Sunday, May 16, 2010
"It has been 10 years since the Institute of Medicine released its damning report, To Err is Human, but it has been 24 centuries since Hippocrates admonished physicians to do no harm," said Dennis S. O'Leary, MD, president emeritus of The Joint Commission and a founding member of the Lucian Leape Institute. "Today, although some progress in improving patient safety continues to be made, healthcare remains fundamentally unsafe as up to one in 10 people admitted to hospitals continue to experience significant, preventable adverse events."
Note: to use the Online Meeting Program registration is required (free).
Online Meeting Program
Use the online Meeting Program to search the complete program listings of sessions and abstract titles. The online Meeting Program will be updated frequently, so use this tool for access to the most up to date information. Once you have found sessions you are interested in attending, you can also build an itinerary.
2010 ASCO Annual Meeting | Meeting Program | What Is New This Year 2010 annual meeting - Trials in Progress Poster Session
Note: the program is now online for the annual meeting June 2010 (searchable) (http://www.asco.org)
What's New This Year
Trials in Progress Poster Session
The new Trials in Progress Poster Session will facilitate awareness of and dialogue about open, ongoing clinical trials. It differs from other Poster Sessions in that
* outcomes data or results are not included
* the goal is to promote discussion among trial investigators, to encourage recruitment of new investigators or sites, and to stimulate discussion of successor or confirmatory trials
* the focus is on the background of the science behind the trial, and preclinical or earlier-phase data (preferably with references) is encouraged
The Trials in Progress Poster Session will be held Monday, June 7 from 8:00 AM to 12:00 PM. All Meeting attendees are welcome to attend this new session.
abstract: miR-20a promotes proliferation and invasion by targeting APP in human ovarian cancer cells.
define: microRNA - A short piece of single-stranded RNA that does not encode a protein and controls the expression of genes.
MicroRNAs (miRNAs) are emerging as a class of small regulated RNAs, and the alterations of miRNAs are implicated in the initiation and progression of human cancers. Our study shows that inhibition of miR-20a in OVCAR3 ovarian cancer cell line could suppress, whereas overexpression of miR-20a could enhance cell long-term proliferation and invasion. We also confirmed amyloid precursor protein (APP) as a direct target gene of miR- 20a. Furthermore, suppression of APP expression could also promote ovarian cancer cell proliferation and invasion, which is consistent with the results of miR-20a overexpression. Therefore, we concluded that the regulation of APP is an important mechanism for miR-20a to promote proliferation and invasion in ovarian cancer cells.
Saturday, May 15, 2010
Note: best viewed in Firefox browser
.....click on 'read more'
BRCA1, BRCA2 and CHEK2 c.1100 delC mutations in patients with double primaries of the breasts and/or ovaries
Expert Reviews full access: On the advent of MSI testing of all colorectal cancers and a substantial part of other Lynch syndrome-related neoplasms
Worldwide, more than 1 million people present with colorectal cancer (CRC) annually. Of these, 2–5% occur in the context of Lynch syndrome (LS), the most common hereditary CRC predisposing syndrome (formerly designated as hereditary nonpolyposis CRC [HNPCC]). LS is characterized by a high lifetime risk for the development of CRC (20–70%), endometrial cancer (15–70%) and other extracolonic cancers (<15%). These extracolonic malignancies include carcinomas of the small intestine, stomach, pancreas and biliary tract, ovarium, brain, upper urinary tract and skin. .......germline mutation in one of the MMR genes MLH1, MSH2, MSH6 or PMS2.
Owing to the MMR deficiency in LS tumors, a microsatellite instability (MSI) phenotype is present. MSI, however, is also found in approximately 10–13% of sporadic CRCs (in total, MSI is present in approximately 15% of all CRCs). In addition to MSI, most LS tumors lack expression in the tumor cell nuclei of one of the four MMR proteins, MLH1, MSH2, MSH6 or PMS2.
Early detection of LS is of great importance, particularly in presymptomatic mutation carriers, since colonoscopic surveillance has proven to reduce CRC morbidity and mortality by 65–70%  and prophylactic surgery may prevent endometrial and ovarium carcinoma effectively.
Different models and strategies have been developed to identify patients with LS. In 1990, the Amsterdam criteria I were developed to provide a basis for uniformity in collaborative studies to find the disease-causing gene. These criteria were designed to be highly specific at the expense of sensitivity. They were criticized because extra-colonic tumors were not taken into account, thereby excluding classical LS families....Therefore, the Amsterdam criteria II were established in 1999"
Hyperthermic intra-peritoneal chemotherapy using Oxaliplatin as consolidation therapy for advanced epithelial ovarian carcinoma. Results of a phase II
Using intra-peritoneal Oxaliplatin associated with hyperthermia as consolidation therapy for advanced ovarian cancer results in a high risk of grade 3 morbidities with only a small benefit on survival
Friday, May 14, 2010
Note: also see prior blog post on Type D personality as per below (date):
Saturday, January 23, 2010
full free access: Type D personality in the general population: a systematic review of health status, mechanisms of disease, and work-related problems "Type D personality in the general population: a systematic review of health status, mechanisms of disease, and work-related problems."
request a copy of the pdf presentation file via: firstname.lastname@example.org
abstract and free full text: How old is this mutation? - a study of three Ashkenazi Jewish founder mutations
The three mutations analyzed were MSH2*1906 G->C, APC*I1307K, and BRCA2*6174delT.
"Mutation age estimates (averages):
16.8 generations for MSH2
106 generations for I1037K
90 generations for 6174delT
Note: long article regarding efforts in progress
One specific area of importance to patients:
"As clinical trials become more complex, so do the concerns researchers must address. Original correlative trials have now led to a new generation of clinical trials, some of which exclude patients who do not possess the specific biomarker being studied. When these biomarker tests must be completed before enrollment onto a clinical trial, it is important that the study budget provide reimbursement for testing of individuals who are afterward deemed ineligible. Additionally, because biomarker testing is generally completed at a central laboratory designated by the sponsor, it is important that physicians know how long it will take to receive the results. If the turnaround time is 3 to 4 weeks, it should be considered whether patients will agree to wait that long to begin treatment, especially if they may ultimately be excluded from the clinical trial on the basis of the test results. Considerations such as these should be discussed in advance with the sponsor, so efforts can be made to expedite testing. The research site should also be aware of all options that can be provided to patients who are excluded from the clinical trial. Sometimes sponsors will offer an expanded access option or suggest alternative trials using the medication, important factors when enrollment onto the clinical trial is the only remaining treatment option for a patient."
FDA Requires Doctors to Advise Patients about ESA Risks and Benefits | Anemia in the News | NAAC National Anemia Action Council (U.S.)
Note: see the website for additional links/information
FDA Requires Doctors to Advise Patients about ESA Risks and Benefits
Updated: February 18, 2010
The U.S. Food and Drug Administration (FDA) announced that they will soon require medical professionals prescribing erythropoiesis-stimulating agents (ESAs) to provide a Medication Guide to patients and to formally educate them about the drug’s risks and benefits.
The FDA will be implementing their new standards as part of a risk evaluation and mitigation strategy (REMS) intended to support informed decisions between patients and professionals, and mitigate the risks associated with the use of anemia drugs. As part of a the new standards, oncologists and professionals prescribing ESAs to treat anemic cancer patients will also be required to enroll in the ESA APPRISE Oncology program and complete a training module.
What Else Do You Need to Know?
Read more about these regulations in the feature article New Rules and APPRISE Program Regulate ESA Use in Oncology.
About the National Anemia Action Council (NAAC)
NAAC is an organization of anemia experts dedicated to raising the awareness of healthcare professionals and the public regarding the prevalence, symptoms, consequences, and treatment options of anemia. We aim to improve the lives of people with anemia by providing quality information to educate patients, consumers, medical professionals, writers and researchers.
Council of Experts
NAAC is an advisory council offering expert information about anemia of chronic disease to any interested person or organization. Because anemia is either a symptom or consequence of many diseases and conditions, the council is comprised of nationally recognized specialists from a broad variety of medical disciplines.
Meet Our Experts
Talk to our experts about anemia in the following areas:
Anesthesiology · Cardiology · Critical Care · Endocrinology · Gastroenterology · Geriatrics · Gynecology · Hematology · Nephrology · Pediatric Nephrology · Nursing · Oncology · Rheumatology · Surgery
Ortho Biotech Watson Affymax Takeda
Roche AMAG AMAG medgenics
abstract: Gynecologic Oncology : End of life care for women with gynecologic cancers Ontario, Canada
Note: no mention of other genetic risks aside from the BRCA's
Theme: Advances in therapy for ovarian cancer - Foreword
Ovarian cancer in 2010
Paul Sabbatini, Jacobus Pfisterer
Novel targeting strategies using recombinant antibodies for early diagnosis and therapy of ovarian cancer
Patient-specific tumor biology-based selection of ovarian cancer therapy
John P Fruehauf
Robotic-assisted minimally invasive surgery and ovarian cancer
Zvi Vaknin, Walter H Gotlieb
News & Views in ... Ovarian cancer
Personalizing therapy for ovarian cancer
Chau Tran, Thomas McNally, Michael J Birrer
Oophorectomy as a preventative measure for ovarian cancer
Mary B Daly
Role of secondary cytoreduction in recurrent ovarian cancer
Joyce N Barlin, Robert E Bristow, Dennis S Chi
Fertility preservation in ovarian cancer
Rebecca Arend, Anne Holland, Caryn St Clair, Thomas J Herzog
Evidence-based chemotherapeutic management of potentially platinum-sensitive recurrent ovarian cancer
Antiangiogenic therapies in ovarian cancer
Carol Townsley, Amit Oza
full free access: Hope and Noncurative Chemotherapies: Which Affects the Other? Journal of Clinical Oncology
Note: references ovarian cancer, factors involved in treatment related decision making "We still do not fully understand the concept of hope and its effects, both positive and negative..."
abstract/free full access: A proposed systems approach to the evaluation of integrated palliative care
"The provision of palliative care that is client focused needs to be the grounding objective in service integration to help refocus some of the territoriality that arises as individual organizations try to protect their own interests."
Thursday, May 13, 2010
Cancer prevalence in 129 breast-ovarian cancer families tested for BRCA1 and BRCA2 mutations (South Africa)
Note: small study (Caucasian); stomach cancer link/BRCA2 (?)
"Stomach cancer prevalence was significantly elevated in the BRCA2-positive families compared with the general population."
Note: this is an issue discussed widely in the recent past (inexpensive/profit/lack of)
Discussing Complementary Therapy Use With Early-Stage Breast Cancer Patients: Exploring the Communication Gap
"These findings indicate that doctors require further education about CAM therapies and supplements as well as guidance in how to raise and effectively discuss CAM issues with concern for their safety while balancing respect for the patients’ beliefs."
abstract: Selenium or No Selenium--That Is the Question in Tumor Patients: A New Controversy -- Integrative Cancer Therapies
What is RNA interference?
RNA interference (RNAi) is a natural process that cells use to turn down, or silence, the activity of specific genes.
Discovered in 1998, RNAi has taken the biomedical community by storm. Researchers quickly capitalized on the discovery and developed RNAi into a powerful research tool that is now used in thousands of labs worldwide.
How does RNAi work?
RNAi works by destroying the molecular messengers that carry information coded in genes to the cell’s protein factories. These messengers, called messenger RNAs (mRNAs), carry out a critical function, without which a gene is essentially inactive.
How can I find out more about RNAi?
See the RNAi section of our Extras on Newsmaking Research page at http://www.nigms.nih.gov/News/Extras/default.htm#rnai.
Epithelial Ovarian Cancer Clinical Trial: A Trial Using Novel Markers to Predict Malignancy in Elevated-Risk Women [Conditions: Epithelial Ovarian Cancer; Interventions
Epithelial Ovarian Cancer Clinical Trial:
Wednesday, May 12, 2010
PurposeWe have developed a database of outcome measures of particular importance to Complementary and Alternative Medicine (CAM) research in order to facilitate and support the assessment of CAM interventions through high quality research, and thus, to improve clinical practice and inform policy.
link- outcomes database/background:
about the team:
link - Nomination form:
FAQ and link to FAQ:
What is the deadline for nominations to be submitted?
- Polls close July 1, 2010, at 6 p.m. Central European Time.
- You may vote once every 24 hours.
- After voting, you will be locked out from voting again (on the computer you voted from) for 24 hours.
- The voting consists of separate monthly contests. Counters will be reset at the beginning of each month.
- L-Soft reserves the right to close some or all polls earlier than the posted end date.
- The top three finalists will be announced Spring 2010.
Note: mucinous/KRAS is also prevalant in colorectal cancers
ConclusionsPrimary mucinous ovarian cancer should be considered separate from the other epithelial ovarian cancers. Ongoing clinical trials in this disease will likely offer improvements in chemotherapeutic agents used to treat women with primary and recurrent mucinous ovarian cancer.
Phase I clinical trials in 85 patients with gynecologic cancer: The M. D. Anderson Cancer Center experience
Note: the abstract does not detail outcomes/disease specific sites
Clinical relevance of rare germline sequence variants in cancer genes: evolution and application of classification models.
Multifactorial models developed for BRCA1/2 variant classification have proved very useful for delineating BRCA1/2 variants associated with very high risk of cancer, or with little clinical significance. Recent linkage of this quantitative assessment of risk to clinical management guidelines has provided a basis to standardize variant reporting, variant classification and management of families with such variants, and can theoretically be applied to any disease gene. As proof of principle, the multifactorial approach already shows great promise for application to the evaluation of mismatch repair gene variants identified in families with suspected Lynch syndrome. However there is need to be cautious of the noted limitations and caveats of the current model, some of which may be exacerbated by differences in ascertainment and biological pathways to disease for different cancer syndromes.
"Endometrial and epithelial ovarian cancers are the fourth and fifth most common cancers in women in developed countries, after breast, lung, and colorectal cancer. In the United States alone, in 2008 there were about 40000 new diagnoses of endometrial cancer and 7500 disease-related deaths. For ovarian cancer, there were about 22000 new diagnoses and 15000 deaths over the same period. The purpose of this article is to review the recent developments in the inherited genetics of ovarian and endometrial cancer, with particular attention to recent progress in identifying common low-penetrance susceptibility genes and their clinical implications."
Editorial: The cancer of bureaucracy: How it will destroy science, medicine, education; and eventually everything else
References and further reading may be available for this article. To view references and further reading you must purchase this article.
SummaryEveryone living in modernizing ‘Western’ societies will have noticed the long-term, progressive growth and spread of bureaucracy infiltrating all forms of social organization: nobody loves it, many loathe it, yet it keeps expanding. Such unrelenting growth implies that bureaucracy is parasitic and its growth uncontrollable – in other words it is a cancer that eludes the host immune system. Old-fashioned functional, ‘rational’ bureaucracy that incorporated individual decision-making is now all-but extinct, rendered obsolete by computerization. But modern bureaucracy evolved from it, the key ‘parasitic’ mutation being the introduction of committees for major decision-making or decision-ratification. Committees are a fundamentally irrational, incoherent, unpredictable decision-making procedure; which has the twin advantages that it cannot be formalized and replaced by computerization, and that it generates random variation or ‘noise’ which provides the basis for natural selection processes. Modern bureaucracies have simultaneously grown and spread in a positive feedback cycle; such that interlinking bureaucracies now constitute the major environmental feature of human society which affects organizational survival and reproduction. Individual bureaucracies must become useless parasites which ignore the ‘real-world’ in order to adapt to rapidly-changing ‘bureaucratic reality’. Within science, the major manifestation of bureaucracy is peer review, which – cancer-like – has expanded to obliterate individual authority and autonomy. There has been local elaboration of peer review and metastatic spread of peer review to include all major functions such as admissions, appointments, promotions, grant review, project management, research evaluation, journal and book refereeing and the award of prizes. Peer review eludes the immune system of science since it has now been accepted by other bureaucracies as intrinsically valid, such that any residual individual decision-making (no matter how effective in real-world terms) is regarded as intrinsically unreliable (self-interested and corrupt). Thus the endemic failures of peer review merely trigger demands for ever-more elaborate and widespread peer review. Just as peer review is killing science with its inefficiency and ineffectiveness, so parasitic bureaucracy is an un-containable phenomenon; dangerous to the extent that it cannot be allowed to exist unmolested, but must be utterly extirpated. Or else modernizing societies will themselves be destroyed by sclerosis, resource misallocation, incorrigibly-wrong decisions and the distortions of ‘bureaucratic reality’. However, unfortunately, social collapse is the more probable outcome, since parasites can evolve more rapidly than host immune systems.
abstract - Jjournal of Medical Hypostheses: Determinants of geographic patterns of diseases: Interaction of lactose/lactase status and sunshine exposure. (vitamin D)
Note: in research
"Then in a preliminary fashion lactose digester and maldigester status are related to relative annual sunshine exposure. Further the relative national annual sunshine exposure is evaluated to outcomes of the same exemplary diseases. The patterns related to sunshine reflect that obtained with national lactase status proportions and also corroborate a literature review. However, correlations are weak to moderate and only ovarian cancer reached conventional statistical significance. Because these comparisons are based on modest number of national data firm conclusions cannot be made.....These could partly explain both north to south and west to east directional changes.
Tuesday, May 11, 2010
Several early animal and laboratory studies report anti-cancer (colon, skin, breast) properties of curcumin. Many mechanisms have been considered, including antioxidant activity, anti-angiogenesis (prevention of new blood vessel growth), and direct effects on cancer cells. Currently it remains unclear if turmeric or curcumin has a role in preventing or treating human cancers. There are several ongoing studies in this area."
Podcast – A Breakthrough in BRCA-Mutated Cancers
11. May, 2010 in Podcast
Alan Ashworth, who helped discover the BRCA2 breast cancer gene in 1995, says understanding basic biology can help researchers find targeted cancer treatments. He shares about his research with PARP inhibitors to treat BRCA-mutated cancers.
short video from the Patient Safety community - Martin J. Hatlie Expert Commentary on Patient-Centered Care
ASCO - Endocyte Officials to Present Results from Four Clinical Trials at ASCO Annual Meeting - PRECEDENT = EC145/platinum resistant ovarian
"Interim results from the PRECEDENT study, a randomized phase II study of the combination of EC145 and Doxil for the treatment of patients with platinum-resistant ovarian cancer, will be provided during an oral presentation. EC145 is a folate-targeted conjugate of a very potent chemotherapy drug."
Risk factors for carcinoma of the fallopian tube in women with and without a germline BRCA mutationBRCA,mutation
full access: Knowledge, attitudes, and clinical experience of physicians regarding preimplantation genetic diagnosis for hereditary cancer predisposit
Note: for full free access click on 'pdf'
CONCLUSION: In laparoscopic hysterectomy, increasing the surgical volume can reduce the operating time and the risk for conversion to laparotomy but not the rate of serious complications
"Audience members emphasized public education and access to information regarding potential choices, which was different from the emphasis on informed consent and other ethical issues prominent in the literature. Members of the general public emphasized ethical issues that were different than those identified by experts and patients. It is essential that members of the public be included in complex and controversial public policy decisions."
Monday, May 10, 2010
Versatility Of Amniotic Fluid Stem CellsMain Category: Stem Cell Research
Also Included In: Diabetes; Urology / Nephrology; Genetics
Article Date: 25 Nov 2009
For the first time, scientists have demonstrated that stem cells found in amniotic fluid meet an important test of potential to become specialized cell types, which suggests they may be useful for treating a wider array of diseases and conditions than scientists originally thought.
Reporting in Oncogene, a publication of Nature Publishing Group, the research teams of Anthony Atala, M.D., director of the Wake Forest Institute for Regenerative Medicine, and Markus Hengstchläger, Ph.D., from the Medical University of Vienna, have shown that these amnion stem cells can form three-dimensional aggregates of cells known as embryoid bodies (EBs). It is believed that cells at this stage of development can be directed to become virtually any cell in the human body.
"This finding suggests that the amnion cells have greater potential than we originally thought and may be able to form many cell types," said Atala. "This could expand the number for diseases and conditions that they may be helpful for."
Atala's team is currently evaluating the cells for their potential to treat diabetes and kidney disease. They were the first to report success (Nature Biotechnology, Jan. 2007) in isolating stem cells from placenta and amniotic fluid, which surrounds the developing fetus. The current research is one of several projects designed to determine the potential of this new type of stem cell.
For the study, scientists generated two additional lines of stem cells from amniotic fluid using the same protocol developed by Atala's lab. They then investigated the incidence of EB formation in all three lines.
"Performing many independent experiments using different approaches, we demonstrate in the report that human amnion stem cells … can indeed form embryoid bodies," write the researchers in Oncogene. "Amnion cells are on the way to become an important source for both basic science and regenerative medicine."
In addition to the finding about EBs, the scientists identified a protein found inside cells (mTOR) as the regulator of EB formation. Hengstshläger, whose team was the first to provide evidence for the existence of stem cells in amniotic fluid, said that this finding may allow for new insights into the molecular mechanism of EB formation.
He said the cells may be a useful source for generating disease-specific stem cell lines for studying the differentiation process to determine what goes wrong in genetic diseases.
"These stem cells allow for studying the effects of mutations causing human genetic diseases on specific cell differentiation processes," he said.
Other potential advantages of the cells are that they can be grown in large quantities and are readily available during gestation and at the time of birth. "Whether these cells are as versatile as embryonic stem cells remains to be determined," said Atala, "but the current finding is certainly encouraging."
Atala stopped short of calling the cells pluripotent, which means the ability to form many cell types. He said while the cells meet some of the characteristics of pluripotency, such as versatility, they do not form tumors when implanted in animals, which is also considered a characteristic. The fact that the amnion cells are less likely to form tumors may be one advantage that they have over embryonic stem cells in their potential for clinical use.
Co-researchers were Alessandro Valli, Ph.D., Margit Rosner, student, Christiane Fuchs, MSc., Nicol Siegel, MSc., and Helmut Dolznig, Ph.D., from the Medical University of Vienna, Colin E. Bishop, Ph.D., from Wake Forest, and Ulrike Mädel, student, and Wilfried Feichtinger, M.D., from Wunschbaby Zentrum, in Vienna, Austria.
Source: Karen Richardson
Wake Forest University Baptist Medical Center
full access: PLoS ONE: Ovarian Cyst Fluid of Serous Ovarian Tumors Contains Large Quantities of the Brain Amino Acid N-acetylaspartate
Arrayit Corporation Reports Strong Surge in Customer Demand for the Company's Leading Edge Life Sciences Microarray Instruments - financial news
Note: in prior new/press releases the Arrayit testing is still seeking FDA (U.S.) approval, this is not the same test as OVA1 which is the test for determining suspicion of ovarian cancer malignancy (search blog for further information on both)
"Arrayit microarrays and instruments offer richer content and greater sensitivity than competing platforms, and these attributes have allowed us to discover the world's only definitive pre-symptomatic biomarkers for ovarian cancer and Parkinson's Disease, as well as a new pharmaceutically important pathway in human biology that will be the subject of future announcements."
Our Onko-Sure™ in vitro diagnostic test enables physicians and their patients to effectively monitor and/or detect solid tumor cancers by measuring the accumulation of specific breakdown products in the blood called Fibrin and Fibrinogen Degradation Products (FDP). Onko-Sure™ is a simple, non‐invasive blood test used for the detection and/or monitoring of 14 different types of cancer including: lung (Oncologystat.com), breast, stomach, liver, colon, rectal, ovarian, esophageal, cervical, trophoblastic, thyroid, malignant lymphoma, and pancreatic. Onko-Sure™ can be a valuable diagnostic tool in the worldwide battle against cancer, the second leading cause of death worldwide. Onko-Sure™ serves the IVD cancer/oncology market which, according to Bio-Medicine.org is growing at an 11% compouned annual growth rate.
Onko-Sure™ is sold as a blood test for cancer in Europe (CE Mark certified), India, Taiwan, Korea, Vietnam, and in Chile (research use); approved in the U.S. for the monitoring of colorectal cancer (CRC); approved in Canada (by Health Canada) for lung cancer detection and lung cancer treatment monitoring; and in many key markets, has the significant potential to be used as a general cancer screening test.
Call for Applications – Wave 3
In announcing the Wave 3 Call for Applications, the Ministry is now accepting submissions to award the remaining 14 Nurse Practitioner-Led Clinics. The Ministry will receive applications until Friday, June 25, 2010. All applications must be received by 5:00 p.m. Friday, June 25, 2010. Late applications will not be considered...."
OBJECTIVE: The aim of this study was to investigate prognostic factors of patients with metastases to the ovaries from non-genital organs.
STUDY DESIGN: From September 1994 to December 2006, 158 patients with pathologically confirmed metastatic tumors to the ovaries at Samsung Medical Center (SMC) were included in this study. The data were obtained from the patients' medical records and pathology reports.
RESULTS: The primary tumor origin was mostly stomach (73 cases) and colon (61 cases). Krukenberg tumor (pathologically proven signet ring cell carcinoma) was found in 34 cases: stomach (25), colon (2), appendix (1), and unknown (6). ....However, age, bilateral tumors, chronology of diagnosis and mass size did not affect survival.
CONCLUSION: Cytoreductive surgery and post-operative adjuvant chemotherapy had a beneficial effect on survival in selected patients.
amednews: Smart pill sends message when medication is swallowed :: May 10, 2010 ... American Medical News
Any views on this one?
Note: these policies address only drug company influences
Medical News: Cancer Costs Double in Less than 20 Years - in Public Health & Policy, General Professional Issues
Note: over the past many years, the cost factors (no matter the country/politics) have formed a large part of cancer research, the one part which is always missing is what if it's me....IMHO obviously
full free access: (breast cancer)Tailored targeted therapy for all: a realistic and worthwhile objective against
"Targeted therapy for breast cancer was actually used, albeit unwittingly, as early as the late 1800s. Beatson first surgically removed the ovaries of women to treat metastatic breast cancer in 1896......"
Sunday, May 09, 2010
"...For Dr. Sutherland, becoming a patient has taught him new lessons as a doctor. "I have learned many things as a patient – some good things and some bad things.."
Saturday, May 08, 2010
Clinical Care Options Oncology - Research Update on PARP Inhibition: Emerging Data in Breast, Ovarian, and Other Cancers - Virtual Presentation
Note: free access/register
|Research Update on PARP Inhibition: Emerging Data in Breast, Ovarian, and Other Cancers|
In this Interactive Virtual Presentation, William J. Gradishar, MD, FACP, reviews the mechanism of PARP inhibition and its rationale as a therapeutic pathway and describes recent data using novel PARP inhibitors.
To begin this Interactive Virtual Presentation, click here.
The slideset that accompanies this Interactive Virtual Presentation is available for use as a self-study resource or in your own noncommercial talks. To download, click here.
This CME-certified Interactive Virtual Presentation is located online at:
"These two ongoing theories showcase the current problems in the field of antiangiogenic research in cancer. After several years of clinical trials, it appears that targeting one angiogenic factor is not enough to permanently halt neovascularization in most tumors. Although these results were initially disheartening, they also opened up the possibility of other angiostatic therapies.
Many clinical trials now use existing chemotherapeutic drugs or radiation along with antiangiogenic drugs. This two-front attack has had more
success than antiangiogenic drugs or chemotherapy alone in a majority of patients."
Decreased severity of ovarian cancer and increased survival in hens fed a flaxseed-enriched diet for 1 year
ConclusionsThese findings show that 10% flaxseed supplementation for 1 year in the laying hen results in a significant reduction in the severity of ovarian cancer, but no change in the incidence of the disease. Hens fed flaxseed had overall better health and reduced mortality. These findings may provide the basis for a clinical trial that evaluates the efficacy of flaxseed as a chemosuppressant of ovarian cancer in women.
Note: a second study published in Menopause/postmenopausal women/preclinical study
"Although Hyder said that the study was independent of whether or not the ovaries were intact, it's still unclear whether progestins have the same effects in pre-menopausal women.
"Especially if there's a family history of breast cancer, it's advisable not to take progestins. It's a difficult call that must be made on an individual basis by a physician," Hyder said...."
Friday, May 07, 2010
Note: easier to read Medscape article from previous blog post
"Cancer researchers at Princess Margaret Hospital (PMH) have discovered that the ovarian hormone progesterone plays a pivotal role in altering breast stem cells, a finding that has important implications for breast cancer risk.......The findings, published online today in Nature (10.1038/nature09091; http://dx.doi.org/), are significant because reproductive history is among the strongest risk factors for breast cancer, says principal investigator Rama Khokha, a molecular biologist at Ontario Cancer Institute and the Campbell Family Cancer Research Institute, PMH. Other major known risk factors are age, genetics and breast density."
Risk Tools Limited in Their Ability to Predict Development of Breast Cancer including Editorial Comment
....Major Limitations Exist
According to the researchers, these models each have major limitations. Most notable is that the models rely on known risk factors, given that up to 60% of breast cancers occur in the absence of known risk factors. In addition, with the exception of the Gail model, these tools have not been well validated, and they also do not include nonhereditary risk factors. However, even the Gail model has limited ability to discriminate between individuals at risk, especially those in higher-risk groups, according to the study authors.
To date, no existing model is "totally able to discriminate between families that do and do not have mutations or between women who will and will not develop breast cancer," they write. "Steady and incremental improvement in the models are being made, but these changes require revalidation."
Other risk factors, such as mammographic density, weight gain, and serum steroid hormone measurements, are being considered for inclusion in the existing models. Studies are underway to determine if these factors are feasible and will improve breast cancer risk prediction, according to the study authors.
Editorial: Models Differ in Details
"The authors have provided a useful survey of the literature and have presented an informative summary of the risk factors used in various models," write Mitchell Gail, MD, PhD, and Phuong Mai, MD, from the National Cancer Institute, in a related editorial. Drs. Gail and Phuong caution, however, that the various models differ in important details and that physicians need to be cognizant of these differences.
"Promising directions include incorporating mammographic density, information on genotype or regulation of gene expression ... and more refined use of pathology data and biomarker data from biopsy samples," the editorialists add.
Abstract: CONCLUSION: MSI was infrequent in ovarian tumors, including both borderline and malignant tumors. MSI was found to be uncommon in sporadic ovarian tumors, even by using additional MSI markers. The clinical significance of MSI is not strong in patients with sporadic ovarian tumors.
Link to full text (pdf file):
....MSI is caused by mutations in the mismatchrepair genes (MMR). MSI has been implicated in the pathogenesis of colon, endometrial, and gastric
carcinomas that occur in the setting of HNPCC (Lynch Syndrome), and also in a subset of sporadic cancers such as upper urinary tract, stomach, colon, andendometrial carcinomas.
In ovarian cancers, the reported incidence of MSI ranges from 0 to 37%, depending on the number and type of markers. Sood et al. first
reported the incidence of MSI in ovarian cancer using the NCI criteria.....Therefore, further study of molecular events that are correlated with ovarian tumors is needed."
Note: scroll down the page - the link as below will automatically start
"JNCI Interview: Dr. Regina Ziegler discusses a large study suggesting that fruits and vegetables are associated with only a modest reduction in cancer risk."
Thursday, May 06, 2010
Note: in research; defining the role of progesterones
"Reproductive history is the strongest risk factor for breast cancer after age, genetics and breast density. Increased breast cancer risk is entwined with a greater number of ovarian hormone-dependent reproductive cycles, yet the basis for this predisposition is unknown..........The emerging role of MaSCs (mammary stem cells) in cancer initiation warrants the study of ovarian hormones in MaSC homeostasis. Here we show that the MaSC pool increases 14-fold during maximal progesterone levels at the luteal dioestrus phase of the mouse."
Int J Gynecol Cancer. 2010 May;20(4):664-684.
Assessing Health-Related Quality of Life in Gynecologic Oncology: A Systematic Review of Questionnaires and Their Ability to Detect Clinically Important Differences and Change.
*Psycho-oncology Co-operative Research Group, School of Psychology, daggerCentre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), University of Sydney, Sydney, New South Wales, Australia; double daggerDepartment of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia; section signAustralia New Zealand Gynaecological Oncology Group (ANZGOG), Sydney, New South Wales, Australia; and parallelSchool of Psychology, University of Sydney, Sydney, New South Wales, Australia.
OBJECTIVES:: Researchers wishing to assess the health-related quality of life (HRQoL) of women with gynecologic cancers have a range of questionnaires to choose from. In general, disease-, treatment-, or symptom-specific questionnaires are assumed to be better able to identify between-group differences (sensitivity) and changes over time (responsiveness) than are cancer-specific or generic questionnaires. However, little work has tested this assumption in oncology. We set out to (a) identify all multidimensional HRQoL questionnaires used in studies with women with gynecologic cancer and (b) evaluate their track records in identifying minimal clinically important differences (MCIDs), with a view to making recommendations. METHODS:: We searched MEDLINE using the term quality of life and each gynecologic cancer type, as well as the names of identified questionnaires. We used 10% of the scale range as the threshold for an MCID. RESULTS:: We identified 1 generic (SF-36/SF-12), 3 cancer-specific (European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ] C30, Functional Assessment of Cancer Therapy-General [FACT-G], and short-form Cancer Rehabilitation Evaluation System [CARES-SF]), and 1 disease-specific (QOL-Ovarian Cancer Patient Version) HRQoL questionnaires and 5 disease-specific (QLQ-OV28, FACT-O for ovarian, QLQ-CX24, FACT-Cx for cervical and FACT-V for vulvar), 1 treatment-specific (FACT and Gynecologic Oncology Group-Ntx for neurotoxicity), and 2 symptom-specific (FACT-Anemia and Functional Assessment of Chronic Illness and Therapy [FACIT]-Fatigue) modules. Twenty-seven articles reported results from 26 studies in which an MCID had been identified. The FACIT's anemia and fatigue subscales were more sensitive, and the neurotoxicity subscale more sensitive and responsive than the FACT-G on at least 1 comparison. However, we found no evidence for superior performance by the FACT-G compared with the SF-36 or EORTC and FACIT disease-specific modules versus the QLQ-C30 and FACT-G. There was also little evidence to favor EORTC versus FACIT questionnaires or vice versa. CONCLUSIONS:: The evidence we reviewed offered little support for the hypothesis that disease-, symptom-, or treatment-specific instruments are more sensitive and responsive than cancer-specific or generic questionnaires. However, conclusions were limited by the small number of head-to-head comparisons available. We summarize the clinical contexts in which each instrument identified an MCID to inform choice of questionnaire(s), sample size calculations, and interpretation of results in future studies.
Atypical identification of Lynch syndrome by immunohistochemistry and microsatellite instability analysis on jejunal adenocarcinoma
Note: abstract/free full text (pdf)
*this case describes a patient with many different cancers in the family including breast cancer, MSH6 deficiency
"LS (Lynch Syndrome) has been traditionally described in terms of earlyonset colorectal and endometrial cancers. Although this remains a confirmed association, we are learning more about the variability of LS and the prevalence of other cancers associated with this condition. The majority of cases of LS are reported to be caused by MLH1 and MSH2 gene mutations, but as evaluation for this condition becomes more widespread and routine in cases beyond the classically reported presentation, it is likely that we will come to find that the prevalence of other mismatch gene mutations is much higher than previously suspected."
Surgical Staging and Treatment of Early Ovarian Cancer: Long-term Analysis From a Randomized Trial -- Trimbos et al., 10.1093/jnci/djq149 -- JNCI Journal of the National Cancer Institute
A long-term follow-up analysis of the randomized clinical trial Adjuvant Chemotherapy in Ovarian Neoplasm (ACTION) from the European Organization for Research and Treatment of Cancer was undertaken to determine whether the original results with a median follow-up of 5.5 years could be verified after longer follow-up with more events........Thus, completeness of surgical staging in patients with early ovarian cancer was found to be statistically significantly associated with better outcomes, and the benefit from adjuvant chemotherapy appeared to be restricted to patients with nonoptimal surgical staging."
CONTEXT AND CAVEATS
Surgical Staging and Treatment of Early Ovarian Cancer: Long-term Analysis From a Randomized Trial -- Trimbos et al., 10.1093/jnci/djq149 -- JNCI Journal of the National Cancer Institute
Surgical Staging and Treatment of Early Ovarian Cancer: Long-term Analysis From a Randomized Trial
Affiliations of authors: Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands (BT); Medisch Centrum Rijnmond Zuid, Rotterdam, the Netherlands (PT); EORTC Data Centre, Brussels, Belgium (PT, CC, KV, AC); Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy (SP); Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands (MvdB); Department of Medical Oncology, Hospital Universitario San Carlos, Madrid, Spain (AC)
Correspondence to: Baptist Trimbos, MD, PhD, Department of Gynecology, Leiden University Medical Center, POB 9600, 2300RC Leiden, the Netherlands (e-mail: email@example.com).
A long-term follow-up analysis of the randomized clinical trial Adjuvant Chemotherapy in Ovarian Neoplasm (ACTION) from the European Organization for Research and Treatment of Cancer was undertaken to determine whether the original results with a median follow-up of 5.5 years could be verified after longer follow-up with more events. In the ACTION trial, 448 patients with early ovarian cancer were randomly assigned, after surgery, to adjuvant chemotherapy or to observation (no further treatment). The original analysis found that adjuvant chemotherapy improved recurrence-free survival but not overall survival and found in a subgroup analysis that completeness of surgical staging was an independent prognostic factor, with better recurrence-free and overall survival among those with complete (optimal) surgical staging. After a median follow-up of 10.1 years, we analyzed the more mature data from the ACTION trial and found support for most of the main conclusions of the original analysis, except that overall survival after optimal surgical staging was improved, even among patients who received adjuvant chemotherapy (hazard ratio of death = 1.89, 95% confidence interval = 0.99 to 3.60; overall two-sided log-rank test P = .05). More cancer-specific deaths were observed among nonoptimally staged patients (40 [27%] of the 147 deaths in the observation arm and 11 [14%] of the 76 deaths in the adjuvant chemotherapy arm) than among optimally staged patients (seven [9%] of the 75 deaths in the observation arm and 11 [14%] of the 76 deaths in the adjuvant chemotherapy arm) (two-sided 2 test for heterogeneity, P = .06). Thus, completeness of surgical staging in patients with early ovarian cancer was found to be statistically significantly associated with better outcomes, and the benefit from adjuvant chemotherapy appeared to be restricted to patients with nonoptimal surgical staging.
|CONTEXT AND CAVEATS|
In the randomized clinical trial Adjuvant Chemotherapy in Ovarian Neoplasm, 448 patients with early ovarian cancer were randomly assigned, after surgery, to adjuvant chemotherapy or to observation. After a median follow-up of 5.5 years, adjuvant chemotherapy was associated with improved recurrence-free survival but not overall survival. In a subgroup analysis, better recurrence-free and overall survival were observed among those with nonoptimal surgical staging than those with optimal staging.
Long-term analysis of data from this trial after a median of 10.1 years of follow-up.
The long-term analysis supported most conclusions from the original analysis, except that overall survival after optimal surgical staging was improved, even among patients who received adjuvant chemotherapy. More cancer-specific deaths were observed among nonoptimally staged patients than among optimally staged patients.
Completeness of surgical staging among patients with early ovarian cancer was statistically significantly associated with better outcomes, and the benefit from adjuvant chemotherapy was restricted to patients with nonoptimal surgical staging.
The trial was not designed to compare different surgical staging procedures. Patients could not be prospectively stratified by surgical staging category. The study had a limited sample size. Quality of life was not studied.
From the Editors
Scleroderma-like cutaneous lesions induced by paclitaxel and carboplatin for ovarian carcinoma, not a single course of carboplatin, but re-induced and worsened by previously administrated paclitaxel (Taxol)
Scleroderma-like cutaneous lesion as an adverse event from paclitaxel and carboplatin has been reported. No report shows the occurrence of scleroderma-like cutaneous lesions from a single course of carboplatin. The patient is a 67-year-old female, administered paclitaxel and carboplatin as neoadjuvant chemotherapy. Following four courses, scleroderma-like cutaneous lesions were demonstrated. Skin biopsy corresponded to histopathological findings of scleroderma. Immunological investigation shows only antinuclear antibodies are positive. The characteristic Raynaud's phenomenon of scleroderma and hemorrhagic spots on the cuticles were not found. Postoperatively, a single course of carboplatin treatment was given. Scleroderma-like cutaneous lesions re-induced and worsened. This is the first report detailing scleroderma-like cutaneous lesions induced by previously administrated paclitaxel that worsened by carboplatin."
"Based on the US Food and Drug Administration's own standards, our findings, and the criticism of others, it is reasonable to conclude that improvements in AA processes are needed. The US Food and Drug Administration should have an open debate about AA restructuring and perhaps develop an entirely new program that better addresses the context of oncology. Public discussion, augmented by open access to relevant data, is essential."
Population-Based Study of the Risk of Second Primary Contralateral Breast Cancer Associated With Carrying a Mutation in BRCA1 or BRCA2 JCO
"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."
"Genentech also reported in April that:
-- It expects results from ongoing Phase II clinical trials of GDC-0449 in first-line metastatic colorectal in mid-2010 and in advanced ovarian cancer during the second half of 2010."
Wednesday, May 05, 2010
Note: with thanks to Helen Palmquist - http://www.ovariancancer.org/2010/04/12/Jean-Strauss/ along with the many Mom's profiled
Assessing Health-Related Quality of Life in Gynecologic Oncology: A Systematic Review of Questionnaires and Their Ability to Detect Clinically....
Assessing Health-Related Quality of Life in Gynecologic Oncology: A Systematic Review of Questionnaires and Their Ability to Detect Clinically Important Differences and Change
Methods: We searched MEDLINE using the term quality of life and each gynecologic cancer type, as well as the names of identified questionnaires.
Conclusions: The evidence we reviewed offered little support for the hypothesis that disease-, symptom-, or treatment-specific instruments are more sensitive and responsive than cancer-specific or generic questionnaires. However, conclusions were limited by the small number of head-to-head comparisons available. We summarize the clinical contexts in which each instrument identified an MCID to inform choice of questionnaire(s), sample size calculations, and interpretation of results in future studies.
Postoperative Pulmonary Embolism Including Asymptomatic Case... : International Journal of Gynecological Cancer
Conclusions: A substantial number of postoperative PEs were occult, and identification of high-risk patients and routine SpO2 level monitoring would reduce the diagnostic delay of PE after gynecologic surgery. Increasing age, longer operation time, and obesity were risks. The use of a perioperative intermittent pneumatic compression device in multimodal conditions might thus prevent PE. (pulmonary embolism/blood clot)
Increasing the Effectiveness of Referral of Ovarian Masses From Cancer Unit to Cancer Center by Using a Higher Referral Value of the Risk of Malig.........
Increasing the Effectiveness of Referral of Ovarian Masses From Cancer Unit to Cancer Center by Using a Higher Referral Value of the Risk of Malignancy Index
Higher risk of malignancy index (RMI) with multidisciplinary approach will reduce the number of referrals of ovarian masses, thus reducing the stress for patients and workload at the cancer center.
Conclusions: A higher RMI with multidisciplinary approach to refer patients with pelvic masses has the potential to reduce the numbers of benign cases, thus reducing stress for patients and reducing workload at centers.
Note: also see post of Dr Maurie Markman (blogger dat May 4th) for Editorial on this particular subject matter
Conclusions: These findings suggest the possibility that SL can improve OS in advanced-stage EOC. However, the efficacy of SL on OS is still unknown because of the lack of RCTs, which requires more relevant studies for investigating the role of SL in EOC
Survivin Small Interfering RNA Transfected With a Microbubbl... : International Journal of Gynecological Cancer
Conclusions: Delivery of survivin siRNA using a microbubble contrast agent combined with ultrasound exposure can effectively inhibit survivin expression and induce apoptosis, providing a new promising approach for siRNA delivery in vivo.
Cervical, Uterine Corpus, and Ovarian Cancer Mortality in Greece During 1980 to 2005: A Trend Analysis
"The increasing trend of uterine corpus and ovarian cancer mortality in older women suggests that development of well-organized tertiary centers for the implementation of modern therapeutic modalities is urgently needed."
The James Lind Alliance announces the launch of online Guidebook for priority setting in research | The Cochrane Collaboration
"Sir Iain Chalmers, co-founder of the JLA says: “It is surprising how difficult it is to find out how research funders decide what research to fund. What is clear is that patients, carers and ordinary ‘jobbing’ clinicians are only very rarely involved in these processes. That is probably one of the reasons that the little evidence there is reveals mismatches between the questions that interest researchers and the questions that interest patients and clinicians. The James Lind Alliance Guidebook will help people who want to try to bridge those gaps.”...cont'd
2010: Collateral damage: toxic effects of targeted antiangiogenic therapies in ovarian cancer : The Lancet Oncology (abstract only)
Note: abstract/full access is by subscription/$$
"We found that women who experienced non-natural menopause are at almost twice the risk of developing lung cancer compared to women who experienced natural menopause," Anita Koushik, a researcher at the Universite de Montreal's Department of Social and Preventive Medicine, said in announcing her team's findings Tuesday.
"This increased risk of lung cancer was particularly observed among women who had non-natural menopause by having had both their ovaries surgically removed."
It's the second study this year to associate bilateral oophorectomy — removal of both ovaries — with higher odds of developing lung cancer...."
Abstract/full access; TIMP-1 and VEGF-165 serum concentration during first-line therapy of ovarian cancer patients
Angiogenesis appears to play an important role in ovarian cancer. Vascular endothelial growth factor (VEGF) has recently been implicated as a therapeutic target in ovarian cancer. The tissue inhibitor of metalloproteinase 1 (TIMP-1) is involved in tissue invasion and angiogenesis. The application of serum TIMP-1 and VEGF to monitor primary therapy and predict clinical outcome of patients with ovarian cancer is unclear.
The role of initial maximal surgical cytoreduction in ovarian cancer still debated Dr Maurie Markman Editorial
"Although the world of surgery is not necessarily characterized by the utility of innovative clinical hypotheses being formally evaluated through the conduct of randomized phase-3 clinical trials, it will hopefully be the case that the gynecologic cancer surgical community will see the wisdom of further exploration of these important concepts in prospective well-designed and evidence-based clinical trials.
Our current and future patients deserve no less."
Note: full access is available/click on 'pdf' "For the majority of citizens worldwide, effective, nontoxic, culturally appropriate, and attainable care for cancer has not yet been defined."
"It’s in the interests of public health to try our best to measure what should guide our health decisions – and to measure what actually does."
"The zoster vaccine has demonstrated benefit in reducing the frequency and severity of zoster in elderly patients. It’s an attenuated vaccine, so should be used with caution in patients who have immunosuppression."
Initial Assessment, Surveillance, and Management of Blood Pressure in Patients Receiving Vascular Endothelial Growth Factor Signaling Pathway Inhibitors -- Maitland et al. 102 (9): 596 -- JNCI Journal of the National Cancer Institute
Box 1. Summary recommendations
- Conduct and document a formal risk assessment for potential cardiovascular complications before vascular endothelial growth factor signaling pathway (VSP) inhibitor treatment. The assessment should include standardized blood pressure measurements (two separate sessions are suggested) and thorough history and examination to assess specific cardiovascular risk factors, and directed laboratory studies as indicated. (Table 2 summarizes the risk factors.) The purpose of this evaluation is to guide the physician and patient in determining the appropriate intensity of monitoring and control of blood pressure elevations. This provides an important opportunity to address comorbidities that through more attentive management could help prolong the patient's life and support more aggressive anticancer therapy.
- Recognize that preexisting hypertension will be common in cancer patients and should be identified and addressed before initiation of VSP inhibitor therapy. Given the suspected importance of pretreatment intervention in the management of VSP inhibitor–induced blood pressure elevations, properly collected, objective, office measurements or more thorough evaluations for isolated office hypertension (also known as "white coat hypertension") should guide the risk assessment rather than patient and/or physician speculation and dismissal.
- Actively monitor blood pressure throughout treatment with more frequent assessments during the first cycle of treatment. The first cycle is typically when the bulk of the blood pressure elevation is expected to occur and when most patients unexpectedly present with elevations warranting treatment even in the absence of preexisting cardiovascular risk factors.
- The goal for hypertension control in patients receiving VSP inhibitor therapy is a maximum blood pressure of 140/90 mmHg, and efforts to reach this goal should begin before initiation of VSP inhibitor therapy. The recommendation for a goal of maintaining blood pressure less than 140/90 mmHg is based on prudence and consistency with general guidelines. As per the risk stratification considerations, targets should be adjusted lower for patients with multiple preexisting risk factors for adverse consequences of high blood pressure. For example, for patients with diabetes and/or chronic kidney disease, a goal blood pressure of less than 130/80 mmHg is the current public health recommendation.
- Manage blood pressure elevations aggressively to avoid the development of complications associated with excessive/prolonged elevations. Management requires attention to proper agent selection, dosing, and scheduling of follow-up to ensure efficacy and to control adverse effects of the antihypertensive agent. The panel suggests that at any time, if the oncologist or responsible medical team member has any difficulty in helping the patient progress to the goal blood pressure of 140/90 mmHg, consultation with the local hypertension specialist (cardiologist, nephrologist, endocrinologist, or certified hypertension specialist) should be obtained promptly.
FDA Finalizes REMS Program for ESAs,; Amgen Continues to Study Risks -- limited information in text/article
Note: extract of article - limited information (requires subscription/$$)
".......The fact that Dahm et al. could not correct the fiber consumption odds ratios for these types of systematic biases casts a shadow over the interpretation of their reported inverse association.
Unfortunately, this shadow extends to virtually the entire body of the existing nutritional epidemiology literature and may well contribute to the fact that few associations between diet and cancer are regarded as established or probable (8).
The explicit use of biomarkers to correct nutritional epidemiology associations for systematic and random measurement error in dietary assessment seems a logical next step in the nutritional epidemiology research agenda..." cont'd
Magnitude of Overdiagnosis in Cancer Indicates Need for Strategies to Address the Problem -- 102 (9): NP -- JNCI Journal of the National Cancer Institute
Note: in general, not specific to ovarian cancer
Note: still recruiting as of Jan 2010 Official Title: Use of the CA 125 Algorithm for the Early Detection of Ovarian Cancer in Low Risk Women
Note: requires registration/free to view
".........She also said that more education should be directed at cancer survivors so that they know where to go when they have a problem when they are not routinely managed by the cancer care team.
“It may not be their oncology pharmacist, it may be their primary care physician or their community pharmacy, but we must tell them that these symptoms can occur and that they should be addressed. Our role as educators shouldn’t simply be to tell them that their chemotherapy can cause nausea and vomiting; rather, I think it should be to tell them that they may experience symptoms..."cont'd
Tuesday, May 04, 2010
Note: click on 'pdf' for (free) access to the full paper
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
"The study, led by researchers at the Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, shows that microRNA-155 (miR-155) can inhibit the activity of genes that normally correct the damage when the wrong bases are paired in DNA.
The loss or silencing of these genes, which are called mismatch repair genes, causes inherited cancer-susceptibility syndromes and contributes to the progression of colorectal, uterine, ovarian and other cancers."
"Overall, Croce says, "Our findings suggest that miR-155 expression might be an important stratification factor in the prognosis and treatment of cancer patients and provide an additional analytical test for exploring the etiology of microsatellite-instability tumors when the standard tests do not provide a conclusive diagnosis."
"About 50 percent of Asians and 20 to 30 percent of North Americans and Europeans, who in general consume less soy than Asians, have the ability to produce equol. Studies in Japan have documented an association between milder menopausal symptoms in equol producers as compared to non-producers."
Monday, May 03, 2010
"Computer-based-system-automatically-tracks-radiation-dose-exposure-in-patients-receiving-CT-scan. "The fact that Valkyrie works with older CT equipment is important. This is an immediate solution for almost all hospitals, many of which may not be able to upgrade their CT technology in the short or medium term," said Shih."
Recipient of First-Ever Breast Cancer Fellowship for Gynecologic Oncologists is Named - media article
Prognostic role of platinum sensitivity in patients with brain metastases from ovarian cancer: results of a German multicenter study
Sunday, May 02, 2010
Epigenetics: Study of how proteins and other molecules that bind to DNA and chromosomes can change gene expression without changing the DNA sequence
CONCLUSIONS: Although the epigenetics of ovarian cancer is still in its beginnings, it holds promising potential in early stage ovarian cancer detection, evaluation of prognosis/drug resistance and targeted cancer treatment.
OBJECTIVE: We sought to estimate mean costs of chemotherapy treatment for recurrent ovarian cancer with or without use of a chemoresponse assay.
STUDY DESIGN: We estimated mean costs for 3 groups: (1) assay assisted: 75 women who received oncologist's choice of chemotherapy following chemoresponse testing (65% adherence to test results), (2) assay adherent: modeled group assuming 100% adherence to assay results, and (3) empiric: modeled from market share data on most frequently utilized chemotherapy regimens. Cost estimates were based on commercial claims database reimbursements.
RESULTS: The most common chemotherapy regimens used were topotecan, doxorubicin, and carboplatin/paclitaxel. Mean chemotherapy costs for 6 cycles were $48,758 (empiric), $33,187 (assay assisted), and $23,986 (assay adherent). The cost savings related to the assay were associated with a shift from higher- to lower-cost chemotherapy regimens and lower use of supportive drugs such as hematopoiesis-stimulating agents.
CONCLUSION: Assay-assisted chemotherapy for recurrent ovarian cancer may result in reduced costs compared to empiric therapy.
Differential sensitivity to platinum-based chemotherapy in primary uterine serous papillary carcinoma cell lines with high vs low HER-2/neu expression
Note: in the lab/uterine cancer
"Higher proliferative capability rather than increased drug resistance may be responsible for the adverse prognosis associated with HER-2/neu overexpression in USPC."
CONCLUSION: Chemotherapy-induced neutropenia was not a significant prognostic indicator in ovarian cancer patients treated with paclitaxel/carboplatin as first-line chemotherapy.
Saturday, May 01, 2010
Serum testosterone levels measured by isotope dilution-liquid chromatography-tandem mass spectrometry in postmenopausal women versus those in women who underwent bilateral oophorectomy
abstract: "A significant decrease was found in testosterone concentrations before and after bilateral oophorectomy, whereas no significant difference was found before and after natural menopause."
Friday, April 30, 2010
Primary peritoneal cancer after bilateral salpingo-oophorectomy in two patients with Lynch syndrome.
Primary peritoneal cancer after bilateral salpingo-oophorectomy in two patients with Lynch syndrome.
Obstet Gynecol. 2010 Feb
Authors: Schmeler KM, Daniels MS, Soliman PT, Broaddus RR, Deavers MT, Vu TM, Chang GJ, Lu KH
BACKGROUND: Women with Lynch syndrome or hereditary nonpolyposis colorectal carcinoma (HNPCC) have a 40-60% lifetime risk of endometrial cancer and a 7-12% lifetime risk of ovarian cancer. Risk-reducing surgery, including hysterectomy and bilateral salpingo-oophorectomy (BSO), is currently recommended once child bearing is complete. We describe two cases of primary peritoneal cancer after BSO in women with Lynch syndrome or HNPCC.
The first patient was a 44-year-old woman who underwent hysterectomy with BSO for benign disease. She presented 12 years later with a pelvic mass and was diagnosed with a high-grade serous primary peritoneal cancer. Genetic testing showed a mutation in the MSH2 DNA mismatch repair gene.
The second case was a 58-year-old woman who had a hysterectomy and BSO for endometrial cancer. She developed a high-grade serous primary peritoneal cancer 8 years later and was found to have a mutation in the PMS2 DNA mismatch repair gene.
CONCLUSION: Women with Lynch syndrome or HNPCC should be counseled that they may be at risk for developing primary peritoneal cancer despite undergoing gynecologic cancer risk-reducing surgery. The magnitude of this risk remains to be determined.
PMID: 20093870 [PubMed - in process]
Somatic Hypermethylation of MSH2 Is a Frequent Event in Lynch Syndrome Colorectal Cancers -- Cancer Research
"In Part 1 of this four-part series, we examine the clinical pathology and molecular biology of (Lynch Syndrome) hereditary nonpolyposis colorectal cancer (HNPCC). In Part 2, we will discuss screening and treatment, and the roles of the epidemiologist, the diagnostician and the surgeon."
An estimated 150,000 Americans may be carriers of the (Lynch Syndrome) HNPCC mutation(s) and have a 90% lifetime risk for developing some type of cancer. (MSH2/MSH6/MLH1/PMS2)
"Dendreon is using cancer immunotherapies that use the patient's own immune system to treat cancer and the approval of Provenge represents a scientific and clinical advancement for the treatment of prostate cancer.
Prima BioMed, an Australian biotechnology firm focused on cancer immunotherapy, is using the technology to develop its CVac immunotherapy cancer vaccine for the treatment of ovarian cancer."
Note: diagram shows the processes of clinical trials
ESAs (erythropoiesis-stimulating agents) not cost effective in cancer patients with anemia | HemOncToday
Blogger opinion: more concerning than cost is the recent research regarding increased mortality rates with the use of ESAs
"The use of erythropoiesis-stimulating agents to reduce the need for blood transfusions and improve quality of life in cancer patients with anemia was found to be economically unattractive by an analysis using the Canadian public health care system."
Previous work has shown that erythropoiesis-stimulating agents (ESAs) are preferred by patients compared with transfusion and can improve short-term disease-specific quality of life in patients with cancer, but there are concerns over toxicity and cost of the agents. Researchers created a decision analytic model incorporating resource utilization and health outcomes to test the cost-effectiveness of ESA use in patients with anemia related to cancer. Using a model cohort, treatment with epoetin resulted in incremental costs of $8,643 over 15 weeks compared to no ESA use. This gave an incremental cost per quality-of-life-year (QALY) gained of $267,000. Even when a model overemphasizing the potential benefits of ESAs was used, the cost per QALY gained remained greater than $100,000.
Finally, separate analyses were conducted using data from studies that followed the most recent American Society of Hematology/ASCO guidelines for ESA use; these guidelines are more conservative in their recommendations for using ESAs. The results did show lower costs than the base case, but the cost per QALY remained greater than $70,000. In three of 10 models, ESA use had more cost and less benefit than no ESA use.
“ESA use in patients with [anemia related to cancer] does not appear to be economically attractive, even when used in the more conservative fashion recommended by current guidelines,” the researchers wrote. “Available evidence suggests that using ESA to treat anemia related to cancer does not represent a good value for the money.”
link to abstract:
open access: The Canadian Facts from the Social Determinents of Health perspective - University of York
Social Determinants of Health:
The Canadian Facts
Juha Mikkonen and Dennis Raphael
Published in May 2010. ISBN 978-0-9683484-1-3
The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living conditions they experience. These conditions have come to be known as the social determinants of health. This information – based on decades of research and hundreds of studies in Canada and elsewhere – is unfamiliar to most Canadians. Canadians are largely unaware that our health is shaped by how income and wealth is distributed, whether or not we are employed and if so, the working conditions we experience.
Our health is also determined by the health and social services we receive, and our ability to obtain quality education, food and housing, among other factors. And contrary to the assumption that Canadians have personal control over these factors, in most cases these living conditions are – for better or worse – imposed upon us by the quality of the communities, housing situations, work settings, health and social service agencies, and educational institutions with which we interact.
Improving the health of Canadians requires we think about health and its determinants in a more sophisticated manner than has been the case to date. Social Determinants of Health: The Canadian Facts considers 14 social determinants of health:
1. Income and Income Distribution
3. Unemployment and Job Security
4. Employment and Working Conditions
5. Early Childhood Development
6. Food Insecurity
8. Social Exclusion
9. Social Safety Network
10. Health Services
11. Aboriginal Status
The publication outlines why they are important; how Canada is doing in addressing them; and what can be done to improve their quality. The purpose of the document is to provide promote greater awareness of the social determinants of health and the development and implementation of public policies that improve their quality.