Western Regional Blog – BC, YK, AB, NWT and Nunavut
Provocative view of the possible prognostic relevance of hormone receptor expression in specific epithelial ovarian cancer patient subsets.
The analysis from Sieh and colleagues provides a provocative view of the possible prognostic relevance of hormone receptor expression in specific epithelial ovarian cancer patient subsets. Although it is certainly reasonable to hypothesize that the observed relationship between receptor status (ER/PR expression in endometrioid carcinoma; PR expression in high-grade serous carcinoma) may result from a unique effect of the hormone environment on outcomes, it is equally tenable to speculate that the more favorable prognosis in the setting of receptor expression represents a far more nonspecific relationship where a less malignant cell population may be more likely to continue to reveal “normal” cell surface or intra-cellular markers in contrast to more dedifferentiated cells. Further, such cells would surely be predicted to exhibit a more indolent/favorable biology, even if their morphology could not be distinguished under a light microscope.
One additional point is worthy of comment. In the discussion, the investigators state: “Immunohistochemical analysis of PR and ER expression … could help physicians to counsel patients about their outlook and distinguish between patients who need aggressive chemotherapy and those who might benefit from less toxic endocrine treatment.” Unfortunately, the term “aggressive chemotherapy” is not defined. It must be noted that cytotoxic chemotherapy has a well-established role in ovarian cancer based on the results of multiple phase 3 randomized trials conducted over the past several decades, in striking contrast to essentially the complete lack of such studies regarding hormonal treatment in this malignancy.
Therefore, it is concerning that the authors would make such a strong suggestion based solely on an analysis suggesting the prognostic value of hormone receptor expression in ovarian cancer and in the absence of data that such expression would predict a patient population who would achieve objective clinical benefit from hormonal manipulation. Further, prematurely abandoning the use of known effective cytotoxic agents in ovarian cancer management may quite negatively impact outcome. While the investigators are certainly entitled to their opinions regarding the “aggressiveness” of therapy, it is critical to acknowledge that this philosophy of care should not be confused with a discussion of evidence of clinical benefit.