo was introduced, especially of the drug Paclitaxel which is part of the commonest initial chemo drug course for oavrian cancer.

The result was that maximum RDI at 100% in the obese is rarely achieved, with consequently less likelihood of cure. As a result, this drug capping was discontinued in 2012. This study looked at RDI achieved in 622 patients from the Yale Tumour Registry who started Paclitaxel treatment during the period 2012-2022.

The results showed that about 1/3rd of the group stopped treatment early with nearly all patients having some interruption of their chemo. Most patients did not achieve an RDI of 100%. The obese patients showed no worse RDI compared to the non-obese and were no more likely to not complete the treatment course.

Is Breastscreen up for change?

Risk-Based vs Annual Breast Cancer Screening: The WISDOM Randomized Clinical Trial

https://tinyurl.com/mpe28amd

Screening women for breast cancer has been a great success. The death rate for women aged 40-70 from breast cancer has been reduced by 45% following the introduction of mammographic screening every two years.

However, this has not been without criticism. The high cost and use of otherwise necessary resources, together with the great number of biopsies and psychological trauma due to cancer anxiety are stated as flaws in the scheme.

The WISDOM clinical trial compared personalized care to standard annual screening. In the randomized trial of over 28,000 women, half were assigned to a risk-based arm. In this arm, women were screened based on genetic and individual risk; for example, those at low risk were not assigned to start regular mammography until age 50. This group’s outcomes were compared to a similar-sized cohort assigned to annual screening.

The initial report shows no disadvantage in terms of advanced (stage IIIB) tumours. The number of biopsies was surprisingly similar in both groups. The authors suggest that risk-based screening is a viable alternative to the current regime.

Some sites of metastases are worse than others

Impact of single-site distant metastases on prognosis in advanced ovarian cancer: a Surveillance, Epidemiology, and End Results population-based study

https://tinyurl.com/4neetm9k

In general, the presence of a distant metastasis is a bad prognostic indicator for women with ovarian cancer. The 5-year survival rate for these women is about 30%.

Distant metastases may occur in the liver, lungs, bones or brain. This study looks at the different survival outcomes for each site. Using the SEER database, which collects cancer information from the US population, the overall survival for 639 patients was determined.

From the information collected the most likely site of distant metastasis is in the liver which was seen in about half of the group. Next the lungs (40%), bones (5%) and brain (1%).

Survival for all these patients is affected. The least impact is seen for those women with liver disease, which has significantly better survival than other distant metastasis sites. This knowledge may help to determine appropriate management of this grave complication of ovarian cancer.

Cancelled RCTs

Characteristics and potential predictors of prematurely terminated interventional clinical trials for ovarian cancer in the ClinicalTrials.gov database

https://tinyurl.com/55efrnfz

Many randomised clinical trials (RCT) do not reach their endpoint with about 25% being terminated for various reasons. This study used data from the Clinical Trials.gov website to discover whether this is true for ovarian cancer also.

The website records all clinical trials recruiting in the US and World-wide, a listing on this site does not require FDA or NIH approval. During the period 2003-2022 1420 RCTs for ovarian cancer were included.

Of these, 21% were terminated early. Mostly this was a result of logistic issues such as recruitment or funding. About 1/5th of the terminations was due to the intervention being non-effective.

The RCTs most likely to be terminated tended to be larger trials requiring big numbers of participants and were more likely when the trial was phase 2. A trial involving multiple large centres of care was most likely to be successfully completed.

Misinformation may cause distress

Quarter of all ovarian cancer cases linked to endometriosis: expert

https://tinyurl.com/vch9rrc9

NewsNation a cable network news service is the leader in US prime-time television being the most-watched service. As such it has a responsibility to ensure that any comment is factual and correct.

A recent posting stating that 25% of ovarian cancer is associated with endometriosis does not meet this benchmark. Information taken from a large cohort study published in JAMA in July 2024 appears to have been misinterpreted or misunderstood.

Endometriosis is associated with ovarian cancer, most notably rare types such as endometrioid and clear cell cancer, which most often present at an early stage. The cohort study shows the greatly increased risk with infiltrative and ovarian endometrioma type disease. However, these represent only a very small proportion of the total spectrum of endometriosis.

The absolute risk of developing ovarian cancer for women with endometriosis is about 2%. Most research suggests about 10 % of all ovarian cancer has some link to endometriosis. To state otherwise in such a public forum may cause unnecessary distress.

FemBloc contraception possibly harmful

FDA grants IDE approval for FemBloc nonsurgical permanent birth control

https://tinyurl.com/4kmjt2s8

Ovarian cancer mortality and incidence have significantly decreased over the last 20 years. One of the reasons for this is the use of hormonal contraception, meaning fewer lifetime menstrual cycles.

Also, resection and ligation of the fallopian tubes as a permanent contraceptive measure has resulted in some protection against ovarian cancer.

A new product called FemBloc threatens to disrupt this. Using an innovative outpatient delivery system, a liquid polymer glue is injected into the Fallopian tube causing permanent obstruction, with no ovarian access to the uterine cavity.

This device has recently been granted Investigational Device Exemption from the FDA and a phase III clinical trial (FINALE) is currently underway. Preliminary phases of the trial have shown the procedure to be safe with no tubal pregnancy reported.

The occlusion of fallopian tubes may be protective against ovarian cancer in a similar manner to surgical ligation. However, should this become a common form of contraception, replacing hormonal control, the consequent increase in menstrual cycles has the potential to increase ovarian cancer incidence.

Easy testing for defective DNA repair

Easy testing for defective DNA repair

Olaparib, durvalumab, and cyclophosphamide, and a prognostic blood signature in platinum-sensitive ovarian cancer: the randomized phase 2 SOLACE2 trial

https://tinyurl.com/dmncvndv

Defective DNA repair causes about half of all ovarian cancer. For those women who develop this cancer, and are shown to have the defect, treatment with PARP inhibitors (PARPi) will extend progress-free survival (PFS). Identifying these women is costly and unreliable. A new finding obtained from an otherwise inconclusive clinical trial may lead to a cheaper and dependable test.

The Solace 2 trial sought over a 4-year period to prove that stimulating an immune response before starting conventional therapy would improve PFS for women with advanced high grade serous ovarian cancer (HGSOC). It is well known that HGSOC depresses immunity, and this accounts for the usual bad outcomes. The trial did not achieve the key indicator, which was 36-week PFS for two-thirds of the treatment group.

An unexpected finding from the trial was the effectiveness of a blood test for defective DNA repair. This test identifies T cell checkpoints found with this defect, meaning it may soon be possible to quickly and easily determine who will benefit from PARPi therapy.