Minyoung Jang

Incidence of ESR1 gene mutations among patients with endometrioid endometrial cancer

Endometrioid endometrial cancer especially low-grade expresses estrogen receptors. A sub-group of patients derives significant benefit from hormonal treatment. The presence of activating ESR1 gene mutations is a common mechanism of resistance to hormonal treatment for patients with breast cancer. We evaluated the incidence of ESR1-activating gene mutations in patients with endometrioid endometrial cancer using the American Association of Cancer Research Genomics Evidence of Neoplasia Information Exchange (v18.0) multi-center data set. A total of 2851 patients with endometrioid endometrial cancer were identified. The overall incidence of ESR1 mutations was 4.0% (n = 113). The incidence of ESR1 mutations was higher among patients with metastatic/recurrent disease than those with primary tumors (7.6% vs 3.4%, p < .001). Patients with ESR1-activating mutations also harbored mTOR/PIK3CA pathway genomic alterations: PTEN (75%), PIK3CA (56%), PIK3R1 (42%), AKT1 (12%). Further research to elucidate the clinical impact of ESR1 gene mutations in endometrial cancer are needed. Clinical trials evaluating novel hormonal agents in this patient population are warranted.

Ovarian carcinoid tumor with carcinoid heart syndrome: A case report and literature review

Early administration of adjuvant chemotherapy for patients with advanced-stage malignant ovarian germ cell tumors is associated with an overall survival benefit

Malignant ovarian germ cell tumors are chemosensitive but also characterized by a rapid tumor growth. This study aimed to evaluate the impact of delay on adjuvant chemotherapy administration on the survival of patients with advanced-stage malignant ovarian germ cell tumors who underwent primary surgery. The National Cancer Database was accessed, and patients diagnosed between 2004 and 2015 with stage III to IV malignant ovarian germ cell tumors who underwent primary surgery and received adjuvant chemotherapy were identified. Clinico-pathologic characteristics and overall survival were compared between patients who received adjuvant chemotherapy 1 to 4 weeks (early administration group) and 4.1 to 12 weeks (delayed administration group). Overall survival was compared with the log-rank test after generation of Kaplan-Meier curves. A Cox model was constructed to control for a priori selected confounders. A total of 622 patients were identified; the median time interval between primary surgery and adjuvant chemotherapy was 25 days (interquartile range 18). Delay in adjuvant chemotherapy administration occurred for 229 patients (36.8%). Patients in the early administration group were younger (median age 22 vs 24 years, p < .001). There were no differences between the two groups in terms of patient race, insurance status, presence of medical co-morbidities, tumor histology, and disease stage. Delay in adjuvant chemotherapy administration was associated with worse overall survival (p = .004; 5-year overall survival rates were 77.6% and 87.5%, respectively). After controlling for confounders, delay in adjuvant chemotherapy administration was associated with worse overall survival (hazard ratio 1.99, 95% confidence interval 1.34 to 3.01). For patients with advanced-stage malignant ovarian germ cell tumors, especially those with non-dysgerminoma histology, early administration of adjuvant should be strongly considered because delay may be associated with a detrimental impact on overall survival.