Pandemic delay of treatment, maybe not so bad

The Effect of Delayed Chemotherapy on the Decrease of CA125 in Epithelial Ovarian Cancer During Coronavirus Disease Pandemic in 2020

https://tinyurl.com/y3mkv5xj

 

         The global pandemic of 2020, has been dreadful, some of the effects are as yet unclear. One certain result is that normal treatment of ovarian cancer has been adversely affected. Unlike other cancers there is a readily available measure of the effectiveness of treatment; this is the serum measure of the protein antigen CA125.

         A good sign of the effectiveness of primary treatment, including surgery and chemo, is that the serum CA125 level returns to the normal range. 

         Because of the risk of the pandemic chemo has been delayed for many ovarian cancer patients. This study looked at 32 women with ovarian cancer who had delay in chemo of up to 60 days. Despite this the half-life time of the CA125 was unaffected in this group when compared to a similar pre pandemic group. Obviously the follow up time is short but thus far the survival is unaffected by the delay.

How risky really is diabetes?

Diabetes mellitus and the risk of ovarian cancer: a systematic review and meta-analysis of cohort and case–control studies

https://tinyurl.com/y3p7lnnu

         It has been noted that there is a link between diabetes and ovarian cancer. This review seeks to examine all the available evidence.

         36 previous reports with full data sets were obtained and collated. A total of almost 14,500 cases of ovarian cancer were recorded with the three subtypes of diabetes; type I, type II, and gestational diabetes.

         Most of the studies showed a weak but positive correlation between diabetes and ovarian cancer. For all diabetes patients there is a 20% increased relative risk of developing ovarian cancer, the risk is highest for type I and there is no increase for women who have experienced gestational diabetes.

         It is noted that women with diabetes have other pathology, notably obesity and decreased exercise routines. These are also factors that may increase ovarian cancer risk.

Having male children increases risk

Offspring sex and risk of epithelial ovarian cancer: a multinational pooled analysis of 12 case–control studies\

https://tinyurl.com/y6rvfunx 

 

         In general, any previous pregnancies reduce the individual risk of ovarian cancer. Reducing the number of menstrual cycles is protective against the cancer.

         This study, a retrospective analysis of 12 groups, looked at whether the sex of the offspring had an effect on cancer risk. Almost 7000 cases with ovarian cancer were included in the group. Overall the risk of developing ovarian cancer was not affected by the sex of the offspring.

         Having only female children was protective; having had at least one male child increased the likelihood of ovarian cancer when compared to female only. However, the risk is increased only for epithelial ovarian cancer with a decreased risk of developing endometrioid cancer, possibly due to hormonal effect.

Don’t write off the elderly

Outcomes for Elderly Ovarian Cancer Patients Treated with Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC)

https://tinyurl.com/y2vsk8bx

 

         Previously there has been a general misunderstanding about the benefit from intense therapy for elderly patients with ovarian cancer, resulting in  a reluctance to follow normal treatment guidelines  for older patients. Current therapy for ovarian cancer aims to achieve the most complete removal of cancer at the initial presentation.

         Intense techniques involve cytoreductive surgery sometimes with prior chemo (neoadjuvant), with subsequent high temperature intraperitoneal chemo (HIPEC). In addition, following recurrence many patients have repeat surgery (salvage) and further HIPEC.

         This study compared outcomes for patients younger and older than 65 years of age. Women who required salvage or repeat surgery did less well when older than 65. Otherwise for intense therapy the results are the same for younger and older patients. The authors suggest that age alone should not be an indicator of best treatment.

Gene signature negative indicator

Prognostic gene expression signature for high-grade serous ovarian cancer

https://tinyurl.com/y9hyozqp

         Some women with High Grade Serous Ovarian Cancer (HGSOC) do better than others. There is an advantage in knowing which patients will have a better survival in order to personalise the medical therapy provided.

         This retrospective survey looked at the gene expression in tissue samples from 3769 patients and compared the findings with overall survival.

         A genetic signature of poor survival was determined with 66 different genes marking the site. The severity of the disease is directly related to this, with increased post 5 years survival for women who did not have the typical gene signature.

         All women in this group received the same standard therapy with surgery and chemo. Early gene sequencing is appropriate to better assess prognosis and appropriate treatment.