Uptake and Outcomes of Neoadjuvant Chemotherapy Among US Patients with Less Common Epithelial Ovarian Carcinomas https://tinyurl.com/5xvnykwb Sometimes there is a temptation to use a treatment protocol, which has shown to be successful for one type of cancer more widely. An example of this is the application of Neoadjuvant chemo (Neo) prior to surgery for rarer types of ovarian cancer. Although Neo is  beneficial for High Grade Serous Ovarian Cancer, it seems to be ineffective for other types. This retrospective review looked at about 1000 cases of Low Grade Serous Ovarian Cancer in women who presented with advanced disease (stage III-IV), during the period 2006-2019. There was a gradual increase in the number receiving Neo, with 15% having delayed surgery with Neo beforehand. When the data was reviewed in 2022, no benefit was shown with survival worse for those who had Neo, and larger residual volumes after  initial  surgery. Similar failed Neo, with worse outcomes, were...

Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy in patients with advanced ovarian cancer (OVHIPEC-1): final survival analysis of a randomised, controlled, phase 3 trial   https://tinyurl.com/3kparpnm      For cancer research it is important to consider the longer term. It is often many years before a conclusion about the merit of a new procedure can be reached.        This study looked at the long-term benefits of hyperthermic intraperitoneal chemo (HIPEC) by revisiting the subjects of the OVHIPEC-1 trial 7 years after the trial ceased. The initial trial showed improved progression free survival and overall survival for those women who received HIPEC as part of their therapy in addition to normal chemo for ovarian cancer.        Review of the data has enabled the determination of 10-year survival for the first time, which shows that HIPEC benefit is prolonged. More patients survive with better q...

Tumour stage, treatment, and survival of women with high-grade serous Tubo -ovarian cancer in UKCTOCS: an exploratory analysis of a randomised controlled trial   https://tinyurl.com/dr7z7sr9        Screening of ovarian cancer has been shown to be ineffectual. The UKCTOCS trial over 15 years, which had more than 200,000 participants proved that there was no benefit in terms of long-term survival for women who received comprehensive ovarian cancer screening when compared to women who did not.        This review of the data looked at the staging for those women who developed ovarian cancer either during the trial or in the 9 years since the trial finished. Of the participants 0.5% had ovarian cancer, the incidence is the same in the screened and non-screened group.        A significant difference is noted in the staging of the cancers detected, with fewer women from the screened group presenting with advanced (III-IV stage) o...

  Bevacizumab Treatment for Low-Grade Serous Ovarian Cancer: A Systematic Review https://tinyurl.com/ms5kt35w Low-grade Serous ovarian cancer (LGSOC) is a completely different cancer type to the commonest high-grade version. Found in about 5% of all ovarian cancer LGSOC has a different mutation, occurs in younger women and is slow growing but resistant to chemotherapy. With full surgical clearance the 5-year survival is about 85%. Because of the resistance to standard chemo there is much research into finding alternative treatment. LGSOC is often noted to be oestrogen receptor positive so aromatase inhibitors such as Arimidex are used to block oestrogen production. Otherwise, the usual platinum-based chemo is commenced. This retrospective review looks at treatment with Bevacizumab; a monoclonal antibody which inhibits new vessel formation in cancer thereby restricting growth. From a literature search, 163 patients were  identified  who received Bevacizumab. Those patients...

Prognostic value of peritoneal scar-like tissue in patients with peritoneal metastases of ovarian origin presenting for curative-intent cytoreductive surgery   https://tinyurl.com/yeuerz2z      The single most important determinant of survival from ovarian cancer is the completeness of removal of the primary tumour and any metastases at the time of the initial surgery. This involves extensive surgery for many women. Often the tumour metastasises to the lining of the abdominal cavity; the peritoneum.        Determining the extent of involvement is problematic, recent techniques using fluorescent dye have assisted in more clearly showing additional involvement. However, the positive predictive value is low at 57% meaning that it is still difficult to discriminate between thickened peritoneum due to scarring, and metastasis.        This retrospective study looks at almost 200 women with ovarian cancer who had extensive clearan...

Long-molecule scars of backup DNA repair in BRCA1- and BRCA2-deficient cancers https://tinyurl.com/kvb8em5n One of the mysteries of ovarian cancer is why is it that chromosomes with a mutation causing defective DNA repair, such as found with BRCA mutations promote cancer cell growth? Usually defective cells are removed as part of the normal stasis or equilibrium of tissue renewal. With the ready availability of whole genome sequencing it has become clear that homologous recombination deficiency (HRD)  of BRCA is complex with multiple other sites of structural change with replication and adhesion or annealing of the DNA strands. The effect of these other abnormalities is to compensate for the  defective DNA repair with other pathways to correct the faulty DNA thereby enabling survival of cancer cells that would normally be destroyed. Discovery of these multiple compensatory mutations may lead to better targeted therapy and possibly the correction of the basic defective mechanis...

Salpingectomy and the Risk of Ovarian Cancer in Ontario https://tinyurl.com/9s7smv4x      Science works best when established procedures and protocols are challenged and hopefully verified.      It has become obvious that much ovarian cancer, especially the commonest; high grade epithelial cancer, arises from the fallopian tube and spreads to the ovary. This suggested risk reduction surgery (RRS) for high-risk patients with elective removal of the fallopian tubes (salpingectomy).      Whether this will prove to be beneficial in the long term is yet to be confirmed. However, this study looks at a large number of women from the Ontario health database and compares the number who subsequently develop ovarian cancer for women who had a previous salpingectomy with those who did not.      The findings were that the risk of developing ovarian cancer over the 7.5-year period was the same for both groups. No difference is shown, this ra...