Tuesday, March 19, 2019

NEJM Study Shows No Long-Term Benefit from Removal of Normal Appearing Lymph Nodes

The results of the LION study was released in this month's the New England Journal of Medicine.

In the Lion study (Lymphadenectomy in Ovarian Neoplasms), 647 women with advanced ovarian cancer - as defined by the International Federation of Gynecology and Obstetrics as Stage IIB to IV - were randomly assigned to  either receive or not receive complete pelvic and paraaortic removal of lymph nodes.

What makes this study interesting is the inclusion criteria. All women had to have no residual disease after a complete resection and all women had to have normal appearing lymph nodes. The nodes had to be viewed directly and not simply palpated. In addition, the centers involved in the study had to be evaluated for surgical quality.

Previously normal appearing pelvic and paraaortic lymph nodes have been seen as hiding places for metastatic cancer cells and treatment protocols called for the removal of these lymph nodes. Recurrences showed in second-look surgeries, that these lymph nodes contained cancer cells that had not been successfully treated with initial chemo, prompting some researchers to call these lymph nodes "pharmacological sanctuaries".

However, as many women have attested to, there are complications associated with the removal of these nodes from having to wear thigh-high compression stockings (try wearing those in the summer) to outright lymphedema. Women who had lymph node resection also had higher rates of post-op complications within 60 days of surgery including death.

Ultimately, the median over all survival rate in women without lymph node removal was 69.4 months vs 65.5 months among women with lymph node removal. Median progression-free survival in both groups was the same at 25.5 months.

To read the extract of this study, follow this link.

Tuesday, March 12, 2019

New 'Trojan Horse' Cancer Treatment Shows Early Promise in Multiple Tumor Types

This article was recently published in EurekaAlert. The drug, tisotumab vidotin, TV for short, releases a toxic substance from within the cancer cell to kill it.

It has been shown to be effective in certain drug-resistant tumors.

According to the article,  researchers saw responses "...in 27 per cent of patients with bladder cancer, 26.5 per cent with cervical cancer, 14 per cent ovarian cancer, 13 per cent with oesophageal, 13 per cent with non-small cell lung and 7 per cent with endometrial cancer (although not in any men with prostate cancer). Responses lasted an average of 5.7 months, and up to 9.5 months in some patients."

The article was originally published in Lancet Oncology

Tuesday, March 5, 2019

Revised FIGO Staging for OC & the Role of Imaging

I recently came across this article from the American Journal of Roentgenology and although it was published in 2016, it's still relevant.

If you'd like to read the text, follow this link.

Tuesday, February 26, 2019

MGH does it again!

MGH ovarian cancer researchers are hoping to start a clinical trial later this year using losartan, a well known anti-hypertensive, to examine how it can enhance the anti-tumor effects of chemotherapy.

Researchers studying pancreatic cancer, have found that losartan reduces the extracellular matrix around tumor cells. This is significant because the matrix increases the density around tumor cells preventing drugs from penetrating the tumor.

To find out more about this research, follow this link to MGH