P-P OSSUM Falls Short: Predicting Morbidity in Ovarian Cancer (OC) Cytoreductive Surgery https://tinyurl.com/mrypfj3j Sometimes there are disappointments in the progress of treatment of ovarian cancer. One such is the realisation that predicting the outcome of surgery is more difficult than previously thought. P-POSSUM ( Physiologic and Operative Severity Score for the Study of Mortality and Morbidity) is a commonly used indicator of perioperative risk used for general surgery patients. Based on Age, Previous History of Disease and Blood Test, P-POSSUM has been shown to be a reasonable predictor of peri-operative morbidity and mortality. This has led to a push for this to be used in the management of ovarian cancer seeking to avoid futile surgery for those most at risk. This retrospective study looked at data from 161 patients with ovarian cancer. Peri-operative morbidity occurred in 40% of these women. The predicted risk fro m the POSSUM score was higher at about 60%. Simila...

Barriers and Breakthroughs in Precision Oncology: A National Registry Study of BRCA Testing and PARP Inhibitor Uptake in Women from the National Gynae-Oncology Registry (NGOR) https://tinyurl.com/2dw5xwdj Australia is a wealthy nation with universal health care. Despite this some women with ovarian cancer do not receive best care . This pr o spective study using the National Gynae-Oncology Registry (NGOR), l ooks at the extent of ge netic testing of the BRCA variant and the subsequent chance of PARP inhibitor ( PARPi ) therapy . Survival for women with ovarian cancer has been significantly improved with the introduction of PARPi . This treatment of defective DNA repair is recommended for the approximately 50% of wo men , who demonstrate this on genetic or biomarker testing. Data from the NGOR show a disparity in testing , with older women and women from regional communities being less likely to be tested . A bout 7 0% of women with ovarian cancer in Australia have genet...

Association between childhood adiposity and gyn a ecologic cancers: a mendelian randomi s ation analysis https://tinyurl.com/mr2nah45 Obesity is a major health problem throughout the developed world. Previous studies have shown increased risks of cancer associated with obesity and being obese means worse survival for t hose affected. Determining the level of risk is difficult because of multiple other factors which may mask the effect . This study using the UK geno m e - wide association study data, sough t to determine the association between obesity for girls aged 10 or less with later development of gyn aecological cancers of the ovary, endometrium , and cervix . This was achieved by a process known as mendelian randomisation which seeks to use genetic information in a non- biased randomised way , like a n RCT. Findings from the data showed increased risk of ovarian and endometrial cancer but not for cervical cancer. The latter finding is not surprising in that cerv ical...

Tracking clonal evolution during treatment in ovarian cancer using cell-free DNA https://tinyurl.com/2xtv64nx Drug resistance is the major cause of death from ovarian cancer. Why this occurs is problematic and varies with individuals. This s tudy looks at the evolving genetic mutations which cause previously effective chemo to lose its ability to control the cancer. Using new sequence genetic profiling of circulating tumour DNA , this prospective study followed the course of disease for 18 women with ovarian cancer from diagnosis to recurrence. The main finding was that the genetic clone s which disabled the chemo response w ere present at diagnosis for all these women . This suggests that evolutional preselection is occurring , whereby the environment of chemo promotes the increase in effectiveness of harmful genetic clone s . The authors suggest that understanding this evolutionary effect should lead to a  change in management, alter the environment, and prevent the...

Myeloid cell networks govern re-establishment of original immune landscapes in recurrent ovarian cancer https://tinyurl.com/47mcxyde Women unfortunate enough to develop a recurrence of ovarian cancer show a range of responses to repeat chemo. This study looks at the immune response to the cancer and the survival outcomes. About half of these women show the presence of tumour infiltrating lymphocytes, (TIL),  suggesting an active cell-mediated immune response. This is associated with better survival. Most of those women also display defective DNA repair with Homologous Recombination Deficiency (HRD). The immune response is stimulated by increased antigen s such as PD-1 , which suggest that immunotherapy with immune checkpoint inhibitors could be of benefit. However, in practice this has not seen to be true. T o understand why this is the case the authors reviewed the immune status of abut 600 patients with ovarian cancer using digital pathology. They subdivided the immune r...