ICON8, final report

Weekly platinum-based chemotherapy versus 3-weekly platinum-based chemotherapy for newly diagnosed ovarian cancer (ICON8): quality-of-life results of a phase 3, randomised, controlled trial

https://tinyurl.com/3sndxv8f

 

         In 2013 a phase III trial In Japan (JGOG 3016) showed a survival advantage when the normal chemotherapy after initial surgery for ovarian cancer was altered. Usually chemo is given as at 3-weekly intervals with 6 doses as a minimum, more if serum markers show the need. Instead of this the frequency was changed to weekly.

         Because of reported increase in toxicity and in order to replicate the findings a prospective randomly allocated phase III trial (ICON8) began in 2011. 1566 women with ovarian cancer were allocated into two groups; either 3-weekly or weekly chemotherapy commenced, with both groups having the same chemotherapeutic agents.

         Parameters measured in the trial were quality of life, survival and neuropathy. Results showed no improvement in survival with more frequent dose regimes. Quality of life measurements at 9 months were similar for both groups, though the weekly dose group reported adverse effects during chemo more often. Both groups had neuropathy, with a later onset for those having extended chemo suggesting it may be related to total dose received.

Reality check

Real-world progression-free survival among patients with newly diagnosed advanced ovarian cancer: Does maintenance therapy work?

https://tinyurl.com/yf5nkc3a

 

         In an ideal world every patient with ovarian cancer would have optimal treatment. However, there is often a difference between the rhetoric and reality.

         Personalised cancer therapy is becoming more frequent including maintenance treatment following surgery and chemo, with monoclonal antibodies or enzyme inhibitors. This study looked at the real experiences of women with advanced ovarian cancer.

         463 women were included in this retrospective study, all ovarian cancer patients at the same centre of excellence. Treatment began during the period 2016-2020. Only 21% of the women received maintenance therapy. Those patients who did had a 29% lower risk of progression, with a median improvement in progression free survival of 4 months compared to those who did not.

 

Early palliative care

Acceptability and Feasibility of Early Palliative Care Among Women with Advanced Epithelial Ovarian Cancer: A Randomized Controlled Pilot Study

https://tinyurl.com/2ndw9xhj

 

         Women with advanced ovarian cancer are usually aware of the probable outcome. Beginning Palliative care is often delayed. Sometimes by patients but also due to hesitation by medical care providers.

         This small study of 32 women all of whom had advanced ovarian cancer, with recurrence after initial treatment, looked at the acceptance of early palliative care.  Of the group, 23 women joined the study with half being allocated to palliative care and the others having standard oncology treatment.

         Prior to commencement all the women had poor wellbeing, many being clinically depressed. Most (87%) knew their disease to be incurable. Acceptance of the offer for early palliative care, which precludes active treatment, was high. Unfortunately because of the high death rate for these women in both groups, no meaningful information about any change in quality of life could be obtained from this small study.

Maybe, aspirin for all

Aspirin and cancer survival: a systematic review and meta-analyses of 118 observational studies of aspirin and 18 cancers

https://tinyurl.com/7esethau

 

         For some time now the protective nature of low dose aspirin in the prevention of solid cancers such as Colon cancer has been well established. It is now apparent that treatment with aspirin, together with standard therapy for established cancers has survival benefits.

         Major clinical trials are currently underway recruiting patients with Colon, Breast and Prostate cancer. Previous studies with various solid cancers have shown survival benefits of up to 20%. This meta-analysis looked at all available information with data collected from patients with cancer, some with ovarian cancer. The results suggest that aspirin is protective for all cancers.

         A concern with aspirin is the risk of catastrophic bleed due to platelet suppression. Gastrointestinal bleeds (GIB) are common with low dose aspirin, with approximately a 50% increase in the incidence. However, the GIB death rate seems low, with some studies suggesting the rate is less for those patients taking low dose aspirin compared to those who do not.

Sometimes to delay is better

 

Association of Salpingectomy With Delayed Oophorectomy Versus Salpingo-oophorectomy With Quality of Life in BRCA1/2 Pathogenic Variant Carriers

https://tinyurl.com/pt9w845h

         For young women who carry the BRCA1/2 gene mutation, there is often a difficult decision to be made as to whether to have risk reduction surgery, to help prevent subsequent ovarian cancer.  Surgery for these women usually involves removal of the fallopian tubes with or without ovary removal. Sometimes removal of the ovaries is delayed either until childbearing is complete or until the normal age for menopause.      

         This prospective trial with 577 recruits randomly assigned women aged 25 to 40 with BRCA1/2 mutations into two groups; those who had simple tubal removal or those who had removal of both tubes and ovaries.  

         Using an objective measurement of quality of life (The Greene Climacteric Scale), the women were reviewed 3 and 12 months after surgery. Results from the survey showed that those women who had delayed ovary removal had a better quality of life. This was despite hormone replacement therapy being available for those whose ovaries had been removed.