PARPi for whom

Deleterious somatic variants in 473 consecutive individuals with ovarian cancer: results of the observational AGO-TR1 study (NCT02222883)

https://tinyurl.com/26f5s3dz

 

         Personalised or precision therapy for ovarian cancer is becoming more common, with some genetic mutations being responsive to new treatments such as PARP inhibitors. 

         There is pressure to make these new drugs available to a larger group of patients. Unfortunately the cost means that a “try it and see” approach is not feasible. This prospective review of 473 non-selected ovarian cancer patients looks at their genetic status seeking to determine the real incidence of these mutations.

         Of these women, who presented consecutively at one centre of excellence with ovarian cancer, 26.4% were suitable for precision drug treatment. Most (20% of the total) were BRCA1/2 positive; the remainder usually non-epithelial subtype ovarian cancers had other susceptible ovarian cancer predisposition genetic mutations. The commonest mutation; P53 which is seen in up to 90% of all ovarian cancer was excluded from the study as no precision therapy is currently available for this group.

Biome matters

Ovarian cancer and the microbiome: a complex relationship

https://tinyurl.com/2p96bvwj

 

         Ecological causes for cancer and other diseases are big news. Discoveries of peptic ulceration following bacterial infection (H. pylori) and the possible elimination of cervical cancer by immunization against papilloma virus were groundbreaking. Maybe ovarian cancer will be next?

         Bacterial colonization of the body is known as the biome. Normally the biome of the vagina is very stable with predominance of lactobacillus species (usually L. crispatus). Previous studies have shown that when the bacterial population is changed, premature labour is more likely.

         Cervical smear samples from young women with BRCA mutation are less likely to show a stable lactobacillus biome. Current research is looking at the biome as a marker for increased ovarian cancer risk, and also to determine whether infection of the fallopian tube may be a stimulus for pre-cancerous change.

Surgeon/Patient mismatch

Association of Surgeon-Patient Sex Concordance With Postoperative Outcomes

https://tinyurl.com/yvsywx4k

 

         Sometimes research is astonishing. This study, which looks at the outcomes after surgery for women who have a male surgeon, is one such. Outcomes for those women are worse than for similar operations performed by female surgeons.

         Data was obtained from a large number of patients (more than 1 million), who had one of the common surgical procedures during the period 2007-2019. Of those patients, about half had surgeons of the opposite sex. Criteria for adverse results from surgery included death, readmission, or complication within a 30-day period following the surgery.

         Results from the data analysis show significantly increased risk of death or complication for those women who had a male surgeon. Interestingly there was no increased risk for men treated by female surgeons. As the authors say,  “Further work should seek to understand the underlying mechanism”.

Coffee and cancer

Lifetime caffeine intake and the risk of epithelial ovarian cancer

https://tinyurl.com/2p8zbvbd

         Caffeine has bad press. Studies have suggested that caffeine may exacerbate various conditions including, diabetes, osteoporosis, hypertension, bleeding disorders, and schizophrenia. Previously a link with ovarian cancer has been suggested. This retrospective study seems to disprove the suggestion.

         Total lifetime caffeine consumption was calculated for 497 women with ovarian cancer and compared to 904 women who did not. Only a very few of each group did not consume caffeine either in coffee, tea or cola. Patterns of caffeine consumption were similar for both groups.

         Risk assessment showed that overall; those women who had the highest caffeine intake did not have any increased risk. It was noted that pre-menopausal women who were high caffeine consumers did have an increased risk. However, this is a small number of women and may be a coincidence.

BRCA +ve screening

The challenging screen detection of ovarian cancer in BRCA mutation carriers adhering to a 6-month follow-up program: results from a 6-years surveillance

https://tinyurl.com/2p84ht3d

 

         For many women who discover they carry either the BRCA1 or BRCA2 mutation, risk reduction surgery is appropriate. For others a screening program aimed at early detection of ovarian cancer is the best course. It is not known how effective these screening programs are.

         This prospective study records the six-year outcomes for 191 women who were found, in 2015, to carry the BRCA mutation. Screening tests done were, 6 monthly CA125 serology and pelvic ultrasound investigation. 58 of the women chose to have risk reduction surgery and were excluded from follow up.

         From the remaining 138 women, 9 cancers were diagnosed, all screen detected, mostly in BRCA1 individuals. All but one of the cancers were early, (stage I/II). CA125 serology alone was not sufficient to detect all these cancers. Screening of women who are BRCA +ve may be expensive but it is essential.