Less than half of women are diagnosed with ovarian cancer within a month of seeing a doctor, finds survey BMJ2018| 363 |k4419| doi: https://doi.org/10.1136/bmj.k4419 | (Published 18 October 2018)|
Under 50 per cent of women with symptoms that are in common with ovarian cancer are diagnosed within one month of their first visit to a doctor, a large international survey of women with the disease has found. The results also revealed low levels of awareness of the cancer among women and delays in seeking medical help.
“This study, for the first time, provides powerful evidence of the challenges faced by women diagnosed with ovarian cancer across the world, and sets an agenda for global change,” said Anwen Jones, chief executive officer of Target Ovarian Cancer in the UK and co-chair of the study (Source: BMJ).
The full article is available to Rotherham NHS staff here
ICR | August 2018 | Drug combination gives ‘exciting’ results in ovarian and lung cancer in early trial
The results of an early clinical trial suggest that a combination of chemotherapy and a new drug could be used to provide treatment for patients with advanced ovarian and lung cancer, where other treatments had failed.
Scientists from The Institute of Cancer Research, London (ICR), and The Royal Marsden NHS Foundation Trust, decided to test vistusertib, which inhibits the activation of a specific molecule in ovarian cancer cells, to determine if the drug combination was safe for patients, the dosage and its efficacy. The combination of targeted drug vistusertib along with paclitaxel chemotherapy caused tumours of over 50 per cent of patients with ovarian cancer and over 33 % with lung cancer to shrink, and stopped patients’ cancers from growing for almost six months.
This far exceeds what is expected with standard treatments in patients with advanced disease who have already had, and have now become resistant to, standard treatment (Source: ICR).
Ovarian Cancer Action | June 2018 |Promising new ovarian cancer treatment could soon be available on the NHS
The National Institute for Health and Care Excellence (NICE) has issued draft guidance on a promising new ovarian cancer drug, niraparib, advising that it is a suitable candidate for use in the Cancer Drugs Fund (CDF) (Ovarian Cancer Action).
Ovarian cancer is the fifth most common cause of cancer death in women and has the highest mortality rate of all gynaecological cancers. Five-year survival in England and Wales is also among the lowest in Europe – well below the European average. While these figures are bleak, it is exciting to think that niraparib could provide a much-needed new option for many women with the disease.
“We are pleased that the NICE committee has recognised the high unmet need in ovarian cancer treatment,” said Katherine Taylor, Chief Executive of Ovarian Cancer Action. “Every day matters for patients and their families and we hope that the CDF submission is successful and will deliver access to many women in England and Wales as soon as possible. We also look forward to a review by the Scottish Medicines Consortium (SMC) later this year.”
Currently, women with a strong family history of cancer can be tested for the BRCA gene, which greatly increases a woman’s chance of developing breast cancer and ovarian cancer. Yet experts believe there may be other cases of sporadic ovarian caner that are inherited via the X chromosome females receive from their father. Full story at BBC News
US researchers have used the largest familial study of ovarian cancer to argue that there exists an ovarian cancer susceptibility gene on the X-chromosome acting independently of BRCA1 and BRCA2. This observation implies that there may be many cases of seemingly sporadicovarian cancer that are actually inherited; for example, only daughters who inherit risk from their fathers. This X-linked pattern implies novel ways to prioritize families for screening even without additional testing-sisters must both be carriers or neither; fathers of women with potentially inherited ovarian cancer may receive new attention.
In addition, the scientists found evidence that other cancers affect fathers and sons in these families. Using sequencing technology, we isolated a candidate gene, MAGEC3, that may be associated with earlier onset of ovarian cancer. The further study of this gene and the X-linked pattern will require additional study. (Author summary from PLOS Genetics)
Hormonal therapy is used as a treatment option in high-grade ovarian carcinoma (HGOC), but the role and choice of treatment remains unclear. Agents used include tamoxifen and aromatase inhibitors | BMC Cancer
Aim: Our aim was to evaluate the efficacy of tamoxifen (T) and letrozole (L) in HGOC in clinical practice and investigate factors influencing clinical outcome.
Methods: A retrospective review of patients with relapsed HGOC treated with either tamoxifen or letrozole at the Royal Marsden Hospital between 2007 and 2012 was performed. The primary endpoint of the study was objective response rate (ORR). Secondary endpoints included CA125 response, clinical benefit rate (CBR) and duration of response. Platinum-sensitivity and ER-status were evaluated as predictors of treatment response.
Results: 97 patients were included (43 T, 54 L); median age 63 years (20–92); 91% high-grade serous; median number of lines of prior chemotherapy 3 (1–8); 60% platinum-resistant, 40% platinum-sensitive; 52% ER + ve, 1% ER-ve, 47% unknown. 14 patients (6 T, 8 L) achieved a partial response, with ORR (RECIST) of 14% (T) and 15% (L). The CBR for ≥3 months was 65% (22/43) for tamoxifen and 56% (22/54) for letrozole. There was no significant difference in ORR (p = 0.99) or CBR (p = 0.14) between tamoxifen and letrozole. 22 patients (23%) had a CA-125 response with hormonal therapy (10 T – 23% and 12 L – 22%). ORR did not differ by platinum sensitivity (p = 0.42); or ER-status (positive vs unknown, p = 0.12). Responders to letrozole had longer durations of response than responders to tamoxifen (26 vs 11.5 months, p = 0.03), but equivalent disease stability duration (9.6 vs 7.2 months respectively, p = 0.11).
Conclusions: Within the constraints of a retrospective study, we identified that patients treated with letrozole had a significantly longer duration of response than those treated with tamoxifen. Treatment with either tamoxifen or letrozole is a rational treatment option for patients with ER + ve HGOC, with equivalent ORR, CBR and disease stability.
The relationship between diet and survival after ovarian cancer diagnosis is unclear as a result of a limited number of studies and inconsistent findings.
Methods: We examined the association between pre-diagnostic diet and overall survival in a population-based cohort (n=811) of Australian women diagnosed with invasive epithelial ovarian cancer between 2002 and 2005. Diet was measured by validated food frequency questionnaire. Deaths were ascertained up to 31 August 2014 via medical record review and Australian National Death Index linkage. We conducted Cox proportional hazards regression analysis, controlling for diagnosis age, tumour stage, grade and subtype, residual disease, smoking status, body mass index, physical activity, marital status, and energy intake.
Results: We observed improved survival with highest compared with lowest quartile of fibre intake (hazard ratio (HR)=0.69, 95% CI: 0.53–0.90, P-trend=0.002). There was a suggestion of better survival for women with highest compared with lowest intake category of green leafy vegetables (HR=0.79, 95% CI: 0.62–0.99), fish (HR=0.74, 95% CI: 0.57–0.95), poly- to mono-unsaturated fat ratio (HR=0.76, 95% CI: 0.59–0.98), and worse survival with higher glycaemic index (HR=1.28, 95% CI: 1.01–1.65, P-trend=0.03).
Conclusions: The associations we observed between healthy components of diet pre-diagnosis and ovarian cancer survival raise the possibility that dietary choices after diagnosis may improve survival.
Cook, L.S. et al. (2017) British Journal of Cancer. 116. pp. 265-269
Background: Combined oral contraceptive (COC) use reduces epithelial ovarian cancer (EOC) risk. However, little is known about risk with COC use before the first full-term pregnancy (FFTP).
Results: Among parous women, per year of COC use exclusively before the FFTP was associated with a 9% risk reduction (95% CI=0.86–0.96). Results were similar for high-grade serous and endometrioid/clear cell EOC. In contrast, per year of use exclusively after the FFTP was not associated with risk (aOR=0.98, 95% CI=0.95–1.02).
Conclusions: Combined oral contraceptive use before the FFTP may provide a risk reduction that remains for many years, informing possible prevention strategies.