Covid impact

The Impact of COVID-19 Infection During the Postoperative Period After Surgery for Ovarian Cancer

https://tinyurl.com/3ntra3r6

 

         During the worst period of the pandemic the demand for hospital care caused other medical procedures to be delayed. Also, ovarian cancer patients who contracted Covid-19 infection could not be admitted to acute care hospitals due to concern about cross infection.

         This small study looks at the immediate post-operative status of 12 women with ovarian cancer who had the misfortune to have been infected with Covid-19 and had their surgery delayed. The outcomes for this group were compared with a similar number of women who had ovarian cancer but not Covid-19.

         There were no pre-operative differences seen between the two groups. Women who had Covid-19 on average waited 6 weeks longer after becoming virus free to have the surgery performed. No significant difference in post-operative complication was seen between the two groups. The hospital stay lengths were slightly greater for the Covid affected group and intra operative blood transfusion was more likely to be required. 

Bugs everywhere

An evaluation of the microbiota of the upper reproductive tract of women with and without epithelial ovarian cancer

 

https://tinyurl.com/2y75pnry

 

         In the quest for knowledge about the cause of ovarian cancer there is great interest in the role of inflammation and infection. Previously it has been supposed that the ovaries and tubes were sterile. It is now known that there is a normal bacterial population (microbiota) and the importance of this is becoming clear.

         For this prospective study 25 women who were scheduled to have resection of the ovaries and tubes gave consent for microbiological examination of the specimens. Women were excluded from the study if they had received antibiotics or were known to have cervical or uterine cancer. Contamination was avoided.

         Results from the study showed two women with previously undiagnosed ovarian cancer and the presence of bacteria in all specimens. Many different bacterial species were identified. Those women shown to have ovarian cancer had less diverse bacteria, raising the possibility of infection.

More MMR

The prevalence of mismatch repair deficiency in ovarian cancer: a systematic review and meta-analysis

 

https://tinyurl.com/2jn8v8ar

 

         One of the many disappointments in the treatment of ovarian cancer has been the failure of immunotherapy.  For other cancers, most significantly melanoma, immune therapy in the form of checkpoint inhibition with drugs such as Keytruda has been game changing.  Thus far this has not been true for ovarian cancer.

         Checkpoint inhibition is most effective for cancers with defective DNA repair mediated through a process called Mismatch Repair deficiency (MMR).  Some ovarian cancer demonstrates MMR.

         This study looks at all the available published information to determine the prevalence of MMR.  Results from the review show MMR to be most likely for women with endometrioid ovarian cancer or cancer due to Lynch syndrome, with an overall prevalence of about 7% of all ovarian cancer. The authors note that MMR testing may guide precision immune therapy to those most likely to respond.

Case closed

Weekly Dose-Dense Chemotherapy as First-Line for Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

https://tinyurl.com/4863ea92

 

         The final report of the ICON-8 trial closes the debate as to whether weekly chemo is more effective than the standard chemo.

         A clinical trial in 2008 involving Japanese women (JGOC 3016) reported a survival benefit for women with ovarian cancer whose chemo frequency was increased from the normal one dose every three weeks to a weekly dose regimen. 

    Some doubt about the benefit for the general population remained and a large clinical trial involving 1566 patients (ICON-8) began in 2011, with random allocation to either standard or weekly chemo. The final results are now available. There is no survival benefit for non-Japanese women. Adverse side effects were commoner with weekly chemo.