Avastin fails RCT

Final Overall Survival of a Randomized Trial of Bevacizumab for Primary Treatment of Ovarian Cancer

http://tinyurl.com/y4khcpoj

The final analysis of overall survival (OS) in GOG-0218, (a phase III, randomized trial of bevacizumab in women with newly diagnosed stage III/IV ovarian, cancer), shows no OS benefit for patients who received bevacizumab with chemo compared with chemotherapy alone.

This result confirms previous evidence, which demonstrated improvement in progression-free survival (PFS) without OS increase. The OS at 8.5 years was 20% with no significant difference between the two patient groups.

Bevacizumab has known toxicity with hypertension, proteinuria and neutropenia being indications to discontinue treatment. The high cost is financially toxic.

In 2011, the US Food and Drug Administration (FDA) revoked accelerated approval of bevacizumab for metastatic breast cancer (partly because of a lack of OS benefit). This result will cause reappraisal of the current FDA approval for maintenance and initial therapy for advanced ovarian cancer.

Monoclonal antibody therapy

False logic

In ovarian cancer care, focus on high-volume centers could come at a cost

https://tinyurl.com/y2ydnwr7

Patients undergoing cancer surgery often have better outcomes when treated at hospitals that perform these procedures routinely. However, implementing minimum-volume standards for cancer surgery could unintentionally prevent many patients from getting timely care for a minimal increase in survival.

Applying a minimum-volume cutoff of 3 procedures would prevent many hospitals, mainly in rural areas, from performing ovarian cancer surgery, affecting nearly 8% of patients. Over 300 patients would need to be moved from a hospital treating 3 or fewer patients to a higher-volume center to prevent 1 death in the year after surgery

A large number of low-volume hospitals had better-than-expected mortality rates. Outcomes are better at low-volume centres that rigorously adhere to evidence-based treatment guidelines for ovarian cancer.

Talc and cancer; how bad is it?

Genital Powder Use and Risk of Ovarian Cancer: A pooled analysis

https://tinyurl.com/yyzjueup

The relationship between genital powder use and risk of ovarian cancer is not well understood. Information is available from 250,641 women, including 2,073 who developed ovarian cancer.

Genital powder use was common (38% of all women). Powder use was associated with a 9% increase in the risk of developing ovarian cancer.

This large prospective study observed a weak association of genital powder with ovarian cancer risk, which appeared to be limited to those women who had not had a tubal ligation or hysterectomy.

Henry, we owe you.

Dr. Henry Lynch dies at 91

https://www.ketv.com/article/dr-henry-lynch-dies-at-91/27703593

Dr. Henry T. Lynch, 91, known as "the father of hereditary cancer detection and prevention," died on Sunday. Lynch recognized genetic causes of cancer. At the time, medical orthodoxy said cancer was not an inherited disease.

Lynch was the first in the world to discover the familial breast-ovarian cancer syndrome, a discovery that led to the identification of BRCA mutations. The geneticist described Lynch syndrome in the early 1960s.

Lynch grew up in New York and joined the U.S. Navy at 16, using an older cousin's ID. Lynch was a gunner on a Marine ship during World War II until discharged in 1946. After a boxing career, Lynch returned to school to become a medical graduate.

Brain metastasis; maybe not such a bad thing.

Brain metastasis in epithelial ovarian cancer by BRCA1/2 mutation status

https://www.sciencedirect.com/science/article/pii/S0090825819312296

Approximately 2.5% of epithelial ovarian cancer patients (EOC) develop brain metastases (BM). 35% of these have a BRCA1/2 mutation

BM were diagnosed at a median of 31 months post diagnosis. Median survival from BM diagnosis to death was longer in BRCA patients. Brain metastases were the only evidence of disease at time of diagnosis in 48% of BRCA positive patients. 

BRCA patients were more likely to have isolated BM, which may be a factor in their long survival. This supports the pursuit of aggressive treatment for BRCA EOC patients with BM.