Recurrent ovarian cancer

Unfortunately, patients with ovarian cancer often have their disease recurred.   As I discussed earlier, we divide the patients into platinum sensitive (have not seen carboplatin or cisplatin in the last 6 months) or platinum resistant (resistant to carbo or cisplatin).   The prognosis is better with platinum sensitive disease.   The treatment usually consists of doublet chemo (2 agents) rather than single agent based on ICON4 study.   The most common combination would be carboplatin and paclitaxel (Taxol) since ICON4 study showed that this combination has survival advantage compared to other platinum based chemo.   Other choices are carboplatin + Doxil or Carboplatin + Gemzar (please note that none of these have survival advantage in comparison to their control arm).

In platinum resistant, we don't use cisplatin or carboplatin.  But paclitaxel, doxil, topotecan, oral etoposide (VP 16) are active.   Recently, the West Clinic published a study using abraxane and avastin on patient with platinum resistant which showed about 50% response rate.  To the best of my knowledge, this is the highest response rate ever documented in medical literature.

Reference:

Phase II clinical trial of bevacizumab with albumin-bound paclitaxel in patients with recurrent, platinum-resistant primary epithelial ovarian or primary peritoneal carcinoma.

Tillmanns TD, Lowe MP, Walker MS, Stepanski EJ, Schwartzberg LS.

Gynecol Oncol. 2013

Using plain water to kill ovarian cancer

Ovarian cancer is the 2nd most common gynecologic cancer in the United States with the highest mortality in all-gynecologic cancers.   Optimal removal of most tumor during initial surgery has been shown to improve survival rate.  The presence of exfoliated ovarian cancer cells in the peritoneal cavity after ovarian cancer debulking surgery is well recognized.  These cells are viable and can grow back again.

We have just completed research showing plain water killed these cancer cells effectively.   We grew ovarian cancer cells in plates.  Then we bathed them in normal saline (same concentration as plasma/blood).   In this concentration (we call it isoosmolar), cancer cells continue to grow.   Then, we place some of these cells in water for 30 minutes.   The water, which is hypoosmolar (less salt concentration), diffused into the cancer cell wall and ruptured the cancer cells.   

We are currently writing this research paper and will submit for publication.   Now, we cannot use this finding yet on patients.  We need to go thru multiple studies in animals and human before we could use it.   But my prediction is to use water into abdomen after ovarian cancer surgery may improve survival.   Currently, we do the same thing using intraperitoneal chemotherapy.  I think water would be less toxic than chemotherapy in patients.  lets keep our finger cross.

Estimating risk of ovarian cancer

We have our research paper just been accepted for publication by the Archieve of Obstet and Gynecol (will be on line and printed version in a few months).   Our study included 324 patients undergoing adnexal/ ovarian mass surgery were recruited into the study. All study patients had a preoperative CT scan and serum CA-125 test. CT scan abnormalities included any solid tumor components, ascites, and pelvic or abdominal lymphadenopathy and omental caking.   There were 225 (70%) benign and 99 (30%]) malignant ovarian masses. Using logistic regression with the area under the curve of the receiver operating curve of 82%, the cancer probability was determined by the equation

e^{-3.6372 + 0.0306 * (A) + 0.001 * (B) + 0. 876 * (C)+1.551 * (D) + 1.7377 * (E) + 2.76 * (F)}

 1+e ^{-3.6372 + 0.0306 * (A) + 0.001 * (B) + 0.876 * (C) + 1.551 * (D) + 1.7377 * (E) + 2.76 * (F)}

where A = age, B = CA-125, C = solid adnexal mass is 1 and cystic is 0, D = ascites is 1, E = omental caking is 1 and absence is 0,; F = node size > 1 cm is 1 and < 1cm no is 0 value. The natural logarithm e is a constant [2.718281828]. For example, for a woman of age 60, CA-125 = 50 U/ml, with solid adnexal mass, ascites, omental caking, and lymphadenopathy, the probability is 0.994. Hence, this woman has a 99.4%  probability of having cancer.

I wish to caution that our study is still preliminary.  This paper showed a mathematical formula could be used in combination with CT scan finding to estimate risk for ovarian cancer.

Reference:

Santoso JT, et al.  CT adnexall mass score to estimate ovarian cancer.  Arch Gynecol Obstet. 2014