Sunday, August 01, 2010
clinical trial: Attitudes About Childbearing And Fertility With Inherited Breast And Ovarian Cancer Syndromes (HBOC) - Full Text View - ClinicalTrials.gov
ongoing clinical trial: Women Who Are At Risk Or May Have Lynch Syndrome - Full Text View - ClinicalTrials.gov
Search of: ovarian cancer | Open Studies | received on or after 07/01/2010 - List Results - ClinicalTrials.gov
|Found 9 studies with search of:||ovarian cancer | Open Studies | received on or after 07/01/2010|
|1||Recruiting||Study Comparing Tumor Debulking Surgery Versus Chemotherapy Alone in Recurrent Platinum-Sensitive Ovarian Cancer |
|2||Recruiting||Study With Wee-1 Inhibitor MK-1775 and Carboplatin to Treat Ovarian Cancer |
|3||Not yet recruiting||Study for Women With Platinum Resistant Ovarian Cancer Evaluating EC145 in Combination With Doxil® (PROCEED) |
|4||Not yet recruiting||Paclitaxel and Carboplatin With or Without Bevacizumab in Treating Patients With Stage III or Stage IV Ovarian Epithelial Cancer, Primary Peritoneal Cancer, or Fallopian Tube Cancer |
|5||Recruiting||Pemetrexed Disodium and Docetaxel in Treating Patients With Advanced Solid Tumors |
|6||Recruiting||Low-Fiber Diet or High-Fiber Diet in Preventing Bowel Side Effects in Patients Undergoing Radiation Therapy for Gynecological Cancer, Bladder Cancer, Colorectal Cancer, or Anal Cancer |
|7||Recruiting||Analysis of Tumors From Patients With Inherited Cancers Having Had Two Surgeries (Primary + Recurrent, or 2 Separate Types of Cancer) |
|8||Recruiting||Heated Chemotherapy for Cancers That Have Spread to the Chest Cavity |
|9||Recruiting||Deferasirox for Treating Patients Who Have Undergone Allogeneic Stem Cell Transplant and Have Iron Overload |
Saturday, July 31, 2010
Medical News: FDA Warns of Cure-All Product Based on Bleach - in Product Alert, OTC from MedPage Today
"The FDA has warned consumers not to use a product called Miracle Mineral Solution -- which makes broad health claims -- because it's actually an industrial strength bleach.
"Consumers who have MMS should stop using it immediately and throw it away," the agency urged.
The FDA has received several reports of people who have suffered severe nausea, vomiting, and life-threatening hypotension after drinking a mixture containing the product.
Sometimes labeled as Miracle Mineral Supplement, MMS is 28% sodium chlorite. Its instructions call for consumers to mix it with citrus juice or another acidic substance.
An enormous variety of health claims are made for the product, including treatment of HIV, hepatitis, the H1N1 flu virus, common colds, acne, and cancer.
According to the FDA, the mixture produces chlorine dioxide, a potent bleach used for stripping textiles and industrial water treatment.
At the doses consumers would ingest under these directions, this agent is known to cause nausea, vomiting, diarrhea, and symptoms of severe dehydration, the FDA said.
MMS is distributed on Internet sites and online auctions by multiple independent distributors with varying labels, the agency said..."cont'd
M E D I A R E L E A S E
e-Patients: Changing the Health Care System in Real-Time Tuesday, September 21, 2010 Toronto (Note: fees)
Note: conference fees which would exclude most patients/e-patients from attending
e-Patients: Changing the Health Care System in Real-Time
Tuesday, September 21, 2010
Novotel Toronto Centre
45 The Esplanade
Toronto, Ontario M5E 1W2
Registration will take place on Tuesday, September 21, 2010,
at 8:30am at the Novotel Toronto Centre, 45 The Esplanade,
Space is not guaranteed, unless payment is received
prior to the event.Registration FeeMember (OHA/OHPA/MOHLTC):
$495.00 + HST $64.35 = Total $559.35
$980.00 + HST $127.40 = Total $1107.40
EvidenceUpdates: Cochrane Collaboration review: Vaccines for preventing influenza in healthy adults including professional commentaries and warning
CONCLUSIONS: Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.
WARNING: This review includes 15 out of 36 trials funded by industry (four had no funding declaration). An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry funded studies were published in more prestigious journals and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favorable to the vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in light of this finding.
Also: link to the Cochrane Collaboration review (The Cochrane Library):
Different types of influenza vaccines are currently produced worldwide. Healthy adults are presently targeted mainly in North America.
Identify, retrieve and assess all studies evaluating the effects of vaccines against influenza in healthy adults
Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.
Plain language summary
Vaccines to prevent influenza in healthy adults
Over 200 viruses cause influenza and influenza-like illness which produce the same symptoms (fever, headache, aches and pains, cough and runny noses). Without laboratory tests, doctors cannot tell the two illnesses apart. Both last for days and rarely lead to death or serious illness. At best, vaccines might be effective against only influenza A and B, which represent about 10% of all circulating viruses. Each year, the World Health Organization recommends which viral strains should be included in vaccinations for the forthcoming season.
Authors of this review assessed all trials that compared vaccinated people with unvaccinated people. The combined results of these trials showed that under ideal conditions (vaccine completely matching circulating viral configuration) 33 healthy adults need to be vaccinated to avoid one set of influenza symptoms. In average conditions (partially matching vaccine) 100 people need to be vaccinated to avoid one set of influenza symptoms. Vaccine use did not affect the number of people hospitalised or working days lost but caused one case of Guillian-Barré syndrome (a major neurological condition leading to paralysis) for every one million vaccinations. Fifteen of the 36 trials were funded by vaccine companies and four had no funding declaration. Our results may be an optimistic estimate because company-sponsored influenza vaccines trials tend to produce results favorable to their products and some of the evidence comes from trials carried out in ideal viral circulation and matching conditions and because the harms evidence base is limited.
Plain language summary
Elastic compression stockings for prevention of deep vein thrombosis during a hospital stay
Hospital patients can develop deep vein thrombosis (DVT) in the legs and pelvic veins immediately after surgery or if they are not mobile because of a medical illness. Symptoms vary from none to pain and swelling in the legs. A blood clot can move from the leg to the lungs with the danger of pulmonary embolism and death. Usually the DVT clears up or has long term effects such as high venous pressure in the leg, leg pain, swelling, darkening of the skin or inflammation.
DVT can be prevented using compression or drugs but drugs may cause bleeding, which is a particular concern in surgical patients. Graduated elastic compression stockings help prevent blood clots forming in the legs by applying varying amounts of pressure to different parts of the leg. Our review confirmed that graduated compression stockings reduce the risk of DVT in hospitalised patients. Our findings also suggest that wearing elastic stockings as well as receiving another method of prophylaxis has increased benefit. We identified 18 randomised controlled trials, eight comparing wearing stockings to no stockings and 10 comparing stockings plus another method with that method alone in patients undergoing surgery. The other methods used were Dextran 70, aspirin, heparin and mechanical sequential compression.
Friday, July 30, 2010
2nd source: EvidenceUpdates: Cochrane Collaboration review; Drug therapy for the management of cancer-related fatigue including professional comment
1) consumer reviewer of this Cochrane Collaboration review;
2) a special appreciation to our own ovarian cancer survivors for their input/opinions on this issue
Note: included in the review were recent studies on the side effects of
erythropoietin and darbopoetin
There is increasing evidence that psychostimulant trials provide evidence for improvement in CRF at a clinically meaningful level. There is still a requirement for a large scale RCT of methylphenidate to confirm the preliminary results from this review. There is new safety data which indicates that the haemopoietic growth factors are associated with increased adverse outcomes. These drugs can no longer be recommended in the treatment of CRF. Readers of the first review should re-read the document in full.
Plain language summary
Drugs for cancer-related fatigue
Fatigue associated with cancer is a significant problem. It can occur because of side effects of treatment or because of the disease itself. It can have a significant impact on a person's ability to function. The causes of fatigue are not fully understood and so it is very difficult to treat appropriately. This review has examined drug treatment for fatigue as it represents one of the ways this problem can be tackled. The review authors looked at trials in all types of cancer and at all stages of treatment. Fifty studies met the inclusion criteria but only 31 (7104 participants) were deemed suitable for detailed analysis as they explored fatigue in sufficient detail. They found mixed results with some drugs showing an effect on fatigue - most notably drugs that stimulate red blood cell production and also drugs that improve levels of concentration. Methylphenidate, a stimulant drug that improves concentration, is effective for the management of cancer-related fatigue but the small samples used in the available studies mean more research is needed to confirm its role. Erythropoietin and darbopoetin, drugs that improve anaemia, are effective in the management of cancer-related fatigue. However safety concerns and side effects from these drugs mean that they can no longer be recommended to treat cancer fatigue.
Thursday, July 29, 2010
abstract: Continued chemotherapy after complete response to primary therapy among women with advanced ovarian cancer (meta-analysis)
Although individual studies have not yet convincingly shown a survival advantage with maintenance chemotherapy in OC, this meta-analysis demonstrates that continued chemotherapy after completion of primary therapy for OC improves PFS and OS. Benefits are greatest in patients with advanced stage OC who reach complete clinical or pathologic response after primary therapy.
Ranking prestige of medical diseases | KevinMD.com blogger + link to the study abstract Album/Westin authors
AbstractSurveys have shown that the prestige of medical specialities is ordered hierarchically. We investigate whether similar tacit agreement in the medical community also applies to diseases, since such rankings can affect priority settings in medical practice. A cross-sectional survey was performed in three samples of physicians and medical students in Norway in 2002. A questionnaire was sent to 305 senior doctors (response rate, 79%), 500 general practitioners (response rate, 65%) and 490 final-year medical students (response rate, 64%). Outcome measures were ratings on a 1-9 scale of the prestige these respondents believed most health personnel would accord to a sample set of 38 different diseases as well as 23 medical specialities. Both diseases and specialities were clearly and consistently ranked according to prestige. Myocardial infarction, leukaemia and brain tumour were among the highest ranked, and fibromyalgia and anxiety neurosis were among the lowest. Among specialities, neurosurgery and thoracic surgery were accorded the highest rank, and geriatrics and dermatovenerology the lowest. Our interpretation of the data is that diseases and specialities associated with technologically sophisticated, immediate and invasive procedures in vital organs located in the upper parts of the body are given high prestige scores, especially where the typical patient is young or middle-aged. At the other end, low prestige scores are given to diseases and specialities associated with chronic conditions located in the lower parts of the body or having no specific bodily location, with less visible treatment procedures, and with elderly patients.
Int J Gynecol Pathol. 2010
Köbel M, Kalloger SE, Huntsman DG, Santos JL, Swenerton KD, Seidman JD, Gilks CB; Cheryl Brown (ovarian cancer survivour/deceased) Ovarian Cancer Outcomes Unit of the British Columbia Cancer Agency, Vancouver BC.
Department of Pathology, University of Calgary, Calgary AB, Canada T2N 2T9. email@example.com
Although there are recognized differences in the type of ovarian carcinomas between those tumors diagnosed at low versus high stage, there is a lack of data on stage distribution of ovarian carcinomas diagnosed according to the current histopathologic criteria from large population-based cohorts. We reviewed full slide sets of 1009 cases of 2555 patients diagnosed with ovarian carcinoma that were referred to the British Columbia Cancer Agency over a 16-year period (1984 to 2000).
On the basis of the reviewed cases we extrapolated the distribution of tumor type in low-stage (I/II) and high-stage (III/IV) tumors. We then compared the frequencies with those seen in a large hospital practice.
The overall frequency of tumor types was as follows: high-grade serous-68.1%, clear-cell-12.2%, endometrioid-11.3%, mucinous-3.4%, low-grade serous-3.4%, rare types-1.6%. High-grade serous carcinomas accounted for 35.5% of stage I/II tumors and 87.7% of stage III/IV tumors.
In contrast, clear-cell (26.2% vs. 4.5%), endometrioid (26.6% vs. 2.5%), and mucinous (7.5% vs. 1.2%) carcinomas were relatively more common among the low-stage versus high-stage tumors.
This distribution was found to be very similar in 410 consecutive cases from the Washington Hospital Center. The distribution of ovarian carcinoma types differs significantly in patients with low-stage versus high-stage ovarian carcinoma when contemporary diagnostic criteria are used, with consistent results seen in 2 independent case series. These findings reflect important biological differences in the behavior of the major tumor types, with important clinical implications.
Vascular Endothelial Growth Factor Is a Promising Therapeutic Target for the Treatment of Clear Cell Carcinoma of the Ovary.
AbstractThis study examines the role of vascular endothelial growth factor (VEGF) as a therapeutic target in clear cell carcinoma (CCC) of the ovary, which has been regarded as a chemoresistant histologic subtype. Immunohistochemical analysis using tissue microarrays of 98 primary ovarian cancers revealed that VEGF was strongly expressed both in early-stage and advanced-stage CCC of the ovary. In early-stage CCCs, patients who had tumors with high levels of VEGF had significantly shorter survival than those with low levels of VEGF. In vitro experiments revealed that VEGF expression was significantly higher in cisplatin-refractory human CCC cells (RMG1-CR and KOC7C-CR), compared with the respective parental cells (RMG1 and KOC7C) in the presence of cisplatin. In vivo treatment with bevacizumab (Avastin) markedly inhibited the growth of both parental CCC cell-derived (RMG1 and KOC7C) and cisplatin-refractory CCC cell-derived (RMG1-CR and KOC7C-CR) tumors as a result of inhibition of tumor angiogenesis.
The results of the current study indicate that VEGF is frequently expressed and can be a promising therapeutic target in the management of CCC. Bevacizumab may be efficacious not only as a first-line treatment but also as a second-line treatment of recurrent disease in patients previously treated with cisplatin.
Mol Cancer Ther; 9(8); OF1-12. (c)2010 AACR.
OBJECTIVE:: To estimate the prevalence of lymph node involvement in women with primary mucinous ovarian carcinomas.
METHODS:: A retrospective study was performed of patients with primary mucinous ovarian carcinomas evaluated at a single institution between 1985 and 2007. A gynecologic oncology pathologist evaluated all cases. Patients with tumors of low malignant potential and mucinous carcinomas metastatic to the ovary from other primary sites were excluded.
RESULTS:: Patients with primary mucinous ovarian carcinomas were identified (n=107). All patients underwent primary surgery. At time of surgery, 93 patients (87%) had tumors that grossly appeared to be confined to the ovary, and 14 patients (13%) had evidence of extraovarian disease. Of the 93 patients with tumors that grossly appeared to be confined to the ovary at surgical exploration, 51 (55%) underwent lymphadenectomy (n=27 pelvic and paraaortic, n=19 pelvic only, n=5 paraaortic only). Of these 51 patients, none had metastatic disease to the pelvic or paraaortic lymph nodes. In addition, there were no significant differences in progression-free survival and overall survival rates between the patients who underwent lymphadenectomy and those who did not.
CONCLUSION:: There were no cases of isolated lymph node metastases among women with primary mucinous carcinoma grossly confined to the ovary, suggesting that routine lymphadenectomy may be omitted in these patients.
LEVEL OF EVIDENCE:: III.
(link to 'levels of evidence': http://www.cancer.gov/cancertopics/pdq/levels-evidence-adult-treatment
Wednesday, July 28, 2010
Future Oncology -- Summary: Palonosetron for the prevention of chemotherapy-induced nausea and vomiting in patients with cancer
Palonosetron for the prevention of chemotherapy-induced nausea and vomiting in patients with cancer
Rudolph M Navari1,2
Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life. The emetogenicity of the chemotherapeutic agents, repeated chemotherapy cycles and patient characteristics (e.g., female gender, younger age, low alcohol consumption and history of motion sickness) are the major risk factors for CINV. This article provides a detailed description of palonosetron, a second-generation 5-hydroxytryptamine-3 (5-HT3) receptor antagonist, which has been approved for the prevention of acute CINV in patients receiving either moderately or highly emetogenic chemotherapy and for the prevention of delayed CINV in patients receiving moderately emetogenic chemotherapy...... palonosetron in combination with dexamethasone demonstrated better control of delayed CINV in patients receiving highly emetogenic chemotherapy and had a similar safety profile. Owing to its efficacy in controlling both acute and delayed CINV, palonosetron may be very effective in the clinical setting of multiple-day chemotherapy and bone marrow transplantation.
Editorial: The Elusive Goal of Maintaining Population (Breast) Cancer Screening: It Is Time for a New Paradigm JNCI
"The promise of breast cancer screening has fallen short of its goals because of its imprecision, failure to screen those at highest risk, lack of compliance with screening continuance over recommended periods of time, and gaps in access to or quality of diagnostic follow-up and treatment (20). It is no longer enough to simply conduct more interventions to understand which work best in motivating individuals to undergo repeat cancer screening. New paradigms, guided by evidence from modeling, novel trials, and new scientific discovery, will be needed to realize the promise of eliminating the burden of cancer."
Note: the Mission Statement is worthy of note, as a FYI.
What We're About
Team Continuum is dedicated to helping cancer patients and their families minimize the disruptions, hardships and uncertainties of everyday life so that they can focus on crucial medical care. We provide immediate and vital assistance - both practical and personal - every step of the way, such as paying household expenses, offering friendship and moral support, and funding health care facilities to enhance the delivery of care, communications and educational services.
Racial differences in stage at diagnosis and survival from epithelial ovarian cancer: A fundamental cause of disease approach
Social Science & Medicine
Associations between race, socioeconomic status (SES) and health outcomes have been well established. One of the ways in which race and SES affect health is by influencing one’s access to resources, which confers ability to avoid or mitigate adverse outcomes. The fundamental cause of disease approach argues that when a new screening tool is introduced, individuals with greater resources tend to have better access to the innovation, thus benefiting from early detection and leading to better survival.
Conversely, when there is no established screening tool, racial and SES differences in early detection may be less pronounced.
Most ovarian cancer is diagnosed at advanced stages, because of the lack of an effective screening tool and few early symptoms. However, once detected, racial differences may still be observed in mortality and survival outcomes. We examined the racial differences in diagnosis and survival among ovarian cancer cases diagnosed during 1994–1998, in Cook County, Illinois (N = 351). There were no racial differences in the stage at diagnosis: 51.7% of white and 52.9% of black women were diagnosed at later stages (III and IV). Only age was associated with the stage at diagnosis. Tumor characteristics also did not differ between white and black women. Compared to white women, black women were less likely to be married, less educated, more frequently used genital powder, had tubal ligation, and resided in higher poverty census tracts. As of December 31, 2005, 44.3% of white and 54.5% of black women had died of ovarian cancer. Controlling for known confounding variables, the hazard ratio for ovarian cancer death between black and white women was 2.2. The findings show that fundamental cause perspective provides a potential framework to explore subtleties in racial disparities, with which broader social causes may be accounted for in explaining post diagnosis racial differences.
>“In this large study including 10,306 women with breast cancer and 10,393 without the disease, we confirm that some of the more important common genetic variants for breast cancer have different effects on different tumor types.”
PLoS ONE: Functional Exploration of the Adult Ovarian Granulosa Cell Tumor-Associated Somatic FOXL2 Mutation p.Cys134Trp (c.402C>G)
"In case you missed this year’s Conference, we have provided with you educational materials for you to print and disseminate in your local communities. You can also find video clips and pictures from the Conference using the teal button above. Please check back as this will be updated in the next few days."
blogger's Note: really the question is not can we do better, but why we have not (aside from stigmatization aka: judging others) given:
1) science's apparent apolitical stance;
2) decision-makers' rationale (evidence based??);
3) politicization of science/results
"...Heather McQuaid, an oncology social worker maintains that lung cancer patients feel stigmatized. The superficial attitude that gives way to this stigma may very well be the reason why $25 million was invested in breast cancer research in 2007, compared with a paltry $8 million towards lung cancer, directly “impacting on the support these cancer victims receive, particularly from the healthcare system,” according to CEO and President of the Canadian Lung Association, Heather Borquez. Can’t we do better?"
Today marks the 2nd anniversary of Libby’s death from ovarian cancer at the age of 26. Although the family healing process continues, we celebrate Libby’s life formally on this day to honor her memory, and remind ourselves that life is precious and should not be taken for granted.
full access: Risk of urothelial bladder cancer in Lynch syndrome is increased, in particular among MSH2 mutation carriers
"In eight out of 21 patients with bladder cancer, this was their first cancer diagnosis, whereas at this stage five of them developed another Lynch syndrome associated cancer at an older age. Therefore, early diagnosis of Lynch syndrome may prevent development of a second primary cancer..."
Recommendations for urothelial carcinomas surveillance in Lynch syndrome
Surveillance with a combination of ultrasound of the bladder and upper urinary tract, urinary cytology and sediment.
In every MSH2 mutation carrier
From age 40 and up
Performed every 1–2 years
Indications and approach to surgical resection of lung metastases.
AbstractPulmonary metastasectomy is a curative option for selected patients with cancer spread to the lungs. Complete surgical removal of pulmonary metastases can improve survival and is recommended under certain criteria. Specific issues that require consideration in a multidisciplinary setting when planning pulmonary metastasectomy include: adherence to established indications for resection, the surgical strategy including the use of minimally invasive techniques, pulmonary parenchyma preservation, and the role of lymphadenectomy.
J. Surg. Oncol. 2010;102:187-195. (c) 2010 Wiley-Liss, Inc.
Health Canada Warns Canadians about Buying Prescription Drugs Online from www.globalpharmacycanada.com - Health Canada Advisory 2010-07-27
Note: if your server (ISP) is from Canada then you are blocked from the globalpharmacycanada link Health Canada is informing Canadians about the potential dangers of buying prescription drugs online from www.globalpharmacycanada.com. The company responsible for the website recently removed Canadian access to it, but Canadians may have purchased from this website in the past. For more information, please visit: http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2010/2010_127-eng.php
The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research — Palliat Med
Spirituality and spiritual care are gaining increasing attention but their potential contribution to palliative care remains unclear. The aim of this study was to synthesize qualitative literature on spirituality and spiritual care at the end of life using a systematic (‘meta-study’) review.
Eleven patient articles and eight with healthcare providers were included, incorporating data from 178 patients and 116 healthcare providers, mainly from elderly White and Judaeo-Christian origin patients with cancer. Spirituality principally focused on relationships, rather than just meaning making, and was given as a relationship. Spirituality was a broader term that may or may not encompass religion. A ‘spirit to spirit’ framework for spiritual care-giving respects individual personhood. This was achieved in the way physical care was given, by focusing on presence, journeying together, listening, connecting, creating openings, and engaging in reciprocal sharing. Affirmative relationships supported patients, enabling them to respond to their spiritual needs. The engagement of family caregivers in spiritual care appears underutilized. Relationships formed an integral part of spirituality as they were a spiritual need, caused spiritual distress when broken and were the way spiritual care was given. Barriers to spiritual care include lack of time, personal, cultural or institutional factors, and professional educational needs. By addressing these, we may make an important contribution to the improvement of patient care towards the end of life.
Attitudes towards weight and weight assessment in oncology patients: survey of hospice staff and patients with advanced cancer — Palliat Med
"...A little over half of hospice staff, 81/146 (56%) considered that weighing could cause patients to be upset.
However, 124/129 (96%) of patients with advanced cancer reported that they had never found the experience of being weighed in a healthcare facility upsetting.
Some 95/129 (74%) of patients weighed themselves at home and 89% would want to know if their weight was changing.
While there is reluctance on the part of many hospice staff to weigh patients, most patients with advanced malignancy in the hospital setting do not report weight measurement to be upsetting."
Incidental Adnexal Masses Detected at Low-Dose Unenhanced CT in Asymptomatic Women Age 50 and Older: Implications for Clinical Management and Ovarian Cancer Screening - Radiology (abstract)
Results: One hundred eighteen women (mean age, 56.2 years), representing 4.1% of the screening cohort, had an indeterminate adnexal mass (108 unilateral, 10 bilateral; mean size, 4.1 cm) at prospective CT interpretation......No ovarian cancers were prospectively identified, although four cases of ovarian cancer developed subsequent to a negative adnexal finding at CT examination during a 15–44-month interval among the remaining 2751 women. cont'd
Materials and Methods: This study was institutional review board approved and HIPAA compliant. Informed consent was waived. The fate of indeterminate adnexal lesions identified at unenhanced CT in 2869 consecutive women (mean age, 57.2 years; age range, 50–97 years) undergoing colonography screening between April 2004 and December 2008 was evaluated.
Incidental indeterminate adnexal lesions were relatively common at unenhanced CT (4.1%), but subsequent work-up revealed no ovarian cancers. Furthermore, a normal finding at CT was not protective against short-term development of ovarian cancer. More sophisticated risk factor assessment is needed to identify women at higher risk.
Tuesday, July 27, 2010
Forty-four asymptomatic putative Lynch syndrome patients participated in a colonoscopy screening program. There were 18 men and 26 women; mean age was 44 yr. Thirty percent of Lynch syndrome patients had at least one adenoma; 20% had multiple adenomas. In 18% of the patients, adenomas were discovered proximal to the splenic flexure. In a reference group of 88 age- and sex-matched patients, 11% had adenomas, 4% had multiple adenomas, and 1% had right-sided adenomas. Twenty-one Lynch syndrome patients had follow-up colonoscopies. Of 7 patients with adenomas on initial examinations, 6 had adenomas at follow-up. Of 14 patients with negative initial examination results, 3 had adenomas at follow-up. The prevalence of adenomas in the Lynch syndromes is greater than in an unselected reference group. The adenomas are more proximally located, corresponding to the site of cancer distribution in the Lynch syndromes. A high rate of synchronous and metachronous lesions is found. Our findings support the hypothesis that adenomatous changes are the premalignant lesion in the Lynch syndromes. We also found evidence of heterogeneity among Lynch syndrome families in adenoma incidence.
One to 2-Year Surveillance Intervals Reduce Risk of Colorectal Cancer in Families With Lynch Syndrome
ConclusionsWith surveillance intervals of 1–2 years, members of families with Lynch syndrome have a lower risk of developing CRC than with surveillance intervals of 2–3 years. Because of the low risk of CRC in non-Lynch syndrome families, a less intensive surveillance protocol can be recommended.
Risk and Epidemiological Time Trends of Gastric Cancer in Lynch Syndrome Carriers in The Netherlands
" Lifetime risk of developing gastric cancer was 8.0% in males vs 5.3% in females and 4.8% and 9% for MLH1 and MSH2 carriers, respectively."
ConclusionsLynch 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.
MabCure, Inc. Announces Positive Results For New Ovarian Cancer Diagnostic Blood Test -- HASSELT, Belgium, July 27 - press release
"...MabCure will soon commence a follow-on study in collaboration with one of the foremost experts in women's cancers, Ignace Vergote, M.D., Head of the Department of Obstetrics and Gynaecology and Gynaecologic Oncology at the Catholic University of Leuven, Belgium. The study will access a large number of previously collected clinical blood samples stored at the Bio-bank of the Catholic University Hospital, Leuven.
Following the conclusion of this study, MabCure plans to launch a multi-center prospective trial in Europe and in the U.S., as well as initiate commercialization of its diagnostic ovarian cancer MAbs in Europe through strategic partnerships and licensing. In parallel, MabCure plans to embark on the regulatory process for obtaining marketing approval in the U.S.
MabCure is currently evaluating the diagnostic potential of it MAbs in detecting ovarian cancer in high-risk patients in a clinical study in Thailand...."
In a monograph released July 15, a coalition of leading health organizations called for more research into the possible cancer-causing effects of exposure to 20 chemical agents. Some of the named agents are commonly found in the environment, whereas others are more often limited to occupational exposures. A summary paper in Environmental Health Perspectives provides an overview of the technical report.
The monograph, titled Identification of research needs to resolve the carcinogenicity of high-priority IARC carcinogens, summarizes available evidence and provides specific guidance on the appropriate studies needed to definitively classify these agents. Several overarching issues were identified that pertain to multiple agents, including recognizing that carcinogenic agents can act through multiple pathways and mechanisms of toxicity.
“This report highlights the importance of conducting research in occupational settings to identify human carcinogens,” said Dr. Debra Silverman, a co-author of the report and chief of the Occupational and Environmental Epidemiology Branch in NCI’s Division of Cancer Epidemiology and Genetics. “Findings from such occupational studies often allow experts to extrapolate the possible effects of low-level exposure to these agents in the general environment.”
“There is significant concern among the public about substances or exposures in the environment that may cause cancer, and there are some common occupational agents and exposure circumstances where evidence of carcinogenicity is substantial but not yet conclusive for humans,” added the report’s lead author, Dr. Elizabeth Ward, from the American Cancer Society (ACS).
The project originated as part of the National Institute for Occupational Safety and Health’s National Occupational Research Agenda to enhance occupational cancer research, and it involves collaboration with NCI, the International Agency for Research on Cancer (IARC), the ACS, and the National Institute of Environmental Health Sciences.
".....The CSC concept is “a work in transition,” said Dr. William Matsui, from the Johns Hopkins School of Medicine, whose lab studies the role of stem cells in hematologic cancers. “To me, as a clinical person, the ideal model is one where you can find something that is going to work in humans. We’re far from that.”.."cont'd
Monday, July 26, 2010
Note: lists different forms of radiation therapy
CTV Montreal - Power of one: Laptops for cancer patients (apparently Canadian Cancer Society doesn't have time.......)
Note: maybe then, based on this article, the Canadian Cancer Society could have funded the project ?? "I first approached the Canadian Cancer Society and asked them if they had any projects [for] computers in cancer wards," she recounts. "They said that they didn't have the time, but thought it was a great idea, so maybe I could start something."
subject areas covered:
Tips for Understand Studies
* Does The Language Fit The Evidence? - Association Versus Causation
* "Off-label" Drug Use and Marketing
* 7 Words (and more) You Shouldn't Use in Medical News
* News from Scientific Meetings
* Absolute vs. Relative Risk
* Number Needed to Treat (NNT)
* Single Source Stories
* FDA Approval Not Guaranteed
* Phases of Drug trials
* Medical Devices
* Animal & Lab Studies
Sunday, July 25, 2010
127 women seek separate suits against Scarborough doctor - media (update) gynecologist Richard Austin
Note: this is an update from a prior investigation which is ongoing but of particular importance is the fact that 3 similar incidents in the GTA have occurred in the past ~decade.
Saturday, July 24, 2010
Obesity is associated with improved survival in patients with organ-confined clear-cell kidney cancer (see 'Note')
Note: while not ovarian cancer specific (noting the common cell type of clear cell) the conclusion is interesting
CONCLUSION: We identified overweight as an independent prognostic marker of improved cancer specific survival in patients with organ-confined but not advanced RCC. Basic research is required to resolve the dilemma of why, if a higher BMI predisposes to RCC, it concurrently prolongs survival after patients have undergone (partial) nephrectomy.
Program SlidesInteractive Case #1—Primary ovarian cancer: What’s optimal surgery?
Interactive Case #2—Initial systemic therapy for ovarian cancer
Interactive Case #3—Recurrent ovarian cancer: Partially platinum–sensitive (Recurrence after 6-12 months)
Interactive Case #4—Stage IIIB ovarian cancer: Recurrence >12 months following completion of induction chemotherapy
—Progress report on novel & targeted therapies for ovarian cancer
Interactive Case #5—Platinum resistant/refractory ovarian cancer: Optimizing quality of life
".....In the first of a series of major breakthroughs in this past year, a pioneering team of ovarian cancer researchers, led by the Agency’s Dr. David Huntsman, found the single genetic mutation or “spelling mistake” in the three billion “letters” that make up the genetic code of an ovarian tumour cell.
This was a true eureka moment for Huntsman’s team. They recognized that this one consistent mutation could be the bull’s eye target in developing new treatments for all patients with this particular cancer. Their game-changing discovery was published in the prestigious New England Journal of Medicine and widely acknowledged in the global cancer community.
The next-generation computer technology provided by the BC Cancer Agency’s Genome Sciences Centre that decoded and sequenced the tumour cell’s three-billion-letter genome is another milestone achievement. A genomic task of this magnitude was unfathomable, in terms of both cost and complexity, even two years ago."
INTRODUCTION: Carcinoid tumors are uncommon neoplasms in the diffuse peripheral endocrine system. Ovarian carcinoids are rare and can be primary or transplanted. Primary ovarian carcinoids make up approximately 0.5-1.7% of all carcinoid tumors.
.....The immunohistochemical study revealed a neuroendocrine origin with strong positivity for NSE, CgA and Syn. Other markers, such as a-inhibin and Calretinin, were negative. Finally, the case was diagnosed as a primary ovarian trabecular carcinoid tumor.
CONCLUSION: Primary ovarian trabecular carcinoid tumors are very rare. The patients lack clinical indicators, and final diagnosis depends on pathological examination, special staining and inmmunohistochemistry staining to confirm the neuroendocrine differentiation.
International distribution and age estimation of the Portuguese BRCA2 c.156_157insAlu founder mutation
"We recommend that all suspected HBOC families from Portugal or with Portuguese ancestry are specifically tested for this rearrangement (BRCA2 c.156_157insAlu)."
Friday, July 23, 2010
TO ALL PEER SUPPORT GROUPS IN THE GTA
During Self-Help Awareness Week, Sept. 20th to 25th, 2010, the Self-Help Resource Centre will be hosting a two-day information fair at the Yonge-Eglinton Centre to raise the profile of peer support in the City of Toronto. This is an opportunity for an agency which hosts a peer support group or a community peer support group to get the word out about their issue and provide information to the general public about how to become involved.
The fair will be held over a two day period - Fri. Sept. 24th and Sat. Sept 25th - and agencies hosting peer support groups and community peer support groups are invited to sign up for either of the two days. We do ask that representatives from the groups commit to staffing their table from 10 am to 4 pm, with coverage during the lunch hour.
Groups would be encouraged to display and give away any materials about their issue or group. Peer support groups listed on the Self-Help Resource Centre's website would be offered a printout from our database listing all their basic information for display at their table.
If interested in having your group represented at the info fair, please get in touch as soon as possible to confirm your participation. Space is limited. For more information or to register for a table, please contact Rick Henry at firstname.lastname@example.org or call (416) 487-4355 ext. 21, and he will return your call as soon as he is able.
Peer Support Group Info Fair
When: Fri. Sept. 24th 10 am - 4 pm
Sat. Sept. 25th 10 am - 4 pm
Where: Yonge-Eglinton Centre,
Upper Mezzanine (Toys 'R Us level)
Who: Agencies hosting peer support groups and
Community peer support groups are invited to participate
"In the United States, there are between 6,000 and 7,000 diseases considered rare, according to the National Institutes of Health. To be classified as "rare", a disease must be believed to affect fewer than 200,000 Americans. This is the definition used by the Food and Drug Administration and by the National Institutes of Health. Since many of these diseases are genetic, many of the patients are children. It is believed that more than two thirds of the individuals affected by rare diseases in the U.S. are children.
Furthermore, most rare diseases are serious and chronic or lifelong. Many are life threatening....."cont'd
Note: registration for this site is required/free
Significant advances in the understanding of the pathogenesis and management of both newly diagnosed and recurrent ovarian cancer have occurred over the past few years, making the possibility of better outcomes for women with advanced ovarian cancer a reality. Recent studies have raised the question of the ideal timing of cytoreductive surgery for newly diagnosed disease and demonstrated benefit with alternative weekly paclitaxel dosing, while ongoing studies continue to clarify the roles of IP chemotherapy and biological agents in this setting. In the setting of recurrence, new chemotherapy combinations are being explored, and investigation of the activity of various targeted agents, including anti-angiogenic agents, PARP-inhibitors, and PI3K/AKT pathway inhibitors, remains an area of active interest.
This article is reviewed in the following articles:
Challenges to the Paclitaxel/Carboplatin Algorithm in Ovarian Cancer Treatment
Ovarian Cancer Care: It’s Time for “Personalized” Approaches
ONCOLOGY. Vol. 24 No. 8
Challenges to the Paclitaxel/Carboplatin Algorithm in Ovarian Cancer Treatment
Kristin K. Zorn, MD
Gynecologic Cancer Program
Magee-Womens Hospital of UPMC
| July 22, 2010
Financial Disclosure: The author has no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.
Interestingly, a review of recent history reveals that a major milestone in ovarian cancer chemotherapy is reached about every 10 years. The publication of Gynecologic Oncology Group (GOG) protocol 47 in 1986 provided randomized evidence of a 4-month improvement in overall survival with the addition of cisplatin to the previous standard of doxorubicin and cyclophosphamide. In 1996, GOG 111 was published, documenting a 14-month improvement in overall survival with the addition of paclitaxel to cisplatin. GOG 172 was published in 2006, becoming the third in a series of GOG trials to demonstrate a survival advantage with the use of combined IV and intraperitoneal (IP) chemotherapy. Despite a 17-month improvement in overall survival that triggered an NCI alert commenting on the results, combined IV/IP therapy has yet to be broadly accepted as a new standard of care. Widespread acceptance of the GOG 172 regimen has been limited by the relative complexity of the treatment (especially when compared to IV paclitaxel/carboplatin); the increased potential for toxicity; the requirement for IP port placement and maintenance; and the relative lack of experience in community centers with IP chemotherapy administration. Perhaps the most challenging part about incorporating IV/IP treatment into routine management of ovarian cancer is the idea that a route of administration—rather than a particular drug, such as cisplatin in the 1980s and then paclitaxel in the 1990s—appears to be the advance.
Concurrent with the evolution of the IP chemotherapy story has been the development of targeted or biologic therapy, particularly the antiangiogenic agent bevacizumab. Results from a phase II trial in women with recurrent ovarian cancer were published in 2007 and revealed a response rate of 21%, made more remarkable by a 51.6% stable disease rate. This level of activity in recurrent disease led to a randomized phase III trial in the frontline setting, GOG 218, which tested the inclusion of bevacizumab both with IV paclitaxel/carboplatin and as a maintenance strategy. Preliminary results from GOG 218 were presented at ASCO 2010, showing a significant improvement in progression-free survival in the arm where patients received bevacizumab maintenance after their initial six cycles of chemotherapy plus bevacizumab, but not in the arm where patients received bevacizumab only during their initial chemotherapy. The improvement was somewhat disappointing at 3.8 months, however, making it a difficult question of whether, despite the added toxicity and expense, bevacizumab merits inclusion in frontline regimens. The overall survival data from GOG 218, when mature, as well as the results from the ongoing ICON study with a comparable design, will help inform that question. In the meantime, oncologists caring for women with ovarian cancer have been left with the decision of whether to prioritize IV/IP therapy or bevacizumab in treatment plans.
Liu and Matulonis point to the GOG's attempt to incorporate both of these treatment advances in the current phase III trial, GOG 252. An additional confounder has been introduced by recent Japanese results, which showed a benefit from weekly IV paclitaxel compared to the traditional IV dose given every 3 weeks. GOG 252 incorporates bevacizumab into IV/IP therapy, while also trying to address the toxicity issue by comparing a modified GOG 172 regimen to an IP carboplatin regimen. It also addresses the dose-density issue by utilizing weekly paclitaxel in the IV arm.
Besides the renewed hope for meaningful improvement in outcomes with advanced ovarian cancer that these trials have provided, we are witnessing another development that has the potential to advance ovarian cancer care on an even more fundamental level. The pathogenesis of ovarian cancer has been exhaustively investigated but never fully elucidated. The identification of the BRCA1 and BRCA2 genes in the early 1990s, however, has allowed a population at high risk for the development of ovarian cancer to be clearly defined. These women, in turn, have been able to undergo risk-reducing bilateral salpingo-oophorectomy to manage their risk. Studies of the specimens collected at the time of prophylactic surgeries have identified an unexpectedly high rate of tubal cancers. Further study of serous cancers thought to be ovarian in origin has shown the unexpectedly frequent presence of fallopian tube dysplasia (termed tubal intraepithelial neoplasia or TIC). Although larger-scale confirmation of these studies is needed, the high-risk population has provided a potential insight into the development of sporadic ovarian cancer. As we move to a more mechanistic understanding of cancer therapy and its targets, these insights into the BRCA pathway may well provide the next big advance in ovarian cancer care through manipulation with agents such as PARP inhibitors. For a disease that saw only halting advances for too long, ovarian cancer is now on the verge of being better understood and more effectively treated than ever before.
—Kristin K. Zorn, MD