L.M. Bean

Survival of women with microinvasive adenocarcinoma of the cervix is not improved by radical surgery

Background Treatment for early‐invasive adenocarcinoma of the cervix remains controversial. Although data have shown similar survival rates to those seen with squamous cell carcinoma, conservative options for patients with microinvasive adenocarcinoma have not been as widely accepted. Despite comparable survival outcomes, patients with early‐invasive adenocarcinoma are still routinely subjected to more radical surgical techniques than their equivalently staged squamous cell counterparts. Objective The objective of the study was to evaluate how less radical surgery has an impact on 5 year survival in patients with microinvasive adenocarcinoma of the cervix. Study Design The Surveillance, Epidemiology, and End Results database was queried from 1988 through 2010 to perform a retrospective analysis of women with International Federation of Gynecology and Obstetrics stage IA1 or IA2 cervical carcinoma. Five year survival by procedure type (local excision, simple hysterectomy, or radical hysterectomy) was determined for each cell type (squamous or adenocarcinoma), as was lymph node status. Results Among 1567 patients with cervical adenocarcinoma, 5 year survival was 97.3% (confidence interval, 95.8–98.2%) for stage IA1 disease and 98.3% (confidence interval, 96.5%, 99.2%) for stage IA2. For comparison, the 5‐year survival rates for 5,749 patients with stage IAI or lA2 squamous cell carcinoma were 96.7% (confidence interval, 96.0–97.3%) and 95.6% (confidence interval, 94.4–96.5%), respectively. For stage IA1 ACA, survival was 96.6%, 98.4% and 96.5% following excision, hysterectomy and radical hysterectomy, respectively. For stage IA2 ACA, survival rates were 100%, 96.9% and 99.4%, respectively. There was no statistical difference in survival between patients having either cell type undergoing local excision (P = .26), simple hysterectomy (P = .08), or radical hysterectomy (P = .87). We also found no statistically significant difference in survival among patients with adenocarcinoma compared by treatment type (local excision compared with simple hysterectomy [P = .64]; local excision compared with radical hysterectomy [P = .82]; or simple hysterectomy compared with radical hysterectomy [P = .70]). Among patients with adenocarcinoma, 0.97% had positive pelvic lymph nodes, none had positive aortic lymph nodes, and 91.85% had confirmed negative lymph nodes. For squamous cell carcinoma, 0.72% of patients had positive pelvic lymph nodes and 0.10% had positive aortic lymph nodes. Conclusion There was no significant difference in survival when patients were compared by cell type or procedure, suggesting that survival of patients with microinvasive adenocarcinoma is not improved by utilizing more invasive surgical methods. Regardless of histology, the frequency of nodal involvement was very low among both groups, supporting an overall excellent prognosis for all patients with microinvasive disease. We submit these data as evidence that preoperative planning of more conservative techniques is appropriate, not just for those with squamous histology or who desire future fertility, but for all patients with microinvasive cervical disease.

Abstract 3812: FAK inhibition resensitizes platinum-resistant serous ovarian cancer

Platinum and taxol administration is standard of care chemotherapy for serous ovarian cancer. Tumor recurrence occurs in a high percentage of patients, and this is directly related to poor overall survival. Ovarian cancer stem cell (CSC) resistance to chemotherapy treatment can give rise to tumor recurrence. Focal adhesion kinase (FAK), an intracellular tyrosine kinase, has been linked to mesothelioma and breast CSC survival. Here, we find that FAK activation is elevated in platinum (CP)-resistant ovarian cancer cells and that FAK tyrosine phosphorylation is increased after CP treatment of CP-sensitive ovarian cancer cells. Nanomolar levels of FAK inhibitor (VS-4718) selectively blocked CP-resistant ovarian carcinoma methylcellulose colony growth via cell cycle inhibition but not apoptosis. Oral VS-4718 administration to mice reduces CP-resistant orthotopic tumor burden with a concomitant decrease in tumor-associated aldehyde dehydrogenase (ALDH) activity, a marker of ovarian CSCs. Residual ovarian tumor cells from VS-4718-treated mice exhibit reduced ALDH activity and secondary tumor initiating capacity. CRISPR-mediated FAK knockout or VS-4718 treated ovarian carcinoma cells exhibit diminished Oct-4 transcription factor and ALDH-1A1 CSC-associated protein marker expression. Co-administration of VS-4718 with CP-taxol chemotherapy reduced CP-resistant tumor burden and exhibited additive inhibitory effects on ovarian carcinoma spheroid growth. As we find that CP activates FAK and that FAK activity sustains ovarian carcinoma CSC phenotypes, our results support the testing of FAK inhibitors in combination with CP to prevent recurrent and chemo-resistant ovarian cancer. Citation Format: Lisa M. Bean, Florian J. Sulzmaier, Isabelle Tancioni, Sean Uryu, Christine Jean, Christine Lawson, Xiao Lei Chen, Elizabeth G. Kleinschmidt, Kristen M. Anderson, Edward A. Cordasco, Joshua Axelrod, Vihren N. Kolev, Jonathan A. Pachter, Dwayne G. Stupack, David D. Schlaepfer. FAK inhibition resensitizes platinum-resistant serous ovarian cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3812.

Abstract NTOC-106: FAK INHIBITION RE–SENSITIZES PLATINUM–RESISTANT SEROUS OVARIAN CANCER

Most ovarian cancer patients respond well to surgical debulking and platinum-taxol chemotherapy. However, ~80% of patients with a complete response to therapy will exhibit tumor recurrence, and in time develop platinum and chemotherapy-resistant disease. It is hypothesized that recurrent disease emanates from the regrowth of microscopic clusters of chemotherapy-resistant tumor cells - also termed cancer stem cells (CSCs). Here, we find that cisplatin chemotherapy elevates focal adhesion (FAK) tyrosine kinase phosphorylation (Y397 FAK) in 3D ovarian tumor spheroids. Notably, FAK is not known as a DNA-damage sensing kinase. Instead, FAK is linked to integrin adhesion-, migration-, and CSC-promoting signaling pathways. In mouse tumors, CP-taxol chemotherapy increases FAK Y397 phosphorylation and aldehyde dehydrogenase (ALDH-1A1, a known markers of CSCs) in tumor areas not associated with necrosis. FAK Y397 phosphorylation is constitutively-elevated in CP-resistant ovarian cancer cells and nanomolar levels of FAK inhibitor (VS-4718) block 3D colony cell growth. Oral VS-4718 administration to mice reduces CP-resistant orthotopic tumor burden with a concomitant decrease in tumor-associated ALDH activity and secondary tumor-initiating capacity. CRISPR-mediated FAK knockout or VS-4718 treated ovarian carcinoma cells exhibit diminished ALDH-1A1 expression. Importantly, co-administration of VS-4718 enhances the anti-tumor effectiveness of CP-taxol chemotherapy in an orthotopic CP-resistant mouse tumor model. As CP activates FAK and FAK signaling sustains ovarian carcinoma CSC phenotypes, our results support the future testing of FAK inhibitors in combination with CP to prevent recurrent and chemo-resistant ovarian cancer. Citation Format: Lisa M. Bean, Florian J. Sulzmaier, Kristen M. Anderson, Isabelle Tancioni, Cheyenne R. Butcher, Sean Uryu, Christine Jean, Christine Lawson, Xiao Lei Chen, Elizabeth G. Kleinschmidt, Vihren N. Kolev, Jonathan A. Pachter, Dwayne G. Stupack, and David D. Schlaepfer. FAK INHIBITION RE–SENSITIZES PLATINUM–RESISTANT SEROUS OVARIAN CANCER [abstract]. In: Proceedings of the 11th Biennial Ovarian Cancer Research Symposium; Sep 12-13, 2016; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(11 Suppl):Abstract nr NTOC-106.

Delayed Nausea/Emesis

The symptoms of chemotherapy-induced nausea and vomiting cause significant physical and emotional distress. Some of the most troubling effects result from delayed symptoms, which occur greater than 24 hours following chemotherapy. Severe or prolonged nausea or vomiting can interfere with a patient’s ability to receive proper treatment and even cause patients to postpone or refuse potentially curative therapy. Providing adequate prophylaxis can prevent these symptoms, allowing chemotherapy to be better tolerated and given without dose modification. The antiemetic regimen which has shown the most promise in clinical trials is a 5-hydroxytryptamine (5-HT3) receptor antagonist combined with a neurokinin-1 receptor antagonist and dexamethasone. This chapter reviews the pathophysiology, diagnosis, and management of chemotherapy-induced nausea and vomiting, with special focus on delayed symptoms and the use of current clinical practice guidelines.