93 Evaluation of perioperative management of advanced ovarian (tubal/peritoneal) cancer patients. A survey from MITO-ManGO Groups

5025 Background: Letrozole is a potent oral aromatase inhibitor which rapidly suppresses circulating estrogen levels by 99% in postmenopausal women. By comparison with cytotoxic agents it is very well tolerated. We previously demonstrated an ‘endocrine sensitive’ subgroup of ovarian cancer patients with ER histoscore cutoff of ≥150 (Bowman et al, Clin Can Res 2002). Methods: This was a phase II study with a planned sample size of 33 patients. Eligible patients had relapsed EOC or primary peritoneal cancer with an ER histoscore of ≥150 and a rising CA125 that had progressed according to Rustin’s criteria. Patients were treated with letrozole 2.5mg daily until clinical or marker evidence of disease progression. The primary endpoint was response according to CA125 and RECIST criteria. Biomarker analysis by tissue microarray is also being performed. Results: 46 patients were accrued, 45 of whom were eligible. The median age was 61 (range 39–81). 24, 10 and 10 patients had received 1,2 and >2 previous lines of chemotherapy respectively. Of 43 patients evaluable for CA125 response, 7 (16%) had a response (decrease of >50%) and 16 (37%) patients had not progressed (doubling of CA125) following 12 weeks on treatment. In the CA125 responders, the nadir CA125 ranged from 0.7–49% of baseline (actual % of baseline: 0.7, 2.6, 11.1, 17.6, 23.6, 42.6, 49). Of the 7 responding patients, 5 had received only one previous line of chemotherapy. The time taken to achieve the nadir CA125 value ranged from 10 to 36 weeks, with a median of 13 weeks. Of 33 patients evaluable for radiological response, 3 (9%) had a PR and 14 (42%) had stable disease at 12 weeks. Overall, 11 patients (26%) had a PFS of >6 months and 2 patients (5%) had a PFS of ≥2 years. Conclusions: To our knowledge this is the first study of a hormonal agent in a selected ER +ve population of ovarian cancer patients. Promising efficacy of the agent is demonstrated in this population of pre-treated patients, many with a considerable bulk of disease. Given the median time of 13 weeks to response, we suggest that this strategy should be tested in ER+ve ovarian cancer patients in the adjuvant setting following first line chemotherapy No significant financial relationships to disclose.

Download Full-text

The role of technology in the perioperative management of bladder cancer patients

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2021.04.020 ◽

2021 ◽

Author(s):

Daniel A. Igel ◽

Eugene K. Lee

Keyword(s):

Bladder Cancer ◽

Cancer Patients ◽

Perioperative Management

Download Full-text

Restaging and Survival Analysis of 4036 Ovarian Cancer Patients According to the 2013 FIGO Classification for Ovarian, Fallopian Tube, and Primary Peritoneal Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000675 ◽

2016 ◽

Vol 26 (4) ◽

pp. 680-687 ◽

Cited By ~ 21

Author(s):

Mikkel Rosendahl ◽

Claus Kim Høgdall ◽

Berit Jul Mosgaard

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Lymph Node Metastases ◽

Stage Iiic ◽

Primary Peritoneal Cancer ◽

Peritoneal Cancer ◽

Figo Staging ◽

Node Metastases ◽

Similar Survival

ObjectiveWith the 2013 International Federation of Gynecology and Obstetrics (FIGO) staging for ovarian, fallopian tube, and primary peritoneal cancer, the number of substages changed from 10 to 14. Any classification of a malignancy should easily assign patients to prognostic groups, refer patients to individualized treatments, and allow benchmarking and comparison of patients and results between centers. The stage should reflect survival in particular. The objective of the study was to validate these requirements of the revised FIGO staging on a high number of ovarian cancer patients.Materials and MethodsDemographic, surgical, histological, and survival data from 4036 ovarian cancer patients were used in the analysis. Five-year survival rates (5YSR) and hazard ratios for the old and revised FIGO staging were calculated using Kaplan-Meier curves and Cox regression.ResultsA total of 1532 patients were assigned to new stages. Stages IA and IC1 had similar survival (5YSR, 87%); and stages IB, IC2, and IC3 had similar survival (5YSR, 75%–80%). Stage IIC was omitted, resulting in similar survival in stages IIA and IIB (5YSR, 61% and 65%). Of 1660 patients in stage IIIC, 79 were restaged: In 16 cases, IIIC was down-staged to IIIA1, as they had only been stage IIIC owing to lymph node metastases; and in 63 cases, IIIC was down-staged to IIIB, as they had lymph node metastases and abdominal tumor of less than 2 cm. The 5YSR in stage IIIC was unchanged (22%). Stage IV (5YSR, 14% ) was restaged as IVA (13%) and IVB (13%). Both were different from IIIC; P < 0.0001.ConclusionWith introduction of new substages, staging becomes more demanding. Second, as fewer patients are allocated to each substage, statistical power is diminished, resulting in uncertainty in the results. Despite this, and most importantly, the revised coding adequately reflects survival, as there was a clear graphical and statistical tendency for poorer survival with increasing stage.

Download Full-text

Recommendations for perioperative management of lung cancer patients with comorbidities

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-017-0864-z ◽

2017 ◽

Vol 66 (2) ◽

pp. 71-80 ◽

Cited By ~ 2

Author(s):

Hiroyoshi Tsubochi ◽

Tomoki Shibano ◽

Shunsuke Endo

Keyword(s):

Lung Cancer ◽

Cancer Patients ◽

Perioperative Management ◽

Lung Cancer Patients

Download Full-text

Do Amide Local Anesthetics Play a Therapeutic Role in the Perioperative Management of Cancer Patients?

International Anesthesiology Clinics ◽

10.1097/aia.0000000000000119 ◽

2016 ◽

Vol 54 (4) ◽

pp. e17-e32 ◽

Cited By ~ 8

Author(s):

Tobias Piegeler ◽

Markus W. Hollmann ◽

Alain Borgeat ◽

Philipp Lirk

Keyword(s):

Cancer Patients ◽

Local Anesthetics ◽

Perioperative Management ◽

Therapeutic Role

Download Full-text

Safety and efficacy of pegfilgrastim administration on the same day as myelosuppressive chemotherapy (CT) in women with ovarian or primary peritoneal cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.16009 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 16009-16009

Author(s):

S. I. Schuman ◽

N. Lambrou ◽

K. Robson ◽

S. Glück ◽

N. Myriounis ◽

...

Keyword(s):

Cancer Patients ◽

Liposomal Doxorubicin ◽

Recurrent Disease ◽

Antibiotic Use ◽

Myelosuppressive Chemotherapy ◽

Safety And Efficacy ◽

Primary Peritoneal Cancer ◽

Peritoneal Cancer ◽

Prescribing Information ◽

Dose Reductions

16009 Background: According to prescribing information, pegfilgrastim should not be administered within 14 days prior to, or within 24 hours after, the administration of cytotoxic CT. However, little data exist to support this recommendation. The purpose of the current study is to determine the safety and efficacy of administering pegfilgrastim on the same day as myelosuppressive CT in patients with ovarian or primary peritoneal carcinoma. Methods: A retrospective review was conducted of all ovarian and primary peritoneal cancer patients that received prophylactic pegfilgrastim on the same day as CT from May 2003 to June 2006. Results: Forty-six patients (mean age: 57, range: 21–82) were treated for the following malignancies: 35 (76%) epithelial ovarian, 6 (13%) primary peritoneal, and 5 (11.0%) ovarian germ cell or stromal cell carcinoma. Twenty-six patients (56%) had primary cancers and 20 (44 %) had recurrent disease. All patients met the ASCO or NCCN recommendations of using colony-stimulating factors for prophylaxis against febrile neutropenia (FN) (Risk of FN > 20%). A total of 269 cycles of CT were administered including 125 cycles (46.5%) docetaxel + carboplatin, 39 cycles (14.5%) gemcitabine + platinum, 30 cycles (11.1%) intravenous paclitaxel + carboplatin, 28 cycles (10.4%) liposomal doxorubicin, 19 cycles (7.1%) paclitaxel + intraperitoneal platinum, 6 cycles (2.2%) docetaxel, 6 cycles (2.2%) liposomal doxorubicin + cisplatin, 5 cycles (2%) bleomycin + etoposide + cisplatin, 4 cycles (1.5%) topotecan, 3 cycles (1.1%) of paclitaxel, 2 cycles (0.7%) vincristine + actinomycin-D + cyclophosphamide, and 2 cycles (0.7%) docetaxel + gemcitabine. All patients received pegfilgrastim within one hour of the completion of CT administration. Grade 1 or 2 neutropenia developed in 10 cycles (3.7%) out of the 269 cycles, mean absolute neutrophil count = 4926 (range, 1293 -24300). No patients had FN episodes, hospitalizations or antibiotic use secondary to neutropenia, or dose-reductions and CT delays due to neutropenia. Conclusions: Administration of pegfilgrastim on the same day as CT in ovarian and primary peritoneal cancer patients is more convenient to the patient and appears safe and effective. No significant financial relationships to disclose.

Download Full-text