Do PARP inhibitors improve survival in women with ovarian cancer, and what are the side effects? https://tinyurl.com/2fx325uh            Independent review of change in medical practice is essential for improvement. Cochrane is an organisation in the UK, partly funded by the NHS, which undertakes such reviews using 30,000 volunteer experts from around the world. Findings from these reviews are published in the Cochrane Library and well respected for their accuracy and validity.          As part of this review of the use of PARP inhibitors, all available randomised clinical trials were accessed, looking for improved survival, better quality of life and possible side effects of treatment. In addition the trials were checked for bias and poor compliance.          From the evidence the conclusions are that maintenance therapy after chemo may improv...

Effect of prior olaparib maintenance therapy for platinum sensitive recurrent ovarian cancer on response to subsequent platinum-based chemotherapy https://tinyurl.com/4475vs9v            Sadly most women who have ovarian cancer will have recurrent disease. With platinum chemotherapy treatment the recurrence rate is about 70% within two years for women with advanced disease. When recurrence occurs the usual second line treatment is repeat platinum chemo, often with good effect.          In the last three years or so a new strategy of maintenance therapy using PARPi drugs such as Olaparib has become common. This study looks at the effect this maintenance has on subsequent effectiveness of repeat platinum chemo.          Unfortunately the effect of maintenance Olaparib therapy is to significantly reduce the benefit of a second platinum chemo course. Th...

Optimizing ‘optimal’ in ovarian cancer cytoreduction https://tinyurl.com/4vrfe5sp   Keeping a sense of perspective with new cancer therapy is difficult. No more so than when operators who may benefit from change promote new procedures. One such example is the recent TGA approval of the drug Pafolacianine for use in ovarian cancer patients at the time of surgery.             This new drug binds to metastatic deposits of ovarian cancer via folate receptors and is fluorescent when viewed with infrared imaging. Claims from surgeons and the mainstream media suggest this will be a game changer in the management of ovarian cancer. It is suggested that for the first time complete resection of the cancer will be possible at the initial surgery and this will improve outcomes.             This article written by Dr. Rossi cautions against excess enthusiasm, saying that it re...

Can integrative oncology increase adherence to chemotherapy in advanced gynecologic cancer? https://tinyurl.com/2p8uz8v9            Complementary medicine is thought to be fraudulent by orthodox medical practitioners. Despite this, there has been a move around the world to integrative oncology, which seeks to be patient driven and non-exclusive of alternative therapy when requested, if not harmful.          This prospective non-randomised article looks at two groups of women with advanced gynaecological cancers and measures their quality of life during oncology treatment. One group of 61 women, had orthodox medical care, the other group of 73 women included integrated oncology in their treatment course.          Results from the study showed that those women who had integrative oncology care had better quality of life when undergoing taxane based ch...

11 ESMO 2021 breakthroughs: practicing oncologist’s perceptions on data presentation https://tinyurl.com/4z6pxhtw          During the pandemic there has been an increasing use of pre-publication reports and presentations at scientific meetings for the release of potentially significant treatment change. This has meant that the normal checks and balances with independent review prior to audited publication have not always occurred.          For urgent circumstances such practice may be appropriate. However, this trend is not confined to the COVID-19 pandemic but also is becoming common for much basic medical research. This article looks at 11 presentations at the recent European Society of Medical Oncology meeting and notes errors in the reports, which raise doubt about the value of the work.          Of the 11 presentations, 2 did not comply with the ini...

Dubious effects of methadone as an “anticancer” drug on ovarian cancer cell-lines and patient-derived tumor-spheroids https://tinyurl.com/2zbu9c97            Self-administered opioid drug addiction is commonplace. Treatment for opioid addiction usually includes methadone therapy, meaning there is widespread use and acceptance of the drug.          Methadone an opioid replacement has previously been shown in vitro to promote cell death and increase sensitivity to chemo. This has led to off-label use of methadone as a cancer treatment.          This study (also in vitro) shows that methadone has no anticancer effect on ovarian cancer cells, and in fact is detrimental, increasing cell growth rates and blocking platinum chemo.

Society of Gynecologic Oncology publishes practice statement on SCR in recurrent ovarian cancer https://tinyurl.com/bddd88st            Best practice is an elusive concept.  So as to promote it, the Society of Gynecologic Oncology (SGO) provides guidance, through practice statements, . This week the SGO issued a guide for patients and surgeons when contemplating secondary cytoreductive surgery (SCR) for women with recurrent ovarian cancer.          Practice statements are based on clinical evidence from randomised trials. In the case of SCR there is a clinical dilemma. From the trials it is clear that for those women whose surgery results in complete clearance there is a survival benefit when compared to women who do not have the surgery. However, when the clearance is incomplete there is evidence that survival is worse than if there had been no surgery.     ...