Publications Update # 29
![Publications Update # 29](/content/images/size/w960/2023/09/IMG_2278.jpg)
Non-Medical Article of the Week
Unlearning Anxiety
On this Ezra Klein Show, neuroscientist Jud Brewer, author of "Unwinding Anxiety," describes anxiety as a learned habit. He breaks down the habit loop into three stages: trigger (like a stressful thought), behavior (such as worrying), and reward (relief from the behavior). This loop can become self-reinforcing, making anxiety a tough cycle to break. To disrupt it, Brewer suggests:
- Recognizing your triggers.
- Practicing mindfulness to observe thoughts and feelings.
- Questioning and reframing negative thoughts.
- Employing healthy coping methods like exercise or relaxation.
- Prioritizing self-compassion.
Brewer believes that understanding anxiety as a habit allows us to unlearn and combat it, leading to more fulfilling lives.
You can buy the book by searching for - Unwinding Anxiety by Judson Brewer
Ovarian Cancer
HIPEC in Ovarian Cancer
OVHIPEC study was published in 2018. Since then, the NCCN guidelines have added a footnote with the following text.
Hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin (100 mg/m2 ) can be considered at the time of IDS for stage III disease.
Two papers published this week further support the routine use of HIPEC in interval debulking surgery:
![](https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image.png)
A 10-year final survival analysis of the original OVHIPEC study shows an overall survival benefit of 1 year (median OS 33·3 months vs. 44·9 months; p=0·011)
A second randomized controlled trial now shows the benefit of HIPEC in ovarian cancer patients undergoing interval debulking surgery.
![](https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image.png)
In this study, 109 patients underwent HIPEC compared to 87 without HIPEC during interval debulking surgery. The median PFS was 23 months in the HIPEC group vs. 14 months (p = 0.05). Overall survival data are not mature completely (HIPEC median OS not reached vs. 53 months).
How does HIPEC improve OS in ovarian cancer?
Critiques have questioned why HIPEC yields a larger OS benefit despite only a modest improvement in PFS. The pattern of recurrence answers this question. In this study (Table 3) - patients with HIPEC had a much lower rate of intraperitoneal recurrence compared to those without HIPEC (32% vs. 64%) and much higher lymph node metastasis (46% vs. 25%). Intraperitoneal recurrences can easily become life-threatening if the bowel is compromised, while patients with visceral or lymphatic recurrences often keep tolerating therapies for recurrence.
How do we encourage people to consider using HIPEC?
Unfortunately, I can no longer find the tweet to give appropriate attribution but someone on twitter (sorry X) suggested - call it HIPECOMAB and the utilization will skyrocket. If you find this tweet, let me know, I will add it to this post :)
Immunotherapy in Ovarian Cancer
Two recent trials in ovarian cancer explored the role of atezolizumab in newly diagnosed ovarian cancer. The first trial - IMagyn050/GOG 3015/ENGOT-OV39, published in 2021. This trial showed no benefit of adding immune checkpoint inhibitors to the combination of chemotherapy (Carboplatin/Taxol) and Bevacizumab (median PFS 20.8 versus 18.5 months, p = n.s).
![](https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image.png)
This week, the results from ATALANTE/ENGOT-ov29 trial were published. This trial used the same combination in recurrent platinum-sensitive ovarian cancer. The results were similar to the IMagyn050 trial. Adding immune checkpoint inhibitors does not improve survival in ovarian cancer.
![](https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image.png)
Ongoing studies are being conducted to identify more effective ways of using immunotherapy for a subset of patients. However, traditional measures of success, such as PD-L1 receptor status and tumor mutational burden, have not been able to predict the response to immunotherapy in HGSOC patients.
Endometrial Cancer
![](https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image.png)
Just read this paper for now; more on this topic next week !!
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