OVANORDEST - “OVAire dans le NORD-EST” (ovarian cancer in North-East of Morocco) - is a three step project that is expected to enhance clinical and translational research on ovarian cancer for the first time in Morocco.

This research initiative was put together by a young Moroccan cancer researcher working on ovarian cancer, a neglected area of gynaecologic oncology in his under-resourced setting.

Khalid El Bairi, the principal investigator in this program has previously demonstrated, based on a bibliometric analysis [1], that research on ovarian cancer is considerably neglected in Morocco.

The study findings showed that original articles in the clinical area of ovarian cancer are lacking. Unfortunately, no specific publications on the epidemiology, clinicopathologic and therapeutic patterns of this aggressive gynaecological cancer were published.

In addition, survival data were also absent. This poor literature was dominated by publications of low levels of evidence, such as case reports on rare ovarian malignancies.

In terms of international collaborations, only preclinical research and meta-research have benefited from some partnerships. Another marked trend of Moroccan publications on ovarian cancer was the number of articles per million inhabitants that was lower than 1.

Moreover, women were under-represented as senior investigators and were also rarely listed as principal researchers.

The investigators of this project developed an individual strategy as a response to the results of this analysis. The authors’ vision encompasses various objectives to be achieved in a period of 14 years (2017-2030) based on several studies and mini-projects that aim to boost ovarian cancer research globally in Morocco (Figure 1) [2].

Building the Initiative (2017-2022)

As an initial feasibility and action plan, the investigators conducted the OVANORDEST-1 study, which is a real-world report to provide data on ovarian cancer patterns in Eastern Morocco, including epidemiology, clinical and pathological features as well as survival outcomes.

The design of this study will also investigate potential surrogate biomarkers for predicting response to chemotherapy and survival.

This will provide a rationale for developing a cost-effective prognostic score in this setting. From this perspective, the Umbrella systematic review, which was recently published by the authors, is an important step towards attaining this milestone [3].

The promotion of the publication of reviews, meta-analyses, and books on ovarian cancer was also achieved in this preliminary step.

To date, the authors were able to publish several papers covering emerging topics on ovarian cancer, including critical reviews [4-8], one Umbrella systematic review [3], one book with Springer publisher on ovarian cancer biomarkers [9] and two special issues in prestigious WoS and Medline-indexed journals, such as Seminars in Cancer Biology with the participation of international experts in the field to foster partnerships and increase the visibility of their project.

Providing support to young Moroccan oncologists and researchers working on ovarian cancer is another key aim of the project.

The senior investigators of this study are currently looking for partnerships with international cancer societies, such as ESGO, ASCO and others, to found masterclasses and fellowships to build the workforce that will improve the management of ovarian cancer and conduct research, particularly with the absence of specialised gynecologic oncologists in Morocco.

They also hope to limit gender inequality in ovarian cancer research via the engagement of young residents in medical oncology in the OVANORDEST project.

Promisingly, the authors developed a working group on cancer biomarkers that aims to enhance the national production of oncology literature with the support of international cancer researchers from developed countries.

Strengthening the Initiative (2023-2026)

After the encouraging results of OVANORDEST-1, the investigators are currently planning OVANORDEST-2, which will prospectively collect patients’ data with a formal hypothesis testing to validate the findings of the first feasibility pilot cohort.

Moreover, to boost this step, an annual 'best article' award for outstanding oncologists, summer schools, and advanced courses on biostatistics, clinical research methods, and evidence-based medicine are also being planned to help Moroccan cancer researchers perform better research on ovarian cancer.

Remarkably, the foundation of a Moroccan society for ovarian cancer and an academic journal with an international publisher is expected to support research on ovarian cancer, given the absence of any Moroccan Pubmed-indexed journals.

During this period, exploration of funding opportunities is also a priority as most of the work done was self-funded. The investigators hope to get public funding and through international organisations to support ongoing projects.

OVANORDEST-3 (2027-2030): the dream!

OVANORDEST-3 will be conducted to prospectively develop and validate an inexpensive score for prognostically stratifying patients in settings with limited resources, such as low- and middle-income countries (LMICs).

To deliver better management for ovarian cancer patients, the foundation of the Moroccan Institute for Ovarian Cancer (MIOC) is a key milestone in this project.

This hospital will deliver personalised care and be a cornerstone for conducting translational and clinical research.

It is anticipated that this independent ovarian cancer centre will participate in establishing academic and industry-sponsored multicentre, randomised and controlled clinical trials.

The plan is for the project to support the building of any future governmental policies to direct clinical research that impacts patient care, daily practice, and evidence-based decision-making for women with ovarian cancer in Morocco.

Figure 1.

References:

El Bairi K, Al Jarroudi O, Afqir S. Tracing ovarian cancer research in Morocco: A bibliometric analysis. Gynecol Oncol Rep. 2021 May 7;37:100777. doi: 10.1016/j.gore.2021.100777.

El Bairi K, Al Jarroudi O, Afqir S. Ovarian cancer in Morocco: time to act is now. Gynecol Oncol Rep. 2021;37:100857. doi: 10.1016/j.gore.2021.100857.

El Bairi K, Al Jarroudi O, Afqir S. Inexpensive Systemic Inflammatory Biomarkers in Ovarian Cancer: An Umbrella Systematic Review of 17 Prognostic Meta-analyses. Front Oncol. 2021. doi: 10.3389/fonc.2021.694821.

El Bairi K, Al Jarroudi O, Afqir S. Revisiting antibody-drug conjugates and their predictive biomarkers in platinum-resistant ovarian cancer. Semin Cancer Biol. 2021 Apr 1:S1044-579X(21)00081-X. doi: 10.1016/j.semcancer.2021.03.031.

El Bairi K, Al Jarroudi O, Le Page C, Afqir S. Does the "Devil" originate from the fallopian tubes? Semin Cancer Biol. 2021 Mar 22:S1044-579X(21)00068-7. doi: 10.1016/j.semcancer.2021.03.018.

El Bairi K, Afqir S, Amrani M. Is HE4 Superior over CA-125 in the Follow-up of Patients with Epithelial Ovarian Cancer? Curr Drug Targets. 2020;21(10):1026-1033. doi: 10.2174/1389450121666200425211732.

El Bairi K, Kandhro AH, Gouri A, Mahfoud W, Louanjli N, Saadani B, Afqir S, Amrani M. Emerging diagnostic, prognostic and therapeutic biomarkers for ovarian cancer. Cell Oncol (Dordr). 2017 Apr;40(2):105-118. doi: 10.1007/s13402-016-0309-1.

El Bairi K, Amrani M, Kandhro AH, Afqir S. Prediction of therapy response in ovarian cancer: Where are we now? Crit Rev Clin Lab Sci. 2017 Jun;54(4):233-266. doi: 10.1080/10408363.2017.1313190.
https://www.springer.com/gp/book/9789811618727

El Bairi K, Singh S, Le Page C. Revisiting platinum-resistant ovarian cancer: Advances in therapy, molecular biomarkers, and clinical outcomes. Semin Cancer Biol. 2021 Sep 4:S1044-579X(21)00226-1. doi: 10.1016/j.semcancer.2021.09.002.

El Bairi K, Amrani M. The Power of Biomarkers in Transforming Patients Care in Gynecologic Oncology. Curr Drug Targets. 2020;21(10):944-945. doi: 10.2174/138945012110200624104942.