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1.
Emerging targeted drug delivery strategies toward ovarian cancer.
Wang, Z, Meng, F, Zhong, Z
Advanced drug delivery reviews. 2021;:113969
Abstract
Ovarian cancer is a high-mortality malignancy in women. The contemporary clinical chemotherapy with classic cytotoxic drugs, targeted molecular inhibitors would mostly fail when ovarian cancer cells become drug-resistant or metastasize through the body or when patients bare no more toleration because of strong adverse effects. The past decade has spotted varying targeted delivery systems including antibody-drug conjugates (ADCs), peptide/folate/aptamer-drug conjugates, polymer-drug conjugates, ligand-functionalized nanomedicines, and dual-targeted nanomedicines that upgrade ovarian cancer chemo- and molecular therapy effectively in preclinical/clinical settings via endowing therapeutic agents selectivity and bypassing drug resistance as well as lessening systemic toxicity. The targeted delivery approaches further provide means to potentiate emergent treatment modalities such as molecular therapy, gene therapy, protein therapy, photodynamic therapy, dual-targeting therapy and combination therapy for ovarian cancer. This review highlights up-to-date development of targeted drug delivery strategies toward advanced, metastatic, relapsed, and drug resistant ovarian cancers.
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2.
Modified intestinal isolation bag as promising tool in promoting bowel resumption after ovarian cancer cytoreductive surgery: a randomized clinical trial.
Perutelli, A, Ferrandina, G, Domenici, L, Cubeddu, A, Garibaldi, S, Aretini, P, Mazzanti, CM, Salerno, MG
Archives of gynecology and obstetrics. 2021;(3):733-742
Abstract
PURPOSE Postoperative ileus (POI) impairs patient recovery, prolonging hospital stay after major surgery in ovarian cancer (OvCa) patients. Thus, intraoperative bowel isolation is expected to reduce manipulation-related impairment. The aim of this study was to investigate the impact of intraoperative intestinal isolation bag on POI in OvCa patients submitted to primary surgery. METHODS A randomized trial including patients managed with or without isolation bag during OvCa primary surgery was conducted. Patients were selected by consecutive randomization. Primary endpoints were the time between surgery and resumption of bowel motility (as passage of first/continued flatus), assessing of postoperative nausea or vomiting and return to regular diet. Secondary endpoint was the impact of intestinal isolation bag on length of hospitalization in the two groups. RESULTS Ninety-two patients respecting inclusion criteria were eligible to be enrolled in the study (48 patients as Group 1 and 44 patients as Group 2). Thirty-eight (79.2%) patients, in which intraoperative isolation bag was used, experienced first/continued flatus within 3 days from surgery and they were susceptible to be discharged within 5 days, compared, respectively, to 34.3% of Group 2 (n = 15). Advantages were more evident in patients whose surgery took over 220 min (OR 0.02, CI 95% 0.001-0.57; p < 0.001) despite the type of surgical effort made. CONCLUSION Despite the small sample size, our study showed that the use of intestinal isolation bag can reduce incidence of POI and length of stay in OvCa patients submitted to primary cytoreductive surgery.
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3.
Diet and ovarian cancer risk: An umbrella review of systematic reviews and meta-analyses of cohort studies.
Sun, H, Gong, TT, Xia, Y, Wen, ZY, Zhao, LG, Zhao, YH, Wu, QJ
Clinical nutrition (Edinburgh, Scotland). 2021;(4):1682-1690
Abstract
BACKGROUND & AIMS Diet may play an important role in the etiology of ovarian cancer (OC). We aimed to evaluate the strength and credibility of evidence pertaining to dietary risk factors for OC. METHODS We comprehensively searched PubMed, Web of Science, Cochrane, CINAHL, JBI Database of Systematic Reviews and Implementation Reports, PROSPERO and EMBASE databases to identify related systematic reviews and meta-analyses of prospective cohort studies. This study had been registered at PROSPERO. The registration number is CRD42020187651. For each association, we estimated the summary effect size using fixed and random effects models, the 95% confidence interval and the 95% prediction interval. We assessed heterogeneity, evidence of small-study effects, and excess significance bias. RESULTS A total of 22 systematic reviews and meta-analyses were included in the present study. These previous reports evaluated 184 individual studies, which proposed a total of 36 associations between dietary factors and OC risk. Out of the 36 associations, there were no strong, highly suggestive and suggestive evidence, only four (black tea, skim/low-fat milk, lactose, and calcium) were determined to be supported by weak evidence. OC risk was inversely associated with intake of black tea or calcium, and positively associated with intake of skim/low-fat milk or lactose. CONCLUSIONS Our studies revealed that four associations between OC risk and dietary factors (black tea, skim/low-fat milk, lactose, and calcium) were supported by weak evidence. The remaining 32 associations were not confirmed. Additional studies are needed to carefully evaluate the relationship between dietary factors and OC risk.
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4.
Scoring systems for the evaluation of adnexal masses nature: current knowledge and clinical applications.
Terzic, M, Aimagambetova, G, Norton, M, Della Corte, L, Marín-Buck, A, Lisón, JF, Amer-Cuenca, JJ, Zito, G, Garzon, S, Caruso, S, et al
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 2021;(3):340-347
Abstract
Adnexal masses are a common finding in women, with 20% of them developing at least one pelvic mass during their lifetime. There are more than 30 different subtypes of adnexal tumours, with multiple different subcategories, and the correct characterisation of the pelvic masses is of paramount importance to guide the correct management. On that basis, different algorithms and scoring systems have been developed to guide the clinical assessment. The first scoring system implemented into the clinical practice was the Risk of Malignancy Index, which combines ultrasound evaluation, menopausal status, and serum CA-125 levels. Today, current guidelines regarding female patients with adnexal masses include the application of International Ovarian Tumours Analysis simple rules, logistic regression model 1 (LR1) and LR2, OVERA, cancer ovarii non-invasive assessment of treating strategy, and assessment of Different Neoplasias in the adnexa. In this scenario, the choice of the scoring system for the discrimination between benign and malignant ovarian tumours can be complex when approaching patients with adnexal masses. This review aims to summarise the available evidence regarding the different scoring systems to provide a complete overview of the topic.
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5.
GERiatric Screening in the treatment of elderly patients with Ovarian Carcinoma (GERSOC): study protocol for a pragmatic, cluster randomised controlled trial.
van Soolingen, NJ, Smorenburg, CH, Hamaker, ME, Groen, WG, Retèl, VP, Lok, CAR, van de Poll-Franse, LV, Trum, JW
Trials. 2020;(1):214
Abstract
BACKGROUND Approximately 40% of the newly diagnosed patients with advanced ovarian cancer are aged 70 years or older. Standard treatment for advanced disease consists of cytoreductive surgery and combination chemotherapy. In older patients, standard treatment is often withheld or prematurely stopped due to suspected frailty. It remains challenging to distinguish fit elderly patients who can endure standard therapy from frail patients who may benefit from an adapted treatment strategy. As a comprehensive geriatric assessment (CGA) can contribute to the identification of frail patients and improve tailored therapy in this population, screening tests were developed to select those who may benefit from a CGA. However, the use of these geriatric screening tests has rarely been compared with usual clinical care. The GERSOC-trial will evaluate whether geriatric screening in elderly patients with advanced-stage ovarian cancer improves treatment completion and quality of life. METHODS This pragmatic, cluster randomised controlled trial will be conducted at a minimum of 20 hospitals in the Netherlands. Hospitals are randomly assigned to geriatric screening care (in which a geriatric screening comprised of the G8 questionnaire and the Timed Up and Go test is performed), or care as usual (in which current usual care is continued). A total of 320 patients aged ≥ 70 years with primary, advanced-stage ovarian carcinoma will be included. Patients considered fit on geriatric screening will receive standard treatment; patients who are considered unfit will be referred to a geriatrician for analysis and treatment advice. The primary outcome is the percentage difference in completed standard and adapted therapies between the two study arms. Secondary outcomes include quality of life, cost-effectiveness and survival. DISCUSSION This trial aims to gather evidence for the use of geriatric screening in treatment decision-making in elderly patients with advanced ovarian cancer. If proven feasible, beneficial and cost-effective, geriatric screening may be implemented in routine clinical practice. TRIAL REGISTRATION Netherlands Trial Registry, ID: NL6745. Registered on 2 August 2017.
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6.
Lipid profile and risk of ovarian tumours: a meta-analysis.
Onwuka, JU, Okekunle, AP, Olutola, OM, Akpa, OM, Feng, R
BMC cancer. 2020;(1):200
Abstract
BACKGROUND Existing data from several reports on the association between lipid profile and ovarian tumour (OT) suggests divergent conclusions. Our aim was to examine whether circulating lipid profile: total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) differed between cases and non-cases of OT. METHODS Electronic repositories; PUBMED, EMBASE and Cochrane library were explored through December 2019 to retrieve published articles for inclusion in the meta-analysis after quality assessment. Heterogeneity was assessed using I2 statistics, the effect of individual studies on the overall effect size was tested using sensitivity analysis and funnel plot was used to evaluate publication bias. RESULTS Twelve studies, involving 1767 OT cases and 229,167 non-cases of OT were included in this meta-analysis and I2 statistics ranged between 97 and 99%. Mean circulating TC (- 16.60 [- 32.43, - 0.77]mg/dL; P = 0.04) and HDL (- 0.25[- 0.43, - 0.08]mmol/L; P = 0.005) were significantly lower among OT cases compared to non-OT cases. CONCLUSION Decreased TC and HDL profiles were observed among subjects with OT in this collection of reports. The implications of TC and HDL in tumour manifestations and growth need to be validated in a large multi-ethnic longitudinal cohort adjusting for relevant confounders.
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7.
Non-epithelial ovarian carcinoma: what is the optimal staging surgery?
Medina-Franco, H, Colonna-Márquez, LE
Chinese clinical oncology. 2020;(4):50
Abstract
Non-epithelial ovarian neoplasms are a group of infrequent, heterogenous clinical and histological tumors that account from 6% to 10% of ovarian malignancies, the two most common non-epithelial ovarian neoplasms are germ cell tumors and sex cord-stromal cell tumors, each of these classifications is divided in multiple histologic subtypes. In the case of epithelial ovarian tumors comprehensive surgical staging has remained as the gold standard for staging, nonetheless for non-epithelial ovarian neoplasms the use of staging surgery has remained debatable and controversial throughout the years in order to correctly stage non-epithelial ovarian carcinomas. Despite the fact that the role of surgery remains critical in the adequate management of all ovarian tumors, there are several manners to surgically approach an ovarian tumor depending on the type of tumor, risk factors and staging of disease. There are multiple reasons why the use of surgery in non-epithelial ovarian tumors is still debatable nowadays, for instance the main reason relies in the low prevalence of this disease, therefore there are few studies that actually offer a clear and sufficient overview to this issue. The objective of this manuscript is to present a comprehensive review of the non-epithelial carcinoma and to focus in the latest information, evidence and recommendations about the optimal treatment and staging surgery for these tumors.
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8.
Systemic therapy for non-serous ovarian carcinoma.
Chávarri-Guerra, Y, González-Ochoa, E, De-la-Mora-Molina, H, Soto-Perez-de-Celis, E
Chinese clinical oncology. 2020;(4):52
Abstract
Ovarian cancer is one of the top ten most common cancers in women around the world, with high-grade serous epithelial cancer being the most frequent type. However, around a quarter of cases consist of non-serous epithelial ovarian cancer (EOC), which is a heterogeneous group of malignancies that includes endometroid, mucinous, clear cell carcinoma (CCC), and carcinosarcoma. Another relevant group of nonepithelial tumors are those arising from germ cells or sex-cord stromal cells, which account for about 10% of all ovarian cancers. Although there are similarities in the presentation, evaluation, and management of these tumors, they have unique characteristics in terms of epidemiology, tumor biology, tumor marker expression, and response to treatment, warranting a different approach to each one of them. Collectively, the treatment of most of EOC include surgical cytoreduction followed by adjuvant systemic platinum-based chemotherapy. The most common chemotherapy and route of administration for systemic treatment is paclitaxel plus carboplatin given intravenously. However, the treatment of EOC has been rapidly evolving and emerging targeted therapies such as poly (adenosine diphosphate-ribose) polymerase inhibitors, immune checkpoint inhibitors, and antiangiogenic agents are also available. On the other hand, non-EOC responds well to combination chemotherapy used to treat testicular cancer (bleomycin, etoposide, cisplatin) and has a good prognosis. Frontline chemotherapeutic regimen selection differs according to histological subtype, molecular alterations, and patient characteristics. Here, we review specific characteristics of non-serous and non-EOC emphasizing the peculiarities of systemic therapy for each subtype.
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9.
Prognostic significance of preoperative prognostic nutritional index in ovarian cancer: A systematic review and meta-analysis.
Dai, Y, Liu, M, Lei, L, Lu, S
Medicine. 2020;(38):e21840
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Abstract
BACKGROUND The prognostic significance of preoperative prognostic nutritional index (PNI) in ovarian cancer (OC) is uncertain, and this study is aimed to clarify the prognostic significance. METHODS We used 4 common databases for conducting a systematic review and meta-analysis, and eligible studies were included in the analysis. The association of preoperative PNI with overall survival (OS), progression-free survival (PFS), and clinicopathological parameters was analyzed. RESULTS A total of 2050 patients with OC receiving the surgical treatment were analyzed in this study. Patients with low PNI tended to have a shorter OS (hazard ratio [HR] = 1.82, 95% CI = 1.30-2.55, P < .01) and PFS (HR = 1.91, 95% CI = 1.53-2.39, P < .01) compared with those with high PNI. Besides, low PNI was significantly associated with more advanced International Federation of Gynecology and Obstetrics stage (P < .01), the occurrence of ascites (P < .01), larger residual tumor (P < .01), insensitive to chemotherapy (P < .01), and higher CA125 (P < .01) compared with high PNI in OC. CONCLUSION Low preoperative PNI is associated with shorter OS, shorter PFS, and worse clinicopathological parameters in OC. Low preoperative PNI is an unfavorable prognostic indicator of patients with OC.
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Recent advancements in fabrication of nanomaterial based biosensors for diagnosis of ovarian cancer: a comprehensive review.
Sha, R, Badhulika, S
Mikrochimica acta. 2020;(3):181
Abstract
Ovarian cancer is commonly diagnosed via determination of biomarkers like CA125, Mucin 1, HE4, and prostasin that can be present in the blood. However, there is a substantial need for less expensive, simpler, and portable diagnostic tools, both for timely diagnosis and management of ovarian cancer. This review (with 101 refs.) discusses various kinds of nanomaterial-based biosensors for tumor markers. Following an introduction into the field, a first section covers different kinds of biomarkers for ovarian cancer including CA125 (MUC16), mucin 1 (MUC1), human epididymis protein 4 (HE4), and prostasin. This is followed by a short overview on conventional diagnostic approaches. A large section is then presented on biosensors for determination of ovarian cancer, with subsections on optical biosensors (fluorimetric, colorimetric, surface plasmon resonance, chemiluminescence, electrochemiluminescence), on electrochemical sensors, molecularly imprinted sensors, paper-based biosensors, microfluidic (lab-on-a-chip) assays, chemiresistive and field effect transistor-based sensors, and giant magnetoresistive sensors. Tables are presented that give an overview on the wealth of methods and materials. A concluding section summarizes the current status, addresses current challenges, and gives an outlook on potential future trends. Graphical abstract Schematic representation of the review covering the advancements in the fabrication of various nanomaterial based biosensors for diagnosis of ovarian cancer.