Salvage issue

Hematological disorders after salvage PARPi treatment for ovarian cancer: cytogenetic and molecular defects and clinical outcomes

https://tinyurl.com/2e84hn5p

         When ovarian cancers recur in the first 6 months after standard treatment it is generally accepted that there is a need for exceptional or salvage therapy. Usually the salvage treatment course involves repeat chemotherapy, with PARP inhibitors being added or recommenced.

         It is becoming clear that this approach to platinum resistant ovarian cancer is simplistic and that these patients have special needs and are liable to significant adverse effects from therapy, meaning platinum chemo and enzyme inhibition may be harmful.

         This study looks at 182 women who commenced salvage therapy and recorded the high risk of hematological disorders. 16 of the women developed marrow cancers, 4 died very soon after diagnosis with only 3 surviving six months later. 10 dying from Leukaemia and 2 from transplant reaction. The authors suggest that management of salvage therapy is complex and the outcomes are poor.

 

Crossed lines

 

Locomotive syndrome in cancer patients: a new role of orthopaedic surgeons as a part of comprehensive cancer care

https://tinyurl.com/2nyunrzp

 

         Sub-specialisation in medical care has lead to great benefits for patients but also causes problems when loss of skills and litigation anxiety results in non-availability of essential care. This is especially true for orthopaedic surgeons who have almost completely removed themselves from cancer care with all patients being referred to a small group of sub-specialists.     

         Cancer patients frequently have need of orthopaedic surgery when fractures occur either as a result of bone metastasis or osteoporosis. There are far too many cases for sub-specialty referral but many general orthopaedic surgeons are loath to accept cancer patients.

         This article describes the current situation in Japan, which is the first super-aged society.  People in Japan have long lives and the birth rate is low. In 2016 the number of new cancer cases exceeded one million far more than the number of newborn. Immobility due to failure to properly manage fractures is called the “Locomotive syndrome”. Because of the demographic this problem gets worse every year and will soon apply to most advanced economies.

Vitamin D might help

Peritoneal restoration by repurposing vitamin D inhibits ovarian cancer dissemination

https://tinyurl.com/5n7uc2ve

 

         Much attention is currently centred on the changes that occur when ovarian cancer metastasises to the peritoneum. A process called epithelial-mesenchymal transition is involved; this results in loss of organisation of the cancer, with consequent escape of primitive cells into the peritoneal space. From these primitive cells metastases occur.

         Research such as this in vitro study looks at possible causes for and possible restoration of the transition. It has previously been shown that Vitamin D therapy reduces cancer mortality. One of the effects of vitamin D is to promote cell adhesion and thereby limit escape. Also, Vitamin D acts through gene regulation to reduce transition.

         This small research project on the effects of Vitamin D in vitro, with no clinical input, suggests that further study is appropriate to determine any clinical benefit. The authors note that Vitamin D deficiency is common in elderly women and that Vitamin D supplement is freely available and non-harmful

Synchronous cancer

Co-existence of breast and ovarian cancers in BRCA germ-line mutation carriers

 

https://tinyurl.com/2f5hy6aj

 

         Mutation of the BRCA genes is known to predispose to women having either breast or ovarian cancer, sometimes both. There is limited previous information about the cause and effect of synchronous breast and ovarian cancers, one study suggesting about two thirds of those women affected are BRCA positive.*

         This small retrospective study looks at 6 women with both cancers, with greater detail about one case suggesting the possibility that the ovarian cancer could be a distant metastasis of a primary breast cancer.

         It is apparent that women unfortunate enough to have both ovarian cancer and breast cancer during their lifetime should prompt genetic screening of close relatives.

* https://tinyurl.com/msn2jybr