In this slide show we highlight some of the top news on gynecologic cancers in 2017, including studies on surgery for cervical and ovarian cancer, the FDA approval of niraparib, and more.
Endometrioid Ovarian Cancer Presents Earlier, Offers Better Survival Than Serous Carcinoma: According to a new study, women presenting with endometrioid ovarian cancer vs. serous ovarian cancer tend to be younger, present at an earlier stage and have higher 5- and 10-year overall survival rates. During a retrospective analysis of 533 women diagnosed with ovarian cancer between 1998 and 2006, researchers found that women with endometrioid ovarian cancer (n = 98) compared with those with serous ovarian cancer (n = 435) presented at younger ages (50 vs. 58 years old, respectively), with earlier stages, had surgery as their primary treatment, and experienced less disease recurrence. Additionally, women with endometrioid ovarian cancer experienced an 80.6% 5-year and 68.4% 10-year overall survival rate vs. 35% and 18.4% in women with serous ovarian cancer. Read more. Image © Rido/shutterstock.com
SLN Biopsy Alone Can Reduce Surgical Morbidity in Early Cervical Cancer: Results of the multicenter SENTICOL2 trial, showed a decrease in surgical morbidity without a significant increase in recurrence in women with early-stage cervical cancer who underwent a sentinel lymph node biopsy (SLS) alone. Of the 206 study participants, 105 underwent SNL biopsy alone; 101 underwent SNL biopsy with pelvic node dissection. The study showed a reduced incidence of surgical morbidity (31.4% vs. 51.5% incidence, respectively) and an increase in quality of life in the SNL biopsy alone group, including less significant lymphedema and leg fatigue and heaviness. While there was a reported difference in surgical morbidity with SNL biopsy alone, recurrence-free intervals and overall survival were not impacted based on surgical approach. Read more. Image © Nestor Rizhniak/shutterstock.com
FDA Approves Niraparib for Recurrent Ovarian Cancer: On March 27, 2017, the US Food and Drug Administration (FDA) announced its approval of niraparib for the treatment of recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer for those who have completely or partially responded to platinum-based chemotherapy. The FDA approval was the result of the phase III NOVA trial, which evaluated 533 patients with a prior partial or complete response to treatment with at least two prior platinum-based chemotherapies. Study participants were randomized to receive niraparib or matched placebo and were further assigned to one of two cohorts based on presence of deleterious or suspected deleterious germline BRCA mutations. BRCA-mutated participants who received niraparib had a 21-month PFS time vs. 5.5 months for placebo recipients. Non-BRCA–mutated participants treated with niraparib experienced a median PFS of 9.3 months vs. 3.9 months with placebo. Read more.
Cancer Antigen Expression Associated With Prognosis in Ovarian Cancer: A recent study of 1,002 women from Roswell Park Cancer Institute in Buffalo, New York revealed a lower overall survival (OS) in women with NY-ESO-1 testis antigen expression. Of the 1,002 tumor assessed women, 40.7% were NY-ESO-1-positive, additionally revealing older age, more advanced stages of disease, higher grade histology, and serous histology in that subset of tumors. During the study, women with NY-ESO-1-positive tumors experienced an OS time of 42.9 months vs. 50 months for NY-ESO-1-negative women. However, extended survival in NY-ESO-1-positive ovarian cancer patients was seen in those enrolled in cancer immunotherapy (vaccine) trials, as opposed to those who did not enroll. Read more. Image © Royaltystockphoto.com/shutterstock.com
Maintenance Chemo After CR Fails to Extend Survival in Ovarian Cancer: The results of GOG 212 were presented at the Society of Gynecologic Oncology (SGO) Annual Meeting in 2017. According to the study, there was no improvement in overall survival (OS) in women with advanced-stage ovarian/fallopian tube/peritoneal cancer who received maintenance chemotherapy with paclitaxel infusion or CT-2103 (paclitaxel poliglumex [PP]) after achieving a complete response to first-line chemotherapy. While the paclitaxel and PP maintenance therapy arms of the trial vs. the surveillance arm revealed an increased median progression-free survival time (18.9, 16.3, and 13.4 months, respectively), there was no significant difference in OS. OS in women who underwent surveillance only was 54.8 months vs. 51.3 months in the paclitaxel arm and 60 months in the PP arm. The results of the study also showed an increase in adverse events and a decrease in quality of life in study participants in the maintenance therapy arms. Read more. Image © Napocska/shutterstock.com
Bilateral Ovarian Removal Associated With Increased All-Cause Mortality: Results of a recent study reveal a higher risk of all-cause mortality following the removal of both ovaries during hysterectomy, supporting the theoretical risk of heart disease in women with a reduction in endogenous estrogen. Researchers evaluated 113,679 benign hysterectomy patients, 37,098 of whom also had both ovaries removed by way of hospital admission and death national databases. Not only was the rate of hospital admission for ischemic heart disease increased in women with ovary removal (1.60% vs. 2.02%, respectively), women who underwent ovary removal also experienced shorter ischemic event intervals than those with intact ovaries (51 months vs. 56 months, respectively). In addition, hospital admission rates relating to cancer were increased in the ovarian removal group compared with those who underwent ovarian conservation (3.49% vs. 2.80%). All-cause mortality rates were also increased in the ovary removal group, yielding a rate of 1.01% vs. 0.60% in the group of women with intact ovaries. Read more. Image © Magic mine/shutterstock.com
Oral Apixaban Safe for Thromboprophylaxis Before Surgery in Gynecologic Cancers: Preoperative thromboprophylaxis recommendations include treatment with enoxaparin; however, subcutaneous administration compromises patient compliance. Results of a recent randomized, open-blinded trial that compared subcutaneous enoxaparin to oral apixaban offer a safe alternative using oral apixaban in gynecologic or suspected gynecologic malignancy surgeries. Planned safety interim analysis of 28-day treatment with apixaban of 120 gynecologic surgical patients revealed no major bleeding events or venous thromboembolism (VTE) and similar adverse events reported with both medications. Arthralgia was increased in the apaxiban group vs. the enoxaparin group (7% vs 3%, respectively), with no other significant differences between either study arm. However, less pain and less administration difficulty was noted in the apixaban arm. The ongoing study aims to enroll a total of 400 patients to evaluate for efficacy. Of the 158 enrolled in this portion of the trial, one VTE occurred due to treatment protocol deviation; no other major bleeding events have been observed. Read more. Image © molekuul_be/shutterstock.com
Immunotherapy Motolimod Fails to Improve Survival in Ovarian Cancer: Results of GOG-3003, which randomized 297 women with recurrent or persistent epithelial ovarian, fallopian tube, or primary peritoneal carcinoma to pegylated liposomal doxorubicin (PLD) plus motolimod (a synthetic small molecule agonist of Toll-like receptor 8/TLR8) or PLD plus placebo (149 patients in each group) administered until disease progression occurred, failed to show an improved overall survival (OS) in the study population. The median OS and progression-free survival rates were not increased with the motolimod group (18.1 vs. 18.9 months and 4.8 vs. 5.2 months, respectively). There was additionally no improvement in the overall response rate in the motolimod arm compared with placebo (20.9% vs. 21.5%). Interestingly, those with injection site reactions did experience a survival advantage of 19.9 months compared with 13.3 months in those without injection site reactions. Read more. Image © CI Photos/shutterstock.com
Lynch Syndrome Studies Highlight Screening, Surveillance Opportunities: Results of two recently published studies report that Lynch syndrome counseling criteria should extend to colorectal and endometrial cancer risk as far as second- and third-degree relatives, with surveillance extending to later ages for those with certain genetic mutations. Researchers of the first study note a 4.3-fold increased risk of colorectal cancer in second-degree relatives of cancer patients who meet the Amsterdam criteria; they conclude that these patients should be offered more intensive screening. The second study, a retrospective analysis of those with Lynch-syndrome associated cancers of the colon, endometrium, and/or ovary revealed that MLH1 mutations were associated with colorectal cancer in 61% of men and women, 27% of women with endometrial cancer, and 8% of women with ovarian cancer. MSH2 mutations were associated with female cancers including 30% of those with endometrial cancer, 10% with ovarian cancer, and 50% of men and women with colorectal cancer in study participants. Read more. Image © Andrei_R/shutterstock.com
Chronic Fatigue Highly Prevalent in Long-Term Cervical Cancer Survivors: A recent Norwegian study reports that of the 382 long-term cervical cancer survivors included in the analysis, 23% experienced chronic fatigue. Treatment modality was noted to affect the rates of chronic fatigue, with the highest rates being in those who received neoadjuvant chemotherapy plus major surgery (45.5%) vs. minimally invasive surgery (19%), and major surgery (18.8%). Chronic fatigue rates in women treated with chemoradiation or major surgery and chemoradiation did not show statistically different rates than other rates in chronic fatigue. Cervical cancer survivors experiencing fatigue also exhibited other conditions such as treatment-related neurotoxic effects, cardiovascular disease, poor self-rated health, less physically active, and/or obesity. Depression and poorer global quality of life were noted in this study to be associated with chronic fatigue in this group of cancer survivors. Read more. Image © Photographee.eu/shutterstock.com
HIV-Positive Women Face Increased Risk of Precancerous Cervical Lesions: A new study reports that human immunodeficiency virus (HIV)–positive women are more likely to have human papillomavirus (HPV) infection that progresses to precancerous cervical lesions. Results of an analysis of six studies conducted from 1994 to 2010 in Senegal, West Africa, reveal a two-fold increase in the likelihood of the progression of HPV infection to HSIL in HIV-positive women and lower rates of cervical change regression. Nations with epidemic HIV rates may also see similar findings and additional research is needed to account for behavioral differences between populations such as smoking, birth control use, and age at first sexual activity. With the use of anti-retroviral therapies to treat HIV, the risk for developing cervical cancer may be increased due to longer longevity in women with HIV. Read more. Image © Komsan Loonprom/shutterstock.com
Lynch Syndrome–Associated Ovarian Cancer Presents Early, Has Good Prognosis: Lynch syndrome–associated ovarian cancer (LSAOC) more commonly presents at an earlier stage with a good prognosis, say researchers from the UK who analyzed data from a prospective UK database of 1,047 MMR-mutated individuals. Fifty-three cases of LSAOC were identified with confirmed staging in 35 cases, most presenting in the early stages of disease. Stage IA accounted for 34%, followed by stage IB (11%), IC (20%), stage II (20%), stage III (11%), and stage IV (3%). Two-year survival rates were reported at 80% with a poor prognosis in those women with advanced-stage disease; however, given the small amount of women presenting with advanced disease in the analysis, statistical significance could not be determined. Given these findings, some women may benefit from ovarian surveillance for early detection of LSAOC. Read more. Image © nobeastsofierce/shutterstock.com
Lymphadenectomy Does Not Improve Survival in Advanced Ovarian Cancer: Dr. Philip Harter presented results of the LION study at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting, reporting that systematic lymphadenectomy (LNE) in patients with advanced ovarian cancer and complete resection does not improve progression-free or overall survival (OS), and should be omitted. During the LION trial, 650 patients advanced epithelial ovarian and macroscopic complete resection were randomized to either undergo systematic pelvic and para-aortic LNE or no LNE. Detection of lymph node metastases occurred in 55.7% of those who underwent LNE, however, this group of patients experienced additional surgery time, increased blood loss (some necessitating transfusions), increased infection rates, and an increase in mortality. No improvements in survival outcomes were observed in the LNE arm. Median survival in the LNE arm was 65.5 months vs. 69.2 in the no LNE arm. Progression-free survival was 25.5 months in both groups with nearly identical quality-of-life analysis in both arms. Read more. Photo by © ASCO/Scott Morgan 2017 Technical
Secondary Debulking Surgery Improves PFS in Recurrent Ovarian Cancer: According to the results of the AGO DESKTOP I trial, patients with a positive predictive AGO score with recurrent platinum-sensitive ovarian cancer who relapse at least 6 months after treatment with platinum therapy have a longer progression-free survival (PFS) following a secondary debulking surgery. Presented at the 2017 ASCO meeting in June, study findings report a 19.6-month PFS in patients who underwent cytoreductive surgery compared with 14 months in those who did not; complete resection was noted to improve postoperative PFS with a median PFS of 21.7 vs. 13.7 months for those with residual disease. Patients who underwent secondary debulking also experienced a longer time to receiving a third-line therapy, noting a 21-month median vs. 13.9 months in nonsurgical patients. Read more. Image © Ideya/shutterstock.com
Whole Pelvic Radiation May Improve Survival in Advanced Cervical Cancer: Results of a retrospective study report that women with stage IVB cervical cancer who underwent treatment with whole pelvic radiation (WPR) plus standard chemotherapy experienced an improved survival over those who received chemotherapy alone. Of the study subjects, those who underwent treatment with WPR experienced a median progression-free survival of 10 months compared with 5 months without it (P = .01). The WPR- treated patients were additionally shown to have an improved overall survival of 14.1 months vs. 6.9 months in the chemotherapy-alone arm. Morbidity including ureteral obstruction, vaginal/rectal bleeding, pelvic infection, pelvic pain, and fistula was the same for both groups. Read more. Image © Thomas Hecker/shutterstock.com