Neoadjuvant chemotherapy followed by interval debulking surgery for advanced epithelial ovarian cancer: GOTIC-019 study.

INTRODUCTION: Three randomized controlled trials have resulted in extremely extensive application of the strategy of using neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS) for patients with advanced epithelial ovarian cancer in Japan. This study aimed to evaluate the status and effectiveness of treatment strategies using NAC followed by IDS in Japanese clinical practice. PATIENTS AND METHODS: We conducted a multi-institutional observational study of 940 women with Federation of Gynecology and Obstetrics (FIGO) stages III-IV epithelial ovarian cancer treated at one of nine centers between 2010 and 2015. Progression-free survival (PFS) and overall survival (OS) were compared between 486 propensity-score matched participants who underwent NAC followed by IDS and primary debulking surgery (PDS) followed by adjuvant chemotherapy. RESULTS: Patients with FIGO stage IIIC receiving NAC had a shorter OS (median OS: 48.1 vs. 68.2 months, hazard ratio [HR]: 1.34; 95% confidence interval [CI] 0.99-1.82, p = 0.06) but not PFS (median PFS: 19.7 vs. 19.4 months, HR: 1.02; 95% CI: 0.80-1.31, p = 0.88). However, patients with FIGO stage IV receiving NAC and PDS had comparable PFS (median PFS: 16.6 vs. 14.7 months, HR: 1.07 95% CI: 0.74-1.53, p = 0.73) and OS (median PFS: 45.2 vs. 35.7 months, HR: 0.98; 95% CI: 0.65-1.47, p = 0.93). CONCLUSIONS: NAC followed by IDS did not improve survival. In patients with FIGO stage IIIC, NAC may be associated with a shorter OS.

Clinical features of gestational thrombocytopenia difficult to differentiate from immune thrombocytopenia diagnosed during pregnancy.

AIM: To investigate the clinical features of gestational thrombocytopenia (GT) difficult to differentiate from immune thrombocytopenia (ITP) during pregnancy. METHODS: The January 2000-December 2012 hospital database was analyzed to identify women with ITP or GT (after excluding other possible causes of thrombocytopenia) among those first noted to have platelet counts of less than 100 000/µL during pregnancy. The maternal characteristics, platelet count fluctuations and pregnancy outcomes were compared between women with ITP and GT. RESULTS: There were 23 pregnancies (22 women) with thrombocytopenia (GT, 13; ITP, 10). The GT group included five twin pregnancies (38.5%), whereas all pregnancies of the ITP group were singleton pregnancies, with significantly more twin pregnancies in the GT group (P = 0.046). Thrombocytopenia in the first trimester occurred in 70% (7/10) of ITP cases and 23.1% (3/13) of even GT cases. The nadir platelet count was less than 70 000/µL in 100% (10/10) of ITP cases and 30.8% (4/13) of GT cases (P < 0.001). Maternal treatment was required in 80% (8/10) of ITP cases, but in none of the GT cases. The pregnancy outcomes were favorable in both groups, and no case required fetal treatment. CONCLUSION: Gestational thrombocytopenia with platelet counts of less than 10 0000/µL occurred more frequently in twin pregnancies. Although onset of thrombocytopenia in the first trimester and a platelet count of less than 70 000/µL is more common in ITP, these findings were not uncommon in GT. Differentiation between ITP and GT may be feasible only with post-partum changes in the platelet count.

Two cases showing the effects of bevacizumab on recurrent cervical cancer with pleural effusion.

The survival rate and quality of life of patients with recurrent cervical cancer and pleural effusion had been extremely poor until bevacizumab was approved. We report two cases of recurrent cervical cancer with remarkably decreased pleural effusion and a long survival rate after combination chemotherapy with bevacizumab. Case 1: A patient was diagnosed with stage IIB cervical adenocarcinoma and treated with concurrent chemoradiotherapy (CCRT), total hysterectomy, and paclitaxel/carboplatin (TC) therapy as the primary treatment. After the first recurrence had been treated with irinotecan-cisplatin therapy and radiotherapy, symptomatic pleural effusion emerged. Paclitaxel-cisplatin-bevacizumab (Pac-Cis-Bev) was administered during 13 cycles of chemotherapy to promptly relieve pleural effusion, respiratory distress, and back pain. She survived for more than a year and a half after starting Pac-Cis-Bev therapy. Case 2: A patient was diagnosed with stage IIIB cervical squamous cell carcinoma and pulmonary recurrence after CCRT. After 21 cycles of TC or Pac-Cis-Bev therapy, pleural effusion emerged. Topotecan-paclitaxel-bevacizumab (Topo-Pac-Bev) was administered for 12 cycles. Respiratory distress was relieved in 2 weeks and pleural effusion almost completely resolved after 2 months. We changed the treatment to ifosfamide and nedaplatin as pleural effusion exacerbated. However, this treatment was not effective; hence the patient was rechallenged with Topo-Pac-Bev therapy. Six cycles of Topo-Pac-Bev rechallenge therapy effectively suppressed pleural effusion. She survived for 2 years after pleural effusion appeared. Chemotherapy with bevacizumab is useful for both symptom relief and improvement in prognosis in patients with recurrent cervical cancer, despite being in the late phase.

Identification of R(-)-isomer of efonidipine as a selective blocker of T-type Ca2+ channels.

Efonidipine, a derivative of dihydropyridine Ca(2+) antagonist, is known to block both L- and T-type Ca(2+) channels. It remains to be clarified, however, whether efonidipine affects other voltage-dependent Ca(2+) channel subtypes such as N-, P/Q- and R-types, and whether the optical isomers of efonidipine have different selectivities in blocking these Ca(2+) channels, including L- and T-types. To address these issues, the effects of efonidipine and its R(-)- and S(+)-isomers on these Ca(2+) channel subtypes were examined electrophysiologically in the expression systems using Xenopus oocytes and baby hamster kidney cells (BHK tk-ts13). Efonidipine, a mixture of R(-)- and S(+)-isomers, exerted blocking actions on L- and T-types, but no effects on N-, P/Q- and R-type Ca(2+) channels. The selective blocking actions on L- and T-type channels were reproduced by the S(+)-efonidipine isomer. By contrast, the R(-)-efonidipine isomer preferentially blocked T-type channels. The blocking actions of efonidipine and its enantiomers were dependent on holding potentials. These findings indicate that the R(-)-isomer of efonidipine is a specific blocker of the T-type Ca(2+) channel.