(Press-News.org) Certain patients with an aggressive form of ovarian cancer have a better chance of a cure through surgical removal of their tumor before chemotherapy instead of the reverse, a new study shows.
Led by researchers at NYU Grossman School of Medicine, Perlmutter Cancer Center, and Dana-Farber Cancer Institute, the study used a mathematical tool to examine how doctors should coordinate available treatments for high-grade serous ovarian cancer (HGSC).
Ovarian cancer is the 8th most common cancer and cancer death in women worldwide, and HGSC constitutes roughly 70 percent of ovarian malignancies and has the worst prognosis. Patients with the condition typically undergo surgery and chemotherapy, but there has been long-standing controversy over the best order of treatment.
Published online June 14 in Proceedings of the National Academy of Sciences, the new analysis argues that patients who can undergo "complete debulking" surgery first, with chemotherapy added after (termed primary debulking surgery or PDS), should have a superior outcome to the other main treatment option: giving patients a few cycles of chemotherapy to shrink the tumor before surgery (neoadjuvant chemotherapy or NACT).
"The issue of whether PDS or NACT should be used was highly controversial, and a major reason for it lies in the different characteristics of patients in different clinical studies," says study first author Shengqing Gu, PhD, a graduate from University of Toronto and now an instructor at Dana-Farber Cancer Institute. "We therefore built a mathematical model to simulate HGSC clinical course, which allows us to compare treatment outcomes in the same virtual patients and examine which group of patients may respond differently to PDS vs NACT."
"Our model, combined with earlier clinical data, suggests that for patients who can undergo complete debulking, surgery offers the best chance of long term survival or even cure," says study co-senior author Benjamin G. Neel, MD, PhD, director of Perlmutter Cancer Center at NYU Langone Health. "Our model also provides some insight about optimal early detection and treatment intervals."
The researchers used clinical data from roughly 300 patients in previous studies of patients' responses to PDS or NACT, taken from the Princess Margaret Cancer Center in Toronto and the Canadian Cancer Trials Group.
The researchers found that in patients who are well enough for surgery, debulking provides better results because it has the best chance of removing cancer cells resistant to chemotherapy. For patients who are too ill for debulking surgery, the study suggests that a shorter period of initial chemotherapy, rather than the currently recommended interval, might provide a greater benefit.
The current analyses suggest several questions that future randomized clinical trials should examine, say the study authors. These include how much the influence of the time gap between surgery and subsequent chemotherapy may affect treatment outcome, whether there is a link between the number of initial chemotherapy cycles and outcomes, and whether complete secondary surgery on relapsed tumor improves prognosis.
"Our model shows that a fraction of patients can have long term survival or even cure, but only when they undergo complete debulking, followed by the currently available therapies," Neel says. "There is an urgent need for new therapies to provide cures for patients for whom complete debulking is not an option and for those with the most treatment-resistant cancer cells."
INFORMATION:
This study was supported by National Institutes of Health (NIH) grants R37 49152, R01 257507, and P30 CA008748; the NIH Terry Fox Foundation (TFPPG 721 020003), the Mary Kay Foundation, DCA Award from University of Toronto and Sara Elizabeth O'Brien Trust Fellowship, Ontario Ministry of Health and Long Term Care, and the Princess Margaret Cancer Foundation.
Along with Neel, co-corresponding author for this study is Myles Brown at Dana-Farber Cancer Institute. Other authors are Stephanie Lheureux, Azin Sayad, Paulina Cybulska, Liat Hogen, Iryna Vyarvelska, Marcus Bernardini, Barry Rosen, and Amit Oza at Princess Margaret Cancer Center in Toronto; Dongsheng Tu and Wendy Parulekar at Canadian Cancer Trials Group; Matthew Nankivell at University College London; Sean Kehoe at University of Birmingham, United Kingdom; and Dennis Chi at Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine.
Neel is a co-founder, holds equity in, and received consulting fees from Navire Pharmaceuticals, Northern Biologics, Inc, and Jengu Therapeutics, Inc. He also receives consulting fees and equity from Avrinas, Inc., has equity in Recursion Pharma, received consulting fees from MPM Capital, and was an expert witness for the Johnson and Johnson ovarian cancer talc litigation in U.S. Federal Court. His spouse has or held equity in Amgen, Inc., Regeneron, Moderna, Inc., Gilead Sciences, Inc., and Arvinas, Inc. These relationships are being managed in accordance with the policies of New York University.
A study of woodland ecosystems that provide habitat for rare and endangered species along streams and rivers throughout California reveals that some of these ecologically important areas are inadvertently benefitting from water that humans are diverting for their own needs. Though it seems a short-term boon to these ecosystems, the artificial supply creates an unintended dependence on its bounty, threatens the long-term survival of natural communities and spotlights the need for changes in the way water is managed across the state.
"We need to be more intentional in incorporating ecosystem water needs when we manage water--both for aquatic organisms and species on land," said Melissa Rohde, the lead author of a study published June ...
The concentration of potentially toxic metals is increasing in the population of the franciscana dolphin --a small cetacean, endemic from the Rio de la Plata and an endangered species-- according to a study led by a team of the Faculty of Biology and the Biodiversity Research Institute (IRBio), published in the journal Science of The Total Environment.
The impact of human activity in the region could be the cause for the increase of trace elements such as chromium, copper, iron and nickel in the dolphins' biological tissues, as stated in the study. The paper counts on the participation of members from the National History Museum of Uruguay, and is subsidized through a project of ...
LAWRENCE -- The United States has the highest population of incarcerated citizens among developed nations. Every year, roughly 2 million women, the majority held in jails, leave incarceration. The COVID-19 pandemic hit jails and correctional facilities harder than almost any other societal setting. Many of the people leaving incarceration are returning to communities that were also disproportionately affected by the pandemic, yet many people in that population have expressed hesitancy to receive a COVID-19 vaccine.
New research from the University of Kansas found high rates of vaccine hesitancy among women transitioning from incarceration, due to a multitude ...
Syracuse, N.Y. - A study of nearly 550 adults with intellectual and developmental disabilities receiving residential services in New York City found that age, larger residential settings, Down syndrome and chronic kidney disease were the most common risk factors for COVID-19 diagnosis, and heart disease was most associated with COVID-19 deaths.
The study, "Risk Factors Associated With COVID-19 Outcomes Among People With Intellectual and Developmental Disabilities Receiving Residential Services," was published June 8 by JAMA Network Open and provided the first evidence of the risk factors leading to COVID-19 diagnosis and death among people with IDD who receive residential services.
The study's findings suggest that ...
Fully occupied intensive care units (ICUs). Physically and mentally exhausted health workers. Chaotically overcrowded hospitals. These and similar problems posed by the COVID-19 pandemic in Brazil have created ideal conditions for the emergence of Candida auris, a microorganism some are calling a "superfungus" because of the speed with which it has developed drug resistance.
The first two cases were confirmed in December 2020 at a hospital in Salvador (state of Bahia, Northeast Brazil), and are described in the Journal of Fungi by a group of researchers led by Arnaldo Colombo, head of the Special Mycology Laboratory at the Federal University of São Paulo (UNIFESP). The study was supported by São Paulo Research Foundation - FAPESP.
"Nine other C. auris patients ...
TROY, N.Y. -- The future of quantum computing may depend on the further development and understanding of semiconductor materials known as transition metal dichalcogenides (TMDCs). These atomically thin materials develop unique and useful electrical, mechanical, and optical properties when they are manipulated by pressure, light, or temperature.
In research published today in Nature Communications, engineers from Rensselaer Polytechnic Institute demonstrated how, when the TMDC materials they make are stacked in a particular geometry, the interaction that occurs between particles gives researchers more control over the devices' properties. Specifically, the interaction between ...
A discovery from researchers at the University of Illinois Chicago may lead to new treatments for individuals who suffer from alcohol use disorder and depression.
The study, "Transcriptomics identifies STAT3 as a key regulator of hippocampal gene expression and anhedonia during withdrawal from chronic alcohol exposure," is published in the journal Translational Psychiatry by researchers at UIC's Center for Alcohol Research in Epigenetics.
"During withdrawal from long-term alcohol use, people often suffer from depression, which may cause them to start drinking again as a way to self-medicate. If we ...
The spin of the Milky Way's galactic bar, which is made up of billions of clustered stars, has slowed by about a quarter since its formation, according to a new study by researchers at University College London (UCL) and the University of Oxford.
For 30 years, astrophysicists have predicted such a slowdown, but this is the first time it has been measured.
The researchers say it gives a new type of insight into the nature of dark matter, which acts like a counterweight slowing the spin.
In the study, published in the Monthly Notices of the Royal Astronomical Society, researchers analysed Gaia space telescope observations of a large group of stars, the Hercules stream, which are in resonance with the bar - that is, they revolve around the galaxy ...
An international team of researchers led by the University of Bonn (Germany) has identified the cause of a rare, severe muscle disease. According to these findings, a single spontaneously occurring mutation results in the muscle cells no longer being able to correctly break down defective proteins. As a result, the cells perish. The condition causes severe heart failure in children, accompanied by skeletal and respiratory muscle damage. Those affected rarely live beyond the age of 20. The study also highlights experimental approaches for potential treatment. Whether this hope will be fulfilled, however, will only become clear in a few years. The results are published in the journal Nature ...
A funny thing happened on the way to discovering how zinc impacts kidney stones - two different theories emerged, each contradicting the other. One: Zinc stops the growth of the calcium oxalate crystals that make up the stones; and two: It alters the surfaces of crystals which encourages further growth. Now it can be told - both theories are correct as reported in the America Chemical Society journal Crystal Growth & Design by Jeffrey Rimer, Abraham E. Dukler Professor of Chemical and Biomolecular Engineering at the University of Houston, who conducted the first study to offer some resolution to the differing hypotheses.
"What we see with zinc is something ...
