Monday, January 27, 2020

Niraparib in Patients With Newly Diagnosed Ovarian Cancer

This article appeared in the New England Journal of Medicine (NEJM). The conclusion showed that women with newly diagnosed OC who were not platinum resistant had a longer progression free survival - regardless of their BRCA status - than those on placebo.

Here's the abstract to the study:



Niraparib, an inhibitor of poly(adenosine diphosphate [ADP]–ribose) polymerase (PARP), has been associated with significantly increased progression-free survival among patients with recurrent ovarian cancer after platinum-based chemotherapy, regardless of the presence or absence of BRCA mutations. The efficacy of niraparib in patients with newly diagnosed advanced ovarian cancer after a response to first-line platinum-based chemotherapy is unknown.


In this randomized, double-blind, phase 3 trial, we randomly assigned patients with newly diagnosed advanced ovarian cancer in a 2:1 ratio to receive niraparib or placebo once daily after a response to platinum-based chemotherapy. The primary end point was progression-free survival in patients who had tumors with homologous-recombination deficiency and in those in the overall population, as determined on hierarchical testing. A prespecified interim analysis for overall survival was conducted at the time of the primary analysis of progression-free survival.


Of the 733 patients who underwent randomization, 373 (50.9%) had tumors with homologous-recombination deficiency. Among the patients in this category, the median progression-free survival was significantly longer in the niraparib group than in the placebo group (21.9 months vs. 10.4 months; hazard ratio for disease progression or death, 0.43; 95% confidence interval [CI], 0.31 to 0.59; P<0.001). In the overall population, the corresponding progression-free survival was 13.8 months and 8.2 months (hazard ratio, 0.62; 95% CI, 0.50 to 0.76; P<0.001). At the 24-month interim analysis, the rate of overall survival was 84% in the niraparib group and 77% in the placebo group (hazard ratio, 0.70; 95% CI, 0.44 to 1.11). The most common adverse events of grade 3 or higher were anemia (in 31.0% of the patients), thrombocytopenia (in 28.7%), and neutropenia (in 12.8%). No treatment-related deaths occurred.


Among patients with newly diagnosed advanced ovarian cancer who had a response to platinum-based chemotherapy, those who received niraparib had significantly longer progression-free survival than those who received placebo, regardless of the presence or absence of homologous-recombination deficiency. (Funded by GlaxoSmithKline; PRIMA/ENGOT-OV26/GOG-3012 number, NCT02655016. opens in new tab.)

Monday, January 20, 2020

Where Does Ovarian Cancer Originate?

It used to be thought that the ovaries were the origin of high grade serous ovarian cancer - certainly the name of the cancer suggests its origins. However research at multiple health centers points to another source: the fallopian tubes.

The consortium of centers included Johns Hopkins University, Toronto University Health Network, Yale University and Memorial Sloan-Kettering Cancer Center. Using molecular profiling, researchers were able to show that the cellular origin of the cancer was most closely aligned to the fallopian tube region rather than the ovaries. This is significant because in high-risk women, currently the ovaries and the fallopian tubes are generally removed. The ability to preserve the ovaries could reduce the risk of heart disease, osteoporosis and other diseases associated with ovarian resection.

To read more about this study, follow this link.  

Monday, January 13, 2020


As we know, ovarian and pancreatic cancer are very difficult to treat because by the time they are diagnosed, they are often late stage.

Houston Methodist and MD Anderson have filed a joint patent for a new monoclonal antibody. (Monoclonal antibodies are cloned from a single parent cell and can mimic a variety of immune functions in cancer treatment.)

MFAP5, a protein secreted in high levels in both these cancers, is a marker of poorer survival rates. Researchers have developed a monoclonal antibody that blocks MFAP5 found in the areas surrounding the tumor cells that feed and support the tumor. Blocking MFAP5 effectively starves the tumor since MFAP5 is associated with sustaining the tumor with nutrients. Without this, these cells are more sensitive to chemo. Phase 1 clinical trials will hopefully start in 2020.

You can read more about this by following this link

Monday, January 6, 2020


Turns out there is not just one smoking gun in pre-cancerous lesions that lead to ovarian cancer. Instead, researchers at Johns Hopkins discovered that some women can have multiple pre-cancerous lesions which are not driven by one specific set of mutations. Many of these pre-cancerous lesions simply remain dormant. Additionally, it can take decades before some of these lesions develop into OC.

Now researchers need to determine which of these precursors will go on to become ovarian cancers as well as how to detect them.

This article first appeared on the Johns Hopkins Institute for Clinical and Translational Research website.

Some deadly ovarian cancers arise from lesions genetically unrelated to each other.
In a novel study of cancer genetics using fallopian tube tissue from 15 women, researchers at the Johns Hopkins Kimmel Cancer Center say they have found evidence that the most common and lethal type of ovarian cancer arises not from a uniform group of precancerous lesions, but from individual growths found in groups genetically unrelated to each other.
If confirmed in further studies, the discovery, described in the May issue of the Journal of Pathology, would go a long way towards upending a longstanding cancer dogma dictating that cancer steadily progresses from any and all precancerous lesions, and could lead to new ways to fight this deadly disease.
“We’re finding that it’s not a straight line progress from precancerous lesions to cancer in these tumors,” says Ren-Chin Wu, Ph.D., first author and associate professor at Chang Gung University School of Medicine in Taiwan  “If we can find a way to eradicate just the ones that progress, and distinguish them from those that maintain dormancy forever, we likely can make treatments more effective and save more women’s lives,” he adds.Up to 70 percent of all ovarian cancers are so-called high-grade serous carcinomas (HGSCs) and account for the vast majority of the 14,000 women who die of ovarian cancer each year in the U.S., explains study leader Tian-Li Wang, Ph.D., director of the Molecular Genetics Laboratory of Female Reproductive Cancer and professor of pathology, oncology, and gynecology and obstetrics at the Johns Hopkins University School of Medicine. “This cancer is incredibly hard to beat because it’s usually diagnosed at a late stage since earlier stages have few to no symptoms,” says Wang.
Recent studies, Wang notes, suggest that these ovarian cancers arise from precancerous lesions in the fallopian tubes, a pair of organs that carry eggs from the ovaries to the uterus. But how this progression proceeds from precancerous lesions to active cancer has been unclear.
To investigate this biological path, Wang and her colleagues, including first author Wu, studied fallopian tube and ovarian tissue from 15 women seen at the Johns Hopkins Hospital.
Eleven of these women had no evidence of cancer when these organs were removed prophylactically to reduce their cancer risk. The other four already were diagnosed with HGSCs.
Using high-powered microscopes, the researchers first identified a variety of different precancerous lesions clustered in three groups according to pathological diagnostic markers on the women’s fallopian tubes. They then removed cells from these lesions using a technique called laser capture microdissection to determine how fast the cells in each of the lesions were dividing, and to enable analysis of their genetic mutations.
The researchers say they found these precancerous lesions were in a variety of stages of activity. Some were dormant and not actively proliferating. Others were proliferating but weren’t yet cancer.
Overall, their genetic analyses on 24 lesions in 11 women identified mutations in 12 different cancer-related genes. Surprisingly, they say, one cancer-free woman had multiple precursor tubal lesions and each appeared to be driven by different sets of mutations, suggesting that they weren’t derived from a common primary lesion and had each arisen independently.
In three of the four women with active ovarian cancer, the researchers were able to link their tumors genetically with a primary precursor lesion on their fallopian tubes. However, for one of the women, the researchers couldn’t find a genetic link with co-existing precancerous lesions—reinforcing the idea that while many precancerous lesions arise in women at risk for ovarian cancer, only some progress to active cancers.
Further experiments that modeled mutation progression in these tumors suggest that it may take decades for tumors to progress from precancerous lesions to HGSCs, says co-lead author Cristian Tomasetti, Ph.D., associate professor of oncology. This potentially offers a large window of time to intervene before cancers become advanced and difficult to treat, but he says researchers will first need to find ways to detect cancer precursors that are dangerous from those unlikely to cause any harm.”
“Unlike prior studies that analyzed precursors and cancers from the same patients, this study includes many precursor lesions without cancer present, and provides a unique molecular landscape of ovarian cancer precursors in place before ovarian cancer actually develops,” says Ie-Ming Shih, M.D., Ph.D., study co-author, Richard W. TeLinde Distinguished Professor, Department of Gynecology and Obstetrics and co-director of the Johns Hopkins Kimmel Cancer Center Women’s Malignancies Program.
Other Johns Hopkins researchers who participated in this study include Shiou-Fu Lin, Ming Zhang, Tiffany Chu, Robert J. Kurman, Russell Vang and Kenneth Kinzler.
This study was supported by funding from the US Department of Defense CDMRP (grant number W81XWH-11-2-0230); the National Institutes of Health/National Cancer Institute (grant numbers UO1CA200469, RO1CA215483, P50CA228991, P30CA006973); the Honorable Tina Brozman Foundation, Ovarian Cancer Research Fund Alliance, Roseman Foundation; Teal Award, and Gray Foundation; the John Templeton Foundation; the Richard W. TeLinde Endowment from the Johns Hopkins University.