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Simple Summary: Patients diagnosed with epithelial ovarian cancer are usually treated with a combination of platinum-based chemotherapy and debulking surgery. Unfortunately, most of them will experience a recurrence of their disease, especially if diagnosed at an advanced stage. Patients with recurrence are typically re-treated with platinum-based chemotherapy if their disease recurs more than 6 months after the completion of previous chemotherapy. These patients are defined as having 'platinum sensitive' disease, while patients progressing less than 6 months after previous treatment are defined as 'platinum resistant'. It is known that patients who do not respond to platinum-based chemotherapy have a poorer prognosis and are expected to have shorter survival. Patients with platinum-sensitive disease will, at some point, become resistant to platinum, with increasing recurrence episodes. This study aims to compare the outcomes of patients who have primary platinum resistance at first treatment versus patients who acquire platinum resistance at a later stage of their illness. Objective: The goal of this study was to evaluate response to treatment and survival in epithelial ovarian cancer patients with acquired secondary platinum resistance (SPR) compared to patients with primary platinum resistance (PPR). Methods: Patients were categorized as PPR (patients with disease recurrence occurring during or <6 months after completing first-line platinum-based chemotherapy) and SPR (patients with previously platinum-sensitive disease that developed platinum resistance on subsequent treatments). Clinico-pathological variables and treatment outcomes were compared. Results: Of the 118 patients included in this study, 60 had PPR and 58 developed SPR. The SPR women had a significantly higher rate of optimal debulking during their upfront and interval operations, significantly lower CA-125 levels during their primary treatment, and a significantly higher complete and partial response rate to primary chemotherapy. Once platinum resistance appeared, no significant difference in survival was observed between the two groups. The median PFS was 2 months in the PPR group and 0.83 months in the SPR group (p = 0.085). Also, no significant difference was found in post-platinum-resistant relapse survival, with a median of 17.63 months in the PPR and 20.26 months in the SPR group (p = 0.515). Conclusions: Platinum resistance is an important prognostic factor in women with EOC. Patients with SPR acquire the same poor treatment outcome as with PPR. There is a great need for future research efforts to discover novel strategies and biological treatments to reverse resistance and improve survival. [ABSTRACT FROM AUTHOR]

Key content: Surgical cytoreduction and platinum‐based chemotherapy are the mainstays of ovarian cancer treatment, but 70% of patients with advanced‐stage disease will relapse after responding to first‐line chemotherapy.Recent randomised controlled trials have shown significant improvement in progression‐free survival by adding maintenance therapy including either PARP inhibitors (PARPi), bevacizumab (VEGF‐A inhibitor), or both.Homologous recombination repair is a pathway to repair DNA breaks; homologous recombination deficiency (HRD) is encountered in approximately 50% of ovarian high‐grade serous cancers (HGSC).Patients with HRD tumours demonstrate better progression‐free survival outcomes with PARPi.HRD testing is now approved for patients with high‐grade ovarian cancers including HGSC. Learning objectives: To understand available molecular testing in ovarian cancer in England and its implications for maintenance treatment strategies. Ethical issues: Patient consent is required if testing involves germline BRCA1/2 mutation (gBRCA1/2mut) assessment. A positive BRCA1/2mut result might have implications for the patient and their family. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the symptoms of women with epithelial ovarian cancer (EOC) during their last admission before death and analyze invasive palliative management administered in relation to symptom control and survival. Materials & Methods: A retrospective review of Israeli patients with EOC, primary peritoneal cancer (PPC) and tubal cancer, admitted to our department prior to death between 2008–2018. Basic palliative treatment was defined as administration of IV fluids, analgesics, oxygen, antiemetics, antibiotics and/or blood transfusions. Procedures regarded as invasive included: peritoneal or pleural fluid drainage; placement of an indwelling catheter, administration of total parenteral nutrition (TPN), chemotherapy and ventilation. Results: 82 patients were included. Most suffered from weakness and fatigue, gastrointestinal complaints, pain and shortness of breath. 34 patients (41.5%) required only basic palliative treatment to alleviate their symptoms; however, in 48 patients (58.5%) invasive interventions were needed. Patients treated with invasive procedures were younger at death by almost 9 years (mean age of 65.73 ± 9.5 vs. 74.78 ± 9.8; p = 0.001). There were significantly more women with platinum sensitive disease in the invasive interventions group compared to the basic palliative care (60.42% vs. 32.35%; p = 0.012). No survival difference was found between the groups from diagnosis to death, relapse to death, last chemotherapy to death and last admission to death. Conclusions: EOC patients suffer from high disease burden and multiple symptoms before death. We found that physicians tend to use more invasive care in dying younger patients. However, this aggressive treatment does not prolong survival. Futile treatments influencing quality of life should be avoided. [ABSTRACT FROM AUTHOR]

Objective: To compare the accuracy of ultrasonographic, calculated, and clinical methods for the estimation of fetal weight (EFW) performed during active labor by residents.Methods: Parturients in active labor underwent prospectively EFW by 3 methods: ultrasonographic, clinical, and calculated (extrapolating EFW from a previous scan). Three different blinded residents evaluated each woman. Background variables were examined for their effect on the accuracy of each method. Comparison of the methods for the detection of macrosomia and small for gestational age (SGA) was also performed.Results: Among the 405 women recruited, the rates of accuracy of ultrasonographic, clinical, and calculated EFW (within ±10%) was 72.5, 74.3, and 71.1%, respectively. The correlation coefficient between the methods and actual birth weight (ABW) were 0.702-0.611 (using 7 Hadlock formulas), 0.649, and 0.622, respectively (all p < 0.001). By logistic regression, epidural analgesia was associated with higher and second stage of labor with lower accuracy of ultrasonographic EFW. For the detection of macrosomia, clinical (p < 0.001) and calculated EFWs (p = 0.035) were superior to ultrasonographic EFW. For the detection of SGA, ultrasonographic EFW was superior to calculated (p < 0.001) and clinical (p < 0.001) EFWs.Conclusion: All 3 methods performed by residents during labor correlated well with ABW. Clinical and calculated EFWs were superior for macrosomia detection, whereas ultrasonographic EFW was superior for SGA detection. [ABSTRACT FROM AUTHOR]