One size doesn’t fit all

Uptake and Outcomes of Neoadjuvant Chemotherapy Among US Patients with Less Common Epithelial Ovarian Carcinomas

https://tinyurl.com/5xvnykwb

Sometimes there is a temptation to use a treatment protocol, which has shown to be successful for one type of cancer more widely. An example of this is the application of Neoadjuvant chemo (Neo) prior to surgery for rarer types of ovarian cancer. Although Neo is beneficial for High Grade Serous Ovarian Cancer, it seems to be ineffective for other types.

This retrospective review looked at about 1000 cases of Low Grade Serous Ovarian Cancer in women who presented with advanced disease (stage III-IV), during the period 2006-2019. There was a gradual increase in the number receiving Neo, with 15% having delayed surgery with Neo beforehand.

When the data was reviewed in 2022, no benefit was shown with survival worse for those who had Neo, and larger residual volumes after initial surgery. Similar failed Neo, with worse outcomes, were seen for women with Clear Cell Ovarian Cancer and Mucinous Ovarian cancer.

HIPEC benefit confirmed

Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy in patients with advanced ovarian cancer (OVHIPEC-1): final survival analysis of a randomised, controlled, phase 3 trial

 

https://tinyurl.com/3kparpnm

    For cancer research it is important to consider the longer term. It is often many years before a conclusion about the merit of a new procedure can be reached. 

    This study looked at the long-term benefits of hyperthermic intraperitoneal chemo (HIPEC) by revisiting the subjects of the OVHIPEC-1 trial 7 years after the trial ceased. The initial trial showed improved progression free survival and overall survival for those women who received HIPEC as part of their therapy in addition to normal chemo for ovarian cancer.

 

    Review of the data has enabled the determination of 10-year survival for the first time, which shows that HIPEC benefit is prolonged. More patients survive with better quality of life due to longer intervals between recurrence and less platinum resistance making repeat treatment easier. 

Another look at UKCTOCS

Tumour stage, treatment, and survival of women with high-grade serous Tubo-ovarian cancer in UKCTOCS: an exploratory analysis of a randomised controlled trial 

https://tinyurl.com/dr7z7sr9 

    Screening of ovarian cancer has been shown to be ineffectual. The UKCTOCS trial over 15 years, which had more than 200,000 participants proved that there was no benefit in terms of long-term survival for women who received comprehensive ovarian cancer screening when compared to women who did not. 

    This review of the data looked at the staging for those women who developed ovarian cancer either during the trial or in the 9 years since the trial finished. Of the participants 0.5% had ovarian cancer, the incidence is the same in the screened and non-screened group. 

    A significant difference is noted in the staging of the cancers detected, with fewer women from the screened group presenting with advanced (III-IV stage) ovarian cancer. Survival after diagnosis with advanced disease was longer for those women who had been screened.  

    Screening does detect advanced disease sooner, and women who have been screened are less likely to have advanced stage ovarian cancer. Maybe the criteria for success need to change? 

Better care LGSOC

 

Bevacizumab Treatment for Low-Grade Serous Ovarian Cancer: A Systematic Review

https://tinyurl.com/ms5kt35w

Low-grade Serous ovarian cancer (LGSOC) is a completely different cancer type to the commonest high-grade version. Found in about 5% of all ovarian cancer LGSOC has a different mutation, occurs in younger women and is slow growing but resistant to chemotherapy.

With full surgical clearance the 5-year survival is about 85%. Because of the resistance to standard chemo there is much research into finding alternative treatment. LGSOC is often noted to be oestrogen receptor positive so aromatase inhibitors such as Arimidex are used to block oestrogen production. Otherwise, the usual platinum-based chemo is commenced.

This retrospective review looks at treatment with Bevacizumab; a monoclonal antibody which inhibits new vessel formation in cancer thereby restricting growth. From a literature search, 163 patients were identified who received Bevacizumab. Those patients had better response to treatment than occurred with standard treatment. The authors suggest that although Bevacizumab has a greater incidence of significant side effects, it should be part of the standard of care.

Cut it out

Prognostic value of peritoneal scar-like tissue in patients with peritoneal metastases of ovarian origin presenting for curative-intent cytoreductive surgery 

https://tinyurl.com/yeuerz2z

    The single most important determinant of survival from ovarian cancer is the completeness of removal of the primary tumour and any metastases at the time of the initial surgery. This involves extensive surgery for many women. Often the tumour metastasises to the lining of the abdominal cavity; the peritoneum. 

    Determining the extent of involvement is problematic, recent techniques using fluorescent dye have assisted in more clearly showing additional involvement. However, the positive predictive value is low at 57% meaning that it is still difficult to discriminate between thickened peritoneum due to scarring, and metastasis. 

    This retrospective study looks at almost 200 women with ovarian cancer who had extensive clearance surgery including removal of any thickened peritoneum regardless of whether it was suspicious for metastasis. 40% of the women had peritoneal scar-like tissue and metastatic cancer was seen in 50% of the additional resected tissue. 

    A high index of suspicion is appropriate in assessing the presence of cancer spread; “If in doubt, cut it out”.