Showing posts with label neoadjuvant chemotherapy. Show all posts
Showing posts with label neoadjuvant chemotherapy. Show all posts

Tuesday, June 5, 2018

#ASCO18 Twitter Highlights June 4, 2018

Many gyn cancer research topics as well as survivorship issue  were covered on Monday at the ASCO Annual Meeting.

If you were at the meeting and think I missed any important developments please share a link to it in my comments section below.

Genetics / Genetics Counseling




Risk Reducing Surgery




CA-125


Endometriosis and Cannibis Treatment
Mindfulness

Neuropathy


Patient Reported Outcomes- Pain
Enodmetrial Cancer- Posters

Ovarian Cancer - Posters

Fertility Preservation

Metformin in Cancer Treatment

HIPEC

Palliative Care

Recurrent Ovarian Cancer

Neoadjuvant Chemotherapy - OC

 Further details may be found at 
https://meetinglibrary.asco.org/record/160515/abstract

Cediranib and Olaparib for recurrent OC
Further info may be found at
https://meetinglibrary.asco.org/record/160525/abstract


Thank you to all the researchers , advocates, and cancer centers who tweeted from this year's Annual Meeting.

Dee
Every Day is a Blessing!


 
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Wednesday, August 10, 2016

Neoadjuvant Chemotherapy Guideline for Advanced Ovarian Cancer

I was privileged to represent women diagnosed with ovarian cancer as the patient representative/advocate on the the joint SGO / ASCO guideline panel  that developed the recently released:

Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline

It was a process that took over a year, a few meetings (in-person and online), and many e-mails. During the entire time I felt that the "patient voice" was an integral part of the process. 

Thank you ASCO, SGO and Drs Alexi Wright and Mitchell Edelson, Guideline Chairs,  and the entire panel for giving me this opportunity. 

 Dee
Every Day is a Blessing
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Saturday, June 11, 2016

The Days of ASCO 16: Ovarian Cancer Research

This post will concentrate on information I learned during the gynecologic cancer sessions which focused on ovarian cancer. A future blog post will discuss research presented on other gynecologic cancers.

Intraperitoneal Chemotherapy for Ovarian Cancer: Trials and Tribulations
Presenters: Drs. Walker, Gourley, Mackay 
A discussion of GOG252 ( phase III trial) that compared IP and IV chemotherapy. All arms received Bevacizumab.
  • Arm 1: intravenous carboplatin AUC (area under the curve) 6/intravenous weekly paclitaxel at 80 mg/m2
  • Arm 2: intraperitoneal carboplatin AUC 6/intravenous weekly paclitaxel at 80 mg/m2
  • Arm 3: intravenous paclitaxel at 135 mg/m2 on day 1/intraperitoneal cisplatin at 75 mg/m2 on day 2/intraperitoneal paclitaxel at 60 mg/m2 on day 8. (Control)
This ASCO POST article  on this session also discusses the trial.

Walker  
Progession Free Survival (PFS) for all arms was similar
IP cisplatin arm had increased blood pressure with Bevacizumab
16% of the IP patients moved into the IV arm which may have influenced results
Neurotoxicity side effect in all arms were equal. All are lower than in GOG 172.
Questions asked regarding the  GOG 252 results:
    Did the dose dense paclitaxel in control make the control arm better than the control arms in the  other studies? 
    Did the addition of Bevacizumab negate the previous positive IP results? 
    Did the surveillance with CT every 6 months decrease PFS results?

Gourley
Other studies ( GOG 104,114,172) showed longer PFS using IP compared to  IV 
The subgroup of BRCA1/2 patients could benefit from IP

  Mackay
"There are still unresolved issues" regarding the use of IP chem
No evidence for combining IP/IV with Bevacizumab
No data so therefore no role of HIPEC ( hyperthermic interperitoneal chemotherapy) to treat ovarian cancer outside of clinical trial. 
Need to understand the microenvironment and biology of  OC
Would use of IP chemotherapy benefit subgroups of patients based on histologic or molecular profiles or platinum sensitivity? 

 Divide and Conquer: Epithelial OC Beyond BRCA
Kristeleit, Kohn , Goodfellow 

 This session discussed genes and pathways that influence the development of ovarian cancer. In addition to germline BRCA 1/2  mutations you can also find somatic BRCA 1/2 mutations, BRCA1 methylation, EMSY amplification, TP53, mutation, tumour suppressors RB1, NF1, RAD51B and PTEN ( which can lead to chemo resistance) and overexpression of MDR1.



Some clinical trials are also looking at Wee1 inhibition ( phase II), Hypoxia, combining parp inhibitors and immunotherapy, and PD1, PDL1 immunotherapy. 

 Symptom Management for Patients with Gynecologic Cancers 
Le, McCormack , Mayer  
Menopause
Dr Le spoke about the impact of menopause symptoms ( hot flashes, genitourinary ) after surgery. She recommended asking patients about what menopausal symptoms they were experiencing, assess the risk of hormone therapy and refer to  gynecologist/PCP for hormonal or non-hormonal treatment. 

 Survivorship Care Plans
Dr Mayer presented background information about the quality of life issues of women diagnosed with ovarian cancer. This slide shows the informational needs of ovarian cancer survivors ( Papadakos, 2012). Younger women had greater needs than older women. 
She concluded that women with gynecologic cancers can experience a number of long terms and late side effects, they have unmet needs especially fear of recurrence ,  patient reported outcomes can help identify the issues and survivorship care plans can help address those needs. 

 Oral Abstracts- Ovarian Cancer

5501- Overall survival (OS) in patients (pts) with platinum-sensitive relapsed serous ovarian cancer (PSR SOC) receiving olaparib maintenance monotherapy
Patients receiving maintenance olaparib after responding to platinum therapy had an overall survival advantage. Patients with a BRCA mutation and platinum sensitive relapsed serous ovarian cancer showed a significant progression free survival benefit. Germline and somatic BRCA mutation gave the same results. 

 

5502 Hormonal maintenance therapy for women with low grade serous carcinoma of the ovary or peritoneum Low grade ovarian cancer is more platinum resistant than high grade ovarian cancer. Women with stage II-IV low grade ovarian cancer who received hormonal maintenance chemotherapy following primary treatment had a statistically significant improvement in progression free survival compared with women who were under surveillance . 

 

LBA5503 OV21/PETROC: A randomized Gynecologic Cancer Intergroup (GCIG) phase II study of intraperitoneal (IP) versus intravenous (IV) chemotherapy following neoadjuvant chemotherapy and optimal debulking surgery in epithelial ovarian cancer (EOC).  After 3-4 courses of IV platinum chemotherapy followed by optimal debulking surgery women were optimized to 1) IV carbo/taxol , 2) IP cisplatin / IV taxol or 3) IV taxol/ IP carboplatinum.  The IP carboplatin based regimen, post neoadjuvant chemotherapy and debulking surgery, was tolerated and a lower number of women showed progression at 9 months compared to IV therapy. 

 

5504 Multicenter phase II study of intraperitoneal carboplatin plus intravenous dose-dense paclitaxel in patients with suboptimally debulked epithelial ovarian or primary peritoneal carcinoma Prospective study of stage II-IV OC. Chemotherapy with dose dense Placitaxel / Cisplatin  is safe and effective for suboptimal residual ovarian patients.

 

5505 The MITO8 phase III international multicenter randomized study testing the effect on survival of prolonging platinum-free interval (PFI) in patients with ovarian cancer (OC) recurring between 6 and 12 months after previous platinum-based chemotherapy: A collaboration of MITO, MANGO, AGO, BGOG, ENGOT, and GCIG  This study showed that  prolonging the platinum-free interval by using a non platinum based chemotherapy  does not improve and even worsens efficacy outcomes in patients with partially platinum sensitive recurrent ovarian cancer . 

 

5507 Performance characteristics and stage distribution of invasive epithelial ovarian/tubal/peritoneal cancers in UKCTOCS This study was first discussed at ASCO 2015 and this abstract presented a further analysis. Patients were randomized to either the Multi modal (MM) Risk of Ovarian Cancer Algorithm (ROCA) arm or ultrasound (USS)  for screening. Sensitivity of the MM was 86% with 4 operations per invasive cancer detected. Sensitivity of the USS was 63 % with 17 operations per invasive cancer detected.

 

 5508 Baseline quality of life (QOL) as a predictor of stopping chemotherapy early, and of overall survival, in platinum-resistant/refractory ovarian cancer (PRROC): The GCIG symptom benefit study (SBS) This Symptom Benefit study showed that Global Health status, Physical function,  Role Function and Abdominal/ GI symptoms were independent predictors for overall survival were significantly associated with stopping chemotherapy early. The worse symptoms the shorter survival. Assessment could help identify patients who may not benefit from palliative chemotherapy. 


Clinical Sciences Session: Leveraging the Immuno-molecular Landscape of Gynecologic Cancers - OVARIAN CANCER

5510 Kurian This study included over 95,000 women with ovarian cancer were tested using the Myriad 25 gene hereditary panel test . Personal histories were also taken. 

Most of the women had BRCA1/2 mutations.  ATM ( a mutation associated with breast cancer)  was seen for the first time . 

5511 Tanyi Mesothelin is a tumor associated antigen in ovarian cancer. This immunotherapy study was Phase 1 and included 6 women with recurrence ovarian cancer . Each women received an intravenous infusion of autologous T cells transduced to express a chimeric antigen receptor directed against mesothelin (CART-meso). The infusion was found to be safe. 

 

Education Session : Neoadjuvant Chemotherapy : Location , Location Location                    Leary and Chi  

There is a risk of progression while on neoadjuvant chemotherapy (NACT). There may also be a risk of driving chemo resistance on NACT. Previous studies showed improved survival but there was no quality control of the surgical aspect of the trials. How much disease remained after surgery? Ultimately it is the clinicians decision whether or not to use neoadjuvant chemotherapy. 

Here is an SGO video on ovarian cancer research at #ASCO16 on ovarian cancer. Presenter is Dr Shannon Westin, MD Anderson.



Dee 
Every Day is a Blessing! 

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Monday, August 5, 2013

Surgery Vs Neoadjuvant Chemotherapy

In the July 2013 European Journal of Cancer there appears a article titled:

Which patients benefit most from primary surgery or neoadjuvant chemotherapy in stage IIIC or IV ovarian cancer? An exploratory analysis of the European Organisation for Research and Treatment of Cancer 55971 randomised trial.


The Abstract appears here.

The study looked at data from the European Organisation for Research and Treatment of Cancer (EORTC) trial which randomized  670 women to receive surgery first or neoadjuvant chemotherapy. Neaoadjuvant treatment is a treatment given to shrink a tumor before treatment. The treatment could be chemotherapy, hormone therapy, radiation. In this study only chemotherapy was used as the neoadjuvant treament. The study also examined biomarkers to see if they could predict whether surgery or neoadjuvant chemotherapy was best. The study endpoint was overall survival.

Results: The study found women staged IIIC or less and smaller ( < 45 mm) metastatic tumors had higher survival rates with surgery first. Women at stage IV with large ( >45mm) metastatic tumors had better survival with neoadjuvant chemotherapy. For other patients the treatments were comparable.


Dee
Every Day is a Blessing!
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Tuesday, June 4, 2013

ASCO from a Distance

I've attended the ASCO Annual meeting in person for the past two years. This year I observed from a distance checking on the latest ovarian Cancer news by following ASCO post on Facebook, Tweets by those I follow and the Daily news e-mail. I also checked the online listing of abstracts for ovarian cancer. I've put together a few abstracts I found most interesting.


Randomized, double-blind, phase III trial of pazopanib versus placebo in women who have not progressed after first-line chemotherapy for advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer (AEOC): Results of an international Intergroup trial (AGO-OVAR16).
Pazopanib is a multikinase inhibitor and an oral formulation. The 940 patients in the randomized trial were initially diagnosed Stage III or IV and had 5 or more cycles of platinum- taxane chemotherapy. Women who took the pazaponib had an average  Progression Free Survival (PFS) of 5.6 months longer than women give a placebo. Patients did experience some adverse reactions. The Study concluded"Conclusions: Pazopanib maintenance therapy provided a statistically significant and clinically meaningful PFS benefit in patients with AEOC; OS data are not mature. The safety profile of pazopanib in this setting was consistent with its established profile. Clinical trial information: NCT00866697. "

My thoughts: Will the overall survival (OS) for the women in the pazopanib arm correlate to the PFS time? Will OS be 5 months? longer? shorter?
note:After reading a Medpage article and comments, I learned that the 800 mg pill taken daily cost $54 each.



The first treatment for Ovarian Cancer is normally Primary surgery( PS)  followed by adjuvant platinum-taxane chemotherapy(P-CT). This study compared survival rates for PS/ P-CT versus neoadjuvant chemotherapy (NACT) where chemo is given first and then surgery occurs after there is tumor shrinkage. There were 550 women in the study. The median OS was 22.8 months for PS vs 24.5 months for NACT. They study concluded " NACT was associated with increased optimal debulking, less early mortality and similar survival in this poor prognosis group. CHORUS results are consistent with EORTC55971 and strengthen evidence that NACT is a viable alternative to PS. Clinical trial information: ISRCTN74802813"

My thoughts: Knowing that there are no issues with NACT is important information for doctors to have when they are deciding what is best for their patients.

 Comparative effectiveness of treatments for recurrent ovarian cancer.
In the past recurrent OC has been treated with chemotherapy but in some cases secondary cytoreductive surgery has been done (SCS). This study compared survival between chemotherapy vs SCS vs both or neither. There were 1623 women in the study. "Conclusions: Patients with recurrent ovarian cancer treated with both secondary surgery and chemotherapy survive longer than patients treated with either chemotherapy or surgery. Women who are Black, or older at time of recurrence have worse survival. "

My Thoughts:After reading this abstract I am happy I  chose SCS followed by chemotherapy when I recurred in 2008.

I with continue to read through the abstracts and will share more of my favorites in the future.

Dee
Every Day is a Blessing!
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