Shape matters

Researchers identify patterns that predict ovarian cancer relapse

https://tinyurl.com/bp5u7kp3

Every now and then something new pops up that has the potential to completely change the way we look at disease.

One such is the ability to examine the spatial structure of ovarian cancer. By this is meant the 3D distribution of B cells, plasma cells, tertiary lymphoid tissues and cancer associated fibroblasts. This is possible due to advances in genetic sequencing techniques which allow multi-cell detail.

Using this technique, samples from 42 patients with ovarian cancer were analysed. When the immune response enabled a good spatial appearance, with plasma cells and other components in proximity and intertwined with cancer cells, those patients had better survival and less likely recurrence of cancer.

This is early work with great promise of further progress in cancer therapy.

Galleri Trial maybe invalid

Cancer Stage Compared with Mortality as End Points in Randomized Clinical Trials of Cancer Screening. A Systematic Review and Meta-Analysis

https://tinyurl.com/7wh75xhy

One of the white hopes for cancer prevention is population screening. It is hoped that cancer can be avoided or detected early in those who have a genetic predisposition.

The NHS in the UK have commenced a large clinical trial called Galleri. In this trial 140,000 people have been tested using the multi cancer early detection (MCED) test, with a similar control group who are not tested.

The purpose of the trial is to determine whether cancer survival can be improved. Unfortunately, the design of the trial is flawed with the endpoints being diagnosis of stage III/IV cancer, instead of the normal endpoints of progress-free or overall survival.

This retrospective review sought to compare the mortality of several cancers with staging. A close correlation was found for ovarian cancer (0.95), moderate for breast cancer (0.6) and low for colorectal cancer (0.4). 

From this study it appears that true understanding of any benefit of MCED will be delayed.

Broken promises

Fewer Than Half of Drugs Granted Accelerated Approval Demonstrated Benefit Within 5 Years 

https://tinyurl.com/33hfxxkx 

Increasingly new cancer drugs, thought by the FDA to show enough evidence of improved outcomes, navigate a short cut in the approval process, with accelerated approval allowing clinical use. 

This study looks at 129 such drugs and reviews the benefit after 5 years, with correlation to confirmatory trials. 

Results from the study suggest that the majority (67%) of these drugs do not improve survival or the quality of life. Despite this many of these drugs received full unqualified approval later. 

The Authors suggest that informed consent should be obtained prior to use of the drugs in this category of accelerated approval, and that confirmatory trials should be undertaken before the limited approval is extended or converted. 

 

Should the appendix be removed?

Is routine appendectomy beneficial in the management of ovarian cancer?

https://tinyurl.com/3zpxrbpx

It has been common practice for the appendix to be removed at the time of initial surgery for ovarian cancer. The reason being to avoid subsequent appendicitis. On occasions, this may be deemed inappropriate, either due to advanced age or complex surgical presentation.

This retrospective survey looked at 136 patients who had their appendix removed. 40% of patients, with high grade epithelial ovarian cancer, had evidence of metastasis of the cancer to the appendix.

Removal of the appendix is helpful for staging of the disease and complete resection of ovarian cancer.