Tuesday, March 30, 2010
Clinical Care Options - CME - Dr Maurie Markman updated CME March 3, 2010
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Oncology - Ovarian Cancer
Authors: Maurie Markman, MD
Date Released: October 01, 2009
Last Updated: March 03, 2010
Table of Contents
-
Ovarian Cancer
- Introduction
- 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
- References
Potential Role of Lymphadenectomy in Advanced Ovarian Cancer: A Combined Exploratory Analysis of Three Prospectively Randomized Phase III Multicenter Trials - Journal of Clinical Oncology
"Purpose: Primary surgery followed by platinum/taxane-based chemotherapy is the standard therapy in advanced ovarian cancer. The prognostic role of complete debulking has been well described; however, the impact of systematic pelvic and para-aortic lymphadenectomy and its interaction with biologic factors are still not fully defined.
Conclusion: Lymphadenectomy in advanced ovarian cancer might offer benefit mainly to patients with complete intraperitoneal debulking. However, this hypothesis should be confirmed in the context of a prospectively randomized trial."
Outcomes of Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer: A Proposal for Patient Selection - Journal of Clinical Oncology
"Forty-five (53.6%) of 84 patients who were nulliparous at fertility-sparing surgery and married at the time of investigation gave birth to 56 healthy children."
"Conclusion: Our data confirm that fertility-sparing surgery is a safe treatment for stage IA patients with favorable histology and suggest that stage IA patients with clear cell histology and stage IC patients with favorable histology can be candidates for fertility-sparing surgery followed by adjuvant chemotherapy."
2010 Annual Conference Scholarships Genetic Alliance
Note: some partial sponsorships available Submit your application by May 10th, 2010. We will respond to your request by May 17th, 2010.
Creighton University Dr Henry Lynch Earns National Award for Lifetime Work in Hereditary Cancer
"Lynch has long been considered a pioneer in the field of hereditary cancer research and prevention. As an internal medicine resident in the 1960s, Lynch met patients who had many family members who were affected by or had died from the same type of cancer; he hypothesized the cancer could be triggered by hereditary factors. That launched a lifelong pursuit to uncover genetic links to certain types of cancer that, at the time, his peers thought to be triggered almost solely by environmental causes.
In the 1970s, Lynch was the first to describe a hereditary breast ovarian cancer syndrome, findings that led to the identification of the BRCA1 and BRCA2 germline mutations that predispose women to this syndrome. Hereditary nonpolyposis colorectal cancer (HNPCC), the most common form of hereditary colorectal cancer, is named after him as the Lynch syndrome."
Immunovaccine Begins Patient Recruitment for Phase 1 Trial of DPX-0907 Cancer Vaccine - MarketWatch
press release
March 29, 2010
Immunovaccine Begins Patient Recruitment for Phase 1 Trial of DPX-0907 Cancer Vaccine
HALIFAX, NOVA SCOTIA, Mar 29, 2010 -- Immunovaccine Inc. today announced that it has started screening patients for its Phase 1 clinical trial, investigating the company's therapeutic cancer vaccine, DPX-0907, as a treatment for patients with advanced stage breast, ovarian and prostate cancer. The primary goal of the trial is to establish the safety of the vaccine candidate which includes the DepoVax(TM) delivery platform. Secondary goals include an evaluation of dosing and an assessment of immune response.
Commentary: Estimating cancer survival--which is the right approach? -- Rachet and Coleman 39 (2): 611 -- International Journal of Epidemiology
Note: full paper requires paid subscription
"Cancer survival has become a key metric to assess the performance of health systems in delivering cancer care, both as part of national cancer programmes and in international comparisons. In this context, we need to know the survival of all cancer patients in the population, not just patients treated in a particular hospital or included in a clinical trial. Population-based survival estimates include all patients, including those who are not treated at all, either because their disease is too advanced at diagnosis for treatment of curative intent, or because they do not have access to the health-care system, or, in some countries, because of resource limitations such as the . . ."
Cancer Symptom Clusters: Old Concept But New Data
Abstract:
Individuals with cancer have multiple symptoms, which frequently co-occur. A nonrandom distribution of symptoms suggests a common mechanism. Symptom clusters (SCs) were considered part of various syndromes in the early years of medicine. The SC concept in clinical medicine is old. Symptom clusters were commonly described in the psychology/psychiatry and neurology literature. Symptom cluster may be defined either clinically or statistically. Statistically derived clusters can differ from clinically defined clusters. The clinical importance of statistically derived clusters is unclear. Pain-insomnia-fatigue and pain-depression-fatigue are commonly recognized clinical clusters. Nausea-vomiting and anxiety-depression are also statistically observed clusters.
Identification of early predictive imaging biomarkers and their relationship to serological angiogenic markers in patients with ovarian cancer with residual disease following cytotoxic therapy
Note: small study
Background: Patients with recurrent ovarian cancer often achieve partial response following chemotherapy, resulting in persistent small volume disease. After completion of treatment, the dilemma of when to initiate subsequent chemotherapy arises. Identification of biomarkers that could be used to predict when subsequent treatment is needed would be of significant benefit. Design: ...A subgroup of patients provided plasma (blood) samples within which a panel of angiogenic biomarkers was quantified.
Diabetes Raises Risk For Post-Surgical Mortality In Cancer Patients
"Care of diabetes before, during and after surgery is very important," Dr. Yeh said. "It should be part of the preoperative discussion."
Mutations in gene protecting body leads to development of cancer
Note: the PTEN mutation has and is being widely studied in ovarian cancer
"The study examined mutations in a gene called PTEN. People who inherit a mutated copy of this gene have Cowden syndrome, a condition that carries a high risk of cancer in a number of organs, including the breast, thyroid and ovary. In addition, PTEN is frequently mutated in normal body cells leading to prostate, lung and pancreatic cancers."
Myriad Loses Ruling Over Breast Cancer-Gene Patents (Update3) - BusinessWeek news article March 29, 2010
"The case is sure to be appealed to a court in Washington that specializes in patent law, and most likely to the Supreme Court.....
Years of Litigation:
He said today’s decision sets the stage for years
of litigation to determine where the line is between what’s eligible
for patents and what is not."
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