Cochrane Collaboration review: Cytoreductive surgery plus chemotherapy versus chemotherapy alone for recurrent epithelial ovarian cancer

Plain language summary

Secondary surgical efforts to remove recurrent ovarian cancer in women who are no longer in remission
Ovarian cancer is the sixth most common cancer among women. Epithelial ovarian cancer is a disease in which malignant cells form in the tissue covering the ovary. It accounts for about 90% of ovarian cancers., the remaining 10% arise from germ cells and the sex cord and stroma of the ovary. Women with epithelial ovarian cancer that has returned after primary surgery (recurrent disease) may need secondary surgery to remove all or part of the cancer. The option of surgery (debulking or cytoreductive surgery) is currently offered to a select group of women with recurrent ovarian cancer. It is important to ascertain whether this surgery helps women with recurrent disease to survive for longer than if they only got chemotherapy.

We searched for studies that compared secondary cytoreductive surgery and chemotherapy with chemotherapy alone in women with recurrent epithelial ovarian cancer. Although we checked 1431 possible articles, we found no relevant studies. Therefore there is currently no evidence to determine if secondary cytoreductive surgery is better or worse than chemotherapy alone in terms of prolonging life.

The review highlights the need for good quality studies comparing secondary cytoreductive surgery to chemotherapy.

Risk of malignancy in sonographically confirmed septated cystic ovarian tumors

CONCLUSIONS: Septated cystic ovarian tumors without solid areas or papillary projections have a low risk of malignancy and can be followed sonographically without surgery

abstract/Cochrane Collaboration review: DNA-repair pathway inhibitors for the treatment of ovarian cancer (PARPs...AZD2281)

Plain language summary

Are DNA repair inhibitors as effective and harmless compared to conventional chemotherapy in the treatment of ovarian cancer?
Ovarian cancer is the sixth commonest cancer in women world-wide and remains a leading cause of death, with an annual incidence of 6.6 cases per 100,000 women and an annual mortality rate of 4.0 deaths per 100,000 women. Most ovarian cancers (90%) are epithelial ovarian cancer and arise from the surface of the ovary. Epithelial ovarian cancer typically occurs in post-menopausal women, with a peak incidence around the age of 60, although it does occur in younger women, often associated with genetic predispositions. The onset of this disease is insidious and 75% of women present with advanced stage disease (stage III or IV) when the 5 year survival is around 30%. Treatment consists of debulking surgery and platinum-based chemotherapy, with or without taxanes. Although initial response to chemotherapy is good, most women will relapse, requiring further chemotherapy treatment and develop cancer that is resistant to chemotherapy.

Conventinal chemotherapy acts on all rapidly dividing cells by damaging DNA. Cancer cells divide very rapidly, which is why chemotherapy works better on cancer cells than normal cells. However, there is no inherent selectivity for normal calls and so rapidly dividing cells, such as gut lining, hair follicles and bone marrow, are also affected, leading to diarrhoea, mouth ulcers, hair loss, anaemia and susceptibility to infections.

All cells are equipped with a number of systems or pathways that repair DNA damage. If cells are unable to repair their DNA, the cell undergoes programmed cell death (apoptosis) in order to prevent an abnormal cell from dividing. Because being able to repair DNA is vital to cell survival, normal cells have more than one DNA-repair pathway, so that if one is lost cells can still repair themselves. Cancer cells often develop defects in these pathways, due to mutations, which may promote development of cancer (e.g. BRCA mutations). However, these same mutations mean that these cancer cells are more susceptible to DNA damage, such as that caused by chemotherapy, than normal cells. Novel therapeutical agents have been developed to inhibit DNA-repair pathways, which makes cells that already have faults in another DNA repair pathway due to a mutation, exquisitely sensitive to DNA damaging chemotherapy agents. The most common target for this type of novel anti-cancer agent are the DNA-repair enzymes called poly (ADP-ribose) polymerases (PARPs). PARPs are a family of related enzymes, which are involved in regulating various cellular processes, including DNA repair, cell death, and inflammation. PARP inhibitors therefore have a potentially wide range of applications.

Our objective was to compare effectiveness and side effects of PARP inhibitors compared to conventional chemotherapy in women with ovarian cancer. The identification of a safe dose of AZD2281 (a PARP inhibitor) has been found by small non randomised trials, with encouraging results. For ovarian cancer, there are currently two ongoing RCTs, but outcome data are not yet available. Results of these trials are awaited to determine if DNA repair inhibitors have a role in addition to conventional chemotherapy in the treatment of ovarian cancer.

OCATS - Ovarian Cancer Awareness & Treatment in Saskatchewan - ovarian cancer survivors meet again this year

August 14 & 15, 2010 – International Gathering of Ovarian Cancer Women Supporting Each Other (ACOR), Regina, SK, Canada.
This event will include a free BBQ Dinner for patients and their partners on the 14th – to register for this contact Darlene at 306-775-1848 or info@ocats.ca

A luncheon for women only on the 15th out at Homestead Hall - a Prairie Girl Experience!

Golfing on the 15th for the guys at the awesome Deer Valley Golf Resort A Block of Rooms have been set aside at the "Regina Inn, for more info or to register under “OCATS Aug 2010”

For more info call Darlene at 306-775-1848 or info@ocats.ca

Abstract/full free access | Increased androgen receptor expression in serous carcinoma of the ovary is associated with an improved survival

Background

Altered androgen hormone homeostasis and androgen receptor (AR) activity have been implicated in ovarian carcinogenesis but the relationship between AR expression in ovarian cancer and clinical outcome remains unclear.

 Conclusions

AR expression is considerably reduced in EOC as compared to fallopian tubes, and in EOC of the serous subtype, high AR expression is a favourable prognostic factor. These results indicate that assessment of AR expression might be of value for treatment stratification of EOC patients with serous ovarian carcinoma.

"While several immunohistochemistry (IHC)-based studies have confirmed widespread AR (androgen receptor)expression in EOC, data describing it as a prognostic biomarker are relatively sparse. One study describing a large series of tumors (n=322), found no association between AR protein expression and clinical outcome, however individual histological subtypes were not examined. Increased levels of AR mRNA
have been described in cells from normal ovarian surface epithelium as compared to ovarian cancer cells, the majority of which were derived from serous tumors. We are, however, unaware of any studies describing AR expression in fallopian tubes, from which a substantial but not yet not fully appreciated proportion of serous ovarian carcinomas are thought to arise.."

UK - Cancer research centre launched - Herald Scotland | News | Health

"A new centre which is set to become one of the UK’s leading research facilities on ovarian, bowel and breast cancer opens in Edinburgh today.

The Edinburgh Cancer Research UK Centre is part of a country-wide network of centres that are run under the auspices of Cancer Research UK.

Their aim is to prevent duplication of research and bring together world class laboratory researchers with doctors to provide the best possible results for cancer patients in the future.

Edinburgh is known for its globally renowned research on genetics and the biology of cancer. The centre aims to become a world centre for developing treatments tailor-made for individual patients.

Researchers will also look at the problem of cancer cells spreading, and developing drug resistance.

David Cameron, professor of oncology and head of NHS Lothian Cancer Services, is the clinical director of the new centre. He said: “This is a very exciting development for cancer patients and for research in Scotland......"

Regulator to reject ovarian cancer treatment approve Trabectedin (Yondelis)

18th June 2010 - The health regulator, "The National Institute for Health and Clinical Excellence (NICE), says a new treatment for ovarian cancer is not recommended for the NHS because the manufacturer did not submit sufficient evidence that the medication benefits patients more than the most widely-used treatments.

NICE is appraising trabectedin (Yondelis) in combination with pegylated liposomal doxorubicin (PLDH) for the treatment of relapsed ovarian cancer that is sensitive to platinum-based therapies.

Its independent advisory found that the evidence submitted by the manufacturer was not robust because it did not compare trabectedin against a current ‘gold-standard’ treatment for relapsed ovarian cancer: paclitaxel in combination with platinum-based chemotherapy. This meant NICE couldn’t confirm whether or not the treatment extends patients’ lives for longer than one of the more effective and commonly-used treatments...."