Stephanie Chow

All Publications

• Trends in ovarian, fallopian tube, and primary peritoneal cancer incidence, mortality, and survival: A 15-year population-based analysis. Gynecologic oncology Somasegar, S., Reddy, R. A., Chow, S., Dorigo, O., Renz, M., Karam, A. 2024; 184: 190-197

  Abstract

  To characterize trends in ovarian, fallopian tube, and primary peritoneal cancer incidence and incidence-based mortality based on histology and site of origin.We obtained age-adjusted incidence and incidence-based mortality for patients with ovarian, fallopian tube, and primary peritoneal cancer from 2000 to 2019 from the US SEER 17 database. Joinpoint 4.9.1.0 was used to characterize log-linear time trends.The incidence and incidence-based mortality of all cancers trended down during the study period. The incidence of epithelial cancers decreased from 2004 to 2019 (AAPC -1.2%, p < 0.001), including that of high-grade (2006-2019: APC -1.2%, p < 0.05) and low-grade (2003-2019: APC -2.4%, p < 0.05) epithelial cancers. There was no change in incidence or incidence-based mortality for ovarian stromal and germ cell cancers.There has been a decrease in the incidence and incidence-based mortality of ovarian, fallopian tube, and primary peritoneal cancer, primarily due to reductions in advanced stage epithelial cancers originating in the ovary, fallopian tube, or peritoneum.

  View details for DOI 10.1016/j.ygyno.2024.01.034

  View details for PubMedID 38330833

• Impact of limiting reproductive rights of pregnant individuals with cancer in the United States. Gynecologic oncology Aryasomayajula, C., Stewart, C., Eakin, C., Reiser, H., Chow, S., Kapp, D. S., Chan, J. K., Liao, C. I. 2023

  View details for DOI 10.1016/j.ygyno.2023.11.003

  View details for PubMedID 37981547

• Monocytes - A Promising New TRAIL in Ovarian Cancer Cell Therapy. Clinical cancer research : an official journal of the American Association for Cancer Research Chow, S., Dorigo, O. 2022

  Abstract

  Adoptive cell transfer of interferon (IFN)-activated monocytes administered intraperitoneally to patients with platinum-resistant ovarian cancer demonstrated anti-tumor effects and acceptable tolerability. The exposure of monocytes to IFNalpha and IFNgamma upregulated TRAIL, which triggered caspase 8 and direct cell-to-cell contact-dependent apoptosis of ovarian cancer cells.

  View details for DOI 10.1158/1078-0432.CCR-22-2877

  View details for PubMedID 36383129

• Role of sentinel lymph node biopsy for gynecologic cancers. Current opinion in obstetrics & gynecology Chow, S., Karam, A. 1800; 34 (1): 15-19

  Abstract

  PURPOSE OF REVIEW: To provide an overview of the current knowledge and recent advances of sentinel lymph node (SLN) assessment in uterine, cervical, vulvar, and ovarian cancers.RECENT FINDINGS: In endometrial cancer, SLN evaluation has become increasingly utilized as part of the treatment of early-stage disease, with data showing improved detection of pelvic lymph node metastasis. In cervical cancer, SLN biopsy has also gained increasing traction with studies demonstrating the feasibility and accuracy of SLN detection. Evaluation with frozen section, however, remains limited in the detection of metastases. The prognostic significance of positive SLN in vulvar cancer is currently being investigated, with preliminary data showing lower recurrence rates in patients receiving adjuvant radiation.SUMMARY: SLN evaluation remains standard of care to detect lymph node metastasis in early-staged endometrial cancer. In cervical cancer, SLN biopsy has been shown to be reliable, while decreasing morbidity without impacting disease-free survival in select patients. The technique and high sensitivity of SLN biopsy in vulvar cancer has been demonstrated in large prospective trials. There are no randomized controlled trials in ovarian cancer that evaluate the role of SLN biopsy on treatment and outcome; current SLN evaluation remains investigational.

  View details for DOI 10.1097/GCO.0000000000000766

  View details for PubMedID 34967810

• Abdominopelvic FLASH Irradiation Improves PD-1 Immune Checkpoint Inhibition in Preclinical Models of Ovarian Cancer. Molecular cancer therapeutics Eggold, J. T., Chow, S., Melemenidis, S., Wang, J., Natarajan, S., Loo, P. E., Manjappa, R., Viswanathan, V., Kidd, E. A., Engleman, E., Dorigo, O., Loo, B. W., Rankin, E. B. 2021

  Abstract

  Treatment of advanced ovarian cancer using PD-1/PD-L1 immune checkpoint blockade shows promise, however current clinical trials are limited by modest response rates. Radiation therapy has been shown to synergize with PD-1/PD-L1 blockade in some cancers but has not been utilized in advanced ovarian cancer due to toxicity associated with conventional abdominopelvic irradiation. While ultra-high dose rate (FLASH) irradiation has emerged as a strategy to reduce radiation-induced toxicity, the immunomodulatory properties of FLASH irradiation remain unknown. Here we demonstrate that single high dose abdominopelvic FLASH irradiation promoted intestinal regeneration and maintained tumor control in a preclinical mouse model of ovarian cancer. Reduced tumor burden in conventional and FLASH treated mice was associated with an early decrease in intratumoral regulatory T cells and a late increase in cytolytic CD8+ T cells. Compared to conventional irradiation, FLASH irradiation increased intratumoral T cell infiltration at early timepoints. Moreover, FLASH irradiation maintained the ability to increase intratumoral CD8+ T cell infiltration and enhance the efficacy of alphaPD-1 therapy in preclinical models of ovarian cancer. These data highlight the potential for FLASH irradiation to improve the therapeutic efficacy of checkpoint inhibition in the treatment of ovarian cancer.

  View details for DOI 10.1158/1535-7163.MCT-21-0358

  View details for PubMedID 34866044

• Differential Diagnosis of a Unique Vulvar Mass in an Adolescent. Obstetrics and gynecology Chow, S., Doyle, A., Hammer, P., Tyson, N. A. 2021

  Abstract

  Vulvar masses in adolescents have a broad differential diagnosis, yet few reports exist detailing masses of mammary origin.A nulliparous, healthy 16-year-old adolescent presented with a longstanding, ulcerated, 17-cm vulvar mass of unknown origin and pronounced inguinal lymphadenopathy. The patient underwent a left radical partial vulvectomy, with pathology revealing terminal duct lobular units consistent with polymastia.Differential diagnosis of a vulvar mass in an adolescent should include polymastia.

  View details for DOI 10.1097/AOG.0000000000004563

  View details for PubMedID 34735404

• Development of Therapeutic Vaccines for Ovarian Cancer. Vaccines Chow, S., Berek, J. S., Dorigo, O. 2020; 8 (4)

  Abstract

  Ovarian cancer remains the deadliest of all gynecologic malignancies. Our expanding knowledge of ovarian cancer immunology has allowed the development of therapies that generate systemic anti-tumor immune responses. Current immunotherapeutic strategies include immune checkpoint blockade, cellular therapies, and cancer vaccines. Vaccine-based therapies are designed to induce both adaptive and innate immune responses directed against ovarian cancer associated antigens. Tumor-specific effector cells, in particular cytotoxic T cells, are activated to recognize and eliminate ovarian cancer cells. Vaccines for ovarian cancer have been studied in various clinical trials over the last three decades. Despite evidence of vaccine-induced humoral and cellular immune responses, the majority of vaccines have not shown significant anti-tumor efficacy. Recently, improved vaccine development using dendritic cells or synthetic platforms for antigen presentation have shown promising clinical benefits in patients with ovarian cancer. In this review, we provide an overview of therapeutic vaccine development in ovarian cancer, discuss proposed mechanisms of action, and summarize the current clinical experience.

  View details for DOI 10.3390/vaccines8040657

  View details for PubMedID 33167428

• Uterine clear cell carcinoma risk in White versus non-White US subpopulations: does race matter? Journal of gynecologic oncology Chow, S., Wong, D., Liao, C. I., Mann, A., Tian, C., Darcy, K. M., Chan, J. K. 2020; 31 (6): e81

  Abstract

  OBJECTIVE: To determine incidence rates of uterine clear cell carcinoma among non-White US subpopulations.METHODS: Data from the United States Cancer Statistics and National Cancer Database from 2004 to 2016 were analyzed using descriptive statistics.RESULTS: A total of 488,811 women were diagnosed with uterine cancer from 2004-2016. Of these, 73.3% were endometrioid, 6.6% were serous, 5.3% were carcinosarcoma, 1.4% were clear cell, and 13.4% were other. Blacks had the highest incidence rate of uterine clear cell compared with Whites, Asian/Pacific Islanders, and American Indian/Alaska Natives (0.59 vs. 0.31, 0.29, and 0.24, respectively). Overall mean age at diagnosis was 68.6 years, with the youngest age in Asian/Pacific Islanders compared to Whites, Blacks, and American Indian/Alaska Natives (65.9 vs. 68.7, 68.6, and 66.3 years, respectively). Analysis of the Asian subpopulation revealed significantly younger age at diagnosis in Vietnamese women (55.8 years) compared with 72.4 years in Japanese, 68.6 years in Pacific Islander, 66.6 years in Indian/Pakistani, 65.9 years in Filipino, 65.8 years in Chinese, 65.2 years in Korean, and 63.7 years in other Asians.CONCLUSIONS: Black women are two times more likely to be diagnosed with uterine clear cell carcinoma compared with other races. Asians present at younger ages, with Vietnamese women most likely to be diagnosed at the youngest age.

  View details for DOI 10.3802/jgo.2020.31.e81

  View details for PubMedID 33078591

• Trends and survival outcomes of robotic, laparoscopic, and open surgery for stage II uterine cancer. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society Abel, M. K., Chan, J. K., Chow, S., Darcy, K., Tian, C., Kapp, D. S., Mann, A. K., Liao, C. 2020

  Abstract

  INTRODUCTION: A recent randomized clinical trial showed that minimally invasive surgery led to poorer survival compared with open surgery in early stage cervical cancer. We determined the trends in adoption of minimally invasive surgery and 5-year overall survival outcomes after open, laparoscopic-assisted, and robotic-assisted hysterectomy for stage II uterine cancer with cervical stromal involvement.METHODS: Data for patients with stage II uterine cancer were acquired from the National Cancer Database from 2010 to 2015. chi2 testing, Kaplan-Meier methods, and Cox models were used for statistical analyses.RESULTS: Of 2949 patients, 44.3% underwent open hysterectomy, 13.9% underwent laparoscopic hysterectomy, and 41.8% underwent robotic hysterectomy. The proportion of robotic cases increased from 26.8% in 2010 to 48.3% in 2015 (annual percent change 10.1%), with a decrease in open hysterectomy from 63.3% to 34.3% (annual percent change -12.5%). The overall 5-year survival was 77.6% in robotic, 76.8% in laparoscopic, and 72.5% in open hysterectomy (p=0.045); however, after adjusting for known prognostic factors, robotic (HR 1.00, 95%CI 0.82 to 1.21; p=0.97) and laparoscopic hysterectomy (HR 1.09, 95%CI 0.83 to 1.44; p=0.54) did not portend for improved survival compared with open hysterectomy. Black women (HR 1.59, 95%CI 1.25 to 2.02; p<0.001) and individuals with co-morbidities (HR 1.45, 95%CI 1.21 to 1.75, p<0.001) had worse adjusted survival and the highest rates of open hysterectomy.CONCLUSION: The use of minimally invasive surgery for stage II uterine cancer has increased over time, with comparable adjusted 5-year survival after robotic or laparoscopic hysterectomy compared with open hysterectomy. Black women and those with co-morbidities had lowest rates of minimally invasive surgery and the poorest adjusted survival.

  View details for DOI 10.1136/ijgc-2020-001646

  View details for PubMedID 32753561

• FLASH irradiation enhances the therapeutic index of abdominal radiotherapy in mice Natarajan, S., Levy, K., Wang, J., Chow, S., Eggold, J., Loo, P., Manjappa, R., Lartey, F. M., Schuler, E., Skinner, L., Rafat, M., Ko, R., Kim, A., Al Rawi, D., von Eyben, R., Dorigo, O., Casey, K. M., Graves, E. E., Bush, K., Yu, A. S., Koong, A. C., Maxim, P. G., Loo, B. W., Rankin, E. B. AMER ASSOC CANCER RESEARCH. 2020

  View details for DOI 10.1158/1538-7445.AM2020-5351

  View details for Web of Science ID 000590059306341

• Total abdominal ultra-rapid FLASH irradiation enhances the efficacy of PD-1 inhibition in preclinical models of ovarian cancer Chow, S., Eggold, J. T., Levy, K., Wang, J., Manjappa, R., Breitkreutz, D. Y., Yu, A. S., Bush, K., Dorigo, O., Loo, B. W., Rankin, E. B. AMER ASSOC CANCER RESEARCH. 2020

  View details for DOI 10.1158/1538-7445.AM2020-5357

  View details for Web of Science ID 000590059306346

• Molecular Classification of Metastatic and Recurrent Endometrial Endometrioid Carcinoma Devereaux, K., Chow, S., Steiner, D., Peters-Schulze, G., Ho, C., Suarez, C., Folkins, A., Howitt, B. NATURE PUBLISHING GROUP. 2020: 1041–42

  View details for Web of Science ID 000518328902228

• Molecular Classification of Metastatic and Recurrent Endometrial Endometrioid Carcinoma Devereaux, K., Chow, S., Steiner, D., Peters-Schulze, G., Ho, C., Suarez, C., Folkins, A., Howitt, B. NATURE PUBLISHING GROUP. 2020: 1041–42

  View details for Web of Science ID 000518328802228

• Abdominal FLASH irradiation reduces radiation-induced gastrointestinal toxicity for the treatment of ovarian cancer in mice. Scientific reports Levy, K. n., Natarajan, S. n., Wang, J. n., Chow, S. n., Eggold, J. T., Loo, P. E., Manjappa, R. n., Melemenidis, S. n., Lartey, F. M., Schüler, E. n., Skinner, L. n., Rafat, M. n., Ko, R. n., Kim, A. n., H Al-Rawi, D. n., von Eyben, R. n., Dorigo, O. n., Casey, K. M., Graves, E. E., Bush, K. n., Yu, A. S., Koong, A. C., Maxim, P. G., Loo, B. W., Rankin, E. B. 2020; 10 (1): 21600

  Abstract

  Radiation therapy is the most effective cytotoxic therapy for localized tumors. However, normal tissue toxicity limits the radiation dose and the curative potential of radiation therapy when treating larger target volumes. In particular, the highly radiosensitive intestine limits the use of radiation for patients with intra-abdominal tumors. In metastatic ovarian cancer, total abdominal irradiation (TAI) was used as an effective postsurgical adjuvant therapy in the management of abdominal metastases. However, TAI fell out of favor due to high toxicity of the intestine. Here we utilized an innovative preclinical irradiation platform to compare the safety and efficacy of TAI ultra-high dose rate FLASH irradiation to conventional dose rate (CONV) irradiation in mice. We demonstrate that single high dose TAI-FLASH produced less mortality from gastrointestinal syndrome, spared gut function and epithelial integrity, and spared cell death in crypt base columnar cells compared to TAI-CONV irradiation. Importantly, TAI-FLASH and TAI-CONV irradiation had similar efficacy in reducing tumor burden while improving intestinal function in a preclinical model of ovarian cancer metastasis. These findings suggest that FLASH irradiation may be an effective strategy to enhance the therapeutic index of abdominal radiotherapy, with potential application to metastatic ovarian cancer.

  View details for DOI 10.1038/s41598-020-78017-7

  View details for PubMedID 33303827

• Does chemotherapy or radiation benefit surgical stage I uterine carcinosarcoma patients? American journal of obstetrics and gynecology Chow, S., Chan, J. K., Kapp, D. S., Mann, A., Liou, W., Liao, C. 2019

  View details for DOI 10.1016/j.ajog.2019.11.1260

  View details for PubMedID 31765639

• Metastatic gynecologic malignancies: advances in treatment and management Chan, J. K., Chow, S., Bhowmik, S., Mann, A., Kapp, D. S., Coleman, R. L. SPRINGER. 2018: 521–33

  Abstract

  Gynecologic cancers comprise of mostly uterine, ovarian, and cervical malignancies and are responsible for 95,000 new cases annually in the United States. Uterine cancer is the most common and the number of new cases and mortality has been increasing. Cervical cancer has decreased due to screening, early detection, and treatment of pre-invasive cancers. However, ovarian cancer remains the most lethal because of advanced stage at diagnosis and drug resistance. The metastatic spread pattern differs amongst these cancers, with uterine and cervical cancer found mostly in the primary organ and ovarian cancer disseminating throughout the peritoneum and upper abdomen at presentation. The primary treatment of ovarian cancer typically involves surgery followed by systemic therapy for more advanced disease. Previously, systemic chemotherapy with platinums, taxanes, doxorubicin, topotecan, and gemcitabine has been the standard in either upfront or recurrent setting. With molecular and genetic breakthroughs, we now have over eight new indications and five novel biologic therapies including antiangiogenics, poly ADP ribose polymerase inhibitors, and immunotherapies approved over the last 3 years. In this review, we will examine the biology of gynecologic cancer metastasis and focus on new treatment options for these cancers with a focus on ovarian cancer.

  View details for PubMedID 29931499

• Trends in the incidence of serous fallopian tube, ovarian, and peritoneal cancer in the US GYNECOLOGIC ONCOLOGY Liao, C., Chow, S., Chen, L., Kapp, D. S., Mann, A., Chan, J. K. 2018; 149 (2): 318–23

  Abstract

  To identify the trends in incidence of serous fallopian tube, ovarian, and peritoneal epithelial cancers in the United States.Data was obtained from United States Cancer Statistics (USCS) from 2001 to 2014. All incidences are per 100,000 women. Analyses were performed using SEER*Stat and Joinpoint regression programs.Of the 146,470 patients with serous cancers, 9381 (6.4%) were fallopian tube, 121,418 (82.9%) were ovarian, and 15,671 (10.7%) were primary peritoneal. The study period was divided from 2001 to 2005, 2006-2010, and 2011-2014, and there was an increase in fallopian tube incidence from 0.19 to 0.35 to 0.63, with a corresponding decrease in ovarian incidence from 5.31 to 5.08 to 4.86. There was no significant change in peritoneal cancers from 0.64 to 0.69 to 0.62. The age-specific peak incidence of fallopian tube cancer was younger at age 70-74, compared to ovarian and peritoneal cancer at age 75-79. Further, the incidence of serous fallopian tube cancer was highest in Whites at 0.42, compared to Blacks at 0.24, Hispanics at 0.27, and Asians at 0.28.From 2001 to 2014, the diagnosis of serous fallopian tube cancer increased fourfold with a corresponding decrease in ovarian cancer. The peak incidence of tubal cancer was 70-74years with an increased incidence in Whites.

  View details for PubMedID 29514737