Primary Peritoneal Adenocarcinoma Research Articles

Real-world study of bevacizumab treatment in patients with ovarian cancer: a Chinese single-institution study of 155 patients

ObjectiveThe purpose of this study was to retrospectively assess the pattern, compliance, efficacy and safety of bevacizumab in Chinese ovarian cancer patients.MethodsWe reviewed the clinicopathological data of patients with histologically confirmed epithelial ovarian cancer, fallopian tube cancer and primary peritoneal adenocarcinoma, who were diagnosed and treated at the Department of Gynecologic Oncology of Peking University Cancer Hospital between May 2012 and January 2022.ResultsA total of 155 patients were eventually enrolled in this study, with 77 as first-line chemotherapy (FL) and 78 as recurrence therapy (RT) among which 37 patients were platinum sensitive and 41 were platinum resistant. Among the 77 patients in the FL group, 35 received bevacizumab during neoadjuvant chemotherapy (NACT) alone (NT), 23 received bevacizumab during both neoadjuvant and first-line chemotherapy (NT + FL) and 19 received bevacizumab during first-line chemotherapy alone (FLA). Among the 43 patients of NT and NT + FL groups undergoing interval debulking surgery (IDS), 38(88.4%) patients achieved optimally debulking and 24 (55.8%) patients had no residual disease after IDS. The patients in the FL group had a median progression free survival (PFS) of 15(95%CI: 9.951–20.049) months, and the 12-month PFS was 61.7%. In the RT group, the overall response rate (ORR) was 53.8%. According to multivariate analysis, the patients' platinum sensitivity had a significant impact on the PFS in the RT group. 13(8.4%) patients discontinued bevacizumab due to toxicity. Seven patients were in the FL group while 4 patients were in the RT group. The most common adverse event associated with bevacizumab therapy was hypertension.ConclusionBevacizumab is effective and well-tolerated in the real world setting of ovarian cancer treatment. Adding bevacizumab to NACT is feasible and tolerable. Receiving the regimen containing bevacizumab in the last preoperative chemotherapy did not result in increased intraoperative bleeding of IDS. Platinum sensitivity is the most important factor affecting the effectiveness of bevacizumab in recurrent patients.

LBA32 Principal results of the EORTC-1508 trial: A phase II randomised, multicentre study of bevacizumab vs atezolizumab and bevacizumab with acetylsalicylic acid or placebo in recurrent platinum-resistant ovarian, fallopian tube or primary peritoneal adenocarcinoma

Anti-PD-1/L1 therapy alone has limited activity in ovarian cancer. We hypothesised that blockade of VEGF and prostaglandin E2 (PGE2) can reverse the endothelial barrier allowing T cell infiltration and subsequent T cell activation by PD-L1 blockade. This is the first trial combining an anti-PD-L1 antibody, atezolizumab (ATE), with bevacizumab (BEV) and the irreversible COX1/2 inhibitor acetylsalicylic acid (ASA).

INDEPENDENT PERITONEAL CANCER, NEARLY MISSED AS A METASTASIS FROM LUNG CANCER

SESSION TITLE: Medical Student/Resident Lung Cancer Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Lung carcinoma is the leading cause of cancer-related mortality and nearly 50% of cases exhibit distal metastasis at the time of diagnosis. The most common sites of metastasis are brain, spine, nerve, adrenal gland, bone, liver, pleura, but rarely involves the peritoneum.[1] Peritoneal involvement in lung cancer is assumed to be due to metastasis from primary lung cancer. The occurrence of primary peritoneal adenocarcinoma and lung cancer together in one person is uncommon and difficult to distinguish from the metastatic spread. [2] CASE PRESENTATION: A 73-year-old female, smoker of 30 pack-year, presented with symptoms of abdominal bloating, distension, and loss of appetite. Computed tomography(CT) chest, abdomen, and pelvis showed moderate abdominal ascites consistent with peritoneal carcinomatosis, along with a 4.3 cm mass in the left lower lobe of the lung and 1.1 cm left-sided mediastinal lymph node. Paracentesis with ascitic fluid analysis was positive for adenocarcinoma. [Picture 1] She underwent endobronchial ultrasound with biopsy with immunohistochemistry staining which showed poorly differentiated squamous cell carcinoma [Picture 2]. Metastatic workup with a magnetic resonance imaging(MRI) of the brain was negative. Positron emission tomography-computed tomography scan showed a Fluorodeoxyglucose avid left lower lobe lung lesion with hilar and subcarinal adenopathy, consistent with primary lung malignancy. Pelvic ultrasound showed enlarged uterus secondary to multiple intramural fibroids. Labs showed Carcinoembryonic antigen level 1.2 and Alpha-fetoprotein 1.6. Oncology planned to start on carboplatin and paclitaxel along with pembrolizumab every 3 weeks for 4 cycles, followed by maintenance therapy with pembrolizumab every 3 weeks. She reported improvement in the abdominal bloating with the removal of 2-3 liter of peritoneal fluid weekly and symptomatic treatment. The patient continued to feel excessively tired and deteriorated within a few weeks. Unfortunately, the patient passed away before the start of the treatment. DISCUSSION: Peritoneal metastasis of primary lung carcinoma is very rare, only present in 2.7–16% of all lung cancer patients.[3] Advanced stage IV non-small cell lung cancer (NSCLC) and peritoneal adenocarcinoma can present in the same patient together, like in our case, which can be easily missed assuming it as metastatic cancer. Management of two separate cancers requires individualized treatment plans dissimilar to standard practices in the setting of a single tumor. A 1-year survival rate after cytotoxic chemotherapy is only 29% in patients with advanced NSCLC hence priority must be given to the treatment regimen that improves symptoms and prolongs survival. CONCLUSIONS: Therefore, one should always be suspicious and more effort should be made to improve the diagnostic approach and management to rule out any other underlying malignancy. Reference #1: McNeill PM, Wagman LD, Neifeld JP. Small bowel metastases from primary carcinoma of the lung. Cancer. 1987;59:1486–1489. Reference #2: MARÍA SERENO,1. Lung cancer and peritoneal carcinomatosis. Oncol Lett. 2013 Sep; 6(3): 705–708 Reference #3: Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer. 1950;3:74–85. DISCLOSURES: No relevant relationships by Mary Grace Bethala, source=Web Response No relevant relationships by Apurwa Karki, source=Web Response No relevant relationships by Salman Khan, source=Web Response No relevant relationships by Shobha Mandal, source=Web Response

An unusual case of primary peritoneal adenocarcinoma

Primary peritoneal adenocarcinoma is sporadic with few cases cited in pre-existing literature. This cancer arises from the peritoneal epithelium lining of the abdomen, which is derived from extra ovarian mesothelium. It generally carries a poor prognosis. The treatment strategies are similar to ovarian serous papillary carcinoma. Report an incidental finding of primary peritoneal adenocarcinoma in a 39-year-old female army personnel, currently undergoing her chemotherapy and thriving. Exploratory laparotomy was done given the incidental finding of a mass on the contrast-enhanced computed tomography scan (CT). The mass was attached to the greater omentum, however, did not invade the mucosa of the transverse colon. Given this, part of greater omentum was removed. The findings of the immunohistochemical studies of the tumour are described within this report. The diagnosis of a primary peritoneal adenocarcinoma, stage II was established as no other primary site were found upon further investigation. The patient was treated with chemotherapy (carboplatin/paclitaxel) which was planned for 6 cycles. Otherwise, the patient had an uneventful postoperative course, is underway her chemotherapy regime and is planned for interim CT study to assess chemotherapy response. To conclude, isolated solitary primary peritoneal adenocarcinoma without peritoneal carcinomatosis, gastrointestinal manifestations and ascites are rare. This case, however, demonstrates the importance of its diagnosis, accurate evaluation and management.

PET/CT 18F-FDG en carcinomatosis peritoneal: revisión de la fisiopatología y presentación de dos casos

Peritoneal carcinomatosis is the dissemination or extension in the peritoneal cavity of a cancer originated in some organ or abdominal viscera, generally associated with digestive or gynaecological neoplasms. It can also occur in primary form, as in mesothelioma and primary peritoneal adenocarcinoma. Anatomical images are essential for the evaluation of peritoneal seeding, but small neoplastic implants can be difficult to detect with CT or MR imaging. PET/CT 18F-FDG can improve the detection of peritoneal metastases. It is indicated in patients with elevated tumour markers, with negative or inconclusive anatomical images, and in patients selected for complete debulking. PET/CT 18F-FDG adds to conventional images in the detection and staging of peritoneal carcinomatosis, and is a useful diagnostic tool in monitoring the response to therapy and in long-term follow-up.

Long-term survival of high-grade primary peritoneal papillary serous adenocarcinoma: a case report and literature review

BackgroundPrimary peritoneal papillary serous carcinoma (PPPSC) is an uncommon disease which has a high malignancy and a poor prognosis.Case presentationWe report here a long-term survival case of PPPSC with postoperative lung metastasis. A 62-year-old female patient with PPPSC was administered two cycles of neoadjuvant chemotherapy (NAC) followed by cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) and six cycles of platinum-based (docetaxel + carboplatin) intraperitoneal chemotherapy postoperatively. The patient reached a complete remission at the completion of primary treatment. Malignant thoracic effusion and lung metastasis developed 5 months after the treatment. The patient underwent video-assisted thoracoscopic surgery plus hyperthermic intrapleural chemotherapy.ConclusionsUp to present, the patient has been survived with tumor for over 86 months with a good performance status, with only encapsulated effusion found at the latest follow-up. As a relatively new regime, the application of CRS + HIPEC in our patient has been proved example for MPE management, although more large-scale studies are needed to substantiate its efficiency and safety.

A Rare Case of Metastatic Primary Peritoneal Adenocarcinoma presenting as Breast Cancer

Metastasis to the breast as a presenting feature of extra mammary malignancy is extremely uncommon. Often in this setting, the distinction between primary and secondary breast malignancy can be challenging. Ovarian or primary peritoneal metastasis to the breast is suggestive of disseminated disease and associated with a guarded prognosis, thus accurate differentiation is crucial for early and appropriate intervention. We report the case of a patient presenting with what initially appeared to be locally advanced breast cancer but subsequent review of pathology and imaging confirmed the presence of metastatic primary peritoneal cancer.

A Rare Case of Metastatic Primary Peritoneal Adenocarcinoma Presenting as Breast Cancer

Metastasis to the breast as a presenting feature of extramammary malignancy is extremely uncommon. Often in this setting, the distinction between primary and secondary breast malignancy can be challenging. Ovarian or primary peritoneal metastasis to the breast is suggestive of disseminated disease and associated with a guarded prognosis, thus accurate differentiation is crucial for early and appropriate intervention. We report the case of a patient presenting with what initially appeared to be locally advanced breast cancer but subsequent review of pathology and imaging confirmed the presence of metastatic primary peritoneal cancer.

Primary Papillary Serous Carcinoma of the Peritoneum

Primary papillary serous carcinoma of peritoneum (PPSCP) is a rare type of primary peritoneal adenocarcinoma and is clinico-histopathologically indistinguishable from primary ovarian papillary serous carcinoma. A 70 -year- female presented with pain abdomen of 4 months duration. On examination partially mobile vague mass was present in the suprapubic region. Exploratory laparotomy revealed normal right ovary and the left ovary showed simple cyst. Nodular, firm tumour was seen arising from omentum and measured 20x13x9.3 cm. Microscopically tumour was composed of large sheets of polygonal cells having large hyperchromatic and pleomorphic nuclei and moderate amount of eosinophilic cytoplasm forming cribriform pattern and papillae. It has similar prognosis as that of ovarian malignancy. This case of extraovarian papillary serous carcinoma of peritoneum (EPSCP) is presented here for its rarity.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 60-62 DOI: http://dx.doi.org/10.3126/njog.v8i2.9774

Outcomes with Single Agent LIPO-DOX in Platinum-Resistant Ovarian and Fallopian Tube Cancers and Primary Peritoneal Adenocarcinoma - Chiang Mai University Hospital Experience

Single pegylated liposomal doxorubicin (PLD) is commonly used as a salvage treatment in platinum-resistant ovarian cancer, fallopian tube cancer and primary peritoneal adenocarcinoma (PPA) with a satisfactory outcome. However, the data for second generation PLD administered in this setting are still limited. We conducted a retrospective study to evaluate the outcome of patients who received single-agent second generation PLD (LIPO-DOX) after the development of clinical platinum resistance. The study period was between March 2008 and March 2013. LIPO-DOX was administered intravenously 40 mg/m2 every 28 days until disease progression, but for not more than six cycles. The response rate was evaluated using the Gynecologic Cancer Intergroup (GCIG) criteria while the toxicity was evaluated according to WHO criteria. Twenty-nine patients met the inclusion criteria in the study period with an overall response rate of 13.8%. The median progression free survival and overall survival were three and eleven months, respectively. With the total of 96 cycles of chemotherapy, the patients developed grades 3 and 4 hematologic toxicity as follows: anemia, 0%, leukopenia, 9.6%, neutropenia, 32.3% and thrombocytopenia, 0%. In conclusion, the single agent second generation PLD demonstrated modest efficacy in patients with platinum-resistant ovarian cancer, fallopian tube cancer and PPA without serious toxicity.

Surgical Approach Including Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Patients with Peritoneal Metastasis

Background: Peritoneal metastasis arising from colorectal cancer, appendiceal cancer, gastric cancer and gynecologic malignancies, or primary peritoneal surface malignancies such as peritoneal mesothelioma and primary peritoneal adenocarcinoma may be efficiently treated by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in selected patients. Method: CRS is based on the technique of parietal and visceral peritonectomy and consists of multiple surgical procedures. HIPEC combines high local doses of cytostatics with the additional cytotoxic effects of hyperthermia. Results: The goal of CRS is to achieve a complete macroscopic cytoreduction (CC-0/1) as a precondition for consecutive HIPEC that should destroy residual tumor cells within the abdominal cavity. Conclusion: CRS and HIPEC can be performed with acceptable morbidity and low mortality in specialized centers. However, due to long learning curves, consistent surgical training is strongly recommended.

Outcome of Single Agent Generic Gemcitabine in Platinum-Resistant Ovarian Cancer, Fallopian Tube Cancer and Primary Peritoneal Adenocarcinoma

Single original gemcitabine is commonly used as salvage treatment in platinum-resistant ovarian cancer, fallopian tube cancer and primary peritoneal adenocarcinoma (PPA) with a satisfactory outcome. However, efficacy data fro this regimen are limited. We therefore conducted a retrospective study to evaluate the outcome of patients who received single-agent generic gemcitabine (GEMITA) after development of clinical platinum resistance. The study period was between May 2008 and December 2010. Gemcitabine was administered intravenously in two different schedules: 1,000 mg/m2 on day 1,8, and 15 every 28 days; and on days 1 and 8 every 21 days with the same dosage. Administration was until disease progression was noted. The response rate was evaluated using the Gynecologic Cancer Intergroup (GCIG ) criteria while toxicity was evaluated according to WHO criteria. Sixty-six patients met the inclusion criteria in the study period. Two-thirds of them received gemcitabine as the second and third line regimen. The overall response rate was 12.1%. The median progression free survival and overall survival was 2 and 10 months, respectively. With the total 550 courses of chemotherapy, the patients developed grades 3 and 4 hematologic toxicity as follows: anemia, 1.5%; leukopenia, 13.7%; neutropenia, 27.3%; and thrombocytopenia, 3.0%. In conclusion, single agent generic gemcitabine revealed a modest efficacy in patients with platinum-resistant ovarian cancer, fallopian tube cancer and PPA without serious toxicity.

Port-site metastasis of advanced primary peritoneal cancer after laparoscopic peritoneal biopsy: A case report

Due to the advancement in laparoscopic surgery in gynecology, laparoscopic surgery of patients with gynecologic malignancy is widely used. A 69-year-old woman who had elevated serum level of CA-125 and malignant ascites was transferred from general surgery after laparoscopic peritoneal biopsy. She complained about 2.5 cm sized abdominal wall mass which developed only 1week after surgery. With the impression of ovarian cancer with port-site metastasis, we performed debulking operation and abdominal wall mass excision. The final pathology confirmed primary peritoneal serous papillary adenocarcinoma. Whenever a female patient has elevated serum level of CA-125 and ascites cytology shows adenocarcinoma, she should be referred to gynecologic oncologists fiAnd considering the primary peritoneal or ovarian cancer, primary debulking operation by gynecologic oncolog ist is recommended.

Colonic or coelomic?

In June, 2007, a 47-year-old woman of Irish descent presented with rectal bleeding, decreased appetite, weight loss, and decreased calibre of her stool. Her family history was signifi cant for reported, but unconfi rmed, early-onset colon cancer in three male and female fi rst-degree and second-degree relatives. Colonoscopy in May, 2006, had shown no abnormalities. Current colonoscopy showed an area of fi rm bulging with oedematous mucosa in the upper rectum. Biopsy showed small fragments of poorly diff erentiated invasive adenocarcinoma (fi gure A). MRI showed a 5·7 cm mass in the posterior wall of the rectosigmoid (fi gure B), with perirectal fat infi ltration and involvement of lymph nodes. Narrowing of the rectosigmoid lumen was seen, but the tumour seemed to be growing by extension into the perirectal fat rather than into the intestinal lumen. Endoscopic ultrasonography confi rmed these fi ndings. The staging was T3/T4 N1 M0, and the patient received neoadjuvant chemoradiation treatment, before undergoing a low anterior resection and diverting ileostomy in February, 2008. A six-cycle regimen of FOLFOX adjuvant chemotherapy was initiated. The pathological diagnosis was a pleiomorphic poorly diff erentiated adenocarcinoma involving the rectosigmoid colon. However, there was no defi nite origin from the colonic mucosal surface and highly bizarre cells with atypical mitotic activity were present. The immunohistochemistry profi le was CK7+, CK20–, CA-125+, ER+, CEA–, CDX2–, WT-1+, which raised the possibility of a gynaecological cancer. The presentation, location, and pathological fi ndings all suggested the diagnosis of a primary serous carcinoma arising from the visceral coelomic peritoneum or, less likely, a metastatic serous ovarian carcinoma, rather than rectal cancer. The patient underwent a subtotal abdominal hysterectomy with bilateral salpingo-oophorectomy in September, 2008. The pathology report mentioned only a few microscopic foci of high-grade serous carcinoma on the left paratubal and superfi cial cortex of the left ovary. These fi ndings were consistent with the fi nal pathological diagnosis of primary peritoneal serous adenocarcinoma. Given this diagnosis, genetic testing was done, showing a deleterious BRCA1 mutation, c.427 G>T, resulting in E143X, previously reported in Ireland. Our patient received three cycles of carboplatin and paclitaxel starting in December, 2008, and was in complete remission in February, 2010. Primary peritoneal adenocarcinoma, like ovarian cancer, often presents with non-specifi c gastrointestinal symptoms. A high degree of suspicion is needed for prompt identifi cation of this entity. In our case, as previously reported, the patient presented with symptoms of rectal bleeding and altered bowel habit, which are both suggestive of colorectal cancer. Also, secondary involvement of the colon by peritoneal carcinoma can mimic the colonoscopic appearance of a primary colon carcinoma—even modern imaging modalities cannot always distinguish between these two entities. An initial small biopsy showing “poorly diff erentiated adenocarcinoma” can, in the clinical context, be easily overlooked and interpreted as a primary cancer of the rectum if no immunohistochemistry is done. Any doubt, or presence of atypical morphologic features, should prompt careful pathological review and immunohistochemical assess ment. Notably, primary peritoneal serous adeno carcinoma is histologically and immunohisto chemically indis tinguish able from primary ovarian serous adeno carcinoma, and primary ovarian cancer must be excluded to establish the diagnosis. About 20% of women diagnosed with ovarian carcinoma at age 40–50 years carry a BRCA germline mutation. Female BRCA mutation carriers are also at a high risk for primary peritoneal carcinoma. Unusual presentations can delay the prompt identifi cation and appropriate management of this cancer.

Clinicopathological analysis and differential diagnosis of primary peritoneal adenocarcinoma

To investigate the clinicopathological characteristics and differential diagnosis of primary peritoneal adenocarcinoma. The clinico-pathological data of 8 patients with primary peritoneal adenocarcinoma, all female, aged 55.7 (45 - 69), were analyzed retrospectively. Immunohistochemistry was used to detect the expression of pan-cytokine, cytokine (CK) 7, CK20, CA125, CEA, epithelial membrane antigen (EMA), vimentin, calretinin, and P63 in the specimens of tumor obtained during tumor reduction surgery. Microscopy was conducted for pathological examination. The common clinical symptoms of these 8 patients included abdominal distention and ascites. Pre-operationally, 6 cases were diagnosed as with ovarian cancer, I case as with malignant mesothelioma, and I as with peritoneal carcinoma. The misdiagnosis rate was 87.5%. Post-operational pathological examination showed 7 cases of serous papillary adenocarcinoma and one case of mucinous adenocarcinoma. Immunohistochemistry showed the positive rates of the different biological markers as follows: pan-CK (8/8), CK7 (8/8), CK20 (1/8), CA125 (7/8), CEA (7/8), EMA (8/8), vimentin (1/8), calretinin (1/8), and P53 (8/8). A rare malignant tumor arising from the secondary Müllerian system, primary peritoneal adenocarcinoma shares similar histopathological characters with ovary carcinoma, so is easy to be misdiagnosed. Immunohistochemical staining is helpful to the differential diagnosis.

Combined pegylated liposomal doxorubicin and carboplatin in the treatment of recurrent epithelial ovarian cancer

To evaluate the efficacy and toxicity of combined pegylated liposomal doxorubicin (PLD) and carboplatin in the treatment of patients with recurrent epithelial ovarian cancer. We retrospectively reviewed 67 patients with recurrent epithelial ovarian cancer or primary peritoneal adenocarcinoma (8 cases) who were treated with combined PLD and carboplatin. The response rate, survival and toxicity were evaluated. The mean age for 67 patients was 52.1 (39 - 76) years. All of them received cytoreductive surgery followed by platinum-based chemotherapy either with paclitaxel or cyclophosphamide and doxorubicin after diagnosis. Combined PLD and carboplatin was used as first or second-line treatment or even after multiple lines of treatment after disease recurred. Patients were treated with PLD at 35 - 40 mg/m(2) combined with carboplatin at an area under curve (AUC) of 5 once every 4 weeks. Forty-nine patients were evaluable for response. Twenty-three (47%) patients had a complete response, 13 (27%) had a partial response, 3 (6%) had stable disease and 10 (20%) had progressive disease. The estimated median progression-free survival (PFS) was 8 months. The 1-year and 2-year survival rates were 73% and 55%, respectively. All of the 67 patients were evaluated for toxicity. The treatment was terminated in 2 patients due to allergic-like infusion reaction. Four patients who had acute infusion reaction with shortness of breath and tightness of chest did not terminate the treatment because no such reaction occurred when restarted the infusion. There were 2 patients with G(2) and 3 patients with G(3) hand-foot syndrome, 2 patients had G(4) stomatitis, and 8 patients had G(3) leukopenia. No G(4) leukopenia or cardiotoxicity occurred. The combination of PLD and carboplatin is an active and well-tolerated regimen in the treatment of patients with recurrent epithelial ovarian cancer.

A Huge Primary Peritoneal Papillary Adenocarcinoma Which Demonstrated Imaging Findings Similar to Those of Extrahepatic-Growing Type Hepatic Tumor: Report of a Case

We herein report a 69-year-old woman who presented with a huge intra-abdominal tumor which demonstrated imaging findings similar to those of extrahepatic-growing type hepatic tumor, but turned out to be primary peritoneal papillary adenocarcinoma. Computed tomography showed a well-demarcated mass, measuring 12.0 cm in diameter, which came in contact with the lateral segment of the liver and invaded the diaphragm and abdominal wall. Distant lymph node metastasis was also detected. A fine-needle aspiration biopsy of the tumor showed poorly differentiated adenocarcinoma of unknown origin. After chemotherapy with 5-fluorouracil and cisplatin, the maximal diameter of the tumor decreased to 6.0 cm. The patient then underwent a tumorectomy together with a lateral segmentectomy of the liver, a splenectomy, a partial resection of the diaphragm and abdominal wall, and a left oophorectomy. Histological and immunohistochemical examinations demonstrated the tumor to be primary peritoneal papillary adenocarcinoma.

Concurrent ovarian-type primary peritoneal adenocarcinoma and peritoneal choriocarcinoma. A case report and review of the literature

Background. Nongestational choriocarcinomas are aggressive tumours occurring either as a global event or as a focal change in solid tumours. The latter is responsible for coexistence of trophoblastic histology with other malignancies. Case. A 65-year old female with stage IV primary peritoneal carcinoma, ovarian type, underwent surgical cytoreduction followed by two courses of paclitaxel/carboplatin chemotherapy. A choriocarcinomatous component was later identified in the resection specimens, as chemotherapy resulted in a differential response of the two malignant variants. Commencement of EMA/CO chemotherapy (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) resulted in symptom palliation and tumour regression, further consolidated with platinum-based EP/EMA (etoposide, cisplatin, methotrexate, actinomycin D). Two months later, relentless choriocarcinomatous disease progression followed, leading to the patient's death while the peritoneal adenocarcinomatous variant remained biochemically quiescent. Conclusion. Choriocarcinomas may coexist with typical ovarian-type peritoneal cancer, creating diagnostic and therapeutic dilemmas. Aggressive weekly chorio-type chemotherapy appears to be warranted despite the low likelihood of cure, as it provides significant symptom palliation.

Extreme drug resistance assay and response to chemotherapy in patients with primary peritoneal carcinoma

Background and Objectives The extreme drug resistance (EDR) assay is an in vitro chemoresistance assay performed on tumor samples grown in culture and is claimed to predict drugs unlikely to produce response. Its clinical value in patients with epithelial ovarian cancer (EOC) has recently been questioned. The aim of this study is to describe EDR assay results and responses to chemotherapy among women with primary peritoneal adenocarcinoma (PPA) and to compare them with those of women with EOC. Methods Fresh tumor specimens from 20 consecutive women with PPA were tested for EDR to the following drugs: cisplatin, carboplatin, paclitaxel, doxorubicin, cyclophosphamide, ifosfamide, etoposide, hexamethylmelamine, and topotecan. They were then treated with cisplatin-based combination chemotherapy. The results of the EDR assay and response to chemotherapy were compared with those among women with EOC. Results There was no significant difference in the incidence of EDR to cisplatin, carboplatin, paclitaxel, doxorubicin, cyclophosphamide, ifosfamide, etoposide, hexamethylmelamine, and topotecan among patients with PPA and those with EOC. The response rate of PPA patients to chemotherapy was 80.0% and unrelated to EDR to the individual drugs used in combination chemotherapy. Conclusions The EDR profile and response to cisplatin-based chemotherapy among women with PPA were similar to those among women with EOC. These findings support treating both conditions similarly. EDR to individual drugs does not preclude response to combination chemotherapy. J. Surg. Oncol. 2000;73:148–152. © 2000 Wiley-Liss, Inc.

Extreme drug resistance assay and response to chemotherapy in patients with primary peritoneal carcinoma.

The extreme drug resistance (EDR) assay is an in vitro chemoresistance assay performed on tumor samples grown in culture and is claimed to predict drugs unlikely to produce response. Its clinical value in patients with epithelial ovarian cancer (EOC) has recently been questioned. The aim of this study is to describe EDR assay results and responses to chemotherapy among women with primary peritoneal adenocarcinoma (PPA) and to compare them with those of women with EOC. Fresh tumor specimens from 20 consecutive women with PPA were tested for EDR to the following drugs: cisplatin, carboplatin, paclitaxel, doxorubicin, cyclophosphamide, ifosfamide, etoposide, hexamethylmelamine, and topotecan. They were then treated with cisplatin-based combination chemotherapy. The results of the EDR assay and response to chemotherapy were compared with those among women with EOC. There was no significant difference in the incidence of EDR to cisplatin, carboplatin, paclitaxel, doxorubicin, cyclophosphamide, ifosfamide, etoposide, hexamethylmelamine, and topotecan among patients with PPA and those with EOC. The response rate of PPA patients to chemotherapy was 80.0% and unrelated to EDR to the individual drugs used in combination chemotherapy. The EDR profile and response to cisplatin-based chemotherapy among women with PPA were similar to those among women with EOC. These findings support treating both conditions similarly. EDR to individual drugs does not preclude response to combination chemotherapy.