Factors associated with declining adjuvant chemotherapy in women with advanced ovarian cancer who accepted initial intervention: A National Cancer Database (NCDB) study

Abstract Most advanced ovarian cancer patients experience recurrence and develop resistance to platinum-based agents. However, the diagnosis of platinum resistance based on platinum-free interval is not always accurate and timely. In this study, we employed laser ablation inductively coupled plasma mass spectrometry to visualize platinum distribution in the tissues at the time of interval debulking surgery following neoadjuvant chemotherapy. Twenty seven patients with advanced high grade serous ovarian cancer were enrolled. Two distinct patterns of platinum distribution were observed. Type A (n = 16): platinum accumulation at the adjacent stroma but little in the tumor; type B (n = 11): even distribution of platinum through tumor and adjacent stroma. Type A was significantly correlated with worse prognosis (P = 0.031). Patients classified in type A and treated with platinum-based adjuvant chemotherapy after operation were significantly shorter period of recurrence after last platinum-based chemotherapy (P = 0.020) and diagnosed with “platinum-resistant recurrence”. Treatment with non-platinum-based chemotherapy after operation could be effective for the patients who were classified in type A. Our data indicate that the platinum resistance can be predicted prior to recurrence with platinum distribution. Thus, we will be able to select more appropriate adjuvant chemotherapy, which may possibly lead to improve patient’s prognosis.

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Laparoscopic Interval Debulking Surgery Including Systemic Lymphadenectomy After Neo-Adjuvant Chemotherapy in Advanced Ovarian Cancer

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2018.09.159 ◽

2018 ◽

Vol 25 (7) ◽

pp. S62

Author(s):

J. Eom ◽

J. Choi ◽

J. Bae ◽

W. Lee ◽

U. Jung

Keyword(s):

Ovarian Cancer ◽

Adjuvant Chemotherapy ◽

Advanced Ovarian Cancer ◽

Debulking Surgery ◽

Interval Debulking Surgery ◽

Neo Adjuvant Chemotherapy

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Venous thromboembolism in advanced ovarian cancer patients undergoing front-line adjuvant chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.5570 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 5570-5570

Author(s):

Alok Pant ◽

Julian C. Schink

Keyword(s):

Ovarian Cancer ◽

Venous Thromboembolism ◽

Adjuvant Chemotherapy ◽

Epithelial Ovarian Cancer ◽

Bowel Resection ◽

Prognostic Significance ◽

Advanced Ovarian Cancer ◽

Ca 125 ◽

Front Line ◽

Advanced Epithelial Ovarian Cancer

5570 Background: To define the incidence and prognostic significance of venous thromboembolism (VTE) in patients with advanced, epithelial ovarian cancer undergoing front-line adjuvant chemotherapy after extended period (28 day) post-operative prophylaxis. Methods: A retrospective analysis of patients with advanced, epithelial ovarian cancer who underwent surgery and chemotherapy at a single institution from January 2008 through December 2011 was performed. Exclusion criteria were prior history of VTE, VTE during the post-operative period, clear cell histology, use of anti-coagulation for a different indication, and lack of compliance with 28 days of post-operative prophylaxis with a low molecular weight heparin. Results: 128 patients met criteria for inclusion. Sixteen patients had a reported VTE during the time they were on front line chemotherapy (12.5%). Nine patients (7%) had a pulmonary embolus (PE) and 8 (6.3%) had a deep vein thrombus (DVT). The average BMI in the group that developed VTE was 28 and in the group without VTE was 26.5 (p = 0.23). Three out of 16 (23%) patients who developed VTE had undergone a suboptimal cytoreduction compared to 12/112 (11%) in the group with no VTE (p = 0.4). Six of the 16 (37%) patients who developed VTE during chemotherapy underwent a bowel resection and/or splenectomy during their cytoreductive surgery compared to 18 of 112 (16%) patients who did not develop VTE (p=0.079). Eight of the patients in the VTE group had indwelling venous catheters during chemotherapy (50%) compared to 39 (35%) in the group with no VTE (p = 0.27). In the group that developed VTE, there was a trend towards increased pre-operative CA-125, higher rates of bowel resection and/or splenectomy during surgery, decreased use of aspirin, and inferior survival. On multivariate analysis, patients who developed VTE had significantly longer post-operative hospital stays (7 vs 5 days [p = 0.009]) and lower rates of complete response (p = 0.01). Conclusions: A 12.5% risk of VTE merits consideration of prophylaxis during chemotherapy in this cohort. A randomized, controlled trial is needed to clarify whether the benefits of long term prophylaxis outweigh the risks and costs of such therapy.

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