[Comparison of primary extraovarian peritoneal serous papillary carcinoma with stage III-IV ovarian papillary serous carcinoma].
1
Citation
0
Reference
10
Related Paper
Citation Trend
Abstract:
Extraovarian peritoneal serous papillary carcinoma (EPSPC) is both histologically and clinically similar to stage III-IV ovarian papillary serous carcinoma (OPSC). The purpose of this study is to investigate the clinical findings, treatment, and outcome of EPSPC patients compared with stage III-IV OPSC patients.The data of 12 EPSPC patients and 45 stage III-IV OPSC patients were retrospectively reviewed, comparing the characteristics on clinical presentation and treatment, sensitivity to first-line chemotherapy agents and survival.By analysis of patients' characteristics, presenting signs and symptoms, type and extent of surgery, tumor response to first-line chemotherapy, recurrence-free interval, recurrence site and serum CA-125 levels, no significant difference was observed between the EPSPC patients and stage III-IV OPSC controls. The prevailing presenting symptoms were abdominal mass and ascites. The mainstay of treatment was debulking surgery followed by adjuvant platinum-based chemotherapy. The complete clinical response of stage III-IV OPSC was 91.8% compared with 25.0% for women with EPSPC (P < 0.01).The clinical and surgical characteristics of EPSPC are similar to those of stage III-IV OPSC. When the same treatment strategy is applied, similar response and survival are expected in either condition.Keywords:
Debulking
Carboplatin
Cite
Cite
Citations (4)
Ovarian cancer is the fifth most common cause of death among malignant diseases in women in Europe. The standard treatment is cytoreductive surgery, followed by platinum-taxane based chemotherapy. In patients with advanced disease, a valid option is a neoadjuvant chemotherapy followed by interval debulking surgery. Despite the progress in primary treatment, almost 70% of the patients relapse. There is a significant need for better first-line treatment to avoid or delay relapse and improve ovarian cancer outcomes. The most significant change involves the changes in the treatment schedule and new drugs in first-line chemotherapy. Bevacizumab is approved in first-line treatment combined with carboplatin and paclitaxel as it improves progression-free survival (PFS) in patients with a higher risk of recurrence. After achieving the response to first-line chemotherapy, maintenance therapy with poly-adenosine-diphosphate-ribose-polymerase (PARP) inhibitors prolongs PFS in patients with homologous recombination deficiency (HRD). Patients with BRCA mutations obtain the most significant benefit.
Taxane
Carboplatin
Debulking
First line treatment
Cite
Citations (0)
Carboplatin
Cite
Citations (0)
Epithelial carcinoma of the ovary is one of the most common gynecologic malignancies and ranks 5th as a cause of cancer death in women, with half of all cases occurring in women aged over 65. Because ovarian cancer is often asymptomatic in its early stages, most patients have widespread disease at the time of diagnosis. Surgery is required for correct diagnosis and accurate staging, representing also the main form of treatment for early-stage disease which is confined to the ovaries. In advanced stages (III and IV) where the tumor has spread beyond the pelvis, the initial surgical treatment is followed by chemotherapy. Ovarian tumors are sensitive to chemotherapy, and most stage III and IV patients receive chemotherapy to increase survival, disease-free interval and improve quality of life (QoL). Until the mid 1990s standard chemotherapy of advanced ovarian cancer involved a platinum compound, either cisplatin or carboplatin, administered either alone or in combination with cyclophosphamide. New therapy standards emerged after the publication of a trial by the Gynecologic Oncology Group ( GOG) in 1996 and the first reports of an intergroup trial in 1998 that confirmed the GOG results. These studies demonstrated that patients treated with cisplatin/paclitaxel had significantly higher response rates, progression-free survival and overall survival compared with the previous standard treatment of cisplatin plus cyclophosphamide.
Carboplatin
Gynecologic oncology
Debulking
Cite
Citations (1)
Epithelial ovarian cancer is the most lethal gynecologic malignancy. In most women, it is diagnosed at an advanced stage, which largely explains the poor prognosis of this malignancy. Germline mutations of the genes BRCA1 and BRCA2, which encode proteins essential for the repair of double-strand DNA breaks through homologous recombination, lead to increased cancer predisposition. BRCA mutations are present in approximately 14% of epithelial ovarian cancers. Somatic BRCA mutations have also been described. Current first-line treatment of high-grade epithelial ovarian cancer includes debulking surgery followed by combination chemotherapy, usually carboplatin and paclitaxel. Ovarian cancer is highly sensitive to chemotherapy, in particular to platinum drugs. Most patient will achieve remission with initial chemotherapy, but most will eventually experience disease recurrence. Targeted therapies, including the anti-angiogenic agent bevacizumab and oral poly (ADP-ribose) polymerase (PARP) inhibitors, have been recently approved for the treatment of ovarian cancer, based on the results from randomized clinical trials showing significant benefits in terms of progression-free survival, with acceptable tolerability and no detrimental effects on quality of life. Olaparib, the first PARP inhibitor to be granted approval, is currently indicated as maintenance monotherapy in ovarian cancer patients with relapsed disease and mutated BRCA who have achieved a complete or partial response to platinum-based chemotherapy. The analysis of BRCA mutational status has, therefore, also become crucial for therapeutic decisions. Such advances are making personalized treatment of ovarian cancer feasible. Here we briefly review treatments for platinum-sensitive, high-grade serous epithelial ovarian cancer that are currently available in Italy, with a focus on targeted therapies and the relevance of BRCA mutational analysis. Based on the evidence and on current guidelines, we propose strategies for the tailored treatment of patients with relapsed ovarian cancer that take into account BRCA mutational status and the treatment received in the first-line setting.
Carboplatin
BRCA Mutation
Olaparib
PARP inhibitor
Debulking
Cite
Citations (102)
Even though 80% of patients with High-Grade Serous Ovarian Cancer respond to standard first-line chemotherapy, a majority of them could relapse in the following five years due to a resistance to platinum. Human Epididymis protein 4 (HE4) is one of the most promising markers in predicting platinum therapy response. This pilot study aims to evaluate the potential role of HE4 value in predicting chemotherapy response in BRCA mutated patients and in BRCA wild-type (non-mutated) ones. We selected 69 patients, affected by High-Grade Serous Ovarian Cancer, and optimally debulked and submitted to standard chemotherapy protocols. HE4 was dosed during every chemotherapy course. Patients were classified as platinum-resistant and platinum-sensitive. According to BRCA mutation test, patients were further divided into BRCA wild-type (53 patients), and BRCA mutated (16 patients). 35 patients out of 69 (52%) were platinum-sensitive (recurrence > 12 months), while 33 patients (48%) were platinum-resistant (recurrence < 12 months). Thus, in the total population, HE4 performed as a marker of chemosensitivity with a sensibility of 79% and a specificity of 97%. In the BRCA WT group, 23 patients out of 53 (43%) were platinum-sensitive, while 30 patients out of 53 (57%) were platinum-resistant. In the BRCA WT group, HE4 performed as a predictive marker of chemosensitivity with a sensibility of 80% and a specificity of 100%. In the BRCA mutated group, 13 patients out of 16 (82%) were platinum-sensitive, while 3 patients (18%) were platinum-resistant. In the BRCA mutated group, HE4 performed as a predictive marker of chemosensitivity in all patients. The ability to detect platinum-resistant patients before tumor relapse probably could open new therapeutic scenarios.
BRCA Mutation
Carboplatin
Cite
Citations (12)
Epithelial ovarian cancer is the second most common malignancy of the female genital tract, with approximately 7,400 new cases annually in Germany. With 5,500 deaths per year, ovarian cancer is the leading gynecologic cause of death. Epithelial ovarian cancer is characterized by morphologic heterogeneity with 4 molecular biological subtypes (immunoreactive-like, differentiated-like, proliferative-like, mesenchymal-like) with different prognosis. Significantly improved survival is achieved by optimal debulking with no residual disease (R0). Systematic lymphonodectomy of clinical negative lymph nodes has no effect on overall survival in advanced ovarian cancer. Interval debulking in advanced ovarian cancer after three cycles of neoadjuvant chemotherapy with carboplatin/paclitaxel is controversial. Standard chemotherapy for advanced ovarian cancer consists of six cycles of carboplatin AUC5 and paclitaxel 175 mg/m2, in a three-week cycle. Intraperitoneal chemotherapy is not a standard therapy. Anti-hormonal therapy with an aromatase inhibitor plays a minor role in therapy of both low grade serous ovarian cancer (LGSOC) and high grade serous ovarian cancer (HGSOC). A major achievement in ovarian cancer therapy has been the results of the SOLO-1 trial, in which olaparib as a first line maintenance monotherapy resulted in an overall 70% lower risk of disease progression in patients with advanced Breast Cancer Gene (BRCA)-mutated ovarian cancer.
Debulking
Carboplatin
Hormonal Therapy
Cite
Citations (25)
Cite
Citations (0)
Chemotherapy in the Treatment of Ovarian Psammocarcinoma: A Case Report and Review of the Literature
Introduction: Psammocarcinoma is a rare form of epithelial serous ovarian carcinoma characterized by extensive formation of psammoma bodies, invasion of ovarian stroma, peritoneum or intraperitoneal viscera, and moderate cytological atypia. These tumors represent a real problem of the diagnostic, and the role of chemotherapy is not yet clearly demonstrated.
Case presentation: We herein report a case of psammocarcinoma of ovary with peritoneal carcinosis in a forty year old Moroccan female. The patient underwent optimal surgical debulking and nine courses of chemotherapy with carboplatinum and paclitaxel with a complete response. The prognosis for this type of ovarian cancer is unclear, but it appears to be better than other forms of epithelial ovarian cancer.
Conclusion: The psammocarcinome is a rare entity, majority of patients are diagnosed at an advanced stage. The role of chemotherapy is poorly defined; some authors have their patients treated by neoadjuvant or adjuvant chemotherapy.
We currently lack evidence of increasing the benefits that can bring chemotherapy in the management of advanced ovarian psammocarcinomas. Only trials in wide yard can answer this question.
Omics
Cite
Citations (2)
Neoadjuvant chemotherapy with cisplatin or carboplatin was administered to 29 patients with advanced ovarian carcinoma prior to their undergoing definitive cytoreductive surgery. Twenty-eight patients had ascites, eight had pleural effusion, and 16 had extensive upper abdominal disease on computerized tomography scan. The CA125 response to neoadjuvant chemotherapy was highly predictive of survival (P<0.0005). A 2-log decrease in CA125 prior to surgery resulted in a median survival of 37 months, while patients with less than a 1-log response in CA125 had a survival of 18 months. Bowel resection after neoadjuvant chemotherapy did not benefit patients, as their survival (17 months) was identical to that of patients who were nonresectable and did not undergo any cytoreductive surgery.
Neoadjuvant chemotherapy offers patients with suboptimal ovarian cancer the same survival as primary cytoreductive surgery with interval debulking, yet with only one operative procedure.
Cite
Citations (88)