Update on the secondary cytoreduction in platinum-sensitive recurrent ovarian cancer: a narrative review

Conte, Carmine; Fagotti, Anna; Avesani, Giacomo; Trombadori, Charlotte Marguerite Lucille; Federico, Alex; D’Indinosante, Marco; Giudice, Maria Teresa; Pelligra, Silvia; Lodoli, Claudio; Marchetti, Cláudia; Ferrandina, Gabriella; Gallotta, Valerio

doi:10.21037/atm-20-4690

Cited by 15 publications

(16 citation statements)

References 98 publications

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“…BRCA testing is recommended in clinical practice because patients with that genetic alteration had a better response to platinum-based therapy and are targetable with PARP-inhibitor agents [ 7 , 8 ]. PFS was chosen as outcome because identifying those patients with a higher risk of relapse may imply a stricter follow-up and more prompt intervention [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

CT-Based Radiomics and Deep Learning for BRCA Mutation and Progression-Free Survival Prediction in Ovarian Cancer Using a Multicentric Dataset

Avesani

Tran

Cammarata

et al. 2022

Cancers

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Purpose: Build predictive radiomic models for early relapse and BRCA mutation based on a multicentric database of high-grade serous ovarian cancer (HGSOC) and validate them in a test set coming from different institutions. Methods: Preoperative CTs of patients with HGSOC treated at four referral centers were retrospectively acquired and manually segmented. Hand-crafted features and deep radiomics features were extracted respectively by dedicated software (MODDICOM) and a dedicated convolutional neural network (CNN). Features were selected with and without prior harmonization (ComBat harmonization), and models were built using different machine learning algorithms, including clinical variables. Results: We included 218 patients. Radiomic models showed low performance in predicting both BRCA mutation (AUC in test set between 0.46 and 0.59) and 1-year relapse (AUC in test set between 0.46 and 0.56); deep learning models demonstrated similar results (AUC in the test of 0.48 for BRCA and 0.50 for relapse). The inclusion of clinical variables improved the performance of the radiomic models to predict BRCA mutation (AUC in the test set of 0.74). Conclusions: In our multicentric dataset, representative of a real-life clinical scenario, we could not find a good radiomic predicting model for PFS and BRCA mutational status, with both traditional radiomics and deep learning, but the combination of clinical and radiomic models improved model performance for the prediction of BRCA mutation. These findings highlight the need for standardization through the whole radiomic pipelines and robust multicentric external validations of results.

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Section: Discussionmentioning

confidence: 99%

CT-Based Radiomics and Deep Learning for BRCA Mutation and Progression-Free Survival Prediction in Ovarian Cancer Using a Multicentric Dataset

Avesani

Tran

Cammarata

et al. 2022

Cancers

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“…Surgical resection is preferable for women with early stage OC; while for most cases of advanced cancer, tumor debulking followed by adjunctive therapy could be performed. However, the recurrence of the cancer remains high despite of these treatments [ 5 – 7 ]. Therefore, effective treatments are urgently needed to improve the survival and quality of life in women with OC.…”

Section: Introductionmentioning

confidence: 99%

Metformin Use and Mortality in Women with Ovarian Cancer: An Updated Meta-Analysis

Guo

Shang

Guo

2022

International Journal of Clinical Practice

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Background. Previous observational studies and meta-analysis suggested a possible association between metformin use and reduced mortality in women with ovarian cancer (OC). However, clinical factors that may influence the relationship remain poorly evaluated. We performed an updated meta-analysis to systematically evaluate the above association and to observe the potential influences of study characteristics on the association. Methods. Relevant studies reporting the association between metformin use and mortality in women with OC in the multivariate adjusted model were identified by search of electronic databases that included PubMed, Embase, and Web of Science. The random-effects model was adopted to combine the results. Results. Nine studies including 10030 women with OC were included. Overall, metformin use was independently associated with reduced overall mortality (hazard ratio (HR): 0.72, 95% confidence interval (CI): 0.55–0.93, P = 0.01 ; I2 = 62%). Consistent results were observed for studies comparing metformin users with nondiabetic women and studies comparing metformin users with diabetic women who did not use metformin ( P for subgroup analysis = 0.70). Further subgroup analyses showed consistent results in studies with metformin use before or after the diagnosis of OC, with or without adjustment of body mass index (BMI) and with or without adjustment of concurrent medications ( P for subgroup analyses all >0.10). Conclusion. Metformin use is associated with reduced mortality in women with OC, which may be independent of the diabetic status of the controls, timing of metformin use, or adjustment of BMI and concurrent medications. Clinical trials are needed to validate the potential benefits of metformin on survival of OC.

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“…In a recent meta-analysis of 34 studies (54), the pooled area under the curve (AUC) of PET/CT for detecting ROC was significantly higher than that of CT or MRI. PET-CT and staging laparoscopy may be helpful in identification of patients in which complete CRS may be feasible (55)(56)(57). Staging laparoscopy is feasible in the vast majority of patients with recurrent ovarian cancer, despite the major abdominal surgery that usually has preceded (55).…”

Section: Patient Selection and Prediction Modelsmentioning

confidence: 99%

The current role of secondary cytoreductive surgery for recurrent ovarian cancer

Bree

Michelakis²,

Anagnostopoulou³

2022

Front. Oncol.

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Ovarian cancer represents worldwide the second most frequent and the most fatal gynecological malignancy, with approximately two thirds of the patients presenting with advanced disease. Cytoreductive surgery, primary or after neoadjuvant chemotherapy, in combination with platinum-based chemotherapy is the standard of care for these patients. Despite the improvement in quality of cytoreductive surgery as well as development of novel drugs and chemotherapy regimens, still most women with ovarian cancer will ultimately develop recurrent disease and die of their disease. In contrast to the management of primary disease, the standard treatment of patients with recurrent ovarian cancer remains a topic of debate. While platinum-based or second line systemic chemotherapy, depending on the time after last platinum treatment, is standard of care, the role of secondary cytoreductive surgery has been a controversial issue for the last decades. Potential outcome benefit must be also weighed against the risk of severe surgical morbidity, impairment of quality of life and costs. In platinum-resistant recurrent disease, i.e., relapse after less than 6 months from the last platinum-based chemotherapy for primary disease, secondary cytoreduction seems generally not to be indicated due to its aggressive biological behavior and the absence of effective systemic treatment. In this comprehensive review, the current role of cytoreductive surgery in platinum-sensitive recurrent ovarian cancer is discussed thoroughly in view of the results of most recent randomized trials and a meta-analysis. There seems to be definitely a role for secondary cytoreductive surgery in selected patients with ovarian cancer recurrence in whom complete resection of macroscopic disease is feasible. However, its role should be continuously reviewed due to the changing systemic treatment of patients with ovarian cancer recurrence over time.

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Update on the secondary cytoreduction in platinum-sensitive recurrent ovarian cancer: a narrative review

Cited by 15 publications

References 98 publications

CT-Based Radiomics and Deep Learning for BRCA Mutation and Progression-Free Survival Prediction in Ovarian Cancer Using a Multicentric Dataset

CT-Based Radiomics and Deep Learning for BRCA Mutation and Progression-Free Survival Prediction in Ovarian Cancer Using a Multicentric Dataset

Metformin Use and Mortality in Women with Ovarian Cancer: An Updated Meta-Analysis

The current role of secondary cytoreductive surgery for recurrent ovarian cancer

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