Abstract B51: Management of ascites via the alfa-pump closed system in platinum-resistant-ovarian-cancer (PROC): A model of sequential non-invasive tumor-cell sampling through the urinary bladder

Abstract

Abstract Background: Malignant ascites in PROC is a therapeutic dilemma. The Sequana-Medical alfapump-System (AP), a remotely controlled device connecting the patients'peritoneal cavity to their urinary bladder, has been evaluated for ascites in liver cirrhosis, but not as yet for malignant ascites. Methods: We implanted the AP in the peritoneal cavity of two heavily pretreated PROC-patients (67y and 70y) who required repetitive ascites drainages monthly. We cross correlated the electronic download of recorded volume pumped (intraperitoneally→bladder) with weekly ultrasound, monthly cystoscopies and QoL-evaluation. Early morning urine for evaluation of cytology and tumor-cell molecular analysis was collected weekly. Results: The implantation was under general anesthesia in a 60- and 35-minute procedure. The pump, draining 350ml – 500ml ascites/day successfully drained the ascites to dryness after 3 days (1stpatient) and 8 days (2ndpatient). The patients did not report pollakiuria or dysuria, merely an increased micturition volume. The 1st patient died of disease progression 2 months later; the 2nd patient we noticed a gradual amelioration of peripheral edemas and overall performance-status within 3 weeks after insertion and was able to commence weekly chemotherapy with paclitaxel. Histopathological analysis of the urine revealed rich malignant cell content; this was used to create FFPE-cell-blocks for molecular- pathological profiling with sequential Caris-Target-Now-analysis and full exome-sequencing. QoL as measured by the EORTC QlQ-C30 and EORTC QLQ-OV28 showed high interindividual differences and only minimal influence by the pump. Conclusion: This innovative approach addresses an area of unmet need for the control of malignant ascites and provides a non-invasive method of collecting tumor tissue for continuous molecular tumor characterization. A EUTROC-multicenter randomized-trial (AMAZE) is planned for evaluation of clinical and translational implications in PROC. Citation Format: Christina Fotopoulou, Laura Spiers, Delali Adjogatse, Emily Pickford, Roberto Dina, Sara Blagden, Nagy Habib, Hani Gabra. Management of ascites via the alfa-pump closed system in platinum-resistant-ovarian-cancer (PROC): A model of sequential non-invasive tumor-cell sampling through the urinary bladder. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: From Concept to Clinic; Sep 18-21, 2013; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2013;19(19 Suppl):Abstract nr B51.