scholarly journals Neo-Adjuvant Chemotherapy Reduces, and Surgery Increases Immunosuppression in First-Line Treatment for Ovarian Cancer

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 5899
Author(s):  
Christine De Bruyn ◽  
Jolien Ceusters ◽  
Chiara Landolfo ◽  
Thaïs Baert ◽  
Gitte Thirion ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Adjuvant Chemotherapy ◽  
Primary Treatment ◽  
Treatment Schedule ◽  
Primary Therapy ◽  
Immune Microenvironment ◽  
Debulking Surgery ◽  
Primary Debulking Surgery ◽  
Neo Adjuvant Chemotherapy ◽  
Related Proteins

In monotherapy, immunotherapy has a poor success rate in ovarian cancer. Upgrading to a successful combinatorial immunotherapy treatment implies knowledge of the immune changes that are induced by chemotherapy and surgery. Methodology: Patients with a new d ovarian cancer diagnosis underwent longitudinal blood samples at different time points during primary treatment. Results.: Ninety patients were included in the study (33% primary debulking surgery (PDS) with adjuvant chemotherapy (ACT), 61% neo-adjuvant chemotherapy (NACT) with interval debulking surgery (IDS), and 6% debulking surgery only). Reductions in immunosuppression were observed after NACT, but surgery reverted this effect. The immune-related proteins showed a pronounced decrease in immune stimulation and immunosuppression when primary treatment was completed. NACT with IDS leads to a transient amelioration of the immune microenvironment compared to PDS with ACT. Conclusion: The implementation of immunotherapy in the primary treatment schedule of ovarian cancer cannot be induced blindly. Carboplatin–paclitaxel seems to ameliorate the hostile immune microenvironment in ovarian cancer, which is less pronounced at the end of primary treatment. This prospective study during primary therapy for ovarian cancer that also looks at the evolution of immune-related proteins provides us with an insight into the temporary windows of opportunity in which to introduce immunotherapy during primary treatment.

Ovarian Cancer and Comorbidity: Is Poor Survival Explained by Choice of Primary Treatment or System Delay?

2017 ◽  
Vol 27 (6) ◽  
pp. 1123-1133 ◽  
Author(s):  
Mette Calundann Noer ◽  
Cecilie Dyg Sperling ◽  
Bent Ottesen ◽  
Sofie Leisby Antonsen ◽  
Ib Jarle Christensen ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Primary Treatment ◽  
Regression Analyses ◽  
System Delay ◽  
Debulking Surgery ◽  
Primary Debulking Surgery ◽  
Choice Of Treatment ◽  
Severe Comorbidity ◽  
Comorbidity Index ◽  
The Impact

ObjectivesComorbidity influences survival in ovarian cancer, but the causal relations between prognosis and comorbidity are not well characterized. The aim of this study was to investigate the associations between comorbidity, system delay, the choice of primary treatment, and survival in Danish ovarian cancer patients.MethodsThis population-based study was conducted on data from 5317 ovarian cancer patients registered in the Danish Gynecological Cancer Database. Comorbidity was classified according to the Charlson Comorbidity Index and the Ovarian Cancer Comorbidity Index. Pearson χ2 test and multivariate logistic regression analyses were used to investigate the association between comorbidity and primary outcome measures: primary treatment (“primary debulking surgery” vs “no primary surgery”) and system delay (more vs less than required by the National Cancer Patient Pathways [NCPPs]). Cox regression analyses, including hypothesized mediators stepwise, were used to investigate if the impact of comorbidity on overall survival is mediated by the choice of treatment or system delay.ResultsA total of 3945 patients (74.2%) underwent primary debulking surgery, whereas 1160 (21.8%) received neoadjuvant chemotherapy. When adjusting for confounders, comorbidity was not significantly associated to the choice of treatment. Surgically treated patients with moderate/severe comorbidity were more often experiencing system delay longer than required by the NCPP. No association between comorbidity and system delay was observed for patients treated with neoadjuvant chemotherapy. Survival analyses demonstrated that system delay longer than NCPP requirement positively impacts survival (hazard ratio, 0.90 [95% confidence interval, 0.82–0.98]), whereas primary treatment modality has no significant impact on survival.ConclusionsPatients with moderate/severe comorbidity experience often a longer system delay than patients with no or mild comorbidity. Age, stage, and comorbidity are factors influencing the choice of treatment, with stage being the most important factor and comorbidity of lesser importance. The impact of comorbidity on survival does not seem to be mediated by the choice of treatment or system delay.

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