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Debate 23A - What is the Best Management Option for Malignant Bowel Obstruction?

Surgery

from Section III - Ovarian Cancer

Published online by Cambridge University Press:  20 July 2023

Dennis S. Chi
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York
Nisha Lakhi
Affiliation:
Richmond University Medical Center, Staten Island
Nicoletta Colombo
Affiliation:
University of Milan-Bicocca
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Summary

Despite the success in various other cancer types, there are no approved immune therapies for ovarian cancer, as response of ovarian cancer to immunotherapies thus far have been modest. Early studies of single agent anti-PD-1 antibodies in patients with platinum-resistant or recurrent ovarian cancer demonstrated response rates of between 8–15%. Combination strategies combining PD-1 or PD-L1 antibodies with anti-CTLA-4 antibodies have demonstrated slightly higher response rates of over 30%. Additional studies including chemotherapy in combination with immune checkpoint inhibitors (ICI) have shown no additional benefit of addition of ICI to traditional chemotherapy regimens. We argue that outside of a clinical trial, there is no evidence to support routine usage of ICIs in EOC, even in a heavily pretreated platinum-resistant setting, although we are hopeful that biomarkers that may predict response to ICIs in ovarian cancer may be identified in the future. Lastly, we anticipate that emerging approaches in ovarian cancer immunotherapy such as novel ICI combinations, antibody-drug conjugates, bispecific antibodies, cytokines, and adoptive cell therapies will prove to be successful and look forward to the results of these studies.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Cousins, SE, et al. Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev 2016;1:CD002764.Google Scholar
Kucukmetin, A, et al. Palliative surgery versus medical management for bowel obstruction in ovarian cancer. Cochrane Database Syst Rev 2010;7:CD007792.Google Scholar
Paul Olson, T, et al. Palliative surgery for malignant bowel obstruction from carcinomatosis: a systematic review. JAMA Surg 2014;149(4):383392.Google Scholar
SWOG S1316. Surgery or non-surgical management in treating patients with intra-abdominal cancer and bowel obstruction, ClinicalTrials.gov Identifier: NCT02270450.Google Scholar

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