Chemotherapy

Novel Insights into Epiploic Appendagitis in a Breast Cancer Patient on Abemaciclib: A Case Report

Introduction: Epiploic appendagitis is an uncommon cause of acute abdominal pain, often mimicking surgical emergencies. This case highlights the diagnostic process for epiploic appendagitis in a breast cancer patient receiving abemaciclib, a CDK4/6 (cyclin-dependent kinase) inhibitor, and discusses potential associations with targeted therapies. Case Presentation: We present a case of a 48-year-old female on adjuvant abemaciclib for stage IIIA breast cancer who developed acute left iliac fossa pain. Clinical assessment, laboratory investigations, transvaginal ultrasound, and subsequent computed tomography (CT) imaging of the abdomen and pelvis were performed to establish the diagnosis. CT imaging revealed a characteristic ovoid fat-density lesion with surrounding inflammation adjacent to the sigmoid colon, consistent with epiploic appendagitis. Other differential diagnoses, including ovarian pathology and diverticulitis, were excluded. The patient was managed conservatively with analgesia, and the abemaciclib was temporarily discontinued and restarted at a lower dose, leading to symptom resolution. This case underscores the importance of considering epiploic appendagitis in the differential diagnosis of acute abdominal pain, particularly in patients on targeted therapies like abemaciclib, which are known to have gastrointestinal side effects. Timely and accurate diagnosis via imaging avoided unnecessary surgical intervention. Conclusion: This case is the first of its kind to propose a novel association between the use of targeted therapies such as abemaciclib and the development of inflammatory conditions such as epiploic appendagitis. It emphasises the crucial role of clinical suspicion and appropriate imaging in establishing this rare diagnosis. Further research is warranted to explore potential links between CDK4/6 inhibitors and the development of epiploic appendagitis.

Rare Case of Endoscopic Treatment for Bevacizumab-Related Gastric Perforation in a Patient with Ovarian Cancer

Antiangiogenic chemotherapy is a common treatment option for patients with advanced ovarian cancer (OC) and has been proven to be effective and generally safe. Nevertheless, in rare cases, these drugs can give serious complications such as gastrointestinal perforations that can be even mortal or very difficult to treat and can heavily impact the clinical management. We present a rare case of bevacizumab-induced gastric perforation in a patient with advanced OC occurred during bevacizumab-including chemotherapy in an adjuvant setting. Surgical treatment was not possible due to the frailty of the clinical condition of the patient and the gastric perforation was successfully treated with endoscopic suturing.

Prolongation of Neoadjuvant Chemotherapy before Surgery: Seeking the Optimal Number of Cycles in Serous Ovarian Cancer

<b><i>Aim:</i></b> The optimal number of neoadjuvant chemotherapy (NACT) cycles is unclear in epithelial ovarian cancer. Our study aimed to evaluate the effect of the number of NACT cycles before interval debulking surgery on survival. <b><i>Methods:</i></b> Data of 221 patients with advanced-stage serous epithelial ovarian cancer (EOC) were retrospectively evaluated. The patients were divided into groups as who received 3 cycles of NACT (group A), 4-5 cycles of NACT (group B), and 6 cycles of NACT (group C). <b><i>Results:</i></b> There were 67 (30%) patients in group A, 70 (32%) in group B, and 84 (38%) in group C. Median overall survival (OS) was 61 (range 43–79) months for group A, 44 (range 36–52) months for group B, and 39 (range 27–50) months for group C. In addition, median disease-free survival (DFS) was 23.1 (range 8.5–32.1) months for group A, 19.2 (range 10.1–28.4) months for group B, and 21.5 (range 16–27) months for group C. Patients receiving >3 NACT cycles had worse OS than patients who received 3 NACT cycles (for group A vs. B, <i>p</i> = 0.018; for group A vs. C, <i>p</i> = 0.049). However, in terms of DFS, patients receiving 3 NACT cycles had no statistically significant difference compared to patients who received >3 NACT cycles. <b><i>Conclusions:</i></b> Patients with advanced-stage serous EOC who received more than 3 cycles of NACT had poor OS. However, there was no statistical difference in terms of DFS. In addition, >3 cycles of NACT did not increase the probability of achieving complete cytoreduction at the time of surgery.

3–4 Cycles versus 6 Cycles Neoadjuvant Chemotherapy in Advanced-Stage Epithelial Ovarian Cancer: Survival Is Not Determined by the Number of Neoadjuvant Chemotherapy Cycles

<b><i>Introduction:</i></b> The aim of this study was to compare the disease-free survival (DFS) and overall survival (OS) of patients who underwent interval cytoreductive surgery after 3–4 cycles or 6 cycles of neoadjuvant chemotherapy (NACT) in advanced epithelial ovarian cancer patients. <b><i>Methods:</i></b> Out of 219 patients with advanced epithelial ovarian cancer, 123 patients received 3–4 cycles and 96 patients received 6 cycles of platinum-based NACT. Afterward, laparotomy was performed for interval cytoreductive surgery. <b><i>Results:</i></b> No statistically significant difference was found for DFS and OS of the patients who received 3–4 cycles and those who received 6 cycles of NACT (HR: 1.047, 95.0% CI [0.779–1.407]; <i>p</i>: 0.746 for DFS, and HR: 1.181, 95.0% CI [0.818–1.707]; <i>p</i>: 0.368 for OS). Evaluating 123 patients who received 3–4 cycles of NACT, 87 patients (70.7%) without macroscopic residual tumor after interval cytoreductive surgery had significantly longer DFS and OS compared to 36 patients (29.3%) with any residual tumor (HR: 1.830, 95.0% CI [1.194–2.806]; <i>p</i>: 0.003 for DFS, and HR: 1.946, 95.0% CI [1.166–3.250]; <i>p</i>: 0.009 for OS). 96 patients who received 6 courses of NACT were evaluated; 63 patients (65.6%) without macroscopic residual tumor after interval cytoreductive surgery had significantly longer DFS and OS than 33 patients (34.4%) with any residual tumor (HR: 1.716, 9 5.0% CI [1.092–2.697]; <i>p</i>: 0.010 for DFS, and HR: 1.921, 95.0% CI [1.125–3.282]; <i>p</i>: 0.013 for OS). <b><i>Conclusion:</i></b> In patients with advanced ovarian cancer, there is no significant difference in DFS and OS between 3 and 4 cycles or 6 cycles of NACT. The most important factor determining survival is whether macroscopic residual tumor tissue remains after interval cytoreductive surgery following NACT.