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Background: The NOVA study (NCT01847274) compared niraparib with placebo as a maintenance treatment for patients with recurrent ovarian cancer (OC) but was not powered to detect an overall survival (OS) improvement. Objective: To compare OS in a real-world population of patients with BRCA wild-type (BRCA wt) recurrent OC who received second-line maintenance (2LM) niraparib monotherapy versus active surveillance (AS). Design: A retrospective study using a US-based nationwide deidentified electronic health record-derived database. Methods: Patients diagnosed with epithelial OC (January 1, 2011–May 31, 2021) who completed second-line (2L) therapy (January 1, 2017–March 2, 2022) and were BRCA wt were included. A NOVA study-like subpopulation included patients with an Eastern Cooperative Oncology Group performance status score of 0–1 and platinum-sensitive disease. Patients were assigned to 2LM niraparib or AS cohorts. Follow-up was measured from the index date (2L non-maintenance therapy end) until the first of study end (May 31, 2022), last clinical activity, or death. Median OS (mOS) and hazard ratios were estimated with an emulated trial methodology. Results: The overall population comprised 199 patients in the 2LM niraparib monotherapy cohort and 707 patients in the AS cohort; the NOVA study-like subpopulation included 123 patients in the 2LM niraparib monotherapy cohort and 143 in the AS cohort. Demographic and clinical characteristics were similar in both populations. Overall, adjusted mOS was 24.1 months for the 2LM niraparib monotherapy cohort versus 18.4 months for the AS cohort (hazard ratio, 0.8; 95% confidence interval [CI]: 0.7–0.9). In the NOVA study-like subpopulation, adjusted mOS was 28.1 months for the 2LM niraparib monotherapy cohort versus 21.5 months for the AS cohort (hazard ratio, 0.6; 95% CI: 0.5–0.9). Conclusion: These results provide important real-world OS data for patients with recurrent BRCA wt OC who received niraparib monotherapy compared with patients receiving AS. Plain language summary: Niraparib maintenance treatment versus monitoring for recurrent ovarian cancer without BRCA mutation This study examined the real-life survival of patients with ovarian cancer (OC) who received two lines of chemotherapy for OC, known as recurrent OC. We compared two groups: one patient group received a subsequent oral medication called niraparib (a type of maintenance therapy) to delay recurrence, whereas the other group was monitored by their physicians without receiving any medication (also known as active surveillance). This study analyzed health records from across the United States, focusing on patients who were diagnosed with OC between January 2011 and May 2021. Importantly, these patients completed their second line of therapy between January 2017 and March 2022 and had BRCA wild-type disease (meaning that they did not have a specific gene mutation known as BRCA). Patients then received maintenance therapy with niraparib or active surveillance. To assess how long patients lived, patient records were reviewed until the study ended in May 2022, or for patients who did not have data available through that date, until the date of their last visit or death. The study found a significant difference in how long the two groups of patients survived on average. Those patients who received the medication niraparib survived for 24.1 months, compared with 18.4 months for patients in the group that was monitored by their physicians. These results provide valuable insights into the real-life benefits of using niraparib to treat OC outside of a clinical trial. Importantly, these results support the positive outcomes seen in clinical trials, indicating that this medication is a promising option for patients with recurring OC. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions Explored the correlation between CD1a expression in recurrence and prognosis of ovarian cancer (OV).The CD1a expression profile in OV, recurrent OV, and normal tissues, as well as corresponding clinical data, were obtained from The Cancer Genome Atlas (TCGA), International Cancer Genome Consortium (ICGC), Gene Expression Omnibus (GEO), and Genotype Tissue Expression (GTEx) databases. Meanwhile, immunohistochemical detection of CD1a expression in normal and OV tissues. Kaplan–Meier curves were plotted to estimate the hazard ratio (HR) of survival in OV. In addition, the correlation between CD1a and immune cells in OV, as well as the CD1a expression profile and corresponding survival time in pan‐cancer were obtained from TCGA database.CD1a was overexpressed in OV and was significantly under‐expressed in recurrent OV (TCGA‐OV, p < 0.0001 and ICGC‐OV, p < 0.0001). CD1a immunohistochemistry is significantly overexpressed in OV compared to normal tissue (p < 0.05). Recurrent OV (ICGC, p < 0.001; GSE17260, p < 0.001; GSE32062, p < 0.05). The prognosis in OV was significantly better when CD1a is overexpressed compared to under‐expressed (HR [low], 1.426: 95% confidence interval [CI], 0.912–2.128; p = 0.050). Meanwhile, the overexpression of CD1a has a better prognosis than low expression in OV and recurrent OV (p = 0.004, HR [low] = 2.462, 95%CI [1.346–4.504] and p = 0.011, HR [low] = 2.199, 95%CI [1.202–4.024]). In addition, CD1a expression was closely correlated with immune cells, the CD8+ T cells, macrophages, and NK cells, while uncharacterized cells were significantly different (p = 2.65e−6, p = 7.52e−13, p = 8.28e−12, and p = 5.89e−8, respectively). Moreover, CD1a expression affected the prognosis in various other cancers.CD1a expression affected the recurrence and prognosis of OV and is closely related to various immune cell levels. [ABSTRACT FROM AUTHOR]

Ovarian cancer is a leading cause of death from gynecological cancers worldwide. Platinum-based chemotherapy provides the cornerstone of the medical management. In first line and subsequent relapses, maintenance strategies are offered to prolong intervals between lines of chemotherapy. Current maintenance options involve bevacizumab and poly ADP-ribose polymerase inhibitors, but these lines of therapy can only be used once in the disease course. Patients in first or second platinum sensitive relapse after poly ADP-ribose polymerase inhibitors and bevacizumab represent an area of unmet medical need. This academic sponsored, international Phase II randomized trial is evaluating the combination of a therapeutic cancer vaccine (OSE2101) with anti-PD1 (pembrolizumab) as maintenance therapy, in patients with platinum-sensitive recurrence regardless of number of prior lines and no progression after platinum-based chemotherapy. Clinical Trial Registration:NCT04713514 (ClinicalTrials.gov) Tweetable Abstract Ongoing Phase II study randomizing vaccine OSE2101 +/- Pembrolizumab vs supportive care as maintenance in platinum-sensitive recurrent ovarian cancer. Plain Language Summary Phase II study evaluating vaccine OSE2101 +/- Pembrolizumab vs supportive care as maintenance in patients with recurrent platinum-sensitive ovarian cancer. Ovarian cancer often becomes a long-term condition that needs ongoing treatment. After chemotherapy, women usually receive additional treatments to keep the cancer under control. There are only two approved treatments for this: bevacizumab administered every 3 weeks, and poly ADP-ribose polymerase inhibitors (PARP) inhibitors, which are pills that women can take if their cancer responds to platinum-based chemotherapy. However, if women have already been treated with both bevacizumab and a PARP inhibitor, there are no approved options left to maintain control of the cancer after chemotherapy. A new potential treatment, called OSE2101, is being studied: it is a vaccine designed to activate the body's immune cells to fight against cancer. The TEDOVA study is looking at how well this vaccine works in women with ovarian cancer who have already been treated with both bevacizumab and a PARP inhibitor and whose cancer is responding to platinum-based chemotherapy again. Participants are randomly assigned to one of three groups after their chemotherapy: standard supportive care, OSE2101 vaccine alone and the combination of OSE2101 vaccine with pembrolizumab. The goal of the TEDOVA study is to see if the combination of the OSE2101 vaccine and pembrolizumab can better control the cancer and to make sure the treatments are safe. The study is being run by ARCAGY-GINECO and is currently recruiting patients in France, Germany and Belgium. The study will continue to accept new patients until the end of 2024, and it is registered on ClinicalTrial.gov under the number NCT04713514. Article highlights Advanced epithelial ovarian cancer Most patients diagnosed with ovarian cancer (OC) have no evidence of disease after standard treatment with debulking surgery and platinum-based chemotherapy. Long-term survival depends on the recurrence of the disease, the delay between the last platinum-based chemotherapy defining the platinum-sensibility which is a major prognostic factor. Study rationale Women with platinum-sensible relapse (more than 6 months after the last platinum received) will be managed as patients with a chronic disease requiring iterative lines of platinum-based chemotherapy. After several cycles of treatment, chemotherapy is usually stopped and one of the major priorities is to extend platinum-free interval proposing maintenance strategies, as targeted therapy bevacizumab or poly ADP-ribose polymerase inhibitors (PARPi). When those lines of therapy have been received during previously, they cannot be reuse. That is the reason of developing new therapies and associations as maintenance therapy. TEDOVA study TEDOVA is a Phase II, randomized, open-label, multicenter study assessing the efficacy of vaccine OSE2101 + anti PD-1 pembrolizumab as maintenance therapy in women with platinum-sensible relapse of OC. We included women with HLA-A2 phenotype (~45% of the general population) with platinum sensitive OC regardless of the number of prior lines of platinum-based chemotherapy. Patients must have been previously treated with bevacizumab and a PARPi, or have a contra-indication. End points The primary end point is to evaluate the progression free survival of maintenance OSE2101 alone or in combination with PD1 inhibitor. The secondary end points are to compare the best overall response rate for patients with measurable disease at randomization, the safety and tolerability, the time to subsequent first and second treatments and the overall survival. Key eligibility Eligible patients were aged ≥18 years of age with histologically proven non-mucinous epithelial OC, positive HLA-A2 phenotype, and platinum sensitive OC regardless of the number of prior lines of platinum-based chemotherapy. Patients must have been previously treated with bevacizumab and a PARPi, or have a contraindication. Study procedures A total of 180 patients with an HLA-A2 positive phenotype will be randomized into three study arms in a 1:1:2 ratio: Arm A (n = 45) will receive observation/best supportive care, Arm B (n = 45) will receive OSE2101 and Arm C (n = 90) will receive OSE2101 plus pembrolizumab. Patients will be followed until disease progression, intolerance, withdrawal of consent, or for up to 2 years. Statistics One-sided log-rank tests will be conducted in a predefined sequence: H1: Compare Arm C (OSE2101 + pembrolizumab) with Arm A (best supportive care). If H1 shows a statistically significant difference, then proceed to: H2: Compare Arm C (OSE2101 + pembrolizumab) with Arm B (OSE2101). If both H1 and H2 show statistically significant differences, then proceed to: H3: Compare Arm B (OSE2101) with Arm A (best supportive care). A total of 121 events (progressions or deaths) is required to perform the first test of H1. [ABSTRACT FROM AUTHOR]

– Selection criteria used in all three randomized trials are predictive of a complete cytoreduction and not the benefit of surgery– Post-hoc & prespecified subgroup analyses indicate that not all patients undergoing secondary cytoreduction benefit from it– Post-hoc and sub-group analysis should be performed separately for patients undergoing a complete gross resection– Impact of incomplete cytoreduction on quality of life and subsequent therapy needs further evaluation– Future randomized trials should use surgical prognostic factors like disease sites and extent as stratification factors

Background: Ovarian cancer (OC) is a gynecological malignancy with a high mortality rate worldwide. The unfavorable prognosis of OC is mainly attributed to the recurrent propensity. Recently, mortality from OC has exhibited a downward trend. These favorable patterns are likely to be driven by advancements in novel therapeutic regimens. However, there is a lack of visualize analysis of the application of these new drugs on women with recurrent OC (ROC). Therefore, we aimed to provide a bibliometric analysis of the evolving paradigms in the ROC treatment. Methods: Documents on ROC treatment were systematically collected from the MEDLINE database and Web of Science Core Collection (WOSCC). The retrieved documents were exported in the plain text file format, and files were named and saved to the paths specified by the Java application. Microsoft Excel (version 2010), Citespace (6.2.R4) and VOSviewer (1.6.19) were used for data analysis, and included the following: 1) annual publication trend; 2) contributions of countries, institutions and authors; 3) co-citation of journals and references; and 4) cooccurrence of keywords. Results: A total of 914 documents published in the MEDLINE and 9,980 ones in WOSCC were retrieved. There has been an upward trend in the productivity of publications on ROC treatment on by years. The United States was the leading contributor in this field, and the University of Texas System stood out as the most productive institution. Giovanni Scambia and Maurie Markman were the research leaders in the field of ROC treatment. The journal Gynecologic Oncology had the highest citation frequency. The reference entitled with "Niraparib Maintenance Therapy in Platinum-Sensitive, Recurrent Ovarian Cancer" got highest centrality of 0.14 in the co-citation network. Keyword analysis revealed that the focus of current ROC treatment was on platinum-based anticancer drugs, paclitaxel, angiogenesis inhibitors (AIs), immune checkpoint inhibitors (ICIs) and poly (ADP-ribose) polymerase inhibitors (PARPis). Conclusion: Scholars from a multitude of countries have been instrumental in the advancement of ROC treatment. The research hotspots and trend in the field of predominantly originated from leading international journals and specialized periodicals focused on gynecologic oncology. Maintenance therapy using AIs or (and) PARPis has emerged as a significant complement to platinum-based chemotherapy for patients with ROC. [ABSTRACT FROM AUTHOR]

As one lethal malignancy in women's reproductive systems, ovarian cancer (OC) is frequently detected at an advanced phase during diagnosis. when the disease has spread widely. The absence of obvious symptoms and powerful screening tools in the early stages makes treatment difficult and the prognosis poor. Despite the clinical remission that can be achieved in some patients after initial treatment, the recurrence rate is conspicuous, posing a considerable challenge in treating recurrent OC (ROC). In the retrospective analysis, we compared the effects of two treatment regimens, aqupla combined with paclitaxel liposome (NP group) versus aqupla combined with docetaxel (ND group), on survival and biomarkers in patients with ROC. The study included 121 OC patients, and clinical data were collected through an electronic medical record system, outpatient review records, and a follow-up record system. The results revealed a notably higher overall remission rate in the ND group than the NP group, but revealed no notable inter-group discrepancy in toxicities, implying that the aqupla combined with docetaxel regimen may be more effective in platinum-sensitive ROC patients. Additionally, post-treatment CA125 levels were lower in patients in the ND group, suggesting that the regimen may be more effective in reducing tumour load. Survival analysis further revealed that treatment regimen, FIGO stage, number of recurrent lesions, and pretreatment CA125 level were independent prognostic factors affecting patients' 5-year OS and PFS. Overall for ROC patients, especially platinum-sensitive patients, the aqupla in combination with docetaxel regimen provided an improved survival benefit with a comparable safety profile, highlighting the importance of individualised treatment strategies. [ABSTRACT FROM AUTHOR]

Simple Summary: Ovarian cancer ranks as the second most prevalent genital malignancy in women and leads to higher rates of mortality among gynecological cancers, often diagnosed at advanced stages with extensive metastases. Historically, treatment for recurrent ovarian cancer (ROC) has focused on managing peritoneal metastases, typically through aggressive surgery followed by systemic chemotherapy. Recent advancements have included secondary cytoreductive surgery and the use of hyperthermic intraperitoneal chemotherapy (HIPEC), aimed at improving survival but still debated due to variable outcomes in prior studies. This study conclusively finds that factors such as radical surgery, good performance status, platinum sensitivity, a positive AGO score, and a low Peritoneal Carcinomatosis Index (PCI) significantly enhance survival rates for patients with ROC undergoing HIPEC. It also highlights the predictive importance of platinum resistance and the AGO score in determining outcomes. Given these results, there is a strong recommendation for further prospective studies to validate these findings and to refine the criteria for selecting patients suitable for HIPEC, aiming to improve the treatment strategies and survival outcomes in this patient group. Background: Recurrent ovarian cancer (ROC) significantly challenges gynecological oncology due to its poor outcomes. This study assesses the impact of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) on ROC survival rates. Materials and Methods: Conducted at the Medical University of Lublin from April 2011 to November 2022, this retrospective observational study involved 71 patients with histologically confirmed ROC who underwent CRS and subsequent HIPEC. Results: The median overall survival (OS) was 41.1 months, with 3-year and 5-year survival rates post-treatment of 0.50 and 0.33, respectively. Patients undergoing radical surgery for primary ovarian cancer had a median OS of 61.9 months. The key survival-related factors included the Peritoneal Carcinomatosis Index (PCI) score, AGO score, platinum sensitivity, and ECOG status. Conclusions: The key factors enhancing ROC patients' survival include radical surgery, optimal performance status, platinum sensitivity, a positive AGO score, and a lower PCI. This study highlights the predictive value of the platinum resistance and AGO score in patient outcomes, underlining their role in treatment planning. Further prospective research is needed to confirm these results and improve patient selection for this treatment approach. [ABSTRACT FROM AUTHOR]

Aim: Hyperthermic intraperitoneal chemotherapy (HIPEC) is treatment method used in advanced-stage ovarian cancers. It aims to control peritoneal metastases in conjunction with cytoreductive surgery by directly administering cancer drugs into the peritoneum along with heat. We aimed to examine relationship between clinical-pathological features at the time of initial treatment and survival of patients diagnosed with advanced-stage ovarian cancer, treated primary cyto-reductive surgery, subsequently with secondary cytoreduction + HIPEC following recurrence. Materials and Methods: Patients diagnosed advanced-stage ovarian cancer, detected after primary treatment, and treated secondary cytoreductive surgery and HIPEC were retrospectively examined. Patients demographic characteristics, stages, laboratory, clinical courses were retrospectively analyzed. Results: 29 patients with recurrent advanced-stage ovarian cancer treated with HIPEC were included in our study. During primary surgery, eight cases had R0, 20 had R1, one patient had R2 resection. Statistically significant higher survival rate was observed in patients undergoing R0 resection (p<0.003), same relationship continued in the survival observed after HIPEC (p<0.004). Our rates of side effects and complications were mostly at grade 1, 2 and were managed palliatively, with grade III in eight patients, grade IV in two patients. Conclusion: HIPEC method allows the administration of high doses of chemotherapy with an acceptable rate of side effects. It is crucial to examine different parameters to determine the ideal application of HIPEC. We found that resection margins of the initial surgery had an impact on post-treatment survival rates. Based on these findings, HIPEC can be presented as an acceptable method in an appropriate patient profile. [ABSTRACT FROM AUTHOR]

Background: Annually, approximately 200 new ovarian cancer cases are diagnosed in Armenia, which is considered an upper-middle-income country. This study aimed to summarize the survival outcomes of patients with relapsed ovarian cancer in Armenia based on the type of recurrence, risk factors, and choice of systemic treatment. Methods: This retrospective case-control study included 228 patients with relapsed ovarian cancer from three different institutions. Results: The median age of the patients was 55. The median follow-up times from relapse and primary diagnosis were 21 and 48 months, respectively. The incidence of platinum-sensitive relapse was 81.6% (186), while platinum-resistant relapse was observed in only 18.4% (42) of patients. The median post-progression survival of the platinum-sensitive group compared to the platinum-resistant group was 54 vs. 25 months (p < 0.001), respectively, while the median survival after relapse was 25 vs. 13 months, respectively; three- and five-year post-progression survival rates in these groups were 31.2% vs. 23.8%, and 15.1% vs. 9.5%, respectively (p = 0.113). Conclusions: Overall, despite new therapeutic approaches, ovarian cancer continues to be one of the deadly malignant diseases affecting women, especially in developing countries with a lack of resources, where chemotherapy remains the primary available systemic treatment for the majority of patients. Low survival rates demonstrate the urgent need for more research focused on this group of patients with poor outcomes.

Background: Annually, approximately 200 new ovarian cancer cases are diagnosed in Armenia, which is considered an upper-middle-income country. This study aimed to summarize the survival outcomes of patients with relapsed ovarian cancer in Armenia based on the type of recurrence, risk factors, and choice of systemic treatment. Methods: This retrospective case-control study included 228 patients with relapsed ovarian cancer from three different institutions. Results: The median age of the patients was 55. The median follow-up times from relapse and primary diagnosis were 21 and 48 months, respectively. The incidence of platinum-sensitive relapse was 81.6% (186), while platinum-resistant relapse was observed in only 18.4% (42) of patients. The median post-progression survival of the platinum-sensitive group compared to the platinum-resistant group was 54 vs. 25 months (p < 0.001), respectively, while the median survival after relapse was 25 vs. 13 months, respectively; three- and five-year post-progression survival rates in these groups were 31.2% vs. 23.8%, and 15.1% vs. 9.5%, respectively (p = 0.113). Conclusions: Overall, despite new therapeutic approaches, ovarian cancer continues to be one of the deadly malignant diseases affecting women, especially in developing countries with a lack of resources, where chemotherapy remains the primary available systemic treatment for the majority of patients. Low survival rates demonstrate the urgent need for more research focused on this group of patients with poor outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Treatment for recurrent ovarian clear cell carcinoma (OCCC) is clinically challenging as response rates to traditional chemotherapy are low, and recurrence rates are high. Immunotherapy has shown promise for this ovarian cancer (OC) subtype, and tumor molecular testing allows for the identification of a patient population that might benefit most from this treatment. We describe the clinical course and somatic genomic testing of 4 patients who received pembrolizumab for recurrent OCCC concurrent with a combination of bevacizumab and/or cyclophosphamide. Methods: All patients with OCCC treated with immune checkpoint inhibitors (ICI) within a single health system between 2018 and 2023 (excluding those on clinical trials) were identified via retrospective chart review. Results: Four patients were included. The average age at diagnosis was 56.5 years, and the number of prior treatments ranged from 1 to 6. All patients received pembrolizumab combined with either bevacizumab and/or cyclophosphamide. All patients (n = 3) who received pembrolizumab and bevacizumab experienced a partial response. Responses were durable, ranging from 6 to 15 months. Somatic genomic testing results demonstrated microsatellite stability and low tumor mutational burden in all patient tumors, and 3 had AT-Rich Interaction Domain 1A gene (ARID1A) mutations. Notably, two patients had treatment-limiting toxicities, one with presumed immune-mediated grade 2 myocarditis, and another with grade 5 hepatitis. Conclusions: Pembrolizumab, combined with bevacizumab and cyclophosphamide, is a promising treatment option for patients with recurrent OCCC, though careful risk assessment and counseling regarding toxicities is necessary to maximize the safety and efficacy of this treatment regimen. Prospective studies are needed for validation.

Abstract Background The chronic nature of ovarian cancer and disease recurrence has a considerable impact on the assessment of follow-up strategies and treatment planning for both oncologists and radiologists. It is imperative to conduct adequate follow-up in ovarian cancer to detect and treat recurrence as early as possible. Presently, surveillance of patients with this malignancy involves the combination of serial CA-125 assay and diverse imaging procedures, yet normal CA-125 levels cannot entirely rule out disease relapse. PET/CT provides whole-body functional imaging that does not necessities contrast injection, and allows for precise diagnosis and restaging of patients with suspected ovarian cancer recurrence, thereby strongly impacting disease management decisions. Our study aims to evaluate the value of FDG-PET/CT as a follow-up imaging tool in detecting and localizing recurrence of ovarian cancer, in conjunction with CA-125 tumor markers. Results In our study, it was demonstrated that recurrent disease manifested in FDG-PET/CT in 24 cases, with 9 of those cases exhibiting CA-125 levels within the normal range. There were two instances of false negative results and one instance of false positive results in FDG-PET/CT. Additionally, three cases were found to be free of disease relapse in FDG-PET/CT and exhibited normal CA-125 levels throughout the follow-up period (true negative). The prevalence of disease recurrent sites was 12% for local recurrence, 60% for peritoneal metastasis, 64% for nodal deposits and 28% for distant metastatic disease. The accuracy of FDG-PET/CT was 88.8%, with a sensitivity of 91.3% and specificity of 75%. Furthermore, FDG-PET/CT showed a positive predictive value of 95.5% and a negative predictive value of 60.3%. Conclusions PET/CT imaging provides a comprehensive and functional view of the entire body, which can accurately diagnose and restage cases with ovarian cancer recurrence. This approach plays a critical role in identifying peritoneal carcinomatosis and is considered a more dependable method than CA-125 tumor markers for detecting and monitoring ovarian cancer recurrence. Additionally, PET/CT imaging has the potential to decrease the number of second-look laparotomies and can thus significantly impact the management plan.

Carboplatin/pegylated liposomal doxorubicin/bevacizumab is an accepted standard anti-cancer treatment option for recurrent ovarian cancer. However, the occurrence of adverse events associated with this therapeutic regimen limits its continued clinical use. Among these adverse events, acquired amegakaryocytic thrombocytopenia is a rare but often potentially life-threatening adverse effect, and is intolerant to multiple treatment approaches. We report, for the first time, the successful treatment using avatrombopag combined with cyclosporine in one case of carboplatin/pegylated liposomal doxorubicin/bevacizumab-induced acquired amegakaryocytic thrombocytopenia, which was refractory or intolerant to glucocorticoids, intravenous immunoglobulin, recombinant human thrombopoietin, androgen, and even thrombopoietin receptor receptor agonist eltrombopag and herombopag. To date, this case manifests as normal platelet counts that are independent of transfusion. Our findings suggest that this combination is a potential and valuable alternative in acquired amegakaryocytic thrombocytopenia. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients diagnosed with epithelial ovarian cancer are usually treated with a combination of platinum-based chemotherapy and debulking surgery. Unfortunately, most of them will experience a recurrence of their disease, especially if diagnosed at an advanced stage. Patients with recurrence are typically re-treated with platinum-based chemotherapy if their disease recurs more than 6 months after the completion of previous chemotherapy. These patients are defined as having 'platinum sensitive' disease, while patients progressing less than 6 months after previous treatment are defined as 'platinum resistant'. It is known that patients who do not respond to platinum-based chemotherapy have a poorer prognosis and are expected to have shorter survival. Patients with platinum-sensitive disease will, at some point, become resistant to platinum, with increasing recurrence episodes. This study aims to compare the outcomes of patients who have primary platinum resistance at first treatment versus patients who acquire platinum resistance at a later stage of their illness. Objective: The goal of this study was to evaluate response to treatment and survival in epithelial ovarian cancer patients with acquired secondary platinum resistance (SPR) compared to patients with primary platinum resistance (PPR). Methods: Patients were categorized as PPR (patients with disease recurrence occurring during or <6 months after completing first-line platinum-based chemotherapy) and SPR (patients with previously platinum-sensitive disease that developed platinum resistance on subsequent treatments). Clinico-pathological variables and treatment outcomes were compared. Results: Of the 118 patients included in this study, 60 had PPR and 58 developed SPR. The SPR women had a significantly higher rate of optimal debulking during their upfront and interval operations, significantly lower CA-125 levels during their primary treatment, and a significantly higher complete and partial response rate to primary chemotherapy. Once platinum resistance appeared, no significant difference in survival was observed between the two groups. The median PFS was 2 months in the PPR group and 0.83 months in the SPR group (p = 0.085). Also, no significant difference was found in post-platinum-resistant relapse survival, with a median of 17.63 months in the PPR and 20.26 months in the SPR group (p = 0.515). Conclusions: Platinum resistance is an important prognostic factor in women with EOC. Patients with SPR acquire the same poor treatment outcome as with PPR. There is a great need for future research efforts to discover novel strategies and biological treatments to reverse resistance and improve survival. [ABSTRACT FROM AUTHOR]

(1) Background: Our aim was to evaluate the efficacy and adverse effects of maintenance chemotherapy in platinum-sensitive recurrent epithelial ovarian cancer after second-line chemotherapy. (2) Methods: A total of 72 patients from a single institute who had been diagnosed with platinum-sensitive recurrent ovarian cancer and had experienced either complete or partial response after six cycles of second-line chemotherapy were divided into a standard group (n = 31) with six cycles or a maintenance group (n = 41) with more than six cycles. We then compared patient characteristics and survival outcomes between these two groups. (3) Results: In all patients, after primary management for the first recurrence, the maintenance group showed worse survival outcomes. Patients who had not undergone either surgery or radiotherapy were divided into complete response and partial response groups after six cycles of chemotherapy. In patients with partial response, maintenance chemotherapy led to a significant improvement in PFS (median, 3.6 vs. 6.7 months, p = 0.007), but no significant change in in OS. The median cycle number of maintenance chemotherapy was four. (4) Conclusions: Maintenance chemotherapy may still play an important role in patients with platinum-sensitive recurrent ovarian cancer, particularly in selected patient groups. [ABSTRACT FROM AUTHOR]

Background: The chronic nature of ovarian cancer and disease recurrence has a considerable impact on the assessment of follow-up strategies and treatment planning for both oncologists and radiologists. It is imperative to conduct adequate follow-up in ovarian cancer to detect and treat recurrence as early as possible. Presently, surveillance of patients with this malignancy involves the combination of serial CA-125 assay and diverse imaging procedures, yet normal CA-125 levels cannot entirely rule out disease relapse. PET/CT provides whole-body functional imaging that does not necessities contrast injection, and allows for precise diagnosis and restaging of patients with suspected ovarian cancer recurrence, thereby strongly impacting disease management decisions. Our study aims to evaluate the value of FDG-PET/CT as a follow-up imaging tool in detecting and localizing recurrence of ovarian cancer, in conjunction with CA-125 tumor markers. Results: In our study, it was demonstrated that recurrent disease manifested in FDG-PET/CT in 24 cases, with 9 of those cases exhibiting CA-125 levels within the normal range. There were two instances of false negative results and one instance of false positive results in FDG-PET/CT. Additionally, three cases were found to be free of disease relapse in FDG-PET/CT and exhibited normal CA-125 levels throughout the follow-up period (true negative). The prevalence of disease recurrent sites was 12% for local recurrence, 60% for peritoneal metastasis, 64% for nodal deposits and 28% for distant metastatic disease. The accuracy of FDG-PET/CT was 88.8%, with a sensitivity of 91.3% and specificity of 75%. Furthermore, FDG-PET/CT showed a positive predictive value of 95.5% and a negative predictive value of 60.3%. Conclusions: PET/CT imaging provides a comprehensive and functional view of the entire body, which can accurately diagnose and restage cases with ovarian cancer recurrence. This approach plays a critical role in identifying peritoneal carcinomatosis and is considered a more dependable method than CA-125 tumor markers for detecting and monitoring ovarian cancer recurrence. Additionally, PET/CT imaging has the potential to decrease the number of second-look laparotomies and can thus significantly impact the management plan. [ABSTRACT FROM AUTHOR]

Introduction: The release of tumor-associated antigens with cytotoxic chemotherapy treatment may enhance the response to immune checkpoint blockade. Eribulin is a microtubule inhibitor with proven overall survival (OS) benefit in metastatic breast cancer (MBC), which may also enhance intratumoral vascular remodeling. Durvalumab, a humanized monoclonal antibody, targets the programmed cell death ligand-1 (PD-L1) receptor. This study sought to determine the maximum tolerated dose and recommended phase II dose (RP2D) of eribulin in combination with durvalumab, as well as the safety and preliminary antitumor activity of the combination in patients with previously treated HER2-negative (HER2−) MBC and recurrent ovarian cancer (ROC). Methods: Cohorts of 3–6 patients with HER2− MBC and ROC were treated in a modified 3+3 design. Eligible patients received escalating doses of eribulin (1.1 mg/m2 or 1.4 mg/m2 IV on day 1 and day 8) with durvalumab (1.12 g IV on day 1) in 21-day cycles until dose-limiting toxicity (DLT), intolerable adverse events (AEs), disease progression, or other reasons for withdrawal. Primary endpoint: the rate of DLTs during cycles 1 and 2 of therapy. Secondary endpoints: AE rate, objective response rate (ORR), progression-free survival (PFS), and OS. Results: Nine patients with a median of 4 prior therapies for advanced disease were treated: 5 patients with HER2− MBC (1 with triple-negative disease and 4 with hormone-positive disease) and 4 patients with ROC. The RP2D of eribulin was 1.4 mg/m2 in combination with durvalumab. There were no DLTs experienced during the first two cycles of therapy. The most common treatment-related AEs (>50%) were fatigue, neutropenia, decreased white blood cell count, anemia, AST and alkaline phosphatase elevation, hyperglycemia, and nausea; most were grade 1 or 2. There was one immune-related AE of grade 3 (hepatitis) after 5 cycles of treatment, for which patient came off study. Two other patients discontinued study drug related to toxicity (neutropenia [n = 1], hepatic toxicity [n = 1]). ORR was 55%, and 4 additional patients experienced stable disease. All MBC patients exhibited a response to therapy. Median PFS was 6.2 months. Median OS was 15.0 months. Conclusion: The combination of eribulin at a dose of 1.4 mg/m2 with standard dose durvalumab had a favorable AE profile in patients with previously treated HER2− MBC and ROC. The early antitumor activity observed in all MBC patients enrolled in the study suggests that further investigation of this combination is warranted. [ABSTRACT FROM AUTHOR]

• In women who have undergone secondary cytoreductive surgery due to locally advanced recurrent ovarian cancer, complete cytoreduction is associated with reduced disease relapse and increased overall survival. • Prior Surgical Score-1 is associated with reduced disease relapse and increased overall survival. • Infiltration of large bowel lymph nodes is associated with increased morbidity. To identify the clinical and pathological factors associated with relapse in women who had undergone secondary cytoreductive surgery due to locally advanced recurrent ovarian cancer. Women with locally advanced recurrent ovarian cancer who had undergone cytoreduction between 2000 and 2018 were included in this study. Demographic, clinical and biochemical intraoperative findings were recorded for each woman. All factors were assessed in order to identify which correlated with the outcomes of interest (i.e. disease relapse, mortality and morbidity). In total, 181 women who had undergone secondary cytoreduction were analysed. The hospital mortality rate was 1.7 % (n = 3) and the morbidity rate was 32.1 % (n = 58). Recurrence was recorded in 101 (55.8 %) women. Infiltration of large bowel lymph nodes was a negative prognostic indicator of morbidity (p = 0.029). A prior surgical score of 1 (PSS-1) [odds ratio (OR) 0.465] and complete cytoreduction (OR 0.518) were found to be significant independent predictors for disease relapse. Median overall survival was greater for patients with PSS-1 (151.3 vs 59.4 vs 44.1 months; p = 0.049) and patients with complete cytoreduction (137.6 vs 36.2 vs 10.0 vs 27.4 months; p < 0.001). Complete cytoreduction and PSS-1 are associated with reduced disease relapse and increased overall survival. Infiltration of large bowel lymph nodes is associated with increased morbidity. [ABSTRACT FROM AUTHOR]

Background and Aim: We report the results of an international consensus on hyperthermic intraperitoneal chemotherapy (HIPEC) regimens for epithelial ovarian cancer (EOC) performed with the following goals: To define the indications for HIPEC To identify the most suitable HIPEC regimens for each indication in EOC To identify areas of future research on HIPEC To provide recommendations for some aspects of perioperative care for HIPEC Methods: The Delphi technique was used with two rounds of voting. There were three categories of questions: evidence-based recommendations [using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system with the patient, intervention, comparator, and outcome (PICO) method], an opinion survey, and research recommendations. Results: Seventy-three (67.5%) of 108 invited experts responded in round I, and 68 (62.9%) in round II. Consensus was achieved for 34/38 (94.7%) questions. However, a strong positive consensus that would lead to inclusion in routine care was reached for only 6/38 (15.7%) questions. HIPEC in addition to interval cytoreductive surgery (CRS) received a strong positive recommendation that merits inclusion in routine care. Single-agent cisplatin was the only drug recommended for routine care, and OVHIPEC-1 was the most preferred regimen. The panel recommended performing HIPEC for a minimum of 60 min with a recommended minimum intraabdominal temperature of 41°C. Nephroprotection with sodium thiosulfate should be used for cisplatin HIPEC. Conclusions: The results of this consensus should guide clinical decisions on indications of HIPEC and the choice and various parameters of HIPEC regimens and could fill current knowledge gaps. These outcomes should be the basis for designing future clinical trials on HIPEC in EOC. [ABSTRACT FROM AUTHOR]

Abstract Background Efforts have been made to investigate the role of salvage radiotherapy (RT) in treating recurrent ovarian cancer (ROC). Stereotactic ablative radiation therapy (SABR) is a state-of-the-art therapy that uses intensity modulation to increase the fractional dose, decrease the number of fractions, and target tumors with high precision. Methods The SABR-ROC trial is a phase 3, multicenter, randomized, prospective study to evaluate whether the addition of SABR to the standard of care significantly improves the 3-year overall survival (OS) of patients with ROC. Patients who have completed the standard treatment for primary epithelial ovarian cancer are eligible. In addition, patients with number of metastases ≤ 10 and maximum diameter of each metastatic site of gross tumor ≤ 5 cm are allowed. Randomization will be stratified by (1) No. of the following clinical factors met, platinum sensitivity, absence of ascites, normal level of CA125, and ECOG performance status of 0–1; 0–3 vs. 4; (2) site of recurrence; with vs. without lymph nodes; and (3) PARP inhibitor; use vs. non-use. The target number of patients to be enrolled in this study is 270. Participants will be randomized in a 1:2 ratio. Participants in Arm 2 will receive SABR for recurrent lesions clearly identified in imaging tests as well as the standard of care (Arm 1) based on treatment guidelines and decisions made in multidisciplinary discussions. The RT fraction number can range from 1 to 10, and the accepted dose range is 16–45 Gy. The RT Quality Assurance (QA) program consists of a three-tiered system: general credentialing, trial-specific credentialing, and individual case reviews. Discussion SABR appears to be preferable as it does not interfere with the schedule of systemic treatment by minimizing the elapsed days of RT. The synergistic effect between systemic treatment and SABR is expected to reduce the tumor burden by eradicating gross tumors identified through imaging with SABR and controlling microscopic cancer with systemic treatment. It might also be beneficial for quality-of-life preservation in older adults or heavily treated patients. Trial registration This trial was registered at ClinicalTrials.gov (NCT05444270) on June 29th, 2022.

Abstract Background 18F-fluorodeoxyglucose (FDG) PET/CT is a noninvasive imaging tool that has been used successfully for the diagnosis, staging, restaging, therapy monitoring, and prognostic prediction of ovarian cancer. For ovarian cancer surveillance, rising CA-125 levels raise the suspicion of recurrence despite its reported low specificity; being elevated in other benign and inflammatory conditions, and thus, confirmation is required. This work aimed to evaluate the role of 18F-FDG PET/CT in suspected ovarian cancer recurrence in patients presenting with elevated CA-125 levels. Results Fifty female patients with suspected ovarian cancer recurrence owing to elevated CA-125 levels were included in this study. Recurrence was confirmed in 46/50 cases whether by histopathological confirmation or by serial follow-up imaging and clinical follow-up. Positive PET/CT findings were reported in 45/50 cases with 2 false-negative cases and 1 false-positive case. PET/CT examination was found to be superior to contrast-enhanced CT in the detection of peritoneal metastatic nodules and metastatic lymph nodes. According to this study, the estimated sensitivity, specificity, and overall diagnostic accuracy of PET/CT in the detection of recurrent ovarian cancer were 95.6%, 75%, and 94%, respectively. Conclusions In ovarian cancer surveillance, 18F-FDG PET/CT was found to be a sensitive and accurate noninvasive imaging tool that can be used in the detection of recurrent ovarian cancer in patients with elevated CA-125 levels, thus interfering with the management plan. The advantage of whole-body imaging in PET/CT allows for the detection and precise localization of recurrent or metastatic foci in abdominal and extra-abdominal sites as well.

Wanyi Chen,1,&ast; Po-Han Fang,2,&ast; Bin Zheng,3 Yue Liang,1 Yiwen Mao,1 Xuefeng Jiang,1 Qionglan Tang4 1Department of Obstetrics and Gynecology, the First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China; 2International School, Jinan University, Guangzhou, People’s Republic of China; 3Guangdong Research Center for Organoid Engineering and Technology, Guangzhou, People’s Republic of China; 4Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qionglan Tang, Email qionglantang@126.comAbstract: So far, ovarian cancer has still been the most lethal gynecological malignancy. The chemotherapy and targeted medication are the mainstay for the recurrent ovarian cancer treatment. About 70% of the advanced-stage cases will relapse. Ascites-derived organoid is a pre-clinical model for the precise prediction of the therapeutic effectiveness for the ovarian cancer: it can be used to assess the drug sensitivity, to guide individualized precise treatment, and to improve advanced stage as well as recurrent ovarian cancer patient’ survival and prognosis. Until now, there has been no report concerning the establishment of the organoid out of the patient’s ascites and the concurrent usage of drug sensitivity test to guide the individualized precise treatment for the ovarian cancer. Here, we report a case of recurrent ovarian cancer of a 59-year-old female patient whose CA125 at its peak increased to 4523.4 U/mL. Then, patient’s own ovarian cancer organoid was constructed from the ascites by the abdominocentesis; concurrently, medication sensitivity test was performed on the organoid to guide individualized precise treatment. After the treatment, CA125 decreased to 33.7 U/mL, and the patient’s condition relieved effectively. This is the first published case report using ascites-derived organoid and the drug sensitivity test thereof to guide the precise treatment of recurrent ovarian cancer.Keywords: ascites-derived organoid, ovarian cancer organoid, recurrent ovarian cancer, drug sensitivity test, precise treatment

Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery has been extensively studied in patients with peritoneal carcinomatosis, and it holds promise as a therapeutic strategy, but its role remains elusive. The aim of this study was to assess the existing evidence for the use or not of HIPEC in primary debulking surgery (PDS), interval debulking surgery (IDS), and recurrent ovarian cancer (ROC), evaluated in terms of survival rates and post-surgical morbidity. Methods: Medline, Pubmed, Cochrane, and Medscape were systematically searched for any article comparing the use of HIPEC treatment with any other therapy in patients with ovarian cancer in PDS, IDS, and ROC. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were followed. We only considered English-language published studies. Results: We included 14 studies, including two RCTs with a total of 1813 women, published between 2003 and 2023 with a recruitment period between 1998 and 2020. In PDS, there were no differences in progression-free survival (PFS) between HIPEC and controls [MD −5.53 months [95% CI −19.91 to 8.84 months]; I2 = 96%]. Conversely, in patients treated with NACT, pooled results showed a significant survival advantage in terms of progression-free survival (PFS) and overall survival (OS) in the combined HIPEC plus IDS group rather than surgery alone [PFS: MD 4.68 months (95% CI 3.49 to 5.86 months, I2 = 95%); OS: MD 11.81 months (95% CI 9.34 to 14.27 months); I2 = 97%]. Concerning ROC patients, pooled MD did not show either a significant PFS difference between intervention and controls [MD 2.68 months (95% CI 433 to 9.70 months); I2 = 95%], and OS significant difference (MD 6.69 months [95% CI −9.09 to 22.47 months]; I2 = 98%). Severe post-operative complications (≥grade 3) were available in 10 studies, accounting for 1108 women. Overall, there was a slightly but significantly increased risk with the combined approach compared to controls [RR 1.26 (95% CI 1.02 to 1.55); I2 = 0%]. Conclusions: The combination of HIPEC with cytoreductive surgery prolongs OS and PFS in advanced epithelial ovarian cancer after NACT with acceptable morbidity. However, additional trials are still needed to determine the effectiveness of HIPEC in primary and recurrence settings. In the era of personalized medicine, the correlation between the efficacy of HIPEC and biological and molecular findings represents a challenge for the future of ovarian cancer. [ABSTRACT FROM AUTHOR]

Background: Efforts have been made to investigate the role of salvage radiotherapy (RT) in treating recurrent ovarian cancer (ROC). Stereotactic ablative radiation therapy (SABR) is a state-of-the-art therapy that uses intensity modulation to increase the fractional dose, decrease the number of fractions, and target tumors with high precision. Methods: The SABR-ROC trial is a phase 3, multicenter, randomized, prospective study to evaluate whether the addition of SABR to the standard of care significantly improves the 3-year overall survival (OS) of patients with ROC. Patients who have completed the standard treatment for primary epithelial ovarian cancer are eligible. In addition, patients with number of metastases ≤ 10 and maximum diameter of each metastatic site of gross tumor ≤ 5 cm are allowed. Randomization will be stratified by (1) No. of the following clinical factors met, platinum sensitivity, absence of ascites, normal level of CA125, and ECOG performance status of 0–1; 0–3 vs. 4; (2) site of recurrence; with vs. without lymph nodes; and (3) PARP inhibitor; use vs. non-use. The target number of patients to be enrolled in this study is 270. Participants will be randomized in a 1:2 ratio. Participants in Arm 2 will receive SABR for recurrent lesions clearly identified in imaging tests as well as the standard of care (Arm 1) based on treatment guidelines and decisions made in multidisciplinary discussions. The RT fraction number can range from 1 to 10, and the accepted dose range is 16–45 Gy. The RT Quality Assurance (QA) program consists of a three-tiered system: general credentialing, trial-specific credentialing, and individual case reviews. Discussion: SABR appears to be preferable as it does not interfere with the schedule of systemic treatment by minimizing the elapsed days of RT. The synergistic effect between systemic treatment and SABR is expected to reduce the tumor burden by eradicating gross tumors identified through imaging with SABR and controlling microscopic cancer with systemic treatment. It might also be beneficial for quality-of-life preservation in older adults or heavily treated patients. Trial registration: This trial was registered at ClinicalTrials.gov (NCT05444270) on June 29th, 2022. [ABSTRACT FROM AUTHOR]

Ovarian cancer (OC) is the most lethal gynecological malignancy with majority of cases diagnosed in advanced stages and associated with high morbidity and mortality. Positron emission tomography/computed tomography (PET/CT) has emerged as an integral part of the management of several nongynecological cancers. We used PubMed search engine using MeSH words "ovarian cancer" and "PET/CT" and reviewed the current status of PET/CT in epithelial OC. Its application related to ovarian tumor including adnexal mass evaluation, baseline staging, as a triaging tool for upfront surgery or neoadjuvant chemotherapy, for response assessment and prognostication, and for relapse detection and treatment planning has been highlighted. we highlight the current guidelines and newer upcoming PET modalities and radiotracers. [ABSTRACT FROM AUTHOR]

Simple Summary: Ovarian cancer (OC) represents one of the most lethal cancers in women, with most cases diagnosed at an advanced stage. Recurrence occurs in around 70% of women within 5 years of diagnosis. In this era, in which maintenance therapy with PARP-inhibitors is the standard of care, most recurrent OC (ROC) patients are platinum-sensitive, and the choice of treatment becomes crucial. Randomized clinical trials investigated the role of surgery plus chemotherapy in the treatment of ROC, underlying an advantage in terms of progression-free survival and overall survival compared with chemotherapy alone. New recommendations concluded that platinum-sensitive OC patients should be assessed for eligibility for secondary cytoreductive surgery (SCS) in a gynecological oncology center. In selected cases, a minimally-invasive approach can be used. This narrative review is focused on minimally-invasive SCS and on the wide range of elements that must be considered in patient selection. The role of secondary cytoreductive surgery (SCS) in the treatment of recurrent ovarian cancer (ROC) has been widely increased in recent years, especially in trying to improve the quality of life of these patients by utilising a minimally-invasive (MI) approach. However, surgery in previously-treated patients may be challenging, and patient selection and surgical planning are crucial. Unfortunately, at the moment, validated criteria to select patients for MI-SCS are not reported, and no predictors of its feasibility are currently available, probably due to the vast heterogeneity of recurrence patterns. The aim of this narrative review is to describe the role of secondary cytoreductive surgery and, in particular, minimally-invasive procedures, in ROC, analyzing patient selection, outcomes, criticisms, and future perspectives. [ABSTRACT FROM AUTHOR]

Background: 18F-fluorodeoxyglucose (FDG) PET/CT is a noninvasive imaging tool that has been used successfully for the diagnosis, staging, restaging, therapy monitoring, and prognostic prediction of ovarian cancer. For ovarian cancer surveillance, rising CA-125 levels raise the suspicion of recurrence despite its reported low specificity; being elevated in other benign and inflammatory conditions, and thus, confirmation is required. This work aimed to evaluate the role of 18F-FDG PET/CT in suspected ovarian cancer recurrence in patients presenting with elevated CA-125 levels. Results: Fifty female patients with suspected ovarian cancer recurrence owing to elevated CA-125 levels were included in this study. Recurrence was confirmed in 46/50 cases whether by histopathological confirmation or by serial follow-up imaging and clinical follow-up. Positive PET/CT findings were reported in 45/50 cases with 2 false-negative cases and 1 false-positive case. PET/CT examination was found to be superior to contrast-enhanced CT in the detection of peritoneal metastatic nodules and metastatic lymph nodes. According to this study, the estimated sensitivity, specificity, and overall diagnostic accuracy of PET/CT in the detection of recurrent ovarian cancer were 95.6%, 75%, and 94%, respectively. Conclusions: In ovarian cancer surveillance, 18F-FDG PET/CT was found to be a sensitive and accurate noninvasive imaging tool that can be used in the detection of recurrent ovarian cancer in patients with elevated CA-125 levels, thus interfering with the management plan. The advantage of whole-body imaging in PET/CT allows for the detection and precise localization of recurrent or metastatic foci in abdominal and extra-abdominal sites as well. [ABSTRACT FROM AUTHOR]

Background. The aim of this pilot study was to evaluate the value of imaging techniques, including computed tomography (CT) and magnetic resonance imaging (MRI), in the diagnosis of a tumor-bowel fistula as a rare form of epithelial ovarian cancer (EOC) relapse. We also performed an initial assessment of the effectiveness of the treatment of this form of relapse. Methods. The study group consisted of eight patients with suspected platinum-sensitive recurrence in the form of a tumor/bowel fistula. All patients finished their first line of chemotherapy and subsequently showed complete remission for 6 months or more. To qualify patients for further treatment, CT and MRI were performed, which suggested the presence of a fistula between the recurrent tumor and intestine. DESKTOP study criteria were used to qualify patients for secondary cytoreduction. Second-line chemotherapy was given after secondary debulking. Results. In all patients, fistulas formed between the tumor and large bowel. On CT, the fistulas were indirectly visible. In all cases, the fistula was visible on MR images, which showed hypointensity on the T2 and T1 post-contrast sequences but did not show restricted diffusion on the diffusion-weighted imaging (DWI) sequence. Patients who were qualified for the study underwent secondary debulking with bowel resection. In all eight cases, the fistula between the tumor and surrounding organs was confirmed. During surgery, seven intestinal anastomoses and one colostomy were performed. No residual macroscopic tumor remained in seven cases (resection R0-87.5%). The progression-free survival (PFS) was 8.4–22.6 months (median 13.4). In the group with cytoreduction R0, the median PFS was 15.5 months (12–22). Conclusion. In patients with suspected EOC recurrence with clinically suspected fistula, CT scan is not sufficient. In CT, the presence of a fistula is suspected based on indirect symptoms. MRI, as a method with much greater tissue resolution, confirms the diagnosis. In addition, MRI can identify the point of the tumor/bowel junction. This is especially true with a large infiltration covering several intestinal parts. Bowel resection with simultaneous anastomosis is a good and safe solution for these patients. However, appropriate qualification for the procedure is necessary, which will allow for surgery without residual macroscopic disease (R0 surgery). Due to the small number of cases, our results cannot be generalized. We treat them as a hypothesis that can be verified in a larger study.

Abstract Background: Rucaparib is a poly(ADP-ribose) polymerase inhibitor approved in Europe as maintenance therapy for recurrent platinum-sensitive (Pt-S) ovarian cancer (OC). The Rucaparib Access Programme (RAP) was designed to provide early access to rucaparib for the above-mentioned indication, as well as for patients with BRCA-mutated Pt-S or platinum-resistant (Pt-R) OC and no therapeutic alternatives. Methods: In this observational, retrospective study we analysed the efficacy and safety of rucaparib within the RAP in Spain. Hospitals associated with the Spanish Ovarian Cancer Research Group (GEICO) recruited patients with high-grade epithelial ovarian, fallopian tube, or primary peritoneal cancer treated with rucaparib 600 mg twice daily as maintenance or treatment (Pt-S/Pt-R) in the RAP. Baseline characteristics, efficacy, and safety data were collected. Results: Between July 2020 and February 2021, 51 patients treated in 22 hospitals in the RAP were included in the study. Eighteen patients with a median of 3 (range, 1–6) prior treatment lines received rucaparib as maintenance; median progression-free survival (PFS) for this group was 9.1 months (95% confidence interval [CI], 4.2–11.6 months). Among 33 patients (median 5 [range, 1–9] prior treatment lines) who received rucaparib as treatment, 7 and 26 patients had Pt-S and Pt-R disease, respectively. Median PFS was 10.6 months (95% CI, 2.5 months-not reached) in the Pt-S group and 2.2 months (95% CI, 1.1–3.2 months) in the Pt-R group. Grade ≥ 3 treatment-emergent adverse events were reported in 39% of all patients, the most common being anaemia (12% and 15% in the maintenance and treatment groups, respectively). At data cut-off, 5 patients remained on treatment. Conclusion Efficacy results in these heavily pre-treated patients were similar to those from previous trials. The safety profile of rucaparib in real life was predictable and manageable.

Objective: Bevacizumab (BEV) is a humanized monoclonal antibody of vascular endothelial growth factor receptors and, as a result of clinical trials, was approved for the treatment of recurrent ovarian cancer (ROC). The aim of this study was to assess the clinical utility of BEV in patients with ROC in real-world practice beyond clinical trials. Materials and Methods: In this single-center retrospective cohort study, we evaluated the medical data of all patients with ROC who were treated with BEV between October 2013 and March 2020. Results: A total of 76 females were evaluated. Forty-nine (64.5%) patients were platinum sensitive and 27 (35.5%) patients were platinum resistant. BEV was used in combination with chemotherapy agents in all patients, and the most preferred combinations were gemcitabine/carboplatin (GC) (78.9%) and carboplatin/paclitaxel (14.5%). In all patients, the BEV dose was 7.5 mg/kg every 3 weeks. The median progression-free survival (PFS) was 11.1 months (95% confidence interval [CI]: 9.6--12.6), and the median overall survival (OS) was 22.3 months (95% CI: 17.5--27.2). In multivariate analysis, serous histological type (P = 0.01), maintenance BEV administration (P = 0.001), and combination of GC-BEV (P < 0.001) were associated with better PFS, while serous histological type (P = 0.016) and good performance status (P = 0.006) were associated with prolonged OS. Conclusions: Low-dose (7.5 mg/kg) BEV was found to be effective in the second-line treatment of patients with ROC in our real-life study. In addition, the combination of BEV with GC was shown to be a viable option, especially in the treatment selection of platinum-resistant patients. [ABSTRACT FROM AUTHOR]

To assess postoperative complications after secondary cytoreductive surgery (SCS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC), we conducted an exploratory analysis of patients with platinum-sensitive recurrent ovarian cancer enrolled in a randomized phase II trial. Complications occurring within 30 days of surgery were graded using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0; only hemoglobin and platelet levels were assessed. Patients were grouped by CTCAE grade ≥ 3 and < 3 complications. Among 83 eligible patients, 33 (40%) had grade ≥ 3 complications and 50 (60%) had grade < 3 complications; anemia and abdominal infections were the most common. There were no perioperative mortalities. Time to initiation of postoperative chemotherapy for patients with grade ≥ 3 and grade < 3 events was 34 days (range, 18–60) and 31 days (range, 21–43), respectively (P =.017). Median progression-free survival (PFS) did not significantly differ between patients with grade ≥ 3 and grade < 3 complications (11.2 months [95% CI: 9.3–14.4] vs 14.9 months [95% CI: 11.3–16.5], respectively; P =.186), nor did median overall survival (OS) (46.9 months [95% CI: 34-NE] vs 68.2 months [95% CI: 52.1-NE], respectively; P =.053). Postoperative complications following SCS with or without HIPEC were associated with slight delays in chemotherapy initiation but did not significantly impact oncologic outcomes. • Morbidity after secondary cytoreductive surgery (SCS) for recurrent ovarian cancer does not impact survival outcomes • The most common complications after SCS are anemia and abdominal infections • Postoperative morbidity after SCS leads to a 3-day delay to chemotherapy initiation [ABSTRACT FROM AUTHOR]

To describe patient characteristics, effectiveness and safety in a real-world population treated with niraparib in the Spanish expanded-access programme. This retrospective observational study included women with platinum-sensitive recurrent high-grade serous ovarian cancer who received maintenance niraparib within the Spanish niraparib expanded-access programme. Eligible patients had received ≥2 previous lines of platinum-containing therapy, remained platinum-sensitive after the penultimate line of platinum and had responded to the most recent platinum-containing therapy. Niraparib dosing was at the treating physician's discretion (300 mg/day fixed starting dose or individualised starting dose [ISD] according to baseline body weight and platelet count). Safety, impact of dose adjustments, patient characteristics and effectiveness were analysed using data extracted from medical records. Among 316 eligible patients, 80% had BRCA wild-type tumours and 66% received an ISD. Median niraparib duration was 7.8 months. The most common adverse events typically occurred within 3 months of starting niraparib. Median progression-free survival was 8.6 (95% confidence interval [CI] 7.6–10.0) months. One- and 2-year overall survival rates were 86% (95% CI 81–89%) and 65% (95% CI 59–70%), respectively. Dose interruptions, dose reductions, haematological toxicities and asthenia/fatigue were less common with ISD than fixed starting dose niraparib, but progression-free survival was similar irrespective of dosing strategy. Subsequent therapy included platinum in 71% of patients who received further treatment. Outcomes in this large real-world dataset of niraparib-treated patients are consistent with phase III trials, providing reassuring evidence of the tolerability and activity of niraparib maintenance therapy for platinum-sensitive recurrent ovarian cancer. NCT04546373. • In this real-world study of maintenance niraparib, 80% had BRCA wt ovarian cancer. • Median progression-free survival was 8.6 (95% confidence interval 7.6–10.0) months. • Adverse events typically occurred within 3 months of starting niraparib. • Tolerability was improved with an individualised versus fixed niraparib starting dose. • Real-world data for niraparib are consistent with phase III results. [ABSTRACT FROM AUTHOR]

Abstract Objective To investigate the efficacy and safety of angiogenesis inhibitors in the treatment of recurrent ovarian cancer (OC). Methods Electronic databases including PubMed, Web of Science, and the Cochrane Library were searched to find eligible studies until August 10, 2021. The data on overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) were pooled. Furthermore, grade ≥ 3 adverse events (AEs) were investigated. Results A total of 13 studies with 3953 patients were included. Compared with control group, angiogenesis inhibitors resulted in significant improvement in PFS (hazard ratio (HR) = 0.61, 95%CI, 0.54–0.69), OS (HR = 0.88, 95%CI, 0.81–0.95), and ORR (odds ratio (OR) = 2.15, 95% CI, 1.74–2.65). However, angiogenesis inhibitors were associated with a higher risk of grade ≥ 3 AEs (relative risk (RR), 1.20, 95% CI, 1.04–1.38). Conclusion Angiogenesis inhibitors can improve ORR, PFS, and OS in patients with recurrent OC, but they can increase the incidence of AEs ≥ 3.

Objective: The aim of NIRVANA-R trial is to investigate the efficacy of niraparib in combination with bevacizumab as a maintenance therapy in platinum-sensitive ovarian cancer patients who were previously treated with a PARP inhibitor (PARPi). Methods: This study includes patients with platinum-sensitive recurrent ovarian cancer who had received at least 2 previous courses of platinum-containing therapy and had been treated with a PARPi. Patients who had responded to the last platinum regimen are eligible to participate in this study. Forty-four patients will be recruited. All enrolled patients are treated with niraparib and bevacizumab for maintenance therapy until disease progression. The primary endpoint of the study is 6-month progression-free survival (PFS) rate. A Simon 2-stage design was utilized. Target accrual was 22 patients in the first stage; =13 patients without progressive disease within 6 months was required to proceed to second stage. Results: We report the results from the first stage. Median age was 56 years old, high grade serous and most of the patients (90.9%) had high-grade serous carcinoma. Of the 22 patients from the first stage, 9 had progressive disease within 6 months (6-month PFS rate=66.5%; 95% confidence interval=48.9%-90.2%). The efficacy boundary to proceed to the second stage was met. No grade 4 treatment-related adverse events were reported, and no TRAEs leading to treatment discontinuation. Conclusion: Our findings indicate encouraging safety and activity of niraparib + bevacizumab as a maintenance therapy in platinum-sensitive ovarian cancer patients who were previously treated with a PARPi in the future. [ABSTRACT FROM AUTHOR]

To assess long-term outcomes of patients with advanced-stage ovarian cancer by treatment type. Patients with newly diagnosed stage III-IV ovarian cancer who underwent primary treatment at our tertiary cancer center from 01/01/2015–12/31/2015 were included. We reviewed electronic medical records for clinicopathological, treatment, and survival characteristics. Of 153 patients, 88 (58%) had stage III and 65 (42%) stage IV disease. Median follow-up was 65.8 months (range, 3.6–75.3). Eighty-nine patients (58%) underwent primary debulking surgery (PDS), 50 (33%) received neoadjuvant chemotherapy followed by interval debulking surgery (IDS), and 14 (9%) received chemotherapy alone, without surgery (NSx). Median PFS to first recurrence was 26.2 months (range, 20.1–36.2), 13.5 months (range, 12–15.1), and 4.2 months (range, 1.1–5.8) in the PDS, IDS, and NSx groups, respectively (P <.001). At first recurrence/progression, 80 patients (72.7%) were treated with chemotherapy, 28 (25.5%) underwent secondary cytoreductive surgery (CRS) followed by chemotherapy, and 2 (1.8%) received no treatment. Seven patients (4.6%) underwent palliative surgery for malignant bowel obstruction. Overall, 62.7% received 1–3 lines of chemotherapy. The 5-year OS rates were 53.2% (95% CI: 44.7%–61%) for the entire cohort, 71.5% (95% CI: 60.2%–80%) for the PDS group, 35.2% (95% CI: 22.2–48.5%) for the IDS group, and 7.9% (95% CI: 0.5%–29.9%) for the NSx group. The longitudinal treatment modalities and outcomes of patients with advanced ovarian cancer described here can be useful for patient counseling, long-term planning, and future comparison studies. • The 5-year OS rate in our cohort was favorably longer compared to what is described in the literature. • The majority of patients (62.7%) received 1–3 lines of chemotherapy. • Nearly 5% of patients underwent palliative surgery for malignant bowel obstruction. • Longitudinal data on treatment modalities and outcomes are useful for patient counseling, planning, and comparison studies. [ABSTRACT FROM AUTHOR]

Introduction: Platinum-based combination chemotherapy is recommended first choice for relapsed ovarian cancer. However, many of the chemotherapeutic agents are nephrotoxic and can promote kidney dysfunction, which affect the efficacy of cancer treatment and the survival of the patient. There is a need to explore long-term treatments of chemotherapy-free regimen of chronic kidney disease in recurrent ovarian cancer. Case presentation: A 41-year-old female patient was presented with stage IIIC well-differentiated ovarian serous papillary adenocarcinoma in 2009. The patient had recurrence of platinum resistance after secondary cytoreductive surgery, and it was difficult to continue chemotherapy after multiple lines of chemotherapy due to myelosuppression, renal impairment and other factors. The patient accepted Niraparib-based treatment regimen after multi-line chemotherapy-induced stage 4 chronic kidney disease. Niraparib combined with anlotinib achieved median PFS of 11 months, disease re-progression, and the patient was switched to niraparib combined with letrozole from October 2021. No evidence of tumor progression was observed till date and the renal toxicity is acceptable. Conclusions: In patients with relapsed ovarian cancer, treatment becomes increasingly challenging to subsequent therapies because of renal impairment and emerging drug resistance. Niraparib-based treatment regimen may be a good choice for patients with well-differentiated serous adenocarcinoma of the ovary who are intolerant to chemotherapy. [ABSTRACT FROM AUTHOR]

Simple Summary: The vast majority of patients with epithelial ovarian carcinoma (OC) will relapse during the natural history of their disease. The role of cytoreductive surgery (CRS) in the treatment of recurrent disease has been emphasized by current studies. Adding hyperthermic intraperitoneal chemotherapy (HIPEC) has been evolved to improve DFS and OS. There are currently two convincing studies of HIPEC after complete cytoreduction in the treatment of primary OC, but there is little homogenous data on the role of HIPEC in platinum-sensitive recurrent ovarian cancer, its ideal compound, and its duration. The aim of this study was to analyze the bicentric experience with CRS + HIPEC in patients with platinum-sensitive recurrent epithelial OC in order to standardize the surgical approach. Thus, multimodal therapy was feasible with acceptable morbidity and mortality. Cisplatin monotherapy as a HIPEC compound and a 90 min HIPEC application proved to be the best option for regional additive treatment. Background: This bicentric study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for platinum-sensitive recurrent ovarian cancer patients. Methods: The data of 88 patients with the first peritoneal recurrence of platinum-sensitive epithelial ovarian cancer who underwent CRS and HIPEC from a prospective HIPEC registry were retrospectively investigated. Endpoints were feasibility, chemotherapeutic compound, time of exposure, complications, and overall survival. Results: The median follow-up was 4.7 years (95%-CI 4.6–5.5). The median age was 55.8 years (IQR: 50.3–66.2). Eighty-four patients (95.5%) had high-grade serous histology. The median peritoneal cancer index was 12.0 (IQR: 7.0–20.5). Sixty-five patients (73.9%) had complete cytoreduction (CCR 0). Thirty-eight patients (43.2%) received HIPEC for 60 min, and fifty patients (56.8%) for 90 min. Eighteen patients (20.5%) had grade III to IV complications. One patient (1.1%) died perioperatively. The overall median survival was 43.1 months (95%-CI 34.1–52.2), and the 5-year survival rate was 39.7%. Only 90 min HIPEC and cisplatin were associated with survival. Conclusion: In well-selected patients with platinum-sensitive recurrent ovarian cancer, survival may correlate with complete CRS and 90 min cisplatin-based HIPEC. We confirmed the results of primary OC studies; therefore, this combination should be used for further analysis in the recurrent situation. [ABSTRACT FROM AUTHOR]

Background. The aim of this pilot study was to evaluate the value of imaging techniques, including computed tomography (CT) and magnetic resonance imaging (MRI), in the diagnosis of a tumor-bowel fistula as a rare form of epithelial ovarian cancer (EOC) relapse. We also performed an initial assessment of the effectiveness of the treatment of this form of relapse. Methods. The study group consisted of eight patients with suspected platinum-sensitive recurrence in the form of a tumor/bowel fistula. All patients finished their first line of chemotherapy and subsequently showed complete remission for 6 months or more. To qualify patients for further treatment, CT and MRI were performed, which suggested the presence of a fistula between the recurrent tumor and intestine. DESKTOP study criteria were used to qualify patients for secondary cytoreduction. Second-line chemotherapy was given after secondary debulking. Results. In all patients, fistulas formed between the tumor and large bowel. On CT, the fistulas were indirectly visible. In all cases, the fistula was visible on MR images, which showed hypointensity on the T2 and T1 post-contrast sequences but did not show restricted diffusion on the diffusion-weighted imaging (DWI) sequence. Patients who were qualified for the study underwent secondary debulking with bowel resection. In all eight cases, the fistula between the tumor and surrounding organs was confirmed. During surgery, seven intestinal anastomoses and one colostomy were performed. No residual macroscopic tumor remained in seven cases (resection R0-87.5%). The progression-free survival (PFS) was 8.4–22.6 months (median 13.4). In the group with cytoreduction R0, the median PFS was 15.5 months (12–22). Conclusion. In patients with suspected EOC recurrence with clinically suspected fistula, CT scan is not sufficient. In CT, the presence of a fistula is suspected based on indirect symptoms. MRI, as a method with much greater tissue resolution, confirms the diagnosis. In addition, MRI can identify the point of the tumor/bowel junction. This is especially true with a large infiltration covering several intestinal parts. Bowel resection with simultaneous anastomosis is a good and safe solution for these patients. However, appropriate qualification for the procedure is necessary, which will allow for surgery without residual macroscopic disease (R0 surgery). Due to the small number of cases, our results cannot be generalized. We treat them as a hypothesis that can be verified in a larger study. [ABSTRACT FROM AUTHOR]

Background: Rucaparib is a poly(ADP-ribose) polymerase inhibitor approved in Europe as maintenance therapy for recurrent platinum-sensitive (Pt-S) ovarian cancer (OC). The Rucaparib Access Programme (RAP) was designed to provide early access to rucaparib for the above-mentioned indication, as well as for patients with BRCA-mutated Pt-S or platinum-resistant (Pt-R) OC and no therapeutic alternatives.Methods: In this observational, retrospective study we analysed the efficacy and safety of rucaparib within the RAP in Spain. Hospitals associated with the Spanish Ovarian Cancer Research Group (GEICO) recruited patients with high-grade epithelial ovarian, fallopian tube, or primary peritoneal cancer treated with rucaparib 600 mg twice daily as maintenance or treatment (Pt-S/Pt-R) in the RAP. Baseline characteristics, efficacy, and safety data were collected.Results: Between July 2020 and February 2021, 51 patients treated in 22 hospitals in the RAP were included in the study. Eighteen patients with a median of 3 (range, 1-6) prior treatment lines received rucaparib as maintenance; median progression-free survival (PFS) for this group was 9.1 months (95% confidence interval [CI], 4.2-11.6 months). Among 33 patients (median 5 [range, 1-9] prior treatment lines) who received rucaparib as treatment, 7 and 26 patients had Pt-S and Pt-R disease, respectively. Median PFS was 10.6 months (95% CI, 2.5 months-not reached) in the Pt-S group and 2.2 months (95% CI, 1.1-3.2 months) in the Pt-R group. Grade ≥ 3 treatment-emergent adverse events were reported in 39% of all patients, the most common being anaemia (12% and 15% in the maintenance and treatment groups, respectively). At data cut-off, 5 patients remained on treatment.Conclusion: Efficacy results in these heavily pre-treated patients were similar to those from previous trials. The safety profile of rucaparib in real life was predictable and manageable. [ABSTRACT FROM AUTHOR]

Despite optimal surgery and first-line platinum-based doublet chemotherapy, approximately 70 to 80% of patients with epithelial ovarian cancers relapse. Two cases of recurrent ovarian cancer (ROC) were treated with non--platinum-based Ayurveda maintenance therapy (AMT) consisting of drugs having a herbal and herbomineral origin. This regimen was followed over a period of 3 years and progression-free survival (PFS) was noted along with platinum-free interval (PFI). Two patients were diagnosed with BRCA1 mutated recurrent high-grade serous ovarian carcinoma and treated with the per-oral AMT regimen labeled as ZINCA-30 in our hospital after completion of standard of care treatment and followed up until progression. The ZINCA-30 regimen comprising Jasada (traditional Zinc preparation), Indukanth kwatham and Curcuma amada powder in combination was prescribed based on Rasayana chikitsa postulated in Ayurveda. The patients were followed up every 3 months. The progression-free survival observed in these patients was 28months and 45months, respectively. These two pilot cases suggested an increased platinum-free interval (PFI), improved progression-free survival (PFS) in recurrent ovarian cancer (ROC), with the AMT labeled as ZINCA-30 after chemotherapy. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to investigate the incidence and hallmarks of long-term survivors of recurrent ovarian carcinoma (LTSROC) in a large-scale retrospective cohort of patients from a multicenter study group. Methods: We performed a regional multicenter retrospective study between January 1986 and September 2021 using clinical data collected under the central pathological review system. Patients who underwent surgery for primary OC at diagnosis and developed recurrent tumors after the initial treatment were included. We defined LTSROC as patients who survived for 5 years or longer after initial tumor recurrence and examined factors affecting the long-term survival of ROC and outcomes of LTSROC. Results: We collected information on patients with malignant ovarian tumors and finally 657 of them that developed ROC were included in the study population. Sixty-eight (10.4%) patients were LTSROC while 399 (60.7%) were short-term survivors of recurrent ovarian carcinoma. In a multivariate logistic regression analysis, negative ascites cytology [odds ratio (OR) 1.865; 95% CI 1.026–3.393; p = 0.041] and a recurrence-free interval (RFI) of 1 year or longer (OR 2.896; 95% CI 1.546–5.425; p < 0.001) were identified as independent factors associated with LTSROC. Approximately 80% of LTSROC presented with solitary recurrent tumors. Furthermore, more than 50% of LTSROC underwent tumor debulking surgery for the first recurrent tumor with or without chemotherapy. Conclusion: RFI of 1 year or longer and negative ascites cytology in the initial surgery were identified as independent predictive factors for LTSROC. [ABSTRACT FROM AUTHOR]

Anti-angiogenic rechallenge with bevacizumab plus chemotherapy is effective in recurrent ovarian cancer (rOC); however, data are limited on tyrosine kinase inhibitors after progression on maintenance bevacizumab. In the randomized phase II TAPAZ trial, patients with rOC during the first year of bevacizumab maintenance therapy were assigned 2:1 to either weekly paclitaxel 65 mg/m2 plus pazopanib 600–800 mg daily or standard weekly paclitaxel 80 mg/m2. The primary endpoint was 4-month progression-free survival (PFS) rate. Overall, 116 patients were randomized and treated: 79 with combination therapy and 37 with single-agent paclitaxel. Median follow-up was 13.1 months. There was no difference between treatment arms in 4-month PFS rate (61% [95% CI, 51–73%] with the combination versus 68% [95% CI, 54–85%] with paclitaxel alone), median PFS (4.9 [95% CI, 4.1–6.1] versus 5.8 [95% CI, 4.8–7.4] months, respectively) or median overall survival (13.6 versus 12.9 months, respectively). The combination was associated with more grade 3/4 toxicities (87% versus 70%, respectively) and toxicity-related paclitaxel discontinuations (22% versus 11%). Pazopanib was discontinued for toxicity in 44% of patients, most commonly for gastrointestinal and vascular events. There were two treatment-related deaths, both in the combination arm (pulmonary embolism and gastrointestinal perforation). At month 4, patient-reported outcomes deteriorated from baseline in the combination arm, particularly for abdominal/gastrointestinal symptoms, which showed a clinically important difference versus paclitaxel alone. In rOC progressing during maintenance bevacizumab, adding pazopanib to paclitaxel did not improve efficacy, increased toxicity, and compromised chemotherapy delivery. ClinicalTrials.gov registration: NCT02383251. • We tested anti-angiogenic rechallenge for ovarian cancer progressing on bevacizumab. • Pazopanib rechallenge did not improve efficacy vs paclitaxel alone. • Adding pazopanib to paclitaxel increased toxicity, compromising paclitaxel delivery. • The combination had a detrimental effect on abdominal/gastrointestinal symptoms. [ABSTRACT FROM AUTHOR]

Background: The mortality rate of ovarian cancer (OC) ranks first among female genital tract malignant tumors, which seriously threatens women's life and health. Because of its insidious onset and poor prognosis, it has become a thorny problem in the clinic, especially for patients with platinum-resistant recurrent ovarian cancer (PROC). In recent years, the medical treatment of OC has made gratifying results, bringing hope to the patients. Case Description: A 54-year-old OC patient who has failed previous neoadjuvant chemotherapy, cytoreductive surgery, and postoperative chemotherapy was diagnosed with PROC. Then she received combination treatment of fuzuloparib (100mg PO BID), apatinib (250mg PO QD), and camrelizumab (200mg IV Q3W) for every 3-week cycle in a Phase II study for PROC patients. In the phase II study, her condition stabilized, responded well to treatment with a sharp decrease by 91.14% of target lesions and disappearances of non-target lesions, and continued to receive regular treatment with progression-free survival exceeding 15 months and no serious adverse events. Conclusion: The present case proves PROC patients might have a sustained response to triplet combination with camrelizumab, combined with fuzuloparib and apatinib. [ABSTRACT FROM AUTHOR]

Poly(ADP-ribose) polymerase (PARP) inhibitors theoretically promote synthetic lethality in cancer cells with homologous recombination deficiency (HRD). However, clinical evidence indicates that PARP inhibitors are also effective for treating HRD-negative ovarian cancer. The PARP inhibitor olaparib became available in Japan as a maintenance therapy for platinum-sensitive recurrent ovarian cancer regardless of homologous recombination status in April 2018. The purpose of this study was to identify potential clinical biomarkers for olaparib sensitivity in patients with recurrent ovarian cancer. Clinical information about the patients with recurrent ovarian cancer treated with olaparib maintenance therapy (OMT) was retrospectively collected. OMT duration was used as an indicator for olaparib sensitivity. The relationship between OMT duration and clinical parameters was statistically analyzed. We found a positive correlation between OMT duration and progression-free survival (PFS) or treatment free interval (TFI). In some cases, OMT duration exceeded PFS before olaparib introduction. We also found that more than half of the patients with measurable target lesions at the time of OMT introduction showed partial or complete response to OMT. These results validated the effectiveness of OMT and identified PFS and TFI as potential clinical markers for olaparib sensitivity in the patients with recurrent ovarian cancer. [ABSTRACT FROM AUTHOR]

The high incidence and fatality rate of recurrent ovarian cancer (ROC) have always been the clinical problem. For part of patients with platinum-sensitive recurrent ovarian cancer, the secondary cytoreductive surgery (SCS) followed by platinum-based combination chemotherapy can prolong their survival time and improve quality of life. Therefore, it's a critical matter to accurately identify the patients who will benefit from surgery treatment. Several predictive models have been proposed for the selection of the patients for SCS. This article summarizes the research progress in the surgical treatment of platinum-sensitive recurrent ovarian cancer in recent years.

Objective: To investigate the efficacy and safety of angiogenesis inhibitors in the treatment of recurrent ovarian cancer (OC). Methods: Electronic databases including PubMed, Web of Science, and the Cochrane Library were searched to find eligible studies until August 10, 2021. The data on overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) were pooled. Furthermore, grade ≥ 3 adverse events (AEs) were investigated. Results: A total of 13 studies with 3953 patients were included. Compared with control group, angiogenesis inhibitors resulted in significant improvement in PFS (hazard ratio (HR) = 0.61, 95%CI, 0.54–0.69), OS (HR = 0.88, 95%CI, 0.81–0.95), and ORR (odds ratio (OR) = 2.15, 95% CI, 1.74–2.65). However, angiogenesis inhibitors were associated with a higher risk of grade ≥ 3 AEs (relative risk (RR), 1.20, 95% CI, 1.04–1.38). Conclusion: Angiogenesis inhibitors can improve ORR, PFS, and OS in patients with recurrent OC, but they can increase the incidence of AEs ≥ 3. [ABSTRACT FROM AUTHOR]