Fumio Asano

Associations of Lipid Metabolism Abnormalities and Obesity With Endometriosis‐Associated Ovarian Cancer

ABSTRACT Aim To investigate the differences in lipid metabolism and obesity between patients with ovarian endometrioid carcinoma (OEC) and ovarian clear cell carcinoma (OCCC), both of which are classified as endometriosis‐associated Type I ovarian cancers. Methods This retrospective study included 133 patients who underwent surgery for OEC ( n  = 50) or OCCC ( n  = 83) between 2010 and 2022. Preoperative serum lipid markers (total cholesterol [TC], low‐density lipoprotein cholesterol [LDL‐C], and high‐density lipoprotein cholesterol [HDL‐C]) and body mass index (BMI) were compared between the two groups. Associations with menopausal status and disease stage were examined, and independent predictors were evaluated by multivariate logistic regression. Results Patients with OEC had significantly higher TC (215 vs. 199.5 mg/dL, p  = 0.040), LDL‐C (139 vs. 120.6 mg/dL, p  = 0.026), and BMI (22.1 vs. 20.4 kg/m 2 , p  = 0.020) compared with those with OCCC. No significant differences were observed for HDL‐C. In premenopausal women, TC and LDL‐C were significantly higher in patients with OEC, whereas no intergroup differences were found in postmenopausal women. Among patients with OEC, those with advanced‐stage disease had higher TC and LDL‐C, whereas no stage‐related differences were observed in patients with OCCC. Multivariate analysis identified BMI and LDL‐C as independent factors associated with OEC. Conclusion Lipid metabolism abnormalities and obesity were more strongly associated with OEC than with OCCC, suggesting subtype‐specific metabolic mechanisms of carcinogenesis and progression. These findings highlight the importance of metabolic factors in OEC, warranting further prospective studies.

Maintenance therapy for platinum-sensitive recurrent ovarian cancer with a history of PARPi administration

This study explored new insights into the selection criteria for maintenance therapy for platinum-sensitive recurrent ovarian cancer by comparing the efficacy of poly(ADP-ribose) polymerase inhibitors (PARPis) and bevacizumab in patients with a history of PARPi administration. Between April 2014 and December 2024, 81 patients underwent maintenance therapy with either PARPi (52 patients) or bevacizumab (29 patients) at our institution. The primary endpoint was progression-free survival (PFS) after the end of the last chemotherapy treatment. The median PFS did not differ significantly between the PARPi and bevacizumab groups (9 vs. 12 months, p=0.942). Similarly, in the propensity score-matched cohort (15 pairs), no significant difference was observed between the PARPi and bevacizumab groups (p=0.444). In the PARPi group, a history of PARPi administration was associated with a significant difference in PFS in both univariate and multivariate analyses (PARPi-naïve vs. PARPi-experienced: 12 vs. 4 months, p=0.002; hazard ratio=3.24, 95% confidence interval=1.56-6.69). In the bevacizumab group, a history of PARPi administration was not associated with a significant difference in PFS. Among patients with a history of PARPi administration, the bevacizumab group had a significantly better PFS than the PARPi group (PARPi rechallenge vs. bevacizumab: 4 vs. 12 months, p=0.042), and the proportion of patients experiencing platinum-resistant recurrence during maintenance therapy was higher in the PARPi rechallenge group (58.8%) than in the bevacizumab group (20.0%) (p=0.049). Maintenance therapy with bevacizumab may be more beneficial for patients with platinum-sensitive recurrent ovarian cancer who have a history of PARPi administration.

Serum CA125 level as predictors of the efficacy of olaparib maintenance therapy for platinum‐sensitive relapsed ovarian cancer

AbstractAimOvarian cancer is a gynecological malignancy with a poor prognosis. For platinum‐sensitive relapsed ovarian cancer, maintenance therapy with poly‐ADP ribose polymerase (PARP) inhibitors after chemotherapy is considered; however, olaparib treatment does not always lead to sufficient progression‐free survival (PFS). This study aimed to identify factors that predict the efficacy of maintenance therapy using olaparib in platinum‐sensitive relapsed ovarian cancer.MethodsTwenty‐seven patients with platinum‐sensitive relapsed ovarian cancer, who received initial treatment and showed complete or partial response to prior chemotherapy at our hospital, were included. The primary outcome was the time from the end of previous platinum‐based chemotherapy to disease progression (PFS). The Kaplan–Meier method was used to generate time‐to‐event curves for PFS; multivariate analysis was performed using the Cox proportional hazards regression model.ResultsThe median PFS was 12 months (95% confidence interval [CI]: 8.3–15.8). Before olaparib administration, the median PFS was 12 months in the <4.1 neutrophil‐to‐lymphocyte ratio group and 4 months in the ≥4.1 group, with PFS being significantly better in the <4.1 group (log‐rank: p = 0.023). When comparing serum cancer antigen 125 (CA125) levels, the median PFS was 13 months in the <18 U/mL group and 6 months in the >18 U/mL group (log‐rank: p = 0.022). Multivariate Cox regression analysis revealed that CA125 was the factor affecting PFS (hazard ratio: 4.85; 95% CI: 1.53–15.38).ConclusionsSerum CA125 levels at olaparib initiation in patients with platinum‐sensitive relapsed ovarian cancer may predict PFS as an effect of maintenance therapy using olaparib to treat recurrent disease.