Age alone not a barrier

The functional trajectories of older women having surgery for gynae-oncology cancer: A single site prospective observational study

http://tinyurl.com/49sebad9

Whether to put elderly women through the challenge of clearance surgery for ovarian cancer is a difficult choice. There has previously been a reluctance to treat older women with the same extensive surgical resection which is the standard of care for younger fitter women.

This prospective review looked at about 100 previously self-reliant women with cancer, who were 65 years old or older and measured their postoperative functional recovery, with correlation to their independence before diagnosis.

Results from the survey showed that 70% of the women were able to function normally with full independence at 12 months post-surgery. Some of the women had impairment of function at six months with subsequent recovery. Those women who had cognitive impairment prior to surgery were unchanged at the 12-month review. 

None of the parameters used in assessment which included measurements of cognition, function, and frailty proved useful in determining the outcome. The authors suggest that age and incapacity should not be criteria for incomplete treatment.

Immune status OC

Unveiling the Immunogenicity of Ovarian Tumours as the Crucial Catalyst for Therapeutic Success

https://tinyurl.com/bd4ke3sx

Ovarian cancer is resistant to immune therapy. Because of this less than 15% will respond to treatments such as checkpoint inhibition or T Cell infusion which are effective as treatment for many other cancers.

Immune resistance occurs in ovarian cancer by various processes which include, downwards regulation of otherwise protective genes, and change of surface proteins on cancer cells that act as targets for immune response. This leads to platinum resistance and early recurrence.

Understanding of this altered immune status results in new classifications of cancer types,with separation of ovarian cancer into homologous recombination deficiency, (about 40%),and epithelial mesenchymal transition, (the rest). The latter group are the most immune resistant and have worse survival.

With this knowledge will come improved targeted therapy, probably in combination, looking to counter immune resistance and enable cytotoxic effect.

Virus RNA predicts survival

Prevalence of viral DNA in high-grade serous epithelial ovarian cancer and correlation with clinical outcomes

https://tinyurl.com/e6e9vaer

It becomes clear with new understanding that many cancers including ovarian cancer show evidence of viral infection. This retrospective study looks at tissue samples from 98 patients with ovarian cancer. Using a polymerase chain reaction, the presence or absence of viral DNA in these samples were measured and compared to the survival outcomes.

46 of the patients showed evidence of viral infection with one or more virus signatures detected. The viruses found included known carcinogens such as the human papilloma virus and Epstein-Barr virus.

Cancers containing viral DNA were more likely to be platinum resistant and had worse survival. This was especially true for younger women, (<70). It is not clear whether the virus infection is a cause of the cancer or an effect of the disease, but the study suggests virus infection is a negative survival predictor.

OC in the young, a different disease

Early-Onset Ovarian Cancer <30 Years: What Do We Know about Its Genetic Predisposition?

https://tinyurl.com/2x6p5jhj

Ovarian cancer in young women (age 18-30) is rare being about 5% of the total. It was assumed that most ovarian cancer in women of this age was due to inherited genetic mutations. Usually, ovarian cancer is a disease of the elderly. Of whom about 20% have a genetic mutation, which causes the disease. This retrospective survey of more than 300 young women from four different data sets found much less genetic mutation; about 3%.

A different spectrum of disease is seen in the young, with about half of ovarian cancer arising from embryonal germ cells. Serous Ovarian Cancer is much less common in young women, being about 40% of all cases compared to 90% overall. Low Grade disease is more likely in the young. However, survival is almost 50% worse for the young, (HR0.53) despite these seemingly favourable pathology types. This is another example of the different nature of ovarian cancer in young women.

The reason why some young women develop ovarian cancer is unknown. It seems to be a random misfortune not associated with any genetic or environmental predisposition. The poor outcomes for these women are also unexplained.

IPEC yes or no

Should We Abandon Intraperitoneal Chemotherapy in the Treatment of Advanced Ovarian Cancer? A Meta-Analysis 

https://tinyurl.com/3drtt9jb

Use of intra peritoneal chemotherapy (IPEC) is low in Australia. The reasons for this include adverse effect with pain and toxicity. Logistic issues such as access and expertise also limit its use.

There has previously been little evidence of the potential benefit. This study, a retrospective analysis of all available data looked at the survival benefits of IPEC.

Six studies, with results for more than 4500 patients were shown to fit the selection criteria. Both overall survival and progress free survival were improved with IPEC, by almost 20%,(HR 0.81).

The implication of the study is that the IPEC therapy should be re-evaluated, and greater use would be beneficial.