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ObjectiveLow grade serous ovarian cancers characterize a unique clinical pattern and likely less frequent incidence of lymphatic metastasis. The expression level of Ki67 is associated with differences in prognosis and therapy outcome. However, its expression in combination with lymphovascular space invasion has not been evaluated in the prediction of lymphatic metastasis.MethodsPatients with low grade serous ovarian cancer were identified in an institutional database. Patients with primary low grade serous ovarian cancer diagnosed and/or treated at our center between September 2000 and December 2018 were identified. Receiver operator characteristics curve analysis was performed to find the cut-off values of per cent Ki67 to discriminate patients with lymph node metastasis. The association between the presence of lymphovascular space invasion and lymph node involvement was analyzed.ResultsA total of 109 patients with primary low grade serous ovarian cancer were identified in our institution's database. Of these, 72 (66.1%) patients underwent primary surgery with pelvic and para-aortic lymph node dissection. Complete data for Ki67 expression and lymphovascular space invasion were obtained for 61 (84.7%) of these patients. Among them, 37 (60.7%) patients had lymph node metastasis. The presence of lymphovascular space invasion was associated with an increased risk of lymph node metastases (odds ratio (OR)=12.78, 95% confidence interval (CI) 3.15 to 51.81; p65 years, peritoneal carcinomatosis, and ascites>500 mL, lymphovascular space invasion remained a significant risk factor for lymphatic metastases (OR=35.11, 95% CI 2.38 to 517.69; p=0.010). Ki67 ≥6% was associated with a higher risk of lymphovascular space invasion (OR=3.67, 95% CI 1.26 to 10.64; p=0.017). No significant correlation between Ki67 expression level and nodal metastases was found (OR=2.19, 95% CI 0.76 to 6.26; p=0.14). Neither presence of lymphovascular space invasion or nodal metastases was associated with a statistically poorer prognosis.ConclusionsWe showed an association between lymphovascular space invasion, Ki67 expression, and risk of lymph node metastasis in primary low grade ovarian cancer. Further prospective trials evaluating lymphovascular space invasion and Ki-67 as predictors of lymph node metastasis are needed.

Objective Low-grade serous ovarian cancers (LGSOC) characterize less frequent incidence of lymph-nodes (LN) metastasis. Ki67 expression level is associated with prognosis and therapy outcome differences. Its’ expression in combination with lympho-vascular space invasion (LVSI) have not been evaluated in prediction of LN involvement yet. Methods Patients with LGSOC were identified in institutional database. Receiver-operator characteristics (ROC) curve analysis was performed to find cut off values of Ki67% to discriminate patients with LN metastasis. The association between LVSI presence and LN involvement was performed. Results A total of 109 patients treated between 2000 and 2018 with primary LGSOC were identified in our institution database. Complete data of Ki67 expression and LVSI in patients who underwent lymph node dissection was obtained in 61 (84.7%) of those patients. Presence of LVSI was associated with higher risk of lymph-nodes metastases in univariate und multivariate analysis (p Conclusions It is the first study showing association between LVSI presence, Ki67 expression and risk of lymph-node metastasis in primary low-grade ovarian cancer. Further prospective trials evaluating LVSI and Ki-67 as a predictor of lymph-node metastasis should be planned.

The choice of the right treatment regimen for recurrent ovarian cancer (rOC) remains a case-by-case decision. It is based on multiple factors that involve patient characteristics and biological factors at the same time. The prioritization of factors is still subject to changes with a trend towards a more personalized medicine. Therefore, participation and engagement in clinical studies constitutes a substantial need for the future development of the treatment algorithm of rOC.

The impact of angiogenesis on long-term survival of high-grade serous ovarian cancer (HGSOC) patients remains unclear. This study investigated whether angiogenic markers correlated with 5-year progression-free survival (PFS) in a large cohort of matched advanced HGSOC tissue samples. Tumor samples from 124 primary HGSOC patients were retrospectively collected within the Tumor Bank Ovarian Cancer ( http://www.toc-network.de ). All patients were in advanced stages (FIGO stage III–IV). No patient had received anti-angiogenesis therapy. The cohort contains 62 long-term survivors and 62 controls matched by age and post-surgical tumor residuals. Long-term survivors were defined as patients with no relapse within 5 years after the end of first-line chemotherapy. Controls were patients who suffered from first relapse within 6–36 months after primary treatment. Samples were assessed for immunohistochemical expression of vascular endothelial growth factor (VEGF) A and VEGF receptor 2 (VEGFR2). Expression profiles of VEGFA and VEGFR2 were compared between the two groups. Significant correlation between VEGFA and VEGFR2 expression was observed (p

AIMS: Advanced-stage ovarian high-grade serous carcinoma (HGSC) is a poor-prognosis cancer; however, a small and poorly characterised subset of patients shows long-term survival. We aimed to establish a cohort of HGSC long-term survivors for histopathological and molecular analysis. METHODS AND RESULTS: Paraffin blocks from 151 patients with primary FIGO III/IV HGSC and progression-free survival (PFS) >5 years were collected within the Tumorbank Ovarian Cancer (TOC) Network; 77 HGSC with a PFS

Desensitization for Olaparib Hypersensitivity Some patients have immediate hypersensitivity responses to olaparib therapy. A gradual increase in oral doses over a 2-day period was successful at des...

Background Niraparib, a PARP inhibitor, is indicated as maintenance therapy in patients with relapsed, platinum sensitive high-grade serous ovarian cancer. The initial dose, especially after presentation of RADAR Analysis remains a subject of discussion. The aim of our study was to evaluate the initial dose management. Methods All subsequent patients who started niraparib maintenance therapy were eligible to be included in this analysis. We collected weight of patient, the initial dose and its modifications within the therapy period. Results We identified 72 patients between May 2017 and January 2019. Twenty patients began the therapy prior and 52 after to RADAR Analysis presentation. The mean weight of all patients was 64.9kg and in mentioned subgroups 61.4kg and 66.2kg respectively. The median dose in all patients was 200mg and in patients who started prior and after RADAR data publication 300mg and 200mg respectively. The mean dose in those groups 300mg and 217.3mg respectively. The dose reduction was necessary in 90% (18 pts.) and 28.8% (17 pts.) within first 3 therapy cycles in patients who started prior and after RADAR Analysis publication respectively. Conclusions To our knowledge, it is the first analysis on niraparib initial dose management. The dose adjustment according RADAR analysis data resulted in more frequent 200mg application from the beginning of the therapy. Moreover, significantly less patients needed dose adjustment in the first three months of the therapy. The initial dose reduction seems to be a reasonable and well tolerated option in patients who are going to start niraparib maintenance therapy. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure J.P. Grabowski: Honoraria (self), Honoraria (institution), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): AstraZeneca; Honoraria (institution), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Clovis; Honoraria (self), Honoraria (institution), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Tesaro; Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Roche; Speaker Bureau / Expert testimony: Pfizer; Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Riemser. E.I. Braicu: Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Clovis; Honoraria (self), Honoraria (institution), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution), Travel / Accommodation / Expenses: Tesaro; Honoraria (self), Honoraria (institution), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution), Travel / Accommodation / Expenses: AstraZeneca; Advisory / Consultancy, Research grant / Funding (institution): Roche; Honoraria (self): Incyte; Honoraria (institution), Advisory / Consultancy: CRA International; Honoraria (self), Advisory / Consultancy: Seattle Genetics. J. Sehouli: Honoraria (self), Honoraria (institution), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution), Travel / Accommodation / Expenses: AstraZeneca; Honoraria (self), Honoraria (institution), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Clovis; Advisory / Consultancy: Lilly; Advisory / Consultancy: Johnson and Johnson; Honoraria (self), Honoraria (institution), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Tesaro; Advisory / Consultancy: Merck; Honoraria (self), Honoraria (institution), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): MSD; Research grant / Funding (institution): Bayer; Honoraria (self), Honoraria (institution), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): PharmaMar; Honoraria (self), Honoraria (institution), Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Pfizer; Honoraria (self), Advisory / Consultancy: Eisai; Honoraria (self), Honoraria (institution): Teva; Honoraria (self): Olympus. All other authors have declared no conflicts of interest.

e17063 Background: OC has the highest mortality rate amongst gynecological malignancies. Nevertheless a small fraction of OC patients will survive longer than 8 years. Aim of our study was to analyze differences in the clinical appearance and management of LTS versus “classical” OC patients. Methods: OC patients living longer than 8 years were identified within the TOC Network between 1998 and 2008, representing the LTS subgroup. PSM analysis was used to select comparable groups of LTS and OC patients who died within first 5 years (control group - CG). PSM was conducted using nearest neighbor caliper matching without replacement to match LTS and CG for age, FIGO and residual tumor mass. All calculations were performed with the R project for Statistical Computing (R-packages used: “MatchIt”). Results: A total of 347 OC patients with different histological subtypes were included in the current analysis, i.e. 173 LTS and 174 in the CG. After PSM 114 patients remained in each group. Patients had similar age, FIGO stage and residual mass (p = 0.99, p = 0.35 and p = 0.88, respectively). Tumor spread in middle and upper abdomen (p = 0.002 and 0.013, respectively) was higher and diaphragm, mesentery and peritoneum (p = 0.009, 0.037 and 0.002, respectively) were significantly more often involved in CG than in the LTS. When only considering the HGSOC patients, 95 patients remained in each group. All patients received surgery and platinum based chemotherapy. The PSM analysis showed significant higher involvement of upper abdomen (p = 0.028), higher peritoneal spread (p = 0.002), higher ascites volume (p = 0.0007) and higher bowel resection rates (p = 0.002) in the CG compared to LTS. Neoadjuvant chemotherapy rate was similar in the LTS and CG (p = 0.5). Conclusions: Based on this PSM analysis, HGSOC-LTS seem to have mainly similar clinical pattern as the control group, however with lower rates of ascites and involvement of upper abdomen. Molecular characterization including analysis of clonal diversity might help elucidate mechanisms of tumor spread and good prognosis.

e17059Background: Ovarian cancer is the leading cause of mortality of all gynecological cancers. Within the first years after diagnosis 75-80% of patients relapse and die from the disease. However,...