Tuesday, April 13, 2010
A Phase Ib trial of CA4P (combretastatin A-4 phosphate), carboplatin, and paclitaxel in patients with advanced cancer
The combination of CA4P with carboplatin and paclitaxel was well tolerated in the majority of patients with adequate premedication and had antitumour activity in patients who were heavily pretreated.
Facebook | Darlene Gray: Sask Minister of Health Questioned in Leg Assembly Over the Closure of Regina Gyne Onc Office
Legislative Assembly of Saskatchewan
N.S. VOL. 52 NO. 42A MONDAY, APRIL 12, 2010, 1:30 p.m.
LEGISLATIVE ASSEMBLY OF SASKATCHEWAN 4697 April 12, 2010
April 12, 2010 Saskatchewan Hansard 4705
INTRODUCTION OF GUESTS
Ms. Junor: — Mr. Speaker, I too on behalf of the opposition want to welcome the members from the Red Hat Society, all the women that have come today. From what I know about this group, not only are they very visible because of their hats — and it’s unfortunate that the member didn’t wear hers; that would have been entertaining — I understand that these women are extremely enthusiastic and they have a lot of fun. That’s what I always hear, that you have a lot of fun. Look at all the hats nodding. So I too would like to welcome all the women here today to the legislature.
While I’m on my feet, Mr. Speaker, I want to introduce others who are in the gallery. On the very top row is Darlene Gray, the director of OCATS, the Ovarian Cancer Awareness and Treatment in Saskatchewan, and Elan Morgan board member. Wave? And sitting beside Elan are Joan and Harvey Schneider, also board members. I just want to say about Joan before I sit down and welcome them, Joan was the executive secretary to the president of SUN [Saskatchewan Union of Nurses] when that was me. So I’m very happy to see Joan here today and welcome them all to the Assembly.
Ms. Junor: — Mr. Speaker, for two years the minister has ignored the pleas of women with ovarian cancer and gyne-oncologists to address substandard working conditions in southern Saskatchewan. As a result, Dr. Brydon, one of only two gyne-oncologists practising in southern Saskatchewan, has closed her practice because she is burned out. To quote Dr. Brydon, “Physically and emotionally, I can’t cope any more.”
Mr. Speaker, the minister’s incompetence and failure to address the substandard working conditions of gyne-oncologists in Regina is putting at risk the lives of women with ovarian cancer. Why?
The Speaker: — I recognize the Minister of Health.
Hon. Mr. McMorris: — Thank you, Mr. Speaker. First of all, Mr. Speaker, on behalf of the government, we want to thank Dr. Brydon for all the work that she has done in southern Saskatchewan. These people are very specialized doctors. They are, Mr. Speaker, gynecology oncologists, which is a very specialized area. We have had four in our province, Mr. Speaker. Dr. Brydon is closing her practice to move on to other options. The health region, the health region as well as the government, is working hard to ensure that that position will be filled, Mr. Speaker.
But what I will say is that in the last two and a half years of our government, we have done more to recruit physicians into this province compared to the 16 years. And especially when you look at the front page of the Leader-Post, from 2001 to 2006 the net out-migration of health care workers in Saskatchewan was 1,160 health care workers out, Mr. Speaker. In our first two and a half years, we have attracted 164 more physicians to our province than under that government, Mr. Speaker.
The Speaker: — I recognize the member from Saskatoon Eastview.
Ms. Junor: — Mr. Speaker, that tired rhetoric is no consolation to women who have ovarian cancer. Mr. Speaker, in every other jurisdiction, including Saskatoon, gyne-oncologists work in a hospital setting with the proper support around them — not so in Regina where the specialists have to find their own office space and work without the support of a nurse.
Mr. Speaker, to the minister: is he going to provide immediate office space and examining room space in the Regina General Hospital along with the proper nursing support, or is he going to continue to ignore the issue until the second gyne-oncologist closes her practice?
The Speaker: — I recognize the Minister of Health.
Hon. Mr. McMorris: — Mr. Speaker, we have a gynecological oncology program working group that was established, Mr. Speaker, under our government. This working group has patient support, is represented through patient support groups. It also has a gynecology oncologist, the four that were in the province, working on this group as well as the health authorities of Regina Qu’Appelle, Saskatoon, and the Saskatchewan Cancer Agency to deal with this issue to have an ongoing program.
Mr. Speaker, the ministry officials have informed me that progress is being steadily made, Mr. Speaker. And yes, there are going to be decisions made by physicians to step aside. But, Mr. Speaker, we’re going in the right direction. It isn’t the working of that group . . .
The Speaker: — Order. Order. I’d ask the opposition members to give the minister the same opportunity to respond as the government gave the member to ask the question. I recognize the minister.
Hon. Mr. McMorris: — Mr. Speaker, it isn’t the working of that group that would get into the micromanagement of what happens within a health region or the Cancer Agency. That is the auspices of the Cancer Agency or the regional health authority in their particular area, Mr. Speaker.
The Speaker: — I recognize the member from Saskatoon Eastview.
Ms. Junor: — Mr. Speaker, this is clearly a lack of leadership. The working group has been ongoing for over two years. They’re going to just keep spinning their wheels unless the minister says, do this. The minister’s incompetence and failure to address the problems means there’s now only one gyne-oncologist looking after all of southern Saskatchewan women. This will put additional pressures on the remaining gyne-oncologist and potentially will increase the wait time for women who are waiting for even an initial diagnosis.
My question to the minister is this: will the Sask Party government be forced to send women out of the province for diagnosis and treatment because of their incompetence and failure?
The Speaker: — I recognize the Minister of Health.
Hon. Mr. McMorris: — As I had mentioned earlier that the health region, the Saskatchewan Cancer Agency, the Regina Qu’Appelle Health Region will be working hard in the next . . . in the past but as we move forward over the next month or so to attract another gyne-oncologist into the province. I am very proud of our government having set up a physician recruitment agency that will deal with this very issue, these very issues, Mr. Speaker.
Unfortunately that hadn’t been done for many, many years — never even contemplated under the former government when we saw hundreds and hundreds of doctors leaving this province, Mr. Speaker. In the last two and a half years, we’ve seen more doctors come to the province than leave — an increase of about 164. There is more work to do. That’s why we set up a recruitment agency, Mr. Speaker. And that’s why we’ve also increased the number of training seats in the College of Medicine and the number of residency positions, up to 108 residency positions in the province, Mr. Speaker, that will bode this province very well into the future.
The Speaker: — I recognize the member from Saskatoon Eastview.
Ms. Junor: — Mr. Speaker, ducking and weaving, I mean there is no answer in the minister’s rhetoric. And Dr. Brydon’s leaving her practice now because the province will not set up a gyne-cancer unit in Regina. This unit would allow women to be diagnosed, treated, and receive follow-up care in one place. To quote Dr. Brydon:
I actually don’t think that the way the system is structured in this province at this time allows anybody to do the job that needs to be done properly and that is because we do not have a gynecologic women’s cancer unit the way all other provinces do.
Mr. Speaker, to the minister: is the minister going to establish a gyne women’s cancer unit in the province now, or is he going to wait and wait and wait, and talk and talk, and talk and continue to risk the lives of women with ovarian cancer?
The Speaker: — I recognize the Minister of Health.
Hon. Mr. McMorris: — Mr. Speaker, we know and understand the very importance of this issue, Mr. Speaker. That’s why we set up a working group that has patient representative groups on it, that has the oncologists on it, that has the Cancer Agency, that has the health regions, to look at how to best manage this project, Mr. Speaker. There has been progress made, absolutely. But it’s interesting that they would stand and criticize the way the program and the way the health system is being run, when they have been in government for 16 years prior, setting up the very program they’re criticizing now, Mr. Speaker.
Mr. Speaker, we’re looking at how we can improve this program as we move forward. We’re looking at how we can have the proper complement of gyne-oncologists within the province, Mr. Speaker, because we know that it is a very important issue, and we’re working to improve the health of women in our province, Mr. Speaker.
AbstractThe HE4 protein is overexpressed in ovarian carcinomas and can be detected in serum by an ELISA with sensitivity similar to CA125 and higher specificity for malignant disease. We now demonstrate that HE4 can also be detected in the urine at a specificity level of 94.4%, including 13/15 (86.6%) with stage I/II and 57/64 (89.0%) with stage III/IV disease and including 90.5% of patients with serous ovarian carcinoma. Assaying serum and urine from the same patients showed similar sensitivity. Our data indicate that measuring HE4 in urine may aid diagnosis and the monitoring of response to therapy.
Med Oncol. 2010 Apr 10
EpCAM-autoantibody levels in the course of disease of ovarian cancer patients.
Heubner M, Errico D, Kasimir-Bauer S, Herlyn D, Kimmig R, Wimberger P.
Clinic of Obstetrics and Gynaecology, Medical Faculty, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany, Martin.firstname.lastname@example.org.
EpCAM is a tumor-associated antigen, which is frequently expressed in ovarian cancer.
Feasibility of extension of platinum-free interval with weekly bolus topotecan and subsequent platinum retreatment outcomes in recurrent ovarian cance
Response: An opportunity to refine our understanding of "response shift" and to educate researchers on designing quality research studies
Journal Quality of Life Research
Issue Volume 19, Number 4 / May, 2010
An opportunity to refine our understanding of “response shift” and to educate researchers on designing quality research studies: response to Ubel, Peeters, and Smith
Bryce B. Reeve1 Contact Information
(1) Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, EPN 4088, 6130 Executive Blvd., MSC 7344, Bethesda, MD 20892-7344, USA
There is no advantage at this time to abandon the term “response shift” as suggested by Ubel et al. (Qual Life Res, 2010). The term is well known in the research field and has impacted the way we think about measuring quality of life (QOL) longitudinally. However, Ubel et al. (Qual Life Res, 2010) have provided the incentive to start an open dialogue on the subject with opportunities to refine the language of response shift and educate researchers. In this article, we identify opportunities in designing research studies to minimize or account for response shifts by considering the (1) selection of QOL concepts to measure, (2) questionnaires used to assess the QOL concepts, (3) design of the research study, (4) target population, and (5) analyses and reporting of results. Careful consideration of each of these issues will help us identify new methodologies and improved study designs that will move the QOL research field forward.
Thomas J. Herzog, MD, Columbia University College of Physicians and Surgeons talks about liposomal doxorubicin, bevacizumab, and temsirolimus in patients with advanced malignancy/GOG reference to trials
Note: This is a repost of the video. Dr Herzog speaks briefly about the direction of GOG trials including the numerous drug combinations and trying to assess the best approaches.
QOL Research Journal: Abandoning the language of “response shift”: a plea for conceptual clarity in distinguishing scale recalibration from true changes in quality of life
"..they have shed light on important mysteries relevant to understanding the experiences of people with chronic illness and disability. And they have focused researchers on the challenge of explaining why people with disabilities often provide quality of life reports that seem to belie their objective circumstances....The term ('response shift') suggests that the high quality of life reported by many people with chronic illness and disability are measurements artifacts - their "responses" have "shifted" - and that such people are not really experiencing high quality of life. We think such connotations, even if not originally intended, are misleading."
Monday, April 12, 2010
commentary/Japanese study - Carbo/Taxol - Dose-Dense Chemotherapy for Ovarian Cancer - National Cancer Institute
"...Women with advanced ovarian cancer lived longer and without their tumors growing after receiving a modified regimen of a standard chemotherapy drug combination, Japanese researchers have reported. In a large phase III clinical trial, the researchers randomly assigned women to receive six cycles of carboplatin and paclitaxel (Taxol) every 3 weeks (standard regimen) or six cycles of carboplatin every 3 weeks and a lower dose of paclitaxel (Taxol) once a week (dose-dense regimen). Women in the dose-dense group had a 29 percent reduction in the risk of progression and a 25 percent reduction in the risk of death after 3 years of follow-up. The results were published online September 18, 2009, in The Lancet (see the journal abstract).
Although the dose-dense regimen had more toxic effects than the standard regimen, survival benefits of this magnitude "have been rare in women with advanced ovarian cancer," wrote. Noriyuki Katsumata, M.D., and colleagues from the Japanese Gynecologic Oncology Group (JGOG).
The results, explained Ted Trimble, M.D., M.P.H., from NCI's Division of Cancer Treatment and Diagnosis, are consistent with what has been seen in breast cancer using a dose-dense chemotherapy regimen. The idea, he continued, is "to balance efficacy and toxicity by using a weekly schedule rather than every 3 weeks."...."
Methods of consumer involvement in developing healthcare policy and research, clinical practice guidelines and patient information material.
Authors’ conclusions There is little evidence from randomised controlled trials of the effects of consumer involvement in healthcare decisions at the population level. The trials included in this review demonstrate that randomised controlled trials are feasible for providing evidence about the effects of involving consumers in these decisions.
Risk and epidemiological time trends of gastric cancer in Lynch syndrome carriers in the Netherlands.
CONCLUSIONS: Lynch syndrome mutation carriers have a substantial risk for gastric cancer, in particular patients with an MLH1 or MSH2 mutation. Family history for gastric cancer is a poor indicator for individual risk. Surveillance gastroscopy for Lynch syndrome patients carrying an MLH1 or MSH2 mutation should therefore be considered.
CONCLUSION: The majority of the uterine cornua had a tubal remnant which suggests that RRSO may leave behind residual tubal epithelium. The clinical significance of this tubal remnant is unclear given the current understanding of tubal carcinogenesis
Referral and ascertainment bias in patients with synchronous and metachronous endometrial malignancy.
The purpose of this study was to evaluate the frequency in patients with endometrial cancer of other malignancies and the influence of referral and ascertainment biases on these associations.
Analysis of 1,028 local and referred patients who had a hysterectomy for endometrial cancer was based on residence at the time of diagnosis.
Altogether, 208 patients had a history of another malignancy, most frequently breast, colon, and ovary. At the time of surgery for endometrial cancer, the prevalence of lymphoma and breast and ovarian cancers was greater than expected although the higher prevalence of lymphoma was limited to referred patients. During follow-up after hysterectomy, the incidence of lung cancer was lower than expected, whereas the incidence of lymphoma was higher. Breast, colorectal, and bladder cancers were more common than expected although this finding was limited to local patients.
We concluded that results of epidemiologic studies from tertiary care centers may be misleading if they do not account for referral and ascertainment biases.
"As the preclinical results of mAb's therapeutic effects on ovarian cancer have been encouraging, further investigations are needed to establish a more effective, specific, and less toxic treatment strategy for this malignancy."
Identification of early predictive imaging biomarkers and their relationship to serological angiogenic markers in patients with ovarian cancer with re
dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)
"CONCLUSIONS: Imaging markers have a potential role in early prediction of disease progression in patients with residual ovarian cancer and may supplement current measures of progression. The correlation of DCE-MRI and serological biomarkers suggests that tumour angiogenesis affects these markers through common biological means and warrants further investigation."
Low malignant potential tumors with micropapillary features are molecularly similar to low-grade serous carcinoma of the ovary.
CONCLUSION: The gene expression profile of LMP-MP is similar to LGSC and distinct from LMP, reflecting their more aggressive clinical behavior. *Low-grade serous carcinoma (LGSC) *LMP with micropapillary features (LMP-MP)
Cancer Causes Control. 2010 Mar 23
"We performed case-control analyses using data from the North Carolina Ovarian Cancer Study to determine risk factors that distinguish primary peritoneal cancer (PPC) from epithelial ovarian cancer (EOC).
Our risk factor analyses were restricted to invasive serous cancers including 495 EOC cases, 62 PPC cases and 1,086 control women....Although many case-control associations for the invasive serous PPC cases were similar to those of the invasive serous EOC cases, some differences were observed including a twofold increase in risk of invasive serous PPC in women who were >/=35 years at last pregnancy, whereas a decreased risk was observed for invasive serous EOC risk.
We could not confirm a previous report of an association between tubal ligation and PPC, a factor consistently associated with a decreased risk of EOC. The difference in the risk factor associations between invasive serous PPC and EOC cancers suggests divergent molecular development of peritoneal and ovarian cancers.
A larger study to determine risk factors for invasive serous PPC is warranted."
CONCLUSIONS:: Lynch syndrome is under-recognized, even when patients have clear criteria unrelated to family history. Multifaceted strategies focused on reducing providers' cognitive errors and harnessing EHR (electronic health record) capabilities to improve recognition of Lynch syndrome are needed "Among 244 patients with uncertainty, a suspicion for Lynch syndrome was documented in the EHR of 6 patients (2.5%); 3 received counseling."
Endometrial and ovarian carcinomas with undifferentiated components: clinically aggressive and frequently underrecognized neoplasms
"Endometrial and ovarian carcinomas with undifferentiated components have a broad histologic differential diagnosis, but they show specific histologic features that should enable accurate diagnosis. These tumors can occur in young women, may be associated with microsatellite instability and behave in a clinically aggressive manner." Modern Pathology
Potent preclinical impact of metronomic low-dose oral topotecan combined with the antiangiogenic drug pazopanib for the treatment of ovarian cancer.
Low-dose metronomic chemotherapy has shown promising activity in many preclinical and some phase II clinical studies involving various tumor types. To evaluate further the potential therapeutic impact of metronomic chemotherapy for ovarian cancer, we developed a preclinical model of advanced human ovarian cancer and tested various low-dose metronomic chemotherapy regimens alone or in concurrent combination with an antiangiogenic drug, pazopanib. Clones of the SKOV-3 human ovarian carcinoma cell line expressing a secretable beta-subunit of human choriogonadotropic (beta-hCG) protein and firefly luciferase were generated and evaluated for growth after orthotopic (i.p.) injection into severe combined immunodeficient mice; a highly aggressive clone, SKOV-3-13, was selected for further study. Mice were treated beginning 10 to 14 days after injection of cells when evidence of carcinomatosis-like disease in the peritoneum was established as assessed by imaging analysis. Chemotherapy drugs tested for initial experiments included oral cyclophosphamide, injected irinotecan or paclitaxel alone or in doublet combinations with cyclophosphamide; the results indicated that metronomic cyclophosphamide had no antitumor activity whereas metronomic irinotecan had potent activity. We therefore tested an oral topoisomerase-1 inhibitor, oral topotecan, at optimal biological dose of 1 mg/kg/d. Metronomic oral topotecan showed excellent antitumor activity, the extent of which was significantly enhanced by concurrent pazopanib, which itself had only modest activity, with 100% survival values of the drug combination after six months of continuous therapy. In conclusion, oral topotecan may be an ideal agent to consider for clinical trial assessment of metronomic chemotherapy for ovarian cancer, especially when combined with an antiangiogenic drug targeting the vascular endothelial growth factor pathway, such as pazopanib. Mol Cancer Ther; 9(4); 996-1006. (c)2010 AACR.
CA 125 and the detection of recurrent ovarian cancer. Robert C. Bast Jr. 2010; Cancer - Wiley InterScience
CA 125 and the detection of recurrent ovarian cancer
A reasonably accurate biomarker for a difficult disease
|Robert C. Bast Jr, MD|
|Department of Experimental Therapeutics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas|
|Rising cancer antigen 125 (CA125) levels have been used to detect recurrence of ovarian cancer. A recent study questions the value of this practice, but the clinical trial has significant limitations and discounts the value of early detection to permit treatment of recurrence with novel and conventional agents.|
British Journal of Cancer -Age of mother and grandmother in relation to a subject's breast cancer risk
Background: On theoretical grounds, the age of the grandmother and the age of the mother at delivery of her daughter may affect the breast cancer risk of the granddaughter.
Conclusion: This study does not suggest a major role of maternal age at delivery or grandmaternal age at delivery of the mother for the (grand)daughters' breast cancer risk.
FDA & Digital Mammography: Why Has FDA Required Full Field Digital Mammography Systems to Be Regulated as Potentially Dangerous Devices for More Than 10 Years?
author: Bioptics Inc.
(Promestriene) Urogenital disorders associated with oestrogen deficiency: the role of promestriene as topical oestrogen therapy; Gynecological Endocrinology
"Given the absence of systemic activity, promestriene may be a good choice in women requiring purely locally oestrogen, and those who have survived, or who are at risk of breast cancer and who have severe vulvo-vaginal symptoms."
Strength in Numbers
Project plans to unite support services for women with breast and reproductive cancers
By Jane Shulman
Cancer support networks in different parts of the country are looking at grouping women’s gynaecological cancers with breast cancer for the purpose of offering more support to women who have had a cervical, ovarian or uterine cancer diagnosis. Manitoba has been working on this for some time, explains Barbara Clow, director of the Atlantic Centre of Excellence for Women’s Health, and now New Brunswick and Newfoundland and Labrador are looking at their own models for delivering programming under the same umbrella.
In a 2008 report for Canadian Partnership Against Cancer, called “Where Do We Go From Here? Support services for women with breast, cervical, ovarian and uterine cancer in Atlantic Canada,” Clow and co-authors looked at the idea of merging services to meet the needs of the underserved gynaecological cancer population.
The idea is not without its detractors. Some have expressed concern that breast cancer groups might jeopardize their funding or lose their identity if they expand their mandate, or stretch their already overextended resources.
But the focus on breast cancer over the past several years, with fundraisers and awareness campaigns popping up all over the country, means that the disease has a lot of attention, and Clow notes that it’s the kind of attention that gynaecological cancers desperately need. While she says that fewer women are diagnosed with cervical, ovarian and uterine cancers combined than breast cancer in Canada each year, with the exception of cervical cancer, their prognosis is not as good. And the psychosocial support specific to their kind of cancer just does not exist.
Clow cites the work of volunteer-based Ovarian Cancer Canada as the only national gynaecologically-based cancer group. There are no national groups for people with cervical or uterine cancer. The needs are different, but there’s overlap, which is why a program that pools resources for cancers that affect women is so appealing.
The report recommendations included:
Foster new research on the needs of women from vulnerable and disadvantaged communities who are faced with a diagnosis of cancer;
Explore the possibility of adopting and adapting the processes and products developed by breast cancer support networks in Atlantic Canada to meet the needs of those with other women’s cancers;
Promote the creation of publicly funded cancer patient navigator programs throughout Atlantic Canada.
Clow says the next step is to look at how feasible this idea is, and where the desire lies. So far, nurses and service providers involved with the planning and delivering of programming are most passionate about it because they see the possibilities that lie in making the most of the services they can offer.
Jane Shulman is a the Director of Knowledge Exchange at the Canadian Women’s Health Network and a former staff member of Breast Cancer Action Montreal
Emerging drugs for the management of cancer treatment induced bone loss; Expert Opinion on Emerging Drugs
Take home message: The very high rate of bone loss and the high incidence of fractures indicate that cancer patients at risk of CTIBL (cancer treatment induced bone loss) need to be carefully monitored and stratified for fracture risk. Although there is a strong evidence of efficacy in prevention of bone loss and reduction of fracture risk for many drugs approved for postmenopausal osteoporosis (PMO) and male osteoporosis, for CTIBL there are actually no drugs approved for this indication.
The Lancet Oncology, Early Online Publication, 1 April 2010
Targeted therapies for rare gynaecological cancers
All these cancers have different clinicopathological characteristics, suggesting different molecular biological pathogeneses. Despite aggressive treatment, some cancers recur or respond poorly to therapy. Comprehensive knowledge of the molecular biology of each cancer might help with development of novel treatments that maximise efficacy and minimise toxic effects. Targeted therapy is a new treatment strategy that has been investigated in various tumours in clinical and laboratory settings.
Since these cancers are rare and large clinical trials are difficult to do, molecular biological techniques might allow rapid proof-of-principle experiments in few patients. Novel targeted agents either alone or in combination with other treatments offer promising therapeutic options.
Sunday, April 11, 2010
Saturday, April 10, 2010
'New' Evidence for Clinical Practice Guidelines: 'New' Evidence for Clinical Practice Guidelines: Should we Search for 'Preference Evidence'?
Clinical practice guidelines (CPGs) are systematically developed statements to assist both patient and practitioner decisions. They link the practice of medicine more closely to the body of underlying evidence, shift the burden of evidence review from the individual practitioner to experts, and aim to improve the quality of care. CPGs do not routinely search for or include evidence related to patients' values and preferences.
We argue that they should.
We think that such evidence can tell us whether a decision is preference sensitive; how patients feel about important health outcomes, treatment goals, and decisions; and whether preferences vary in different types of patients. The likely effects of reviewing the literature are a general sensitization to the importance of preferences in decision making, the recognition that some decisions are simply all about preferences, a more considered approach to forming preferences among patients and other stakeholders, and more effective integration of preferences into decisions.
Friday, April 09, 2010
Bevacizumab toxicities and their management in ovarian cancer.
AbstractOBJECTIVES: The purpose of this review is to discuss the side effect profile of bevacizumab, to discuss proposed mechanisms of these toxicities, and to provide suggestions for management of adverse events.
METHODS: A search of MEDLINE and ASCO and SGO abstract databases of articles published between January 1970 and August 2009 addressing the toxicity of bevacizumab in solid tumors was conducted. Reporting was limited to best available evidence including any available phase III studies and ovarian cancer phase II studies. Original publications addressing underlying mechanisms of bevacizumab toxicities were included.
RESULTS: Extensive experience with bevacizumab has proven the agent to be generally well tolerated, with an adverse event profile distinct from traditional cytotoxic chemotherapy and likely peculiar to its novel mechanism of action. The most common bevacizumab-attributable adverse event, hypertension, can be medically-managed, but more serious adverse events such as bowel perforation require drug discontinuation.
CONCLUSIONS: Current best evidence supports the use of bevacizumab in selected patients, and safe administration of bevacizumab requires an understanding of the management of adverse events attributable to its use.
Ovarian cancer: the duplicity of CA125 measurement.Nat Rev Clin Oncol. 2010 Apr 6. [Epub ahead of print]
AbstractSince it was first described in 1981, CA125 has held an important role in monitoring patients with ovarian cancer. CA125 is elevated in 80% of patients with epithelial ovarian cancer at initial diagnosis and correlates well with response to therapy. CA125 monitoring is used for the follow up of patients with epithelial ovarian cancer, and elevations in CA125 measurements often antedate any signs, symptoms or radiographic evidence of disease by several months.
Unfortunately, data favoring early therapeutic intervention for recurrent ovarian cancer is lacking, especially in patients with isolated CA125 elevations.
In asymptomatic patients, elevations in CA125 have been associated with considerable anxiety and deterioration in quality of life without any significant gains in survival.
Patients with ovarian cancer should, therefore, be counseled regarding the advantages and shortcomings of intensive CA125 testing.
While some patients may benefit from early detection of recurrent disease and be candidates for secondary cytoreductive surgery, others may choose to delay therapy until they develop symptoms of disease recurrence.
The results of a clinical trial suggest that withholding treatment in the event of isolated rising CA125 levels will not negatively impact these patients overall survival, highlighting the need for improved salvage therapies for recurrent ovarian cancer
Note: this issue of a protective effect was known at the time the original WHI study information was published but also received very little attention
New study confirms HRT helps ward off colon cancer
But the Women's Health Initiative had also found that HRT protected against colon cancer. Some studies have also suggested that oral contraceptives might reduce the risk of the disease, while the fact that women are at lower risk of colon cancer than men also hints at a hormonal role in disease risk.
To investigate ties between HRT and colon cancer further, Dr. Millie D. Long of the University of North Carolina at Chapel Hill and her colleagues matched 443 women diagnosed between 2001 and 2006 with distal large bowel cancer (meaning tumors at the far end of the colon and the rectum) to 405 healthy control women. The average age of the study participants was around 63.
Long's team found that women who had ever used HRT were at half the risk of this type of colon cancer compared to women who'd never used hormone replacement, and the longer a woman was on HRT, the lower the risk.
For example, women who used hormones for less than four years cut their colon cancer risk by about one-quarter; four to eight years of HRT cut risk by a third; nine to 14 years of use halved risk; and 15 years or more of HRT reduced risk by two-thirds. The effects were the same for African-American women and white women.
However, there was no relationship between oral contraceptive use and colon cancer risk, the study team reports in the American Journal of Gastroenterology.
Long-term hormone therapy is no longer recommended for postmenopausal women, Long and her team note, although it is still sometimes prescribed on a short-term basis to help women with menopausal symptoms such as hot flashes. The major drop off in distal large bowel cancer in recent years could have been related to widespread use of HRT, the researchers say.
More research is needed to determine if HRT's protective effects persist after women stop taking hormones, the researchers add, or whether there might be a "rebound" effect with more pre-cancerous polyps developing after a woman halts
"It may become important in the future to tailor timing of women's colorectal screening based on cessation of hormonal therapy," Long and her colleagues conclude.
SOURCE: The American Journal of Gastroenterology, online March 30, 2010.
Session V: Ovarian Cancer III: Novel Therapies
* Emerging options in antiangiogenic targeted therapy for ovarian cancer
Andrew Clamp, MD, PhD
* Targeted therapy for ovarian cancer: Beyond angiogenesis
Stanley B. Kaye, MD
Session IV: Ovarian Cancer II: A Case-Based Approach to Recurrence
* Interactive clinical case: non surgical Management of platinum sensitive ovarian cancer
Andreas du Bois, MD
* Interactive clinical case: Considerations for the management of a partially platinum sensitive relapse (6-12 months)
Bradley J. Monk, MD
* Interactive clinical case: Management of platinum resistant/refractory ovarian cancer
Eric Pujade-Lauraine, MD, PhD
* Keynote Lecture: Changing standards of care: The role of CA125 in the management of Ovarian Cancer
Gordon J.S. Rustin, MD, FRCP
*State of the art surgical strategies in ovarian cancer: How to do it?
*State of the art surgical strategies in ovarian cancer: When to do it?
*Interactive clinical case: First-line systemic therapies for ovarian cancer
*Definition and characterization of low-grade and high-grade ovarian serous carcinomas
Note: "prioritise topics for new reviews"
In response to a request from the Cochrane Network, ovarian cancer women/caregivers were asked to respond to a survey regarding priortisation. This was done, in part, through the ACOR Ovarian Cancer group (http://www.acor.org). A large response was received and the Cochrane Network responded in a positive manner.
About consumer participation
- ensure that a review question is relevant to people requiring health care and who are offered an intervention by their healthcare providers;
- identify outcomes from healthcare interventions that are important for consumers – which may be different from those identified by service providers;
- improve access to reviews by ensuring that the review can be read by a wide audience, and the language is sensitive to consumers;
- weigh up the benefits of a healthcare intervention against the potential harms – from a healthcare user perspective;
- prioritise topics for new reviews.
"No one will own the problem" Departing oncologist cites frustration - Dr. Lizabeth Brydon Saskatchewan
"No one will own the problem and it is a problem," Brydon said. "The fact of my leaving puts more pressure on it. I realize by doing this I have created a crisis, but we've given them two drop-dead dates saying, 'We're closing our office here because we can't cope.' "
Thursday, April 08, 2010
PennMed Clinical Trial: Phase 1/2a Study of DTA-H19 (IP) in Advanced Stage Ovarian Cancer With Symptomatic Ascites
Description This study is designed to assess the safety, tolerability, pharmacokinetics (PK) and preliminary efficacy for ascites palliation of DTA-H19 administered intraperitoneally (IP) in subjects with advanced stage ovarian cancer who have evidence of symptomatic ascites
Investigators George Coukos, M.D., Ph.D., Principal Investigator University of Pennsylvania Medical Center Philadelphia, Pennsylvania 19104-6142
2010 full free access: Analysis - When Should Surgical Cytoreduction in Advanced Ovarian Cancer Take Place?
"By aggregating patent rights for existing and emerging tests that may lead to personalized treatment (e.g., hereditary hearing loss in infants, breast cancer, ovarian cancer, cardiovascular disease, Lynch syndrome) and licensing them nonexclusively for diagnostic use, MPEG LA's diagnostic genetics patent licensing facility, or "supermarket," will assist laboratories, testing companies and researchers in obtaining rights they need to design comprehensive diagnostic genetics tests that the market wants, thereby making these tests widely available through multiple channels at affordable prices."
Four new cases of double heterozygosity for BRCA1 ... [Breast Cancer Res Treat. 2010] - PubMed result
"Double heterozygosity (DH) for BRCA1 and BRCA2 mutations is a very rare finding, particularly in non-Ashkenazi individuals, and only a few cases have been reported to date. In addition, little is known on the pathological features of the tumors that occur in DH cases and on their family history of cancer. Four carriers of pathogenic mutations in both BRCA1 and BRCA2 were identified among women who underwent genetic counseling for hereditary susceptibility to breast and ovarian carcinoma at three different Italian institutions"
Ovacome :News survey on cancer related fatigue (online) - survey is cancer related fatigue not specific to ovarian cancer
Can you help with research on cancer related fatigue?
"This study on cancer fatigue is being carried out by researchers in the School of Psychology, Trinity College Dublin. The study is funded by the Irish Cancer Society and the Irish Research Council for Science Engineering and Technology."
Researchers in Trinity College Dublin are investigating the causes of cancer fatigue and the factors that contribute to the development of chronic fatigue in some cancer patients. The study is funded by the Irish Cancer Society and the IRCSET 'Embark Initiative'.
Who can participate?
Anyone who (a) has been treated for cancer or is currently being treated for cancer and (b) is experiencing fatigue.
What does participation involve?
Participation involves filling in a number of questionnaires about your fatigue, the factors you believe contribute to your fatigue, and the coping strategies you use to manage this symptom.
How can I participate?
If you would like to participate please complete this online questionnaire: http://www.surveymonkey.com/s/CancerFatigueStudy
If you would prefer to complete the questionnaire in hard copy or if you would like further information, please contact the researcher: Maria Pertl (Phone: 01 896 3083 / E-mail: email@example.com).
Note: references to France, UK and Europe
Quest PharmaTech completes critical review of development status for its recently acquired therapeutic antibody platform - Oregovomab + chemo trials..
"An 80 patient multicentre Italian cooperative trial will establish evidence for the clinical benefit associated with enhanced specific T cell immunity achievable by combining oregovomab with carboplatin and paclitaxel in the initial treatment of advanced ovarian cancer. Concurrent to this effort, a 30 patient Canadian clinical trial will evaluate the ability of a TLR-3 agonist to enhance the strength of the oregovomab immune response generated in the 'maintenance' setting in advanced ovarian cancer patients following front-line chemotherapy. The third clinical trial to be conducted in the U.S. will use gemcitabine, another cytotoxic agent, in a cohort of patients with CA125 associated resectable pancreatic cancer in combination with oregovomab."
""Successful completion of our clinical strategy will lead to a product for one or all treatment phases of advanced ovarian cancer, starting with front line treatment followed by watchful waiting and finally retreatment or initial treatment of recurrent disease."
"The additional antibodies in the platform (anti-MUC1, anti-PSA, anti-CA19.9 and anti-TAG 72) will undergo continuing preclinical development in anticipation of rapid clinical development once the initial oregovomab studies establish the validity of the combination therapy premise."
"Quest PharmaTech is developing the high affinity monoclonal antibody oregovomab (MAb B43.13) for the treatment of ovarian cancer. Oregovomab targets the circulating tumour-associated antigen CA125."
"The Gynecologic Oncology Service at the Lois Hole Hospital for Women looks after patients from all over northern Alberta, the Arctic (Nunavut) and parts of northern B.C. Women initially seen at the Cross Cancer Institute with cervical, endometrial or ovarian cancer that require surgery will have it performed at the Lois Hole Hospital for Women."
Wednesday, April 07, 2010
Note: Very long but interesting video - 1 1/2 hrs. The subject matter sounds very technical but the content is in good plain english language - talks about unresolved side effects, patient concerns....
GenomeTV — March 29, 2010 — March 23, 2010
Howard McLeod, Pharm.D.
Current Topics in Genome Analysis 2010
CONCLUSIONS: In overall performance, the PAT is at least comparable to the Myriad II and Penn II models in screening women appropriate for genetic referral. Simplicity and identification of families with non-BRCA hereditary BC syndromes suggest that the PAT is better suited for BC risk screening.
"CONCLUSION: These findings suggest that, in addition to tumor biology, disparities in access to care may have a significant effect on the timely diagnosis of epithelial ovarian cancer."
Cancer Causes Control. 2010 Apr 3. [Epub ahead of print]
Ovarian cancer: predictors of early-stage diagnosis.
Morris CR, Sands MT, Smith LH.
California Cancer Registry, Public Health Institute, California Department of Public Health, 1825 Bell St., Suite 102, Sacramento, CA, 95825, USA, firstname.lastname@example.org.
Bridging the Gap between Cytotoxic and Biologic Therapy with Metronomic Topotecan and Pazopanib in Ovarian Cancer
"Pazopanib therapy in combination with metronomic topotecan therapy showed significant antitumor and antiangiogenic properties in preclinical ovarian cancer models and warrants further investigation as a novel therapeutic regimen in clinical trials."
(abstract) Review: The use of proteomics as a research methodology for studying cancer-related fatigue: a review
Note: limited information in the abstract
Some key excerpts - full text of Editorial available without cost:
- In this issue of the Journal, Boffetta et al. (6) report findings from a European cohort of nearly 400 000 men and women who developed approximately 30 000 cancers at all sites combined over nearly 9 years of follow-up. After accounting for measurement error, a very weak but statistically significant inverse association was seen—a 4% lower incidence of all cancers combined for an increment of 200 g of total fruits and vegetables per day, which corresponds to about two extra servings per day.
- Most fundamentally, this study strongly confirms the findings from other prospective studies that the results of case–control studies were overly optimistic and that any association of intake of fruits and vegetables with risk of cancer is weak at best.
- Their more detailed analyses suggesting a stronge rbenefit among heavier consumers of alcohol lend some weight to a causal interpretation because other studies (7,8) have suggested that folate, primarily from fruits and vegetables,may be more beneficial in the context of regular alcohol consumption.
- A very weak or undetectable association between fruits and vegetables and risk of cancer does not exclude the possibility that oneor a small group of fruits or vegetables, or a specific substance in some of these foods, has an important protective effect.
- Even if we assume that the weak association seen in the EPIC cohort represents a true protective effect of fruits and vegetables,the question would still remain whether an effect of this magnitude should lead to clinical interventions or public health actions.Conveniently, although the evidence for benefits of fruits and vegetables against cancer was waning, data supporting benefits for cardiovascular disease were accumulating.
- In summary, the findings from the EPIC cohort add further evidence that a broad effort to increase consumption of fruits and vegetables will not have a major effect on cancer incidence.
Fruit and Vegetable Intake and Overall Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition (EPIC) - JNCI abstract
Conclusions: A very small inverse association between intake of total fruits and vegetables and cancer risk was observed in this study. Given the small magnitude of the observed associations, caution should be applied in their interpretation.
CONTEXT AND CAVEATS
The association between high intake of fruits and vegetables and reduction in overall cancer risk is not conclusively established.
European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study was conducted between 1992 and 2000. Diet and lifestyle data were self-reported by the participants. Cancer incidence and mortality data were obtained from country-specific national and regional registries. Association between overall cancer risk and high intake of total fruits, total vegetables, and total fruits and vegetables combined was assessed. Estimated cancer risks were adjusted for smoking, alcohol consumption, and many other variables.
High intake of vegetables, and fruits and vegetables combined, was associated with a small reduction in overall cancer risk. The association was stronger in heavy alcohol drinkers but was restricted to cancers caused by smoking and drinking.
This study reveals a very modest association between high intake of fruits and vegetables and reduced risk of cancer.
The inverse association between overall cancer risk and high intake of fruits and vegetables was weak. Errors inherent to self-reported dietary habits may have resulted in bias.
From the Editors
Tuesday, April 06, 2010
An open-label, non-randomized comparison of venlafaxine and gabapentin as monotherapy or adjuvant therapy in the management of neuropathic pain in patients with peripheral neuropathy
*click on 'pdf' to access the full paper (free)
* this paper is not specific to neuropathy as a treatment related adverse effect of cancer therapies
* it is written in fairly easy to understand language
* discusses side effects
Save the Date: Living with Lynch Syndrome: An Update for Families with HNPCC
June 27, 2009, 10 a.m. -3 p.m., Mayo Clinic, Rochester
This half-day educational program will offer a variety of topics focusing on Lynch syndrome—also known as Hereditary Non-Polyposis Colorectal Cancer (HNPCC)—from the biological basis of the condition and psychological impact of a diagnosis to practical health care tips.
The program is designed for people living with Lynch syndrome, their family members, and interested health care professionals. Patients and families will be able to expand their knowledge, network with one another, and share their experiences. Anna Leininger, M.S., C.G.C., Minnesota Colorectal Cancer Initiative coordinator and consultant to the Masonic Cancer Center's William C. Bernstein MD Familial Cancer Registry, will be one of the presenters at the program.
The program is hosted by Mayo Clinic; organizing sponsors include the William C. Bernstein MD Familial Cancer Registry, HealthEast Cancer Care, and the Colon Cancer Coalition. Cost is $20 per person; $35 per couple; and $50 per family (up to 5 members). For more information or to register, call 507-284-2241 or e-mail email@example.com
Note: journal article by paid subscription
CA 125: Value or addiction?
|Patricia A. Goldman, BA *|
|President Emerita, Ovarian Cancer National Alliance, Washington, DC|
|The author challenges a recent study indicating that there is no apparent benefit in routinely measuring cancer antigen 125 (CA 125) in the follow-up of women with ovarian cancer.|
What is the World Cancer Declaration?
- Launched in 2006 and revised in 2008, the World Cancer Declaration is a call to action to substantially reduce the global cancer burden by 2020.
- It was developed by international cancer control advocates to bring the cancer crisis to the attention of policymakers worldwide.
- It lays out an ambitious set of 11 targets and action plan to stop and reverse current trends.
- It was unanimously adopted at the World Leader’s Summit of policymakers, leaders & health experts during the 2008 World Cancer Congress in Geneva, Switzerland.
- UICC is the “custodian” of the World Cancer Declaration and prioritizes development of a comprehensive response.
Sexual Morbidity Associated With Poorer Psychological Adjustment Among Gynecological Cancer Survivors
Note: excerpts from abstract
Objectives: Sexual morbidity is a distressing and undertreated problem in gynecological cancer survivorship known to occur early and persist well beyond the period of physical recovery.
Sexual Morbidity Associated With Poorer Psychological Adjustment Among Gynecological Cancer Survivors
Note: excerpts from abstract
Objectives: Sexual morbidity is a distressing and undertreated problem in gynecological cancer survivorship known to occur early and persist well beyond the period of physical recovery.
Methods: A cross-sectional design was used. The participants were gynecological (cervical, endometrial, ovarian, and vulvar) cancer survivors who were partnered (N = 186), whose cancer was diagnosed 2 to 10 years previously, and who were at least 6 months post any cancer therapy. Most had been found to have early-stage disease (70%) and were treated with hysterectomy (77%), chemotherapy (43%), and/or radiotherapy (23%).
Conclusions: These findings suggest that prevention or treatment of sexual morbidity might foster improved psychological adjustment/QoL. Given the high rates of sexual morbidity in this population and the connection between sexuality and broader psychological adjustment/QoL, there is a clear need for better integration of sexuality rehabilitation into routine clinical care.
Fecal Incontinence Affecting Quality of Life and Social Functioning Among Long-Term Gynecological Cancer Survivors
Conclusions: Among gynecological cancer survivors having undergone pelvic radiotherapy alone or as part of a combined treatment, fecal incontinence is associated with social, psychological, sexual, and functional consequences.
Follow-Up Study of the Correlation Between Postoperative Com... : International Journal of Gynecological Cancer
Follow-Up Study of the Correlation Between Postoperative Computed Tomographic Scan and Primary Surgeon Assessment in Patients With Advanced Ovarian, Tubal, or Peritoneal Carcinoma Reported to Have Undergone Primary Surgical Cytoreduction to Residual Disease of 1 cm or Smaller
Conclusions: On this follow-up analysis, only age, stage, and residual disease were significant prognostic factors for overall survival. Discordant findings between the primary surgeon's assessment and the postoperative CT scan findings of residual disease was not an independent prognostic factor.
econdary Surgery in Patients With Serous Low Malignant Potential Ovarian Tumors With Peritoneal Implants
Conclusions: Secondary surgery seems to reduce the risk of recurrence in patients with serous LMPOT and peritoneal implants. Patients with residual disease are probably those likely to benefit from such surgery. Further studies are needed to confirm these preliminary results.
Conclusions: Based on diagnostic value, the result suggests that the role of lymphadenectomy might differ by histological type, as its therapeutic effect might be unclear. A multicenter analysis is essential for confirmation
Physician-Ownership Of Ambulatory Surgery Centers Linked To Higher Volume Of Surgeries -- Health Affairs
Intraperitoneal Paclitaxel as Consolidation Treatment in Ovarian Cancer Patients: A Case Control Study
Conclusion: Weekly IP consolidation chemotherapy with paclitaxel 60 mg/mq is well tolerated and, in this experience, a prolongation of progression-free survival was observed.
abstract: Population-Based Study of the Risk of Second Primary Contralateral Breast Cancer Associated With Carrying a Mutation in BRCA1 or BRCA2
Results: Compared with noncarriers, BRCA1 and BRCA2 mutation carriers had 4.5-fold (95% CI, 2.8- to 7.1-fold) and 3.4-fold (95% CI, 2.0- to 5.8-fold) increased risks of contralateral breast cancer, respectively. The relative risk of contralateral breast cancer for BRCA1 mutation carriers increased as age of first diagnosis decreased. Age-specific cumulative risks are provided for clinical guidance.
Conclusion: The risks of subsequent contralateral breast cancer are substantial for women who carry a BRCA1/BRCA2 mutation. These findings have important clinical relevance regarding the assessment of BRCA1/BRCA2 status in patients with breast cancer and the counseling and clinical management of patients found to carry a mutation.
abstract: Apr 5, 2010: Development of a Multimarker Assay for Early Detection of Ovarian Cancer -- JCO
Note: accompanying Editorial notes that this study was comprised of postmenopausal women only
JCO Early Release, published online ahead of print Apr 5 2010
Journal of Clinical Oncology, 10.1200/JCO.2008.19.2484
Accepted January 5, 2010
Development of a Multimarker Assay for Early Detection of Ovarian Cancer
Purpose: Early detection of ovarian cancer has great promise to improve clinical outcome.
(reference link for authors)
Patients and Methods: Ninety-six serum biomarkers were analyzed in sera from healthy women and from patients with ovarian cancer, benign pelvic tumors, and breast, colorectal, and lung cancers, using multiplex xMAP bead-based immunoassays. A Metropolis algorithm with Monte Carlo simulation (MMC) was used for analysis of the data.
Results: A training set, including sera from 139 patients with early-stage ovarian cancer, 149 patients with late-stage ovarian cancer, and 1,102 healthy women, was analyzed with MMC algorithm and cross validation to identify an optimal biomarker panel discriminating early-stage cancer from healthy controls. The four-biomarker panel providing the highest diagnostic power of 86% sensitivity (SN) for early-stage and 93% SN for late-stage ovarian cancer at 98% specificity (SP) was comprised of CA-125, HE4, CEA, and VCAM-1. This model was applied to an independent blinded validation set consisting of sera from 44 patients with early-stage ovarian cancer, 124 patients with late-stage ovarian cancer, and 929 healthy women, providing unbiased estimates of 86% SN for stage I and II and 95% SN for stage III and IV disease at 98% SP. This panel was selective for ovarian cancer showing SN of 33% for benign pelvic disease, SN of 6% for breast cancer, SN of 0% for colorectal cancer, and SN of 36% for lung cancer.
Conclusion: A panel of CA-125, HE4, CEA, and VCAM-1, after additional validation, could serve as an initial stage in a screening strategy for epithelial ovarian cancer.
A Step Forward for Two-Step Screening for Ovarian Cancer
Martee L. Hensley, Department of Medicine, Gynecologic Medical Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY
See accompanying article doi: 10.1200/JCO.19.2484
'Ovarian Cancer and Our Pets' Montage (video) free to view - no passwords needed - just click on the link
Monday, April 05, 2010
NHGRI Names New Chief of Genome Technology Branch, April 5, 2010 News Release - National Institutes of Health (NIH) U.S.
"Dr. Brody has headed GTB's Molecular Pathogenesis Section, investigating genetic variants that lead to changes in normal metabolic pathways to cause cancer and birth defects. He has made key discoveries regarding the genetics of breast cancer and neural tube defects. For example, the Brody laboratory was among the first to report that women who carry mutations in the BRCA1 or BRCA2 genes are at a higher risk of developing both breast cancer and ovarian cancer compared to women without such mutations. In addition, his group was the first to report that the frequency of specific BRCA1 and BRCA2 gene mutations are elevated in the Jewish population. In collaboration with scientists at Howard University, Washington, D.C., he described a series of mutations and rare variants in BRCA1 carried by some African-American women with breast and ovarian cancer."
uTube - Bradley J. Monk, MD, University of California Irvine talks about early stage ovarian cancer including clear cell SGO
Note: the title on this video is wrong
utube: Thomas J. Herzog, MD, Columbia University College of Physicians and Surgeons talks about liposomal doxorubicin, bevacizumab, and temsirolimus in patients with advanced malignancy SGO
Thomas J. Herzog, MD, Columbia University College of Physicians and Surgeons talks about liposomal doxorubicin, bevacizumab, and temsirolimus in patients with advanced malignancy.
Chemotherapy time interval and development of platinum and taxane resistance in ovarian, fallopian, and peritoneal carcinomas
OBJECTIVE: To evaluate drug resistance after exposure to neoadjuvant chemotherapy and to postoperative chemotherapy in epithelial ovarian, fallopian, and primary peritoneal carcinomas.
Is the current concept of recurrent ovarian carcinoma as a chronic disease also applicable in platinum resistant patients?
Note: the authors' opinions confirm ovarian cancer as a chronic disease
full free access: COMMENTARY Initial Assessment, Surveillance, and Management of Blood Pressure in Patients Receiving Vascular Endothelial Growth Factor Signaling Pathway Inhibitors
"Inhibiting angiogenesis is an effective approach to cancer therapy, but it has been associated with cardiovascular toxic effects. At times, adverse events such as hypertension and heart failure have led to treatment cessation and even life-threatening consequences. Cancer patients have often been excluded from studies of cardiovascular disease, and patients with clinically significant cardiovascular disease have been excluded from studies of new cancer therapies. Consequently, the capacity for determining the incidence or prevalence of cardiovascular toxic effects of anticancer agents and to determine their optimal management has been limited. Oncologists and cardiovascular medicine specialists have increasingly recognized that the prevention and management of these toxic effects is important for these potentially life-sustaining anticancer agents to benefit the greatest possible number of patients."
Box 1. Summary recommendations
"The follow-up study showed an increase of HE4 5-8 months before CA125 increment in five of the eight patients, this early expression being strictly associated to a relapse of the disease. In conclusion, this study showed that HE4, compared to CA125, potentially is a better marker for the diagnosis of OC and could be an important early indicator of the recurrence of the disease."
Nutr Cancer. 2010 Apr;62(3):271-83.
Epidemiologic evidence on coffee and cancer.
David Geffen School of Medicine, University of California, Los Angeles, USA.
Coffee consumption is a major and frequent dietary exposure in diverse cultures around the globe whose safety has been questioned. A substantial body of epidemiologic evidence, consisting of over 500 papers relating the consumption of coffee to cancer of various sites, has accumulated to date. Numerous individual, site-specific meta analyses have been undertaken at various times. However, there is no comprehensive, up-to-date overview of the entirety of the knowledge base. To address this need, this review summarized the findings of the meta analyses and recent papers on site-specific human cancers among coffee consumers. For hepatocellular and endometrial cancers, there appears to be a strong and consistent protective association; for colorectal cancer, the direction of association is borderline protective. There appears to be no association with breast, pancreatic, kidney, ovarian, prostate, or gastric cancer. Risk of bladder cancer appears to be associated with heavy coffee consumption in some populations and among men. The associations with childhood leukemia and mother's consumption of coffee were ambiguous-with some suggestion of risk at high levels of daily consumption.
PMID: 20358464 [PubMed - in process]
Development of a culturally tailored genetic counseling booklet about hereditary breast and ovarian cancer for Black women.
Search - preformated - Ovarian / Fallopian Tube / Peritoneal = 58 clinical trials
1) results are not necessarily specific to Ovarian/FT/P cancer but include differing tumor types (cancers) e.g.phase 1;
2) should be cross referenced to http://www.clinicaltrials.gov for potential duplications/excluded/not included
Note: includes public comments
“It’s OK to make and identify an error,” he added, “It’s not OK to cover up an error.”
The following are the 15 patient safety indicators studied:
Complications of anesthesia
Death in low mortality Diagnostic Related Groupings (DRGs)
Decubitus ulcer (bed sores)
Death among surgical inpatients with serious treatable
Selected infections due to medical care
Post-operative hip fracture
Post-operative hemorrhage or hematoma
Post-operative physiologic and metabolic derangements
Post-operative respiratory failure
Post-operative pulmonary embolism or deep vein thrombosis
Post-operative abdominal wound dehiscence
Accidental puncture or laceration
abstract: pre-clinical - A Novel Breast/Ovarian Cancer Peptide Vaccine Platform That Promotes Specific Type-1 but not Treg/Tr1-type Responses - DepoVax
"HUNTINGTON BEACH, California and AMSTERDAM, March 24, 2010 /PRNewswire/ -- Agendia, a world leader in molecular cancer diagnostics, today announced that its breast cancer product offering, consisting of breast cancer recurrence test MammaPrint(R), and TargetPrint(TM), has been expanded with BluePrint (TM) to report important additional information on tumor subtypes. This new service is based on an 80-gene signature that identifies the basal-like, luminal-like, and HER2 molecular subtypes in breast cancer tumors...."
Search of: ovarian cancer | Open Studies | received from 03/01/2010 to 04/05/2010 - List Results - ClinicalTrials.gov
12 new clinical trials listed - search terms: ovarian cancer | Open Studies | received from 03/01/2010 to 04/05/2010
Rank Status Study
1 Not yet recruiting Seprafilm™ for the Prevention of Intraperitoneal Adhesions and Improved Delivery of Therapy in Women Undergoing Staging and Intraperitoneal Chemotherapy for Advanced Ovarian Cancer
2 Recruiting Trial of Best Supportive Care and Either Cisplatin or Paclitaxel to Treat Patients With Ovarian Cancer and Inoperable Malignant Bowel Obstruction
Conditions: Ovarian Cancer; Bowel Obstruction
3 Recruiting Carboplatin and Paclitaxel or Oxaliplatin and Capecitabine, With or Without Bevacizumab, as First-Line Therapy in Treating Patients With Newly Diagnosed Stage II, Stage III, Stage IV, or Recurrent Stage I Epithelial Ovarian Cancer or Fallopian Tube Cancer
4 Not yet recruiting Irinotecan and Bevacizumab for Recurrent Ovarian Cancer
Condition: Ovarian Cancer
5 Recruiting MLN8237 in Patients With Ovarian, Fallopian Tube or Peritoneal Cancer Preceded by Phase 1 Study of MLN8237 Plus Paclitaxel Treatment of Ovary or Breast Cancer
Conditions: Ovarian Carcinoma; Fallopian Tube Cancer; Peritoneal Cancer; Breast Carcinoma
6 Not yet recruiting First-line Treatment of Weekly Paclitaxel With Carboplatin and Bevacizumab in Ovarian Cancer
Conditions: Epithelial Ovarian Cancer; Primary Peritoneal Cancer; Fallopian Tube Cancer
7 Recruiting Collection of Tissue Samples From Patients With Stage III or Stage IV Ovarian Epithelial Cancer
Condition: Ovarian Cancer
8 Not yet recruiting Changes in Brain Function in Patients With Stage I, Stage II, Stage III, or Stage IV Ovarian, Primary Peritoneal, or Fallopian Tube Cancer Who Are Receiving Chemotherapy
Conditions: Cognitive/Functional Effects; Fallopian Tube Cancer; Ovarian Cancer; Peritoneal Cavity Cancer
9 Recruiting Hyperbaric Oxygen Therapy in Treating Long-Term Gastrointestinal Adverse Effects Caused by Radiation Therapy in Patients With Pelvic Cancer
Conditions: Bladder Cancer; Cervical Cancer; Colorectal Cancer; Endometrial Cancer; Gastrointestinal Complications; Long-term Effects Secondary to Cancer Therapy in Adults; Ovarian Cancer; Prostate Cancer; Radiation Toxicity; Sarcoma; Testicular Germ Cell Tumor; Vaginal Cancer
10 Recruiting A Phase I Safety Study of a Cancer Vaccine to Treat HLA-A2 Positive Advanced Stage Ovarian, Breast and Prostate Cancer
Conditions: Ovarian Neoplasms; Breast Neoplasms; Prostatic Neoplasms
Intervention: Biological: DPX-0907 consists of 7 tumor-specific HLA-A2-restricted peptides, a universal T Helper peptide, a polynucleotide adjuvant, a liposome and Montanide ISA51 VG
11 Recruiting Stereotactic Radiosurgery Using CyberKnife in Treating Women With Advanced or Recurrent Gynecological Malignancies
Conditions: Fallopian Tube Cancer; Ovarian Sarcoma; Ovarian Stromal Cancer; Recurrent Cervical Cancer; Recurrent Endometrial Carcinoma; Recurrent Ovarian Epithelial Cancer; Recurrent Ovarian Germ Cell Tumor; Recurrent Uterine Sarcoma; Recurrent Vaginal Cancer; Recurrent Vulvar Cancer; Stage III Cervical Cancer; Stage III Endometrial Carcinoma; Stage III Ovarian Epithelial Cancer; Stage III Ovarian Germ Cell Tumor; Stage III Uterine Sarcoma; Stage III Vaginal Cancer; Stage III Vulvar Cancer; Stage IV Endometrial Carcinoma; Stage IV Ovarian Epithelial Cancer; Stage IV Ovarian Germ Cell Tumor; Stage IV Uterine Sarcoma; Stage IV Vulvar Cancer; Stage IVA Cervical Cancer; Stage IVA Vaginal Cancer; Stage IVB Cervical Cancer; Stage IVB Vaginal Cancer
12 Recruiting Open Label Study to Assess Efficacy and Safety of Olaparib in Confirmed Genetic BRCA1 or BRCA2 Mutation Pats
Conditions: Ovarian; Breast; Prostate; Pancreatic; Advanced Tumours
Saturday, April 03, 2010
Credit where credit is due? Regulation, research integrity and the attribution of authorship in the health sciences
ObjectiveTo compare the survival impact of diagnosing recurrent disease by routine surveillance testing versus clinical symptomatology in patients with recurrent epithelial ovarian cancer (EOC) who have achieved a complete response following primary therapy.
Tertiary cytoreduction in patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer: An updated series
Objective Surgical cytoreduction is an integral therapeutic modality for patients with epithelial ovarian (EOC), fallopian tube (FTC), or primary peritoneal (PPC) cancer in the primary setting. The role of surgical cytoreduction in the recurrent setting is not clearly defined and remains controversial. The objective of this study was to assess this potential survival benefit in a large cohort of patients with a long follow-up period.
Pathway analysis of gene lists associated with platinum-based chemotherapy resistance in ovarian cancer: The big picture
"We propose that future international cooperation should aim at a uniform pooled analysis of the wealth of ovarian cancer array data already available. This will enhance the power of each separate ovarian cancer study and can lead to promising results."
The Psychosocial Oncology Learning Assessment: A Province-Wide Survey of Cancer Care Providers' Learning Needs
"This research suggests that cancer care providers are interested in learning more about the psychosocial issues related to cancer care."
MAIN MEASURES: Familial cancer risk was estimated based on the number of first-degree relatives with a breast and ovarian cancer syndrome (BRCA)- or a Lynch-associated cancer, age of onset (<50 or >/=50 years), and personal history of any cancer.
CONCLUSIONS: These nationally representative data provide estimates of the prevalence of familial cancer risk in the US and suggest that information about genetic testing is not reaching many at higher risk of inherited cancer.
Chemotherapy use and risk of bone marrow suppression in a large population-based cohort of older women with breast and ovarian cancer.
Merck KGaA - EU regulator calls for review of Erbitux (cetuximab) / cancer vaccine Stimuvax (BLP25 liposome vaccine)
1) Erbitux (cetuximab)
2) cancer vaccine Stimuvax (BLP25 liposome vaccine)
Thursday, April 01, 2010
Canadian Health Reference Guide - Saskatchewan Government and Health System Partners Release Plan to Improve Surgical Care
Note: no specific mention of ovarian cancer
Curis to Present at the 17th Annual Future Leaders in the Biotech Industry Conference - Hedgehog Pathway inhibitor GDC-0449 (financial news)
"Dan Passeri, Curis' President and Chief Executive Officer, will provide an overview of the status of GDC-0449, an orally-administered small molecule Hedgehog Pathway Inhibitor. GDC-0449 is currently being developed in three Phase II clinical trials by Curis' collaborator Genentech, including in a pivotal Phase II trial in advanced basal cell carcinoma and Phase II trials in metastatic colorectal cancer and advanced ovarian cancer. Mr. Passeri will also discuss CUDC-101, Debio 0932 and Curis' other targeted cancer programs, in addition to other corporate activities.
There will be a corresponding webcast of the presentation, which can be accessed by visiting:
The presentation will be archived shortly after the live event and available for 30 days following the conference. In addition, it will be available for 30 days on the Investor Relations section of the Curis website at www.curis.com."
Best Evidence Interview: Use of Some SSRIs With Tamoxifen Increases Mortality in Breast Cancer Patients: A Best Evidence Interview With Catherine Kelly, MD
Note: included in interview is discussion of U.S./Canadian/Global research on this subject matter (reminder: Medscape articles are freely accessible with registration)
Phase I trial of ixabepilone plus pegylated liposomal doxorubicin in patients with adenocarcinoma of breast or ovary
Background: Ixabepilone is a semisynthetic epothilone B analogue that is active in taxane-resistant cell lines and has shown activity in patients with refractory breast and ovarian cancer. We carried out a phase I trial of ixabepilone plus pegylated liposomal doxorubicin (PLD) in patients with advanced taxane-pretreated ovarian and breast cancer.
Wednesday, March 31, 2010
Note: very preliminary/requires further research/article discusses primarily breast cancer/many limitations in study
Early Release, published online ahead of print Mar 30 2010
Journal of Clinical Oncology, 10.1200/JCO.2009.25.2874
Physicians' Awareness and Attitudes Toward Decision Aids for Patients With Cancer
Chantalle Brace, Selina Schmocker, Harden Huang, J. Charles Victor, Robin S. McLeod, and Erin D. Kennedy*
From the Department of Surgery, University Health Network–Toronto General Hospital; Department of Surgery, Mount Sinai Hospital; Dr Zane Cohen Digestive Disease Research Unit; and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Purpose: Patient decision aids are interventions designed to help patients make deliberative choices about their treatment options and have been shown to significantly improve patient outcomes. Although considered optimal, decision aids are not widely used in clinical practice for cancer treatment. The objectives of this study are to determine physicians' awareness and use of decision aids, physicians' perceptions of the major barriers to the use of decision aids, and physician characteristics predictive of use of decision aids in clinical practice.
Adhesions and incisional hernias following laparoscopic versus open surgery for colorectal cancer in the CLASICC trial
Note: colorectal cancer study but similar surgical complications
CONCLUSION: Although this study has not confirmed that laparoscopic surgery reduces rates of AIO and IH (incisional hernia)after colorectal cancer surgery, trends suggest that a reduction in conversion to open surgery and elimination of port-site hernias may produce such an effect.
CONCLUSION: Patients with extensive widespread generalized peritonitis and metastatic abdominal tumours need special attention regarding wound closure. This modified technique of midline abdominal wound closure is associated with low incidence of wound dehiscence and incisional hernia formation.
Surgical Procedures and Morbidities of Diaphragmatic Surgery in Patients Undergoing Initial or Interval Debulking Surgery for Advanced-Stage Ovarian Cancer.
A phase I study of weekly temsirolimus and topotecan in the treatment of advanced and/or recurrent gynecologic malignancies
Tuesday, March 30, 2010
Effects of tamoxifen and exemestane on cognitive functioning of postmenopausal patients with breast cancer: results from the neuropsychological side study of the tamoxifen and exemestane adjuvant multinational trial
Note: requires Password/Registration (free):
Oncology - Ovarian Cancer
Authors: Maurie Markman, MD
Date Released: October 01, 2009
Last Updated: March 03, 2010
Table of Contents
- BRCA Mutations in Ovarian Cancer
- Screening for Ovarian Cancer
- Symptoms of Ovarian Cancer
- Surgical Staging of Ovarian Cancer
- Primary Surgical Cytoreduction in Ovarian Cancer
- Interval Surgical Cytoreduction and Neoadjuvant Chemotherapy
- Chemotherapy for High-Risk Early-Stage Ovarian Cancer
- Primary Chemotherapy of Advanced Stage Ovarian Cancer
- Second-Line Therapy of Ovarian Cancer
- Platinum-Sensitive vs Platinum-Resistant Recurrent Ovarian Cancer
- Treatment of Platinum-Sensitive Recurrent Ovarian Cancer
- Treatment of Platinum-Resistant Ovarian Cancer
- Intermediate Platinum Sensitivity
- Carboplatin Hypersensitivity Reactions
- Other Management Options in Recurrent/Resistant Ovarian Cancer
- Future Research Directions in Ovarian Cancer
- Tables and Figures