Evolving Concepts in the Management of Newly Diagnosed Epithelial Ovarian Cancer

Gourley, Charlie; Bookman, Michael A.

doi:10.1200/jco.19.00337

Cited by 17 publications

(18 citation statements)

References 85 publications

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“…1 Much of the historical evidence regarding therapeutic efficacy in ovarian carcinoma either identifies histological type based on poorly reproducible criteria or does not distinguish one type from another. 2 Therefore, much of the evidence regarding ovarian cancer treatment reflects the predominant histological type, which is high-grade serous carcinoma. However, it is now evident that clear cell carcinoma is a discrete entity, both biologically and clinically, and treatment should be specific for this type.…”

Section: Introductionmentioning

confidence: 99%

Clear cell carcinoma of the ovary: a clinical and molecular perspective

Iida

Okamoto

Hollis

et al. 2020

Int J Gynecol Cancer

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104

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Clear cell carcinoma of the ovary has distinct biology and clinical behavior. There are significant geographical and racial differences in the incidence of clear cell carcinoma compared with other epithelial ovarian tumors. Patients with clear cell carcinoma are younger, tend to present at an early stage, and their tumors are commonly associated with endometriosis, which is widely accepted as a direct precursor of clear cell carcinoma and has been identified pathologically in approximately 50% of clear cell carcinoma cases. The most frequent and important specific gene alterations in clear cell carcinoma are mutations of AT-rich interaction domain 1A (ARID1A) (~50% of cases) and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) (~50% cases). More broadly, subgroups of clear cell carcinoma have been identified based on C-APOBEC (apolipoprotein B mRNA editing enzyme, catalytic polypeptide-like) and C-AGE (age-related) mutational signatures. Gene expression profiling shows upregulation of hepatocyte nuclear factor 1-beta (HNF1β) and oxidative stress-related genes, and has identified epithelial-like and mesenchymal-like tumor subgroups. Although the benefit of platinum-based chemotherapy is not clearly defined it remains the mainstay of first-line therapy. Patients with early-stage disease have a favorable clinical outcome but the prognosis of patients with advanced-stage or recurrent disease is poor. Alternative treatment strategies are required to improve patient outcome and the development of targeted therapies based on molecular characteristics is a promising approach. Improved specificity of the histological definition of this tumor type is helping these efforts but, due to the rarity of clear cell carcinoma, international collaboration will be essential to design appropriately powered, large-scale clinical trials.

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Section: Introductionmentioning

confidence: 99%

Clear cell carcinoma of the ovary: a clinical and molecular perspective

Iida

Okamoto

Hollis

et al. 2020

Int J Gynecol Cancer

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104

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“…International Federation of Obstetrics and Gynecology (FIGO) stage, tumor grade, histological subtype and residual tumor after surgery are the established prognostic factors of progression-free survival (PFS) and overall survival (OS) for women with epithelial ovarian cancer (EOC). 2 The standard treatment for advanced-stage EOC is primary debulking surgery (PDS) followed by adjuvant chemotherapy. 3 , 4 Adjuvant chemotherapy is important to eliminate residual diseases or microscopic diseases.…”

Section: Introductionmentioning

confidence: 99%

Impact of the Time Interval Between Primary Debulking Surgery and Start of Adjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer

Lin

Chen

et al. 2021

CMAR

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Aim: To investigate whether the time interval between primary debulking surgery (PDS) and initiating adjuvant chemotherapy affects survival in patients with epithelial ovarian cancer (EOC). Methods: We retrospectively reviewed FIGO stage IIB to IV EOC patients who received PDS followed by adjuvant chemotherapy in our hospital between January 2008 and December 2016. The optimal cut-off time interval to chemotherapy related to survival was determined using the Contal and O'Quigley method and Cox hazard models. Cox regression analysis was used to identify the independent effect of time interval on survival. Results: A total of 152 patients were identified and divided into three groups based on the time interval between PDS and initiating adjuvant chemotherapy: early (<23 days), intermediate (23-43 days) and late (>43 days). The intermediate group had a significantly better median progression-free survival (PFS, 35.5 months) compared to the early (20 months) and late (22.6 months) groups. After adjustments for confounding factors, time interval was still an independent variable affecting PFS. The intermediate group was associated with a better PFS compared with the early and late groups (hazard ratio 0.27, 95% CI 0.10-0.83, p=0.002). There was no statistical significance in overall survival (OS) in univariate or multivariate analysis, although there was a trend towards better OS in the intermediate group. Conclusion:Our results provide evidence that the time interval from PDS to chemotherapy influences PFS in patients with advanced EOC. The optimal time to initiate chemotherapy was between 23 and 43 days, within 3-6 weeks post-operatively. Initiating chemotherapy early (<23 days) did not appear to benefit PFS.

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“…Generally, approximately 40% of EOC patients present with malnutrition, bowel dysfunction, extensive upper abdominal or extraperitoneal disease, large-volume ascites, advanced age and associated comorbidities. Many of these EOC patients will receive neoadjuvant CHT with consideration of interval cytoreductive surgery 54 . The majority of the responding specialists established the appropriate number of neoadjuvant CHT cycles as three, but this number is often higher for physicians who candidate more patients to neoadjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

An Italian National Survey on Ovarian Cancer Treatment at first diagnosis. There's None so Deaf as those who will not Hear

Mandato¹,

Torricelli²,

Uccella³

et al. 2021

J. Cancer

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Objective: Epithelial ovarian cancer (EOC) is the most lethal gynecological malignancy, crucial prognostic factors are no gross residual disease and centralization of cases. To evaluate the centralization of EOC patients, we report the results of a survey that shows the daily management of EOC patients in Italy. Methods: A 49-items electronic unblinded survey assessing demographics, practice characteristics, current opinions and approach to managing advanced EOC at first diagnosis was sent both to general gynecologists (GG) and gynecologic oncologists (GO). Differences in frequency distribution of answers between gynecologists with different expertise were evaluated using Fisher exact test. Multivariable analyses were performed applying generalized linear models. Results: 84/192 (44%) GG and 108/192 (56%) GO from all Italian regions answered to our survey. GOs declared to perform fertility sparing surgery in early EOC more frequently than GG (p=0.002). GOs can perform a frozen section and have both a gynecopathologist and a dedicated general surgeon. 89% of GOs consider as “optimal debulking” no gross residual disease and 81% achieve this at upfront cytoreduction in more than 40% of patients. Use of neoadjuvant chemotherapy decreases in higher volume centers (p<0.001) while it is lower in the group of GOs than in the GGs group (p<0.001). Conclusions: EOC patients are still treated by GGs. GOs perform more upfront surgery and achieve optimal debulking in a greater percentage of patients than GGs. In Italy an adequate centralization of cases has not yet been achieved, and this may have detrimental effects on the quality of treatment.

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Evolving Concepts in the Management of Newly Diagnosed Epithelial Ovarian Cancer

Cited by 17 publications

References 85 publications

Clear cell carcinoma of the ovary: a clinical and molecular perspective

Clear cell carcinoma of the ovary: a clinical and molecular perspective

Impact of the Time Interval Between Primary Debulking Surgery and Start of Adjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer

An Italian National Survey on Ovarian Cancer Treatment at first diagnosis. There's None so Deaf as those who will not Hear

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