Gynaecological Tumor Investigation Case . . After 82 years of age/BRCAwt/heart attack, Olapali maintenance therapy has a significant effect on patients with advanced relapsed ovarian cancer, PFS over 22 months!

Editor's note: As the highest fatality rate of gynaecological malignancies, ovarian cancer is called "king of gynaecological tumors", which seriously threatens women's life and health.
although most patients can obtain clinical remission after initial treatment, 70% of patients still relapse within 3 years, and the five-year survival rate is only 30% to 40%.
the emergence of polygonal glycoside cystic glycolytase (PARP) inhibitors significantly improved the survival of patients and pushed ovarian cancer treatment into a new mode of full management.
the recurrence rate of ovarian cancer is high, the treatment of elderly women is relatively more difficult, for the maintenance of platinum-sensitive ovarian cancer in the elderly, parp inhibitors performance? Let's explore it together.
Li Min Professor Li Min, Deputy Director physician, works in obstetrics and gynecology at the First Hospital affiliated with the University of Science and Technology of China, is currently the secretary of the department of teaching and research of the base of obstetrics and gynecology standardized training of residents, mastering the diagnosis and treatment of common and frequent diseases of obstetrics and gynecology, the main research Direction for cervical cancer, endometrial cancer, ovarian malignant tumor disease screening and diagnosis, endometriosis management, good at gynecological laparoscopy and laparoscopic routine surgery, currently serving in the Institute: Anhui Provincial Physicians Association Obstetrics and Gynecology Youth member of the Branch, Young Member of the Professional Committee of Obstetrics and Gynecology of Anhui Minimally Invasive Medical Association, Secretary and Member of the Professional Committee of Gynaecological Oncology of Anhui Anti-Cancer Association, Member of the Professional Committee of Ovarian Cancer of Anhui Anti-Cancer Association, Editor of the Manual of Diagnosis and Treatment of Ovarian Malignant Tumors, The editorial board of the Journal of Chronic Diseases, the editorial board of the Chinese Medical Education Question Bank (The Standardized Training Library for Residents), has presided over a school fund project, participated in a number of National Natural Fund projects, published more than ten papers, and participated in the training of college students' skills competitions many times. In 2019, he won the first prize in the first basic skills teaching competition for young teachers affiliated with the First Hospital of China University of Science and Technology, won the first prize;
won the title of "Excellent Teacher" of Anhui Medical University in 2020.
Of the patient's medical history 1. The patient, female, 79 years old, was hospitalized in an external hospital on May 3, 2016 due to "bloating discomfort, aggravation after eating".
patients denied a family history of genetic diseases and a family history of tumors.
2. Detailed medical history of the initial treatment in December 2015 patients have no obvious trigger for bloating discomfort, aggravation after eating, not attention, after self-conscious symptoms aggravated, bloating after eating obvious, with stool is not formed.
, April 26, 2016, in the hospital to check the abdominal B super: a large amount of celiac fluid.
was admitted to an external hospital on May 3, 2016, with the following results.
CEA:7.01 ng/ml;CA125:5197 U/ml;CA153:364.4 U/ml。
found adenocar cancer cells in the abdomen.
chest pelvic CT: gastric thickening, liver right leaf calcification stove, pelvic irregular soft tissue density stove, consider metastasis, ovarian malignancies, abdominal pelvic cavity a large amount of fluid.
PET-CT imaging: soft tissue lumps in the right attachment area, abnormally higher metabolism of fluoride deoxygenated glucose (FDG), abnormal increase in liver envelope, spleen envelope, large retina, small retina, small intestine membrane and pelvic foldback peritina, with abdominal cavity and pelvic fluid, thickening peritina FDG metabolism abnormal increase High, the left collarbone upper armpit, the two-sided inner blood vessels and the right pelvic wall multiple swollen lymph nodes, all consider malignant lesions, to the right attachment primary malignancies with the possibility of multiple metastasis, the right lung upper leaf and the front of the multiple small noddle lesions with fine dot calcification, considering the possibility of stale lesions, the right thoracic cavity and oblique cleavage fluid.
the initial diagnosis of ovarian malignancies, ovarian cancer with retina, abdominal lymph nodes multiple metastasis (IV. phase), taking into account the patient's older age, poor physical quality, surgery risk is high, not intended for surgical treatment.
ECOG score of 2 and the physical condition met the requirements of chemotherapy.
May 9, 2016 - September 12, 2016, visited our hospital, the line "Beva bead monoantigen and yew alcohol and cisplatin" program chemotherapy 2 courses, "beval bead monoantigen and yew alcohol and carptonin" 4 courses.
800 ml of asymission water on May 10, 2016 and infusion of 60 mg of cisplatin.
review after the evaluation of the effect of the water disappeared, obvious partial relief (PR).
was assessed as disease stabilization (SD) in October 2016, i.e. the lesions shrunk and did not reach PR or increase the disease progression (PD).
relapse treatment on October 24, 2017 after 13 months of follow-up observation, the evaluation of the disease as PD, in our hospital DDP "D1-D2 abdominal perfusion and beva bead monoanti-dositasi" program chemotherapy 1 course.
acute myocardial infarction (front wall) occurred on 11 November 2017 and improved after treatment.
30 November 2017 - April 8, 2018 in our hospital dossytherapy program 5 courses.
17, 2018 on the "Dorsy Race 80 mg d1" program chemotherapy 1 course.
: CA125:69.56 U/ml; CEA: 4.31 ng/ml; Amino End B Sodium Urapide Prebiotor (NT-proBNP): 747 pg/ml; Myoglobin: 39.60 μ g/L; mendonine amino transferase/alanine amino transferase: 1.59 U/L; Uric acid: 364.0 μmol/L; Average erythropoietin concentration: 310.0 g/L; red blood cell volume distribution width: 15.8%.
B super: (1) no obvious abnormalities in the pelvic cavity, (2) no significant position in the liver and pancreas spleen, (3) no significant expansion of the bile, (4) no significant fluid build-up in the abdominal cavity, and (5) no significant swelling of lymph nodes after the peritometrium.
8, 2018 on april 8, 2018 in Dorsey 80 mg d1 course of chemotherapy 1 course.
out of the hospital with medication: Li Kejun (for the prevention and treatment of white blood cell reduction and platelet reduction), Mitolor slow release tablets (treatment of hypertension), clopidogrel (for the prevention of atherosclerosis thrombosis).
follow-up review of maintenance therapy from April 2018 to March 2019.
took Olapali (150 mg bid) in March 2019, during which the gene test BRCA (-).
taken so far, CA125 is checked every 3 months and remains around 8 U/ml.
the current patient indicators are basically normal, adverse reactions can also be toned.
patients with a small sample of ca125 level change trends were hospitalized on May 3, 2016 for "bloating discomfort, aggravation after eating", and tests showed CEA:7.01 ng/ml, CA125:5197 U/ml, CA153:364.4 U/ml;
Combined with thoracic pelvic CT and PET-CT examination results, the initial diagnosis of ovarian malignancies, ovarian cancer with the retina, abdominal lymph nodes multiple metastasis (IV. phase), taking into account the patient's older age, poor physical quality, surgery risk is too large, not intended for surgical treatment.
ECOG score of 2 and the physical condition met the requirements of chemotherapy.
from May 9 to September 12, 2016, the "Beval Bead Monoantigen and Yew Alcohol and Cisplatin" program chemotherapy 2 courses, "Beval Bead Monoantitons and Yew Alcohols and Carp platinum" 4 courses.
was assessed as SD in October.
the recurrence of ovarian cancer in October 2017, the patient's initial treatment reached SD and then the next recurrence interval of about 13 months, platinum sensitivity recurrence (PSR).
on October 24, 2017 - April 8, 2018 DDP "D1-D2 abdominal perfusion and beva bead monoanti-dorcytha" program chemotherapy 6 courses, during which november 11, 2017 occurred acute myocardial infarction (front wall), after treatment to improve.
review, CA125:69.56 U/ml; CEA:4.31 ng/ml.
to follow-up reviews from April 2018 to March 2019.
2019 on 150 mg bid maintenance, during which no BRCA mutation was detected in genetic testing for BRCA wild PSR ovarian cancer.
take Olapali so far, no progression survival (PFS) has reached 22 months, the current patient indicators are basically normal, adverse reactions can be toned, indicating that Olapa used in BRCA wild PSR elderly ovarian cancer patients to maintain the treatment safe and effective.
Expert Reviews Professor Wu Dabao Professor Wu Dabao: Academic Director, Chief Physician, Professor, Doctoral Mentor of Anhui Medical University, Postdoctoral Guidance Teacher of the First Hospital affiliated with China University of Science and Technology; Former and Chairman-designate of the Obstetrics and Gynaecology Branch of the Medical Association; Chairman of the Obstetrics and Gynecology Branch of the Anhui Minimally Invasive Medical Association; Member of the Obstetrics and Gynaecology Branch of the Chinese Medical Association; Member of the Obstetrics and Gynaecology Branch of the Chinese Physicians Association; Director of the Four-level Lapscopic Training Base of the Gynaecology and Gynaecology Of the Health and Gynaecology Commission; Chairman of the Professional Committee for Women's Pelvic Bottom Rehabilitation of Anhui Provincial Maternal and Child Health Association; Chairman of the Professional Committee of the Department of Gynaecology and Oncology of the Anhui Anti-Cancer Association; And Advisory Committee of the Ovarian Cancer Association of Anhui Province.
chaired 1 project on science and technology in Anhui Province and participated in 2 projects of the National Natural Science Foundation of China, mainly engaged in minimally invasive and clinical research on gynaecological tumors, published more than 10 SCI articles, and edited the Handbook on diagnosis and treatment of ovarian malignant tumors (China University of Science and Technology Press).
- Sliding up to see all the introductions In recent years, PARP inhibitor maintenance therapy for PSR ovarian cancer research has made a major breakthrough, has been recognized as PSR ovarian cancer patients after the general treatment of symptoms to maintain the standard treatment.
as the first PARP inhibitor approved worldwide and in China, Study 19 and OPINION studies have shown that Olapali is the preferred option for the maintenance of PSR ovarian cancer.
Sudy 19's six-year long-term follow-up results showed that some patients were able to obtain long-term disease control recurrence (olapali group 11%, placebo group slt;1%); 26.6 months, P-0.039).
OPINION study is a single-arm, IIIb phase study that explores the efficacy of Olapali monodrative maintenance therapy in patients receiving gBRCA mutant-negative PSR ovarian cancer with platinum-containing chemotherapy above the ≥2 line.
latest interim results released by the United States show that non-gBRCAm patients had mPFS for 9.2 months, HRD-positive (including sBRCAm) patients had a medium PFS of 10.9 months, and HRD-positive (BRCA mutation negative) patients had a medium PFS of 9 .7 months, even in HD-negative patients, the medium PFS reached 7.3 months, and the time between the middle and the next treatment (TFST) was 13.4 months, further confirming that Olapali's clinical benefits in PSR patients were not limited to BRCA and HRD states.
And the results of the summary results of the safety of the treatment maintained by PARP inhibitors in PSR patients showed that opal was safe compared to other PARP inhibitors, with a lower incidence of adverse reactions (25.8%) and a lower proportion of drug reduction (15.1%) than other PARP inhibitors, which had some advantages in the maintenance treatment of PSR ovarian cancer patients in BRCAwt.
BRCAwt accounts for a large proportion of all ovarian cancer patients, and this group tends to have poor prognostics.
both studies have confirmed that Olapali significantly prolongs OS in patients while maintaining drug safety, efficacy and safety, regardless of BRCA mutation or not, Olapali can benefit PSR ovarian cancer patients in the long-term survival.
after the complete or partial remission of tumor therapy, reducing the risk of recurrence and improving the survival rate of patients with relapsed ovarian cancer are the "core meaning" of PARP inhibitor maintenance therapy.
The patients in this case were BRCA wild PSR ovarian cancer, and PFS had reached 22 months after maintenance treatment with Olapali, significantly exceeding the PFS (13 months) time after initial treatment, and follow-up indicators were good, adverse reactions were toned, and there were no signs of disease progression.
case shows the good efficacy of Olapali and we'll see if we can see how long it will take for patients to benefit."
Wang Feng commented on Wang Feng Professor Wang Feng, Director of Obstetrics and Gynecology, Chief Physician and Professor of the Fifth Hospital affiliated with Zhongshan University.
graduated from The Medical Department of Tongji Medical University in 1982, worked in obstetrics and gynecology at Concord Hospital affiliated with Tongji Medical University from 1982 to 1996, and worked in obstetrics and gynecology at the Capital General Hospital of Equatorial Guinea from 1998 to 2000, where he worked in obstetrics and gynecology for more than 30 years.
Long-term in the university teaching hospital engaged in clinical, teaching and scientific research work, a solid theoretical foundation, the standardized diagnosis and treatment of gynaecological tumors, gynecological endocrine diseases and gynecological inflammation treatment has a wealth of clinical experience, especially in the gynaecological malignant tumor surgical treatment decision-making, timing mastery, surgical skills have a deep knowledge, in Zhuhai and surrounding areas of gynecology has a high reputation.
Zhuhai region to take the lead in gynaecological laparoscopy, laparoscopic surgery, has accumulated a wealth of clinical experience.
won the second prize for scientific progress in Zhuhai.
completed the provincial and municipal scientific research projects 4.
Has served as a member of the Obstetrics and Gynaecology Association of the Guangdong Medical Association, a member of the Obstetrics and Gynaecologists Branch of the Guangdong Physicians Association, a member of the Vice Chairman of the Obstetrics and Gynaecology Branch of the Zhuhai Medical Association, and other academic bodies.
working languages: Mandarin, English-English.
survival rate for ovarian cancer patients over 65 is still low compared to younger patients.