[The treatment of ovarian cancer. Recommendation of the Hungarian Society of Gynaecologic Oncologists]. / A petefészekrák kezelése. A Magyar Nogyógyász Onkológusok Társaságának (MNOT) ajánlása.

In Hungary, there is no actual ovarian cancer guideline, despite this disease being the most lethal gynaecologic cancer. An expert panel was created by the Hungarian Society of Gynaecologic Oncologists to prepare a recommendation for the reatment of ovarian cancer patients. This multidisciplinary expert group worked together during the first trimester of 2022 using the guidelines and recommendations of the European Society of Gynaecologic Oncologists (ESGO) and the European Society for Medical Oncology (ESMO) and created the updated recommendations. This paper presents the recommended surgical and medical treatment of early, advanced stage and recurrent ovarian cancer.

Dual PD-1 and CTLA-4 Checkpoint Blockade Using Balstilimab and Zalifrelimab Combination as Second-Line Treatment for Advanced Cervical Cancer: An Open-Label Phase II Study.

PURPOSE: Balstilimab (antiprogrammed death-1) and zalifrelimab (anticytotoxic T-lymphocyte-associated antigen-4) are two new checkpoint inhibitors emerging as promising investigational agents for the treatment of advanced cervical cancer. This phase II trial (ClinicalTrials.gov identifier: NCT03495882) evaluated the combination of balstilimab plus zalifrelimab in patients with recurrent and/or metastatic cervical cancer who relapsed after prior platinum-based therapy. PATIENTS AND METHODS: Patients were intravenously dosed with balstilimab 3 mg/kg once every 2 weeks and zalifrelimab 1 mg/kg once every 6 weeks, for up to 24 months. The primary end point was objective response rate (ORR, RECIST version 1.1, assessed by independent central review). Secondary end points included duration of response, safety and tolerability, and survival. RESULTS: In total, 155 women (median age, 50 years [range, 24-76 years]) were enrolled and treated with balstilimab plus zalifrelimab; 125 patients had measurable disease at baseline and one prior line of platinum-based therapy in the advanced setting, and these patients constituted the efficacy-evaluable population. The median follow-up was 21 months. The confirmed ORR was 25.6% (95% CI, 18.8 to 33.9), including 10 complete responders and 22 partial responders, with median duration of response not reached (86.5%, 75.5%, and 64.2% at 6, 9, and 12 months, respectively). The ORRs were 32.8% and 9.1% in patients with programmed death ligand-1-positive and programmed death ligand-1-negative tumors, respectively. For patients with squamous cell carcinoma, the ORR was 32.6%. The overall disease control rate was 52% (95% CI, 43.3 to 60.6). Hypothyroidism (14.2%) and hyperthyroidism (7.1%) were the most common immune-mediated adverse events. CONCLUSION: Promising and durable clinical activity, with favorable tolerability, was seen in this largest trial to date evaluating dual programmed death-1/cytotoxic T-lymphocyte-associated antigen-4 blockade in patients with recurrent and/or metastatic cervical cancer. Further investigation of the balstilimab and zalifrelimab combination in this setting is continuing.

[Results of docetaxel therapy in patients with relapsed ovarian cancer]. / A kiújult petefészekrákos betegekben alkalmazott docetaxel kezelés eredményei.

UNLABELLED: Successful treatment of relapsed ovarian cancer has not been solved. Docetaxel, being one of the medicines of special interest in Hungary from 2002, has been ranked with the other well known treatment forms. In this study the authors evaluated the results of the docetaxel-carboplatin combination treatment in two oncological centers. MATERIAL AND METHODS: Sixteen patients with relapsed ovarian cancer, premedicated with steroids, were given docetaxel-carboplatin chemotherapy at a dose of 75 mg/m2 and AUC 5 in 94 courses at the Gynecological Dept., National Institute of Oncology and Oncotherapeutic Clinic of Szeged University. Median of courses was 6 (range: 2 to 15). RESULTS: CR was found in 1, PR in 4 and PD in 5 patients. Six patients showed stable disease. There was no need for dose reduction. The authors observed no extreme side effects (this evaluation does not contain the data of a patient who refused chemotherapy because of the development of hypersensitivity reaction). Almost all patients developed reversible alopecia. The probability of freedom from progression dropped to 50% 5 months after the beginning of treatment. CONCLUSION: Docetaxel has expanded the chemotherapeutic arsenal in relapsed ovarian cancer. Our results are in harmony with those reported in the literature on other drugs or combination treatments. Further trials are required to improve the effectiveness of chemotherapy.

Does increasing the steroid dose enhance the efficacy of the antiemetic combination of granisetron and methylprednisolone in gynecologic cancer patients--a randomized study.

OBJECTIVE: The authors administered two doses of oral methylprednisolone in combination with 3mg granisetron intravenously for the prophylaxis of cisplatin-induced emesis in gynecologic cancer patients. MATERIALS AND METHODS: Thirty-nine patients received 100mg (group A) and 25 received 200mg (group B) methylprednisolone in the antiemetic combination in a randomized prospective trial. RESULTS: No vomiting in 90.2 and 96.7%, one emetic episode in 3 and 1.1% and two episodes in 3 and 2.2% were detected in groups A and B, respectively. More than two emetic episodes were considered to be a failure and were observed only in group A (3.8%). There was no significant difference between the two treatment groups (P=0.3160). CONCLUSIONS: There was no evidence for enhanced antiemetic effect of elevated steroidal dose in combination with granisetron.

[Reinduction of paclitaxel therapy after a successfully treated hypersensitivity reaction]. / Paclitaxel-kezelés sikeres újraindítása (reindukciója) hiperszenzitív reakció ellátását követóen.

INTRODUCTION: Paclitaxel containing chemotherapy is considered to be the first-line adjuvant treatment of epithelial ovarian cancers. Hypersensitive reaction is its most serious side effect including hypotension, respiratory distress, extensive urticaria or an intense cardiotoxicity. Due to these signs several physicians abandon of the otherwise hopeful chemotherapy. AIM: Having ceased the hypersensitive reaction one could successfully re-induct paclitaxel therapy after a repeated premedication course. METHOD: A slow paclitaxel infusion rate with a 1/20 dose of the original concentration was administered for reinduction therapy when the patient became symptom-free after treatment with steroid and antihistamines. RESULT: Paclitaxel treatment was uneventfully instituted after reinduction as hypersensitivity has not been developed again. CONCLUSION: According to the authors in case of hypersensitive reaction you need not abandon the otherwise effective paclitaxel treatment: it is worthy to institute the reinduction therapy.

[Early results of topotecan therapy in patients with recurrent ovarian cancer]. / Kiújult petefészekrák topotecankezelésével szerzett korai tapasztalatok.

INTRODUCTION: Topotecan inhibits the topoisomerase-I enzyme resulting its stabilisation on the DNA and the suspension of replication and transcription. AIMS: The authors summarized their first experience on second-line topotecan treatment in a prospective non-randomized study. METHOD: Topotecan was given for recurrent epithelial ovarian cancer in the dose of 1.5 mg/m2/d for 5 days repeated in every 3 weeks in a 30-minute infusion intravenously. RESULTS: Twenty five recurrent ovarian cancer patients were treated between March, 1999 and March, 2001. Complete and partial response rates were found 12% and 12%, respectively. Stable disease was observed in 48% of patients for 4-8 courses, then progression continued. In these 3 groups of patients the median progression free interval was shown as 12 weeks. CONCLUSION: When comparing to previous chemotherapies, topotecan treatment failed to show a definitive improvement in the outcome of recurrent ovarian cancer.