Emergencies best avoided

Patients with low socio-economic status are more likely to present for non-elective Ovarian Cancer surgery

https://tinyurl.com/j2dv32a7

         Survival for women with ovarian cancer is dependent on the quality of care provided. One of the most significant markers of better care is the completeness of surgical clearance at the initial surgery. Obviously there will be a better chance of this when the surgery follows careful pre-operative planning.

         Sometimes this is not possible and many women present with complications of ovarian cancer requiring immediate emergency surgery. This retrospective survey looked at about 100,000 women in the US who had surgery for ovarian cancer during the period 2010-2015. Of these women, 19% were emergencies.

         Those women who needed emergency care had higher mortality (2.7% vs. 0.6%), longer hospital stays, and more post-operative complications. The non-elective surgery group had lower incomes, were younger, with more co-existing disease shown as marked weight loss, diabetes and cardiac failure. Surgery for urgent cases was often incomplete without pelvic clearance or lymph node sampling.

Toxic means effective

Adverse Events as a Potential Clinical Marker of Antitumor Efficacy in Ovarian Cancer Patients Treated With Poly ADP-Ribose Polymerase Inhibitor

https://tinyurl.com/vcwbxxn4

 

         For cancer patients undergoing chemotherapy adverse reactions are part and parcel of the treatment. Previous studies have shown that patients who have adverse effects early on (within one week) have better response to the treatment. This study looks at PARPi treatment for ovarian cancer and notes a similar outcome.

         PARPi drugs are a targeted chemotherapy for ovarian cancer patients. Most if not all patients taking PARPi drugs have adverse effects. 10-15% of the patients cannot complete the course due to significant toxicity, with marrow suppression, nausea, and fatigue being common.

         Results from this small prospective study (78 women) confirmed that an early adverse response did improve the outcome. In addition those women who developed anaemia during the first 4 weeks of treatment, suggesting marrow suppression, had better progress free survival, with a median of 30 weeks compared to 20 weeks for those not anaemic.

Hidden benefits

Clinical and pathological outcomes of risk-reducing salpingo-oophorectomy for Japanese women with hereditary breast and ovarian cancer

https://tinyurl.com/jyusbsvx

 

         Increasingly women with a greater genetic risk of developing ovarian cancer are encouraged to have risk reduction surgery. For these women it is important to understand the risk-benefit ratio. Another benefit apart from prevention is early detection of cancer.

         In the study 117 women with either BRCA1 (72) or BRCA2 (45) mutations had MRI scan followed by elective surgery one month later. The surgical specimens were examined for cancerous change. Most ovarian cancer arises from the fallopian tube with a precursor condition known as Serous Tubular Intraepithelial Carcinoma (STIC).

         At surgery three STIC lesions were found and three stage I invasive carcinomas. All pre-operative MRI scans were normal. It is suggested that the study shows another benefit of risk-reduction surgery; enabling early diagnosis of malignancy in 5% not otherwise detectable.

 

False hopes

Immune checkpoint inhibitors in ovarian cancer: where do we stand?

https://tinyurl.com/hrcvufkb

 

         When a new treatment for cancer is found, women with lethal ovarian cancer often have their hopes raised. Checkpoint inhibition is one of these new forms of treatment. First used in the management of melanoma, Pembrolizumab (Keytruda) has radically changed the outcomes for many melanoma and lung cancer patients by “curing the incurable”.

         Unfortunately despite multiple trials of Keytruda and similar formulations, both alone and in combination, no benefit in terms of improved survival for ovarian cancer has been shown. This review looks at how checkpoint inhibition works and what the prospects are.

         All cells die. Some cancer cells slow the rate of cell death by blocking the T cell immune response, through a checkpoint. It seems that ovarian cancers do not induce T cell checkpoints. The authors conclude that there is likely to be no benefit in using checkpoint inhibition for ovarian cancer.