Cochrane Review PARPi

Do PARP inhibitors improve survival in women with ovarian cancer, and what are the side effects?

https://tinyurl.com/2fx325uh

 

         Independent review of change in medical practice is essential for improvement. Cochrane is an organisation in the UK, partly funded by the NHS, which undertakes such reviews using 30,000 volunteer experts from around the world. Findings from these reviews are published in the Cochrane Library and well respected for their accuracy and validity.

         As part of this review of the use of PARP inhibitors, all available randomised clinical trials were accessed, looking for improved survival, better quality of life and possible side effects of treatment. In addition the trials were checked for bias and poor compliance.

         From the evidence the conclusions are that maintenance therapy after chemo may improve progression free survival, with little to no effect on overall survival. Severe side effects are increased and there is little satisfactory record of change to quality of life. The review noted some bias and a lack of consistency in reporting between different trials.

Unintended consequences

Effect of prior olaparib maintenance therapy for platinum sensitive recurrent ovarian cancer on response to subsequent platinum-based chemotherapy

https://tinyurl.com/4475vs9v

 

         Sadly most women who have ovarian cancer will have recurrent disease. With platinum chemotherapy treatment the recurrence rate is about 70% within two years for women with advanced disease. When recurrence occurs the usual second line treatment is repeat platinum chemo, often with good effect.

         In the last three years or so a new strategy of maintenance therapy using PARPi drugs such as Olaparib has become common. This study looks at the effect this maintenance has on subsequent effectiveness of repeat platinum chemo.

         Unfortunately the effect of maintenance Olaparib therapy is to significantly reduce the benefit of a second platinum chemo course. The mechanism of this is not known but there is speculation that reactivation of DNA repair processes, which is the usual cause of PARPi resistance, may be why, as platinum chemo acts by DNA disruption.

Wait & See

Optimizing ‘optimal’ in ovarian cancer cytoreduction

https://tinyurl.com/4vrfe5sp

 

Keeping a sense of perspective with new cancer therapy is difficult. No more so than when operators who may benefit from change promote new procedures. One such example is the recent TGA approval of the drug Pafolacianine for use in ovarian cancer patients at the time of surgery.

            This new drug binds to metastatic deposits of ovarian cancer via folate receptors and is fluorescent when viewed with infrared imaging. Claims from surgeons and the mainstream media suggest this will be a game changer in the management of ovarian cancer. It is suggested that for the first time complete resection of the cancer will be possible at the initial surgery and this will improve outcomes.

            This article written by Dr. Rossi cautions against excess enthusiasm, saying that it remains to be seen whether any improvement in survival will result. As she says, “The effect of surgical effort contributes less than that of predetermined patterns of disease presentation”. By which she means that ovarian cancer frequently includes microscopic metastases undetectable by any imaging and that previously, extended surgical resection has proved unhelpful.

Integrative oncology

Can integrative oncology increase adherence to chemotherapy in advanced gynecologic cancer?

https://tinyurl.com/2p8uz8v9

 

         Complementary medicine is thought to be fraudulent by orthodox medical practitioners. Despite this, there has been a move around the world to integrative oncology, which seeks to be patient driven and non-exclusive of alternative therapy when requested, if not harmful.

         This prospective non-randomised article looks at two groups of women with advanced gynaecological cancers and measures their quality of life during oncology treatment. One group of 61 women, had orthodox medical care, the other group of 73 women included integrated oncology in their treatment course.

         Results from the study showed that those women who had integrative oncology care had better quality of life when undergoing taxane based chemo but this was less marked for platinum chemo. Those women in the integrative oncology group also were less likely to abscond from follow-up.