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  Table of Contents  
Year : 2015  |  Volume : 52  |  Issue : 2  |  Page : 190

Triple negative epithelial ovarian cancer: “A new entity”

1 Department of Obstetrics and Gynecology, Pondicherry Institute of Medical Sciences, Puducherry, India
2 Department of Medical Oncology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India

Date of Web Publication5-Feb-2016

Correspondence Address:
P Jain
Department of Obstetrics and Gynecology, Pondicherry Institute of Medical Sciences, Puducherry
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-509X.175811

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How to cite this article:
Jain P, Jain A, Dubashi B. Triple negative epithelial ovarian cancer: “A new entity”. Indian J Cancer 2015;52:190

How to cite this URL:
Jain P, Jain A, Dubashi B. Triple negative epithelial ovarian cancer: “A new entity”. Indian J Cancer [serial online] 2015 [cited 2021 Aug 5];52:190. Available from: https://www.indianjcancer.com/text.asp?2015/52/2/190/175811


Till now triple negativity was exclusively defined for breast cancer. Triple negative breast cancer is a subtype with negativity for estrogen receptor (ER), progesterone receptor (PR) and HER-2 receptor. This subtype of breast cancer is associated with poor prognosis. Therapeutic options for this entity are still evolving.[1]

The recent data published by Liu N et al. is very interesting as they have defined a specific subgroup of an epithelial ovarian cancer called as triple negative epithelial ovarian cancer (TNEOC). They have done a retrospective analysis of 116 patients with primary epithelial ovarian cancer. The tissue blocks of these patients were analyzed by immunohistochemistry methods. They tested for ER, PR, p53, Ki67 and epidermal growth factor receptor (EGFR). In this study 15.5% of cases (18/116) were defined as TNEOC. In contrast to triple negative breast cancer EGFR overexpression was not seen in TNEOC. The authors also analyzed the statistical correlation of these molecular markers with clincopathological parameters. This subgroup was associated with shorter progression free survival and over all survival in both univariate and multivariate analyses.[2] This is an interesting observation with limitations of a retrospective study. Kothari R et al. has defined a similar subgroup of triple negativity in endometrial cancer.

They retrospectively analyzed the specimen of 396 endometrial cancer patients. 27% of patients had triple negative phenotype. This phenotype was associated with lymph node metastases, myometrial invasion (>50%), high grade disease, non endometrioid histology, and advanced stage disease (P < 0.023 for lymphnode metastases and P < 0.0001 for others). This TNP was associated with a significant worse survival, including decrease PFS (P = 0.009) and OS (P = 0.01).[3]

The triple negative tumors are known to defects in DNA repair pathway. This is more common in patients with BRCA 1 mutation. These tumors are responsive to a new group of drugs called as PARP inhibitors like Olaparnib. Recent studies have shown benefits of PARP inhibitors in both breast cancer and ovarian cancer. This pathway can be explored in sporadic cancers also because epigenetic changes in BRCA gene can affect its functions of DNA repair.[4]

TNBCs have enhanced angiogenesis level and vascular endothelial growth factor A (VEGFA) was reported to be increased in one third of the TNBC tumors.[5] These results formed the basis for use of antiangigenesis inhibitors like bevacizumab and sunitinib in TNBCs. Similar studies should be planned in TNEOC.

Recently two types of ovarian cancer are defined Type 1 and Type 2. Type 1 are slow growing low grade tumors associated with K ras and PTEN defects and Type 2 are fast growing tumors with p53 gene defects. The TNEOC are seen in both the groups. The recent data of Kras gene mutation in triple negative breast cancer needs evaluation in TNEOC.[6]

All these studies suggest that triple negative subset of cancer is associated with poor prognosis at all the sites including breast, ovary and endometrium. These new observations defining a new subset of triple negativity in epithelial ovarian cancer and endometrial cancer will act as an initial gate way for research in translational and genomic medicine in these cancers.

  References Top

Carey L, Winer E, Viale G, Cameron D, Gianni L. Triple-negative breast cancer: Disease entity or title of convenience?Nat Rev Clin Oncol 2010;7:683-92.  Back to cited text no. 1
Liu N, Wang X, Sheng X. The clinicopathological characteristics of 'triple negative' epithelial ovarian cancer. J Clin Pathol 2010;63:240-3.  Back to cited text no. 2
Kothari R, Morrison C, Richardson D, Seward S, Malley D, Copeland L, et al. The prognostic significance of the triple negative phenotype in endometrial cancer. Gynecol Oncol 2010;118:172-5.  Back to cited text no. 3
Fong PC, Boss DS, Yap TA, Tutt A, Wu P, Roelvink MM, et al. Inhibition of Poly (ADP-Ribose) Polymerase in Tumors from BRCAMutation Carriers. N Engl J Med 2009;361:123-34.  Back to cited text no. 4
Andre F, Job B, Dessen P, Tordai A, Michiels S, Liedtke C, et al. Molecular characterization of breast cancer with high-resolution oligonucleotide comparative genomic hybridization array. Clin Cancer Res 2009;15:441-51.  Back to cited text no. 5
Paranjape T, Heneghan H, Lindner R, Keane FK, Hoffman A, Hollestelle A, et al. A 3'-untranslated region KRASvariant and triple-negative breast cancer: A case-control and genetic analysis. Lancet Oncol 2011;12:377-86.  Back to cited text no. 6


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