Survival Associated With First Line Bevacizumab Maintenance Therapy Among Older Patients With Ovarian Cancer Findings From The Viera Study

Background:Bevacizumab with chemotherapy followed by bevacizumab was approved in 2018 for the first-line (1L) treatment of patients with ovarian cancer (OC). However, little is known about the real-world experience of OC patients treated with bevacizumab.Methods: This SEER-Medicare retrospective cohort study included females u2265 66 years, OC (stage II-IV) diagnosis between 2009 and 2015, who continued bevacizumab or observation alone after 4 u2013 10 cycles of 1L platinum-based chemotherapy with or without bevacizumab. The primary outcome was overall survival (OS), measured from 1L treatment initiation to death. Safety events of interest included thrombosis, hemorrhage, stroke, and gastrointestinal perforation. Inverse probability of treatment weighting (IPTW) incorporated 32 demographic and prognostic characteristics. Cox proportional hazards models with IPTW were used to compare outcomes.Results:In this cohort (N=2262), 66 (3%) patients received bevacizumab maintenance. Mean age (u00b1SD) was 74.6 (6.2) years, 89% were Stage III or IV, and 26.9% of patients had u22651 co-morbidity. Patients treated (preapproval) with 1L maintenance bevacizumab increased from 0.3% in 2009 to 4.1% in 2015. Compared to observation alone, median OS in patients treated with bevacizumab maintenance was 43.6 vs 37.9 months (adjusted hazard ratio [HR]=0.83 [95% CI: 0.50 u2013 1.36]). Among those who received >7 cycles of bevacizumab, OS was longer, though not significantly, compared to observation alone (aHR = 0.62 [95% CI: 0.32-1.18]). Initiation of nonplatinum chemotherapy within 12 months occurred in 36.4% of observation only and 20.9% of bevacizumab maintenance patients. Compared to observation alone, specified safety events were not higher with bevacizumab maintenance, aHR: 0.94 [0.49 u2013 1.82].Conclusions: Survival among this small cohort of elderly OC patients in this real-world study is consistent with that observed in trials of 1L bevacizumab maintenance. First-line maintenance bevacizumab therapy appears to provide modest survival benefit.

Objective. Bevacizumab maintenance following platinum-based chemotherapy is an effective treatment for epithelial ovarian cancer (EOC), both in primary and recurrent disease. Our aim was to identify criteria to select elderly patients who can safely benefit from bevacizumab addition.Methods. This is a case-control study on patients with primary or recurrent EOC who received platinum-based chemotherapy plus bevacizumab, between January 2015 - December 2016. Patient characteristics, treatment details and adverse events were reviewed and analyzed in two setting: younger (65 years, group 1) and elderly (65 years, group 2). A binary logistic model was applied to correlate clinical variables and severe (grade u22653) toxicity risk. Results. Overall, 283 patients with EOC were included, with 72 (25.4%) older patients compared with 211 (74.6%) younger women. Bevacizumab had been administered to 234 patients (82.7%) as first-line treatment and in 49 (17.3%) with recurrent disease. At diagnosis, elderly patients presented with at least one comorbidity and were taking at least 1 medication in 84.7% and 80.6% of the cases respectively, compared with correspondingly 47.4% and 37.4% in group 1 (p0.001). Nonetheless, the occurrence of serous (G3/G4) adverse events did not increase among the older group. Creatinine serum levels 1.1 g/dl, estimated glomerular filtration rate (eGFR)

This practical book provides up-to-date information on the particular features of ovarian cancer in older women and the best management approach. The full range of relevant topics is covered. Guidance is provided on geriatric assessment, screening, pathology, diagnosis, and follow-up. The various treatment options are carefully explained, covering surgical approaches, chemotherapy as a first-line strategy, the use of anti-angiogenic agents, and treatment of relapse. The cognitive problems that may arise in elderly women during and after treatment of ovarian cancer are documented, with advice on response. Guidance is also provided on the design of clinical trials, and current directions in biological research are reviewed. This book will be of value to both practitioners and researchers with an interest in ovarian cancer and the elderly.​

Background : Maintenance therapy with olaparib considerably improved progression-free survival (PFS) among women with newly-diagnosed, advanced BRCA-mutated high grade epithelial ovarian carcinoma (HGEOC)(1). Based on the large real-life ESME ovarian cancer cohort, we aimed to describe the patient's characteristics and survival outcomes of a selected cohort of BRCA-mutated patients before the era of PARP inhibitors maintenance in first line.Methods : ESME ovarian cancer is a national cohort including all patients with ovarian carcinoma managed in the 18 French Comprehensive Cancer Centres (NCT03275298). ESME Research program collected retrospective data from patient's medical records. BRCA1, BRCA2, or both mutated patients with de novo diagnosed advanced (FIGO stage III or IV) HGEOC were eligible. All data for surgical and medical management were reviewed by medical oncologist or gynecologist oncologist in each centers. PFS was defined as the time from beginning of first line until earliest documented disease progression or death.Results : Of the 4777 patients with ovarian cancer treated in 1st line by platinum-based chemotherapy between 2011 and 2016, 266 patients were included. Median age was 57.0 years (33-81). 187 patients (70.3%) harbored a BRCA1 mutation, and 75 (28.2%) a BRCA2 mutation. Majority of patients (66.9%) had FIGO stage III disease. Almost all patients (95.5%) underwent surgical resection, after neoadjuvant chemotherapy (50%), or upfront debulking surgery (50%). 147 patients (55.3%) received maintenance therapy, majority with bevacizumab alone (78.9%). Some patients, included in clinical trials, received PARP inhibitor alone or in combination with bevacizumab. After a median follow-up of 51.7 months, the median PFS was 28.6 months [95 CI: 26.2-32.4]. A better mPFS was observed for patients with FIGO stage III than stage IV (32.4 months and 25.4 months, respectively), or BRCA2 mutation than BRCA1 (33.3 months and 27.7 months, respectively). Estimated 5-year overall survival (OS) for the whole population was 69.2% [95 CI: 65.3-73.0].Conclusion : This large ESME ovarian cancer cohort described clinical features and real-life survival outcomes among patients with newly diagnosed advanced BRCA-mutated HGEOC treated in comprehensive cancer centres. Looking to the poor prognosis of these patients, before PARPi area, already 55% of patients received maintenance therapy with bevacizumab.

Introduction/Background:Low grade serous ovarian cancer (LGSOC) accounts for 10% of serous epithelial ovarian cancers. In contrast to high grade serous ovarian cancer (HGSOC), it is characterised by an early age of onset, indolent growth rate and relative resistance to cytotoxic chemotherapy. The use of Bevacizumab in ovarian cancer has mostly been investigated in HGSOC and is contra-indicated in patients with extensive disease associated with the bowel, due to risks of bowel perforation. Several single-institution studies have reported activity of Bevacizumab in LGSOC in the recurrent disease or adjuvant setting. We present a case series of two patients with advanced LGSOC and extensive serosal disease involving the bowel that were treated with Bevacizumab in the first-line setting.Methodology:Case notes, pathology results and CT scans were reviewed. Histology slides from initial biopsy and debulking surgery specimens were stained for H&E to assess chemotherapy-response scores.Results:Both patients had Stage IIIC disease, with extensive disease involving the bowel which prohibited surgery. No response was seen on CT scan or serum Ca125 levels after three cycles of Carboplatin and Paclitaxel in either case, but following the addition of Bevacizumab both patients had a marked reduction in disease volume enabling debulking surgery that was not previously feasible. Serum Ca125 levels reduced to near-normal values prior to surgery following three cycles of Bevacizumab in both cases (438 to 50 and 151 to 54). There were no adverse events associated with Bevacizumab use (18 cycles 7.5mg/kg). Conclusion:We propose that Bevacizumab is safe to use in our set of LGSOC patients with extensive bowel involvement, and can facilitate surgery in those patients that were previously inoperable. Further evaluation of its use in the first line setting, particularly in patients that have had no response to conventional chemotherapy agents, is recommended. We have commenced an observational study including all LGSOC patients receiving Bevacizumab.

The ASCRS Textbook of Surgery of the Colon and Rectum offers a comprehensive textbook designed to provide state of the art information to residents in training and fully trained surgeons seeking recertification. The textbook also supports the mission of the ASCRS to be the world’s authority on colon and rectal disease. The combination of junior and senior authors selected from the membership of the ASCRS for each chapter will provide a comprehensive summary of each topic and allow the touch of experience to focus and temper the material. This approach should provide the reader with a very open minded, evidence based approach to all aspects of colorectal disease. Derived from the textbook, The ASCRS Manual of Surgery of the Colon and Rectum offers a “hands on” version of the textbook, written with the same comprehensive, evidence-based approach but distilled to the clinical essentials. In a handy pocket format, readers will find the bread and butter information for the broad spectrum of practice. In a consistent style, each chapter outlines the condition or procedure being discussed in a concise outline format – easy to read, appropriately illustrated and referenced.

This book deals with the paradoxical role of autophagy in tumor suppression and tumor promotion in cancer cells. Autophagy plays opposing, context-dependent roles in tumors; accordingly, strategies based on inhibiting or stimulating autophagy could offer as potential cancer therapies. The book elucidates the physiological role of autophagy in modulating cancer metastasis, which is the primary cause of cancer-associated mortality. Further, it reviews its role in the differentiation, development, and activation of multiple immune cells, and its potential applications in tumor immunotherapy. In addition, it examines the effect of epigenetic modifications of autophagy-associated genes in regulating tumor growth and therapeutic response and summarizes autophagy’s role in the development of resistance to a variety of anti-cancer drugs in cancer cells. In closing, it assesses autophagy as a potential therapeutic target for cancer treatment. Given its scope, the book offers a valuable asset for all oncologists and researchers who wish to understand the potential role of autophagy in tumor biology.

This book presents comprehensive coverage on the importance of good nutrition in the treatment and management of obesity, cancer and diabetes. Naturally occurring bioactive compounds are ubiquitous in most dietary plants available to humans and provide opportunities for the management of diseases. The text provides information about the major causes of these diseases and their association with nutrition. The text also covers the role of dietary phytochemicals in drug development and their pathways. Later chapters emphasize novel bioactive compounds as anti-diabetic, anti-cancer and anti-obesity agents and describe their mechanisms to regulate cell metabolism. Written by global team of experts, Dietary Phytochemicals: A Source of Novel Bioactive Compounds for the Treatment of Obesity, Cancer and Diabetes describes the potentials of novel phytochemicals, their sources, and underlying mechanism of action. The chapters were drawn systematically and incorporated sequentially to facilitate proper understanding. This book is intended for nutritionists, physicians, medicinal chemists, drug developers in research and development, postgraduate students and scientists in area of nutrition and life sciences.

This book is a compilation of articles that brings together current knowledge from an international team of contributors who are dedicated investigators exploring novel strategies for the treatment of glioblastoma. These articles describe some of the latest concepts that will provide students, researchers and clinicians with an overview of the therapeutic approaches being developed in the field of neuro-oncology to combat this deadly disease.