High-grade serous carcinoma tends to grow quickly. It is often diagnosed in advanced stages Stage III or IV , meaning that the cancer cells have already spread outside of the ovaries.
Recent studies have shown that high-grade serous carcinomas that begin with a primary tumor in the fallopian tubes take an average of 6. Advanced stage carcinomas generally spread to the peritoneum the lining of the organs of the pelvis and abdomen first, and can lead to fluid buildup in the peritoneal cavity — a condition called ascites, which can cause abdominal bloating, and in some cases is the first noticeable symptom of presence of ovarian cancer.
Early stage high-grade serous carcinoma often does not cause any noticeable signs or symptoms , thus the cancer is often diagnosed at more advanced stages. Note: Patients whose debulking surgery is performed by a gynecologic oncologist have been shown to experience better outcomes than those whose surgery is performed by other medical professionals.
Learn more about gynecologic oncologists. Ovarian cancer is commonly diagnosed at more advanced stages because early-stage ovarian cancer symptoms are often mistaken for benign ailments.
Symptoms of advanced-stage ovarian cancer include bloating, belly pain, frequent need to urinate, and quickly feeling full after eating. Ovarian cancer is diagnosed using transvaginal ultrasound and a blood test to detect a protein called CA The ultrasound can detect a tumor or mass but cannot tell if the mass is cancerous or benign.
CA is measured because it is often found at elevated levels in the bloodstream of people with ovarian cancer. The diagnosis is then confirmed by pathology—laboratory testing of a sample of the tumor cells, usually done after surgery to remove the tumor.
If surgery is not an option, an ultrasound- or CT-guided needle biopsy can be used to retrieve a piece of the tumor for pathology testing. Ovarian cancer is also defined by grade—how closely the cancer cells resemble normal cells a lower grade is more normal, and patients with a lower grade have a better outlook —and stage, which depends on how much the disease may have spread from the ovaries.
The standard of care for ovarian cancer is surgery and chemotherapy, particularly platinum-based chemotherapy. Neoadjuvant chemotherapy followed by interval debulking surgery IDS should be reserved to these patients, who usually experience a poorer prognosis.
In a retrospective Italian investigation, PDS was performed in 68 of 72 patients Overall, 12 of the 19 Nineteen patients underwent IDS, which was optimal in 12 cases For the entire cohort, median PFS was A retrospective study of Johns Hopkins Medical Institutions assessed 26 patients with ovarian micropapillary serous carcinoma, of which 21 underwent SCS and 15 Patients undergoing optimal SCS had longer median survival after recurrence Women who were initially treated with SCS at the time of recurrence showed a trend towards a longer median survival than those who underwent chemotherapy followed by SCS An objective response was obtained in 10 patients Twelve patients with measurable recurrent LGSOC received platinum-based salvage chemotherapy, with the most common regimen being a platinum agent combined with PTX [ 50 ].
Two patients achieved a complete response and one patient achieved a partial response, for an overall response rate of The analysis of the departmental databases of MD Anderson Cancer Center reported one complete response and three partial responses following different chemotherapy regimens to 58 patients with recurrent LGSOC, for on overall response rate of 3.
The stable disease rate was Escobar et al. Gershenson et al. Hormone therapy consisted of letrozole in 38 cases Patients who had maintenance endocrine therapy had better PFS median, Six The M. There were six complete responses and two partial responses, for an overall response rate of 9.
The objective responses were achieved in six of the 33 cases Median to progression was 7. Anastrozole obtained a partial response in 5 The median PFS was Single-agent bevacizumab achieved a dramatic response lasting from 15 to 22 months in three patients with recurrent disease [ 58 ].
A partial response was obtained in six The 5-year OS was Weekly PTX was the most common chemotherapy administered in combination with bevacizumab and it accounted for five of the six partial responses. Rose et al. Only one 8. Dalton et al. Five of these were treated with bevacizumab on two separate occasions. Three and 16 patients obtained a complete response and a partial response, respectively, for an overall response rate of Bowel perforation and entero-cutaneous fistula occurred in two patients and one patient, respectively.
The high prevalence of MAPK pathway alterations in LGSOC and the limited activity of chemotherapy has stimulated the evaluation of selective MEK inhibitors in patients with this malignancy [ 25 , 26 , 27 , 28 , 63 , 64 , 65 ].
A complete response and a partial response were achieved in one and seven patients, respectively, for an overall response rate of Median time to response was 4. The most frequent, but manageable, adverse events were grade 3 gastrointestinal toxicity There was no significant difference in partial response rate Eighteen Moreover, metformin decreases the production of insulin, IGF-1 and vascular endothelial growth factor, and therefore it exerts anti-mitotic and anti-angiogenetic effects.
Ribociclib has been approved by the Food and Drug Administration and the European Commission as initial endocrine-based therapy for postmenopausal women with hormone receptor positive, human epidermal growth factor receptor 2 HER2 -negative advanced breast cancer in combination with an aromatase inhibitor following a randomized phase III trial [ 71 ].
A phase II study is currently assessing the combination of letrozole 2. Primary outcome measure is response rate, secondary outcome measures are clinical benefit rate, toxicity, PFS and OS, and other outcome measures include ER and PR expression, mutation analysis of genomic signatures, and Ki expression.
These biological variables will be correlated with response and clinical benefit. A pilot phase II study of neoadjuvant fulvestrant mg im. The primary endpoint is the clinical benefit rate after four cycles of treatment. Okoye et al. Ahn et al. Conversely, low levels of PR were associated with a more aggressive clinical course.
Surgery is the keystone of treatment, and considering that this malignancy is not very chemo-sensitive, an attempt of primary maximal cytoreduction is strongly warranted [ 40 ]. Women with stage IA—IB disease should undergo observation alone after comprehensive staging surgery, whereas observation, chemotherapy or endocrine therapy are all possible options for those with stage IC-IIA disease [ 13 , 55 , 76 ].
While some authors [ 11 ] have assumed that only patients with both ER and PR expression can benefit from hormonal treatment, others [ 14 , 77 ] have suggested that additional translational research is warranted to identify the molecular predictors of response to endocrine therapy.
There is no agreement in the literature about the type and timing of examinations to perform for the follow-up of patients after primary treatment for ovarian cancer in general [ 79 ]. A minimalist protocol consists of periodical history, physical examinations and CA assay, while an intensive approach also includes planned diagnostic imaging procedures in asymptomatic patients.
The surveillance programs for patients with LGSOC are the same used for those with ovarian carcinoma in general [ 37 ]. However, a post-therapy increase in peritoneal implant calcification on a CT scan is not suggestive of a response to treatment, differently from other malignancies such as lymphoma, colorectal cancer and glioblastoma [ 80 ]. SCS, chemotherapy and endocrine therapy are used also in patients with recurrent disease. Molecularly targeted agents, and especially MEK inhibitors and CDK inhibitors, are currently under evaluation, especially in this clinical setting.
Conceptualization, Writing—original draft: A. All authors have read and agreed to the published version of the manuscript. National Center for Biotechnology Information , U. Journal List Cancers Basel v. Cancers Basel. Published online May Author information Article notes Copyright and License information Disclaimer. The purpose of this study is to evaluate how well pembrolizumab works in treating participants with ovarian cancer that has come back after previous treatment.
This is an open label, single-arm, phase II study. The study population is adult patients with asymptomatic recurrent ovarian cancer who have an elevation in their CA level. The purpose of this study is to understand changes that take place in the blood of patients with ovarian cancer, fallopian tube cancer, and primary peritoneal cancer. This portion of the study is to understand the changes that occur in your blood during and after treatment with carboplatin and paclitaxel chemotherapy in women with ovarian cancer, fallopian tube cancer, and primary peritoneal cancer.
This randomized phase II trial studies how well oncolytic measles virus encoding thyroidal sodium iodide symporter MV-NIS compared to investigator's choice chemotherapy works in treating patients with ovarian, fallopian, or peritoneal cancer. Measles virus, which has been changed in a certain way, may be able to kill tumor cells without damaging normal cells.
The purpose of this study is to compare gemcitabine hydrochloride in combination with AZD to gemcitabine hydrochloride given alone to treat patients with ovarian, primary peritoneal, or fallopian tube cancer that has returned after a period of time.
Gemcitabine hydrochloride may prevent tumor cells from multiplying by damaging their deoxyribonucleic acid DNA molecules that contain instructions for the proper development and functioning of cells, which in turn stops the tumor from growing. AZD may block specific protein activity and may increase the effectiveness of gemcitabine hydrochloride by preventing the protein from repairing damaged tumor cells without causing harm to normal cells.
The purpose of this study is to see how well cediranib maleate and olaparib work when given together or separately, and compares them to standard chemotherapy in treating patients with ovarian, fallopian tube, or primary peritoneal cancer that has returned after receiving chemotherapy with drugs that contain platinum platinum-resistant or continued to grow while being treated with platinum-based chemotherapy drugs platinum-refractory.
Cediranib maleate and olaparib may stop the growth of tumor cells by blocking enzymes needed for cell growth.
Drugs used in chemotherapy work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping This randomized phase II trial studies how well ATR kinase inhibitor M M and gemcitabine hydrochloride work compared to standard treatment with gemcitabine hydrochloride alone in treating patients with ovarian, primary peritoneal, or fallopian tube cancer that has come back after a period of improvement recurrent.
ATR kinase inhibitor M may stop the growth of tumor cells by blocking an enzyme needed for cell growth, and may also help gemcitabine hydrochloride work better. Gemcitabine hydrochloride is a drug used in chemotherapy that works to stop the growth of tumor cells by blocking cells from growing and repairing themselves, causing them This phase II trial studies how well Avatar-directed chemotherapy works in treating patients with ovarian, primary peritoneal, or fallopian tube cancer that does not respond to platinum anti-cancer drugs.
Drugs used in chemotherapy, such as paclitaxel, gemcitabine hydrochloride, pegylated liposomal doxorubicin hydrochloride, topotecan hydrochloride, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading.
Monoclonal antibodies, such as bevacizumab, may interfere with the ability of tumor cells to grow and spread. Using an Avatar, a living tumor sample with similar genetic characteristics to The focus of this study is to evaluate the efficacy, safety, and tolerability of veliparib in women with previously untreated, Stage III or IV, high-grade serous, epithelial ovarian, fallopian tube, or primary peritoneal cancer.
This research trial studies comprehensive patient questionnaires in predicting complications in older patients with gynecologic cancer undergoing surgery. Comprehensive patient questionnaires completed before surgery may help identify complications, such as the need for assistance in taking medications, decreased mobility, decreased social activity, and falls, and may improve outcomes for older patients with gynecologic cancer.
The purpose of the study is to determine the best dose of CC oral azacitidine combined with pembrolizumab for the treatment of platinum-resistant epithelial ovarian, fallopian tube, or peritoneal cancer. Drugs used in chemotherapy work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
Chemoprotective drugs, such as glutathione, may help prevent peripheral neuropathy caused by paclitaxel and carboplatin.
It is not yet known whether glutathione is more effective than a placebo in preventing peripheral neuropathy. The purpose of this study is to evaluate the safety and effectiveness of combined treatment with niraparib and pembrolizumab MK in patients who have triple-negative breast cancer that is advanced or has spread, or ovarian cancer that has returned after previous treatment.
This pilot clinical trial studies the safety and immunogenicity of vaccine therapy in treating patients with stage IIIC-IV ovarian epithelial, fallopian tube, or primary peritoneal cavity cancer following surgery and chemotherapy. Vaccines made from a person's peptide treated white blood cells may help the body build an effective immune response to kill tumor cells.
This is a Phase 2, open-label, single arm study to evaluate the safety and efficacy of niraparib in ovarian cancer patients who have received three or four previous chemotherapy regimens. Niraparib is an orally active PARP inhibitor. Niraparib will be administered once daily continuously during a day cycle.
This is a Phase 3, multicenter, randomized, double-blind, placebo-controlled study of niraparib as maintenance in platinum sensitive ovarian cancer patients who have either gBRCAmut or a tumor with high-grade serous histology and who have responded to their most recent chemotherapy containing a platinum agent.
Niraparib or placebo in a ratio will be administered once daily continuously during a day cycle. Safety and The purpose of this study is to evaluate the safety and tolerability, as well as some activity parameters, of TG in patients with ovarian, fallopian or peritoneal serous carcinoma. This randomized phase III trial studies olaparib or cediranib maleate and olaparib to see how well they work compared with standard platinum-based chemotherapy in treating patients with platinum-sensitive ovarian, fallopian tube, or primary peritoneal cancer that has come back.
Cediranib maleate may stop the growth of ovarian, fallopian tube, or primary peritoneal cancer by blocking the growth of new blood vessels necessary for tumor growth. Drugs used in chemotherapy, such as carboplatin, paclitaxel, gemcitabine hydrochloride, and pegylated liposomal doxorubicin The purpose of this study is to evaluate the response to treatment with Ribociclib and Letrozole in patients with low-grade serous cancer of the ovary, fallopian tube or peritoneum.
The purpose of this study is to assemble a collection of serial plasma biospecimens from women with ovarian, primary peritoneal, or fallopian tube cancer for future research projects to identify changes in levels of various plasma components that occur during the course of ovarian cancer, including changes that occur with debulking surgery, chemotherapy, disease relapse, and subsequent therapy.
This is a Phase 1 multi-center study to evaluate the clinical safety and immune response of ID-LV when injected intradermally in patients with advanced cancer. ID-LV is a novel immunotherapy agent designed to target dendritic cells and stimulate the body's immune system to fight the spread and growth of cancer for patients whose tumors express the NY-ESO-1 protein. Patients with melanoma, sarcoma, ovarian cancer, or non-small cell lung cancer that express NY-ESO-1 may be considered for the trial.
Selected sites will be evaluating ID-LV with pembrolizumab for patients with melanoma who have inadequately responded to anti-PD-1 therapy. This study is a double-blind, randomized, placebo-controlled niraparib:placebo study in patients with Stage III or IV ovarian cancer. The study will assess the efficacy of niraparib as maintenance treatment, as measured by PFS.
This phase II trial studies how well surgery works in preventing ovarian cancer in patients with genetic mutations at risk of ovarian cancer. Risk reducing salpingo oophorectomy RRSO is surgery to remove the fallopian tubes and ovaries at the same time.
Interval salpingectomy with delayed oophorectomy ISDO is surgery to remove the fallopian tubes.
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