A Different Chemotherapy Approach for Ovarian Cancer

OVARIAN CANCER that spreads to the lining of the abdominal cavity, called the peritoneum, is difficult to treat. Patients with this advanced cancer typically undergo debulking, also called cytoreductive surgery, a lengthy procedure in which surgeons aim to remove all cancer from the abdominal cavity and affected organs, including the ovaries and fallopian tubes as well as the bladder, colon and other parts of the gastrointestinal tract. In recent years, researchers have looked at the efficacy of using hyperthermic intraperitoneal chemotherapy (HIPEC), which is heated chemotherapy delivered directly to the peritoneum, to destroy remaining cancer cells immediately after debulking surgery.

Scientists in Belgium and the Netherlands published long-term data from OVHIPEC-1, a randomized phase III trial to evaluate adding HIPEC to interval cytoreductive surgery for ovarian cancer, in the October 2023 Lancet Oncology. (In interval surgery, chemotherapy is given to shrink the cancer prior to surgery.) The study enrolled 245 women with stage III epithelial ovarian cancer whose cancer showed no signs of progression after upfront chemotherapy. Researchers randomly assigned women to have debulking surgery alone, or surgery plus HIPEC using the chemotherapy drug cisplatin. After 10 years, median overall survival for the surgery-plus-HIPEC group was 44.9 months versus 33.3 months for the surgery group. Median progression-free survival was 14.3 months and 10.7 months, respectively. The rates of adverse events were similar—25% with surgery alone versus 27% with surgery plus HIPEC—and the most common events were abdominal pain, infection and slowed bowel function.

These results are in line with the researchers’ five-year analysis, published in the New England Journal of Medicine in 2018. In that analysis, 6.6% of patients in the surgery group had survived without progression at five years, compared with 12.3% in the surgery-plus-HIPEC group. At 10 years, 6.6% of the people who received surgery were alive with no progression versus 10.1% in the surgery-plus-HIPEC group. While surgery plus HIPEC did not result in better cure rates, the authors note that it significantly prolonged the time cancer was controlled. “The most important finding is that the benefit for patients with stage III ovarian carcinoma when interval cytoreductive surgery is combined with HIPEC remains present after a 10-year follow up,” says Willemien van Driel, lead author and a gynecologic oncologist at the Netherlands Cancer Institute in Amsterdam, who notes that patients in both arms of the study received similar treatment after subsequent recurrences.

Van Driel says that there is still variation in the use of HIPEC along with cytoreductive surgery. European guidelines published in October 2023 note that HIPEC with cytoreductive surgery should not be considered a standard of care. In the U.S., National Comprehensive Cancer Network guidelines state that HIPEC can be considered for patients with stage III epithelial ovarian cancer.

Van Driel and her colleagues are now enrolling patients in the OVHIPEC-2 trial, which will study the effect of adding HIPEC in women with stage III ovarian cancer undergoing primary surgery, which is surgery done upfront prior to chemotherapy. Other trials are evaluating HIPEC use for recurrent ovarian cancer. She notes there are several unanswered questions, including optimal dosing and temperature for HIPEC and the impact of including other drugs, such as PARP inhibitors, with this approach, since many of these drugs were not standard of care at the time of the trial.

HIPEC may be a valid choice for patients who are generally healthy and open to a longer procedure and hospital stay. Although the length of surgery plus HIPEC varies, HIPEC generally adds 90 minutes or more to debulking surgery, which itself takes several hours. Also, patients typically require a longer hospital stay for recovery, possibly with intravenous or tube feedings while the digestive system recovers. 

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A Different Chemotherapy Approach for Ovarian Cancer

Stem Cell Therapy: A New Horizon in Breast Cancer Treatment

Breast cancer is one of the most common cancers affecting women worldwide, with millions of new cases diagnosed each year. Despite advances in treatment, it remains a leading cause of cancer-related deaths among women. Traditional treatments such as surgery, chemotherapy, and radiation have improved survival rates, but they often come with significant side effects and may not be effective in all cases, particularly in advanced or metastatic stages of the disease. As the medical community continues to seek more effective and less invasive treatments, stem cell therapy is emerging as a promising frontier in the fight against breast cancer.

Understanding Breast Cancer: A Global Challenge

Breast cancer occurs when cells in the breast tissue grow uncontrollably, forming a tumor that can invade surrounding tissues and spread to other parts of the body. The causes of breast cancer are multifactorial, involving genetic, environmental, and lifestyle factors. Early detection through screening programs like mammography has significantly improved outcomes, but the need for more effective treatments remains critical, especially for patients with aggressive or resistant forms of the disease.

Traditional treatments, while often life-saving, can have significant drawbacks. Surgery can be disfiguring and may not completely eliminate the risk of recurrence. Chemotherapy and radiation, although effective at killing cancer cells, also damage healthy cells, leading to side effects like fatigue, hair loss, and compromised immune function. Moreover, some breast cancers do not respond well to these treatments, particularly triple-negative breast cancer, which lacks the hormone receptors targeted by many therapies.

This is where stem cell therapy comes into play—a novel approach that has the potential to revolutionize breast cancer treatment.

Stem Cell Therapy: A New Horizon in Breast Cancer Treatment

Stem cell therapy has garnered significant attention in recent years as a potential game-changer in cancer treatment. Unlike traditional therapies that target the symptoms or manifestations of the disease, stem cell therapy aims to address the underlying causes by regenerating damaged tissues, boosting the immune system, and even targeting cancer stem cells that are believed to drive tumor growth and recurrence.

1. Understanding Stem Cells:

  • Stem cells are unique in their ability to develop into different types of cells in the body. They have the potential to repair or replace damaged tissues and can be used to regenerate healthy tissue in areas affected by cancer.
  • There are two primary types of stem cells relevant to cancer therapy: embryonic stem cells, which can differentiate into any cell type, and adult stem cells, which are more limited but still hold significant therapeutic potential. In breast cancer, researchers are particularly interested in the role of cancer stem cells— a small subset of cells within tumors that are resistant to conventional treatments and are thought to be responsible for relapse and metastasis.

2. The Role of Stem Cells in Breast Cancer:

  • One of the most promising aspects of stem cell therapy in breast cancer is its potential to target cancer stem cells. These cells are thought to be the root cause of tumor growth and metastasis, and they often evade traditional therapies, leading to recurrence. By specifically targeting and eliminating these cells, stem cell therapy could significantly reduce the risk of relapse and improve long-term outcomes.
  • Additionally, stem cell therapy can be used to regenerate healthy tissue damaged by surgery, chemotherapy, or radiation. For example, adipose-derived stem cells (from fat tissue) are being explored for their ability to repair tissue damage after a mastectomy or lumpectomy, improving cosmetic outcomes and reducing the need for additional surgeries.

3. Current Research and Clinical Trials:

  • While stem cell therapy for breast cancer is still in its early stages, there have been promising developments in both preclinical and clinical research. Clinical trials are currently underway to evaluate the safety and efficacy of various stem cell-based therapies for breast cancer.
  • One area of focus is the use of mesenchymal stem cells (MSCs), which have shown potential in targeting breast cancer cells and enhancing the effects of chemotherapy. These stem cells can be engineered to deliver anti-cancer drugs directly to tumors, increasing the precision and effectiveness of treatment while minimizing side effects.
  • Another exciting avenue is the use of stem cells in combination with immunotherapy. By enhancing the body’s immune response to cancer, stem cells could help to overcome the immune evasion tactics used by tumors, making immunotherapy more effective.

4. Challenges and Future Directions:

  • Despite the promise of stem cell therapy, there are still significant challenges to overcome. Ensuring the safety of these therapies is paramount, as there is a risk that stem cells could promote tumor growth if not properly controlled. Moreover, the complex nature of cancer stem cells means that therapies must be precisely targeted to avoid unintended consequences.
  • The future of stem cell therapy in breast cancer will likely involve a combination of approaches, integrating stem cells with existing treatments such as chemotherapy, radiation, and immunotherapy. As our understanding of cancer biology continues to grow, so too will the potential of stem cell therapy to provide more effective and less toxic treatment options for breast cancer patients.

    Conclusion: A Promising Future Ahead

    The fight against breast cancer is far from over, but the advent of stem cell therapy offers a new ray of hope. As research continues to advance, this innovative approach could become a cornerstone of breast cancer treatment, offering patients more effective, personalized, and less invasive options. While challenges remain, the potential of stem cell therapy to transform breast cancer care is undeniable, and the ongoing research in this field is something that the medical community and patients alike should watch closely.

    As we move forward, it is essential to continue supporting research and clinical trials that explore the full potential of stem cell therapy in breast cancer. With continued innovation and collaboration, we may one day see a world where breast cancer is not only treatable but curable—thanks in part to the incredible power of stem cells.

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How to Find the Right Oncologist for You

After a cancer diagnosis, it’s one of the most important decisions you’ll make.

After a career as a golf professional in southeastern New Mexico, Doug Lyle, 76, decided he had somewhere better to be than on the course: spending time with his new grandchild. Then this summer, just as he was settling into retirement, he learned he had prostate cancer.

“When you’re first diagnosed, you immediately go to the internet, and you can be overwhelmed in short order,” he said. “The more you read about it, the more complicated it gets.”

One of the first and most important choices he had to make was who his oncologist would be. Many of the two million patients diagnosed with cancer in the United States each year get the news from a primary care doctor. Those patients might accept a referral to an oncologist without question. But research suggests that it’s worth considering the choice closely: It can shape the care you receive, your satisfaction with the treatment and your chances of survival.

Not everyone has a choice of oncologists. There are fewer providers in rural areas, and patients must travel farther to reach them. Insurers may only cover certain clinicians and hospitals. And patients from certain populations have less access to oncologists for a range of reasons, which may affect the care they receive. For example, research suggests that Black and Hispanic women with breast cancer are more likely than white women to experience delays in starting radiotherapy. And Black men with prostate cancer are less likely than white men to receive treatment that’s intended to cure their condition, even when they’re at similar stages of disease.

No matter your circumstances, you should feel empowered to have a say in who treats your cancer.

Ideally, experts said, you’d be able to easily compare doctors’ levels of experience and the outcomes of patients they’ve treated with your same diagnosis. But such apples-to-apples comparisons are not always easy to make. But “right now, there are no publicly available data to help a patient with cancer say, ‘Oh, this is where I want to go,’” said Dr. Nancy Keating, a physician and professor of health care policy and medicine at Harvard Medical School. (And even if there were, apples-to-apples comparisons are not always easy to make, since patient populations vary from one doctor to the next).

Still, there are some accreditations to look for. The National Cancer Institute has given a special designation to 72 cancer centers, which must show they treat patients in accordance with the latest evidence and also conduct research into new therapies. The American College of Surgeons Commission on Cancer has accredited over 1,500 programs that meet certain standards. And the American Society of Clinical Oncology has several certification programs, including a list of 300 practices recognized for their quality and safety.

There are resources to help you search for oncologists, too, including a U.S. News & World Report directory that lets you sort by location, patient reviews and accepted forms of insurance. The consumer research firm Castle Connolly also has a database of doctors who are nominated by their peers and then evaluated for their qualifications, interpersonal skills and more.

Look for an oncologist who frequently treats patients with diagnoses similar to yours. Research has long shown that when doctors perform certain procedures more often, their patients have better outcomes. One study found that patients of surgeons who removed more than 25 lung cancers a year spent less time in the hospital, had a lower risk of infection and were more likely to survive three years without recurrence of disease.

Dr. Timothy Pawlik, the chair of the surgery department at Ohio State University Wexner Medical Center, said he only treats a handful of cancers. “You want someone with depth, not breadth,” Dr. Pawlik said. That way, he explained, “the patient may have a rare cancer, but it’s not rare to that doctor.”

Additionally, everyone else on the care team including the anesthesiologists and nurses, will also be familiar with your particular cancer and treatment.

Your primary care provider may be able to find someone specializing in your diagnosis. Some physicians’ websites will identify sub-specialties, and you can also ask for guidance from patient advocacy groups focused on your type of cancer. When you reach out to a doctor, don’t be shy about asking how many patients with similar cancers they treat per year.

Mr. Lyle hesitated to get a second opinion for fear of offending the first doctor he’d seen. But he ultimately chose to do so, a step many experts recommend. “Medicine is an art, and there are sometimes differences of opinion,” said Karen Knudsen, the chief executive of the American Cancer Society. Weighing those differences can help you make a more informed choice.

If a second physician agrees with your original treatment plan, it can give you more confidence in the approach. Research suggests a second opinion can also lead to clinically meaningful changes in treatment. One 2023 study of 120 cancer patients found that a for a third of patients, a second opinion led to treatment changes that yielded better outcomes. Many had received evidence-based care from their first doctor but decided after a second opinion to scale back treatments that might have been unnecessary and had harmful side effects.

Mr. Lyle said that during his first conversation with a physician, he didn’t know enough to ask the right questions about his diagnosis and newer treatment options. “The fine points, you’re not aware of yet. So you almost need a rehearsal,” he said. (For help with what to ask during an appointment, the National Comprehensive Cancer Network has detailed information about care for many cancers.)

When it is clinically appropriate, some cancer centers now offer second opinions through telehealth. You can call to see if it’s possible to submit your medical records and get a remote consultation.

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