Immunotherapy and ovarian cancer

Advances in immunotherapies in ovarian cancer

https://tinyurl.com/5397dpd5

Immunotherapy acts by promoting the activity of cell-mediated immunity to target and kill cancer cells. It is extremely effective for several cancers, such as melanoma, but thus far has been ineffective for ovarian cancer, which is considered to be immunologically "cold".

This editorial review shows why this is so and suggests targets for more effective treatment in the future. Cell-mediated immunity acts by T cells invading the tumour microenvironment (TME). Ovarian cancer cells prevent this from happening, usually by reinforcing the cell membrane with antigen checkpoints that prevent the infiltration of these T cells.

Immunotherapy helps to overcome this protection either by direct checkpoint blockade or by identifying the relevant antigen and using an antibody drug combination to overcome the resistance and access the TME. Manipulation of T cell activity by genetic re-engineering to produce specific antigen receptivity is also used, especially for certain blood cancers (CART cells).

It is hoped that similar treatments will be developed for ovarian cancer. About half of all ovarian cancers show an immune response, with an increased number of lymphocytes visible on pathological examination. This response increases after neoadjuvant chemo, which offers some hope that immunotherapy may be possible.

A recently approved antibody drug combination (elahere), used for platinum-resistant ovarian cancer, shows some promise. The authors suggest that a better understanding of the TME and cellular protection is required before significant progress is possible.

Is endometriosis a significant cancer risk?

Endometriosis and ovarian cancer risk

https://tinyurl.com/36vyrxjf

Endometriosis is a chronic cause of pain for about 10% of women during their reproductive life. The cause remains uncertain; initially thought to result from retrograde menstruation, the implanted cells found throughout the pelvis, which have a similar appearance to the uterine epithelium, may be due to stem cell activation.

Chronic inflammation from endometriosis has been cited as a possible cause for ovarian cancer. This study, looking at all available information using a standard methodology known as the PRISMA guidelines, suggests that the risk is low for most types of ovarian cancer, although there is an increased risk of endometrioid and clear cell cancer, which account for about 10% of the total.

Because ovarian cancer generally has a low incidence, with about 11/1000 women developing the disease during their lifetime, the overall risk increase due to endometriosis at about 1.3 means a small number of 3-4 extra cases. Because of this, the authors suggest that women with endometriosis should be reassured that ovarian cancer is unlikely, and extra surveillance is not indicated.

Insomnia and cancer

‘What has changed?’: Insomnia could explain the rise in early-onset hormonal cancer in women

https://tinyurl.com/4ph4v97e

The incidence of cancer in young people is increasing. Why remains uncertain, with obesity and pollution having been suggested as potential causes. At the recent ASCO meeting, data from a study were disclosed which suggested insomnia may be contributing to this increase.

A retrospective 5-year study of more than 400,000 adults with insomnia looked at cancer incidence and compared the outcomes with a large control group.

Women with insomnia had a significantly greater chance of developing breast, uterine and ovarian cancer. Men with insomnia seem to be more likely to have prostate or testicular cancer, though the evidence is incomplete.

Insomnia is said to affect about 16% of the population; behaviour modification may be protective. Melatonin, often deficient in insomnia, is an oestrogen blocker. Being an insomniac looks like a health hazard.

Fertility saving surgery for borderline ovarian tumours

Recurrence and Malignant Transformation After Borderline Ovarian Tumours: A Systematic Review and Meta-analysis

https://tinyurl.com/yk7et5rw

Borderline ovarian tumours make up 10 to 20% of ovarian masses. They present at an earlier age and rarely progress to invasive cancer. Because of this, surgery for these tumours is often limited to removal of the ovarian mass with preservation of fertility.

This analysis of all the available information looks at the risks of recurrence and malignant change to determine whether limited fertility-saving surgery is harmful.

More than 5000 women were included who underwent surgery for borderline tumours, which included complete clearance for some, with others having less radical surgery, many for preservation of fertility. Recurrence of the tumour is more likely with limited surgical clearance, with as much as a 30% chance in some instances. Those women who had radical surgery had a low risk of recurrence at about 3%.

Progression to invasive cancer is rare, in about 1% of the whole group. The risk increases after recurrence, with up to 20% malignant change after local recurrence. Usually, the cancer is of low grade, with survival rates at around 60%.

The authors suggest that fertility-saving surgery has serious consequences and that informed consent should include the increased risk of recurrence and malignancy.