Friday, August 20, 2010
As I see it: Ten reasons to be happy about hormone replacement therapy: a guide for patients - Menopause International
"Discussion of side-effects should not be avoided, particularly the 1% extra lifetime risk of breast cancer. This should be balanced against the fewer heart attacks, fewer deaths and less osteoporotic fractures in those who start HRT below the age of 60."
Note: in the absence of available full paper/s (pay per view/subscription) of the several related articles blogged, there is no reference to those with genetic predispositions/risks/advantages with hormone replacement therapy. The one abstract (Review - Hinds/Price) discusses risks related to sarcoma/granulosa but no mention of genetics eg. BRCA's/familial colorectal cancers and/or prior research regarding ERT/colorectal cancers.
"Our understanding of the menopause and the management of its issues is in a continual state of flux. Since the publication of the original Women's Health Initiative study and the immediate conclusions and position statements from various specialist societies and regulatory authorities, clinicians have had little choice other than to significantly change their clinical management. So, is this a change for good? Whether you were a supporter or detractor of hormone replacement therapy (HRT), or even sat on the academic fence you will be aware that many clinicians have withdrawn from even discussing the place of HRT in the management of menopausal issues with their patients. This cannot be a good thing...."cont'd
Compliance with estrogen hormone replacement therapy after oophorectomy: a prospective study -- Menopause International
Results. The median age of women at the time of hysterectomy was 42 (range 22–46) years
Note: abstract, full access via subscription ($$$)
Menopause, hormone replacement and gynaecological cancers
Belfast City Hospital, Northern Ireland
Correspondence: Dr Lynsey Hinds, 1 Strawhill Manor, Donaghcloney, Belfast BT66 7GH Northern Ireland. Email: firstname.lastname@example.org
Approximately 18,000 women are diagnosed with a gynaecological cancer in the UK each year. Predisposing risk factors for some of these gynaecological cancers include an early menarche/late menopause and hormone replacement therapy (HRT). Furthermore, treatment of gynaecological malignancies often induces an iatrogenic menopause, which may be more severe than a natural onset. HRT is an extremely effective treatment that may dramatically improve physical and psychological symptoms and ultimately quality of life in patients with cancer. However, the safety of using HRT in patients with gynaecological cancer is a controversial issue and not entirely clear. The main concern is the theoretical risk of the stimulation of residual cancer cells by estrogen replacement. The review of the evidence in this article found that for most gynaecological cancers this hypothesis was not proven. No study to date has found HRT to have a detrimental effect on survival in patients with early stage endometrial cancer, epithelial ovarian cancer, cervical cancer and vulval tumours. HRT is only an absolute contraindication in low-grade endometrial stromal sarcomas and is best avoided in granulosa cell ovarian tumours. Therefore, HRT should not be withheld in the majority of patients with gynaecological cancer. If quality of life is being adversely affected by symptoms of the menopause, then patients with cancer should be counselled regarding the known risks and benefits of HRT to enable them to make an informed decision on their treatment.
In research - Georgia Tech Team Claims 100 Percent Accuracy for Metabolomic Ovarian Cancer Test in Initial Trial ProteoMonitor GenomeWeb
........"In ovarian cancer, the single protein that's commonly used [as a biomarker], CA-125, is not a very accurate test," he said. "The reason for that is that all cancers are variable. So if you're relying on a single biomarker, it's very unlikely that that single biomarker will be 100 percent accurate or even 99 or 95 percent accurate."
"Even going from one to five [biomarkers] increases accuracy tremendously. In our case we're using at the minimum 2,000 to 3,000 features. That should in theory give us an even higher degree of accuracy," he said.
By comparison, most protein-based tests that are commercially available or under development use a handful of markers. Vermillion's OVA1, for example, analyzes five protein markers, including CA-125. The HealthLinx OvPlex test also uses five proteins, including CA-125, and the company is currently evaluating two additional markers to add to the test (PM 6/18/2010)....cont'd
Berwick's Institute for Healthcare Improvement (IHI) developed programmes in the US and around the world that focused on improved delivery systems. Among the group's innovations is the “100 000 Lives” campaign, which challenged hospitals to reduce medical errors. Altman said the programme “almost single handedly” changed attitudes among hospital administrators towards a focus on patient safety.
Abstract The HE4 protein is overexpressed in ovarian carcinomas and can be detected in serum by an ELISA with sensitivity similar to CA125 and higher specificity for malignant disease. We now demonstrate that HE4 can also be detected in the urine at a specificity level of 94.4%, including 13/15 (86.6%) with stage I/II and 57/64 (89.0%) with stage III/IV disease and including 90.5% of patients with serous carcinoma. Assaying serum and urine from the same patients showed similar sensitivity. Our data indicate that measuring HE4 in urine may aid diagnosis and the monitoring of response to therapy.
Patient Willingness to Be Seen by Physician Assistants, Nurse Practitioners, and Residents in the Emergency Department: Does the Presumption of Assent Have an Empirical Basis? - The American Journal of Bioethics
Note: the journal has a number of similar papers regarding this issue, however, this is a subscription/pay-per-view journal without access to abstracts in many cases
Thursday, August 19, 2010
Management of Asymptomatic Ovarian and Other Adnexal Cysts Imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement1 — Radiology
Note: excellent detailed paper
Note: Table 1 includes cumulative toxicity and other comparisons between commonly prescribed ovarian cancer chemotherapies
This review describes the use of polymer micelle nanotechnology based chemotherapies for ovarian cancer. While various chemotherapeutic agents can be utilized to improve the survival rate of patients with ovarian cancer, their distribution throughout the entire body results in high normal organ toxicity. Polymer micelle nanotechnology aims to improve the therapeutic efficacy of anti-cancer drugs while minimizing the side effects....... An important feature of polymer micelle nanotechnology is the small size (10-100 nm) of particles which improves circulation and enables superior accumulation of the therapeutic drugs at the tumor sites. This review provides a comprehensive evaluation of different types of polymer micelles and their implications in ovarian cancer therapeutics.
Patients Are Urged to Call Now for Appointments
The National Association of Free Clinics (NAFC) will sponsor the free medical clinic on Aug. 31 from 11:00 a.m. to 7:00 p.m. and on Sept. 1 from 2:00 p.m. to 7:00 p.m. at the Ernest N. Morial Convention Center.
"This free clinic is not just for the sick but also for anyone who is uninsured and has not seen a doctor recently," NAFC Executive Director Nicole Lamoureux said. "All participants will receive preventive primary medical care and be connected to the area's safety-net providers such as free clinics."...cont'd
You Must Login First (free)
* Epithelial Ovarian Cancer (including Fallopian Tube Cancer and Primary Peritoneal Cancer)
* Borderline Epithelial Ovarian Cancer (Low Malignant Potential)
* Less Common Ovarian Histologies
"Advances in genomic technologies permit the simultaneous analysis of millions of variants across the genome and may soon allow for meaningful estimation of one’s risks of developing cancer, diabetes, and other common diseases. These advances are converging with the movement toward consumer-driven health care and patient empowerment. Whereas in the past, medical testing was firmly under the control of medical practitioners, genomic information is now increasingly available outside traditional medical settings. Patients are no longer subordinate, passive recipients of physician-initiated genetic testing; rather, patients can instigate their own testing and often know more than their clinicians about particular genetic topics. Indeed, health care providers are increasingly bypassed altogether, as patients embrace direct-to-consumer (DTC) genetic tests and turn to social networks for help in interpreting their results. In the future, a primary role of health care professionals may be to interpret patients’ DTC genetic test results and advise them about appropriate follow-up. How can we maximize the benefits of these new developments and minimize the harms? How can we encourage patients’ involvement and autonomy yet establish appropriate safeguards while avoiding inappropriate paternalism? How do we promote the understanding that interpretations of genomic information may evolve as research unravels the meaning of gene–gene and gene–environment interactions and the roles of noncoding DNA sequences, copy-number variants, epigenetic mechanisms, and behavioral factors in health and disease?..."cont'd
Wednesday, August 18, 2010
"Although TAs (taste alterations) have been incorporated in the National Cancer Institute Common Toxicity Criteria since 1999, the literature on underlying biological mechanisms, on physical and physiological consequences, and even on prevalence is scarce. It has to be taken into account that even though taste and smell are anatomically distinct systems, in the sensory perception of food, they are intimately connected ."
Menopausal symptoms in women undergoing chemotherapy-induced and natural menopause: a prospective controlled study - abstract
CONCLUSIONS: Women undergoing chemotherapy-induced menopause may experience worse symptoms than women undergoing natural menopause.
Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement - multinational/abstract/eletters/response
This version published online on June 21, 2010
Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2009-2509
Accepted on April 21, 2010
Postmenopausal Hormone Therapy: An Endocrine Society Scientific StatementRichard J. Santen*,
Division of Endocrinology and Metabolism (R.J.S.), Department of Obstetrics and Gynecology (J.V.P.), University of Virginia, Charlottesville, Virginia 22908; Tufts University School of Medicine (R.H.K.), Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; Jean Hailes Research Centre (H.T.), School of Public Health, Melbourne, Australia 3168; Prince Henry's Institute of Medical Research (H.G.B.), Monash Medical Centre, Melbourne, Australia 3168; Department of Medicine/Women's Health Program (S.R.D.), Monash University, Melbourne, Australia 3181; Departments of Health Research and Policy (Epidemiology) and of Neurology and Neurological Sciences (V.W.H.), Stanford University, Stanford, California 94305; Departments of Pathology and Immunology (D.C.A.) and Surgery (G.A.C.), Washington University School of Medicine, St. Louis, Missouri 63110; Department of Nutrition Sciences (B.A.G.), University of Alabama at Birmingham, Birmingham, Alabama 35294; St. Joseph Hospital (M.K.), Internal Medicine, Reichert Health Center, Ypsilanti, Michigan 48197; Division of Immunology and Rheumatology, Ohio State University School of Medicine (W.N.J., S.P.A.), Columbus, Ohio 43219; University of Pisa (M.G.), Department of Obstetrics and Gynecology, Pisa I-56100, Italy; University of Toronto (N.B., L.M.), Department of Nutritional Sciences, Department of Medicine, Toronto, Ontario, Canada M5G 2C1; Cedars-Sinai Medical Center (G.D.B.), Department of Medicine, Los Angeles, California 90048; Columbia University Medical Center (R.A.L.), Department of Obstetrics and Gynecology, New York, New York 10037; Eastern Virginia Medical School (D.F.A.), Clinical Research Center, Norfolk, Virginia 23507; North American Menopause Society (W.H.U.), Mayfield Heights, Ohio 44124; Massachusetts General Hospital (K.A.M.), UptoDate, Waltham, Massachusetts 02453; University of North Carolina at Chapel Hill (D.R.R.), Chapel Hill, North Carolina 27516; Section of Dermatology (D.M.T.), Hershey Medical Center, Pennsylvania State University School of Medicine, Hershey, Pennsylvania 17033; King's Breast Care (J.M.), King's College Hospital, London SE5 9RS, United Kingdom; and Harvard Medical School (J.E.M.), Brigham and Women's Hospital, Boston, Massachusetts 02215
Objective: Our objective was to provide a scholarly review of the published literature on menopausal hormonal therapy (MHT), make scientifically valid assessments of the available data, and grade the level of evidence available for each clinically important endpoint.
Participants in Development of Scientific Statement: The 12-member Scientific Statement Task Force of The Endocrine Society selected the leader of the statement development group (R.J.S.) and suggested experts with expertise in specific areas. In conjunction with the Task Force, lead authors (n = 25) and peer reviewers (n = 14) for each specific topic were selected. All discussions regarding content and grading of evidence occurred via teleconference or electronic and written correspondence. No funding was provided to any expert or peer reviewer, and all participants volunteered their time to prepare this Scientific Statement.
Evidence: Each expert conducted extensive literature searches of case control, cohort, and randomized controlled trials as well as meta-analyses, Cochrane reviews, and Position Statements from other professional societies in order to compile and evaluate available evidence. No unpublished data were used to draw conclusions from the evidence.
Consensus Process: A consensus was reached after several iterations. Each topic was considered separately, and a consensus was achieved as to content to be included and conclusions reached between the primary author and the peer reviewer specific to that topic. In a separate iteration, the quality of evidence was judged using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system in common use by The Endocrine Society for preparing clinical guidelines. The final iteration involved responses to four levels of additional review: 1) general comments offered by each of the 25 authors; 2) comments of the individual Task Force members; 3) critiques by the reviewers of the Journal of Clinical Endocrinology & Metabolism; and 4) suggestions offered by the Council and members of The Endocrine Society. The lead author compiled each individual topic into a coherent document and finalized the content for the final Statement. The writing process was analogous to preparation of a multiauthored textbook with input from individual authors and the textbook editors.
Conclusions: The major conclusions related to the overall benefits and risks of MHT expressed as the number of women per 1000 taking MHT for 5 yr who would experience benefit or harm. Primary areas of benefit included relief of hot flashes and symptoms of urogenital atrophy and prevention of fractures and diabetes. Risks included venothrombotic episodes, stroke, and cholecystitis. In the subgroup of women starting MHT between ages 50 and 59 or less than 10 yr after onset of menopause, congruent trends suggested additional benefit including reduction of overall mortality and coronary artery disease. In this subgroup, estrogen plus some progestogens increased the risk of breast cancer, whereas estrogen alone did not. Beneficial effects on colorectal and endometrial cancer and harmful effects on ovarian cancer occurred but affected only a small number of women. Data from the various Women's Health Initiative studies, which involved women of average age 63, cannot be appropriately applied to calculate risks and benefits of MHT in women starting shortly after menopause. At the present time, assessments of benefit and risk in these younger women are based on lower levels of evidence.
Read all eLetters
- Statistical Analysis in the Postmenopausal Hormone Therapy
- Joseph W. Goldzieher
- JCEM Online, 17 Aug 2010 [Full text]
"It is to be hoped that this monumental, desperately needed report will help to counter the persistent damaging effect of the 2002 WHI publication, and have an influence that ranges from generators of policy and guidelines to the most remote doctor/patient interaction...."
How to follow up advanced-stage borderline tumours? Mode of diagnosis of recurrence in a large series stage II-III serous borderline tumours of the ov
BACKGROUND: The aim of this study was to describe how recurrences were diagnosed in the largest series of patients treated for an advanced-stage serous borderline ovarian tumour.
PATIENTS AND METHODS: From 1973 to 2006, 45 patients with a serous borderline tumour and peritoneal implants relapsed among 162 patients with a follow-up exceeding 1 year. Data concerning recurrences and the mode of diagnosis were reviewed.
CONCLUSIONS: This study demonstrates that ultrasound is the most relevant follow-up procedure in this context. Nevertheless, the blood CA 125 test is of particular interest for detecting invasive recurrent disease, which is the most crucial event.
How medical specialists appraise three controversial health innovations: scientific, clinical and social arguments (abstract)
How medical specialists appraise three controversial health innovations: scientific, clinical and social arguments.
AbstractMedical specialists play a pivotal role in health innovation evaluation and policy making. Their influence derives not only from their expertise, but also from their social status and the power of their professional organisations. Little is known, however, about how medical specialists determine what makes a health innovation desirable and why. Our qualitative study investigated the views of 28 medical specialists and experts from Quebec and Ontario (Canada) ...cont'd (not specific to ovarian cancer)
Vermillion's OVA1 2010 Sales Target Is Looking Like a Moon Shot. How Will it Hit It? GenomeWeb (financial)
The test, approved last September, costs $650 and is reimbursed at $540 by Medicare, according to the company. (assuming U.S. dollars)
Tuesday, August 17, 2010
tribute page: http://www.ocao.org/tealtributes.aspx
Arresting Development: Blood Biomarker Patterns May Aid Early Diagnosis of Ovarian Cancer: Scientific American
Note: in research
full free access: More stakeholder engagement is needed to improve quality of research, say US experts
Blogger's note: Agree based on years of RCT reviews
"Researchers need to overcome the evidence paradox of 18 000 randomised trials being published each year but almost every review concluding that not enough hard evidence exists to actually inform decision making, experts have said."
"We can’t just keep putting band aids on this system," she said. "Either health care is going to be subject to scientific methods and actually become evidence based or we are just going to keep generating little bits of evidence here and there and valiantly try to assemble them into some kind of path forward."
Slideshow: Preparing for Surgery. Tips to get ready for surgery and your post-surgery recovery (not specific to ovarian cancer )
Note: easy to read/good tips
Identification of a Danish breast/ovarian cancer family double heterozygote for BRCA1 and BRCA2 mutations
Mutations in the two breast cancer susceptibility genes BRCA1 and BRCA2 are associated with increased risk of breast and ovarian cancer. Patients with mutations in both genes are rarely reported and often involve Ashkenazi founder mutations. ......Since the BRCA1 Arg1699Gln mutation is also suggested to be disease-causing, we consider this family double heterozygote for BRCA1 and BRCA2 mutations.
abstract: A 67-Year-Old Woman with BRCA 1 Mutation Associated with Pancreatic Adenocarcinoma case report/discussion
INTRODUCTION: There are approximately 40,000 new cases of pancreatic adenocarcinoma diagnosed in the USA each year. It is estimated that 5-10% of all patients with pancreatic cancer have a first-degree relative with the disease, while up to 20% of cases have a hereditary component. Individuals who carry a germline mutation in the BRCA 1 or 2 genes have an increased lifetime risk of developing pancreatic adenocarcinoma when compared with the general population.
CASE REPORT: Here, we present a case of metastatic pancreatic adenocarcinoma arising in a 67-year-old carrier of a BRCA 1 germline mutation.
DISCUSSION: In patients with known BRCA 1 or 2 mutation-associated pancreatic adenocarcinoma, the addition of a DNA cross-linking agent such as cisplatin, oxaliplatin, or mitomycin to a standard gemcitabine chemotherapy backbone should be considered. Poly ADP-ribose inhibitors are a novel class of drug, which have demonstrated promising efficacy in trials of BRCA 1 and 2 mutant breast and ovarian cancer, and are currently undergoing prospective evaluation in advanced pancreatic cancer.
For Women with Ovarian Cancer: A Toll Free Educational Teleconference. Free press release - Sept 20th Monday
Monday, September 20, from 8:00 pm – 9:00 pm (EST) The program is free. Women interested in participating should call Support Connection IN ADVANCE to register and receive instructions. On the night of the teleconference, participants will call a special toll-free number and be connected with the group. To learn more or to register, call Support Connection at 914-962-6402 or 1-800-532-4290. For Women with Ovarian Cancer: A Toll Free Educational Teleconference. Free. For women with ovarian cancer: A toll-free teleconference presentation & discussion with Dr. Thomas J. Herzog of Columbia University Herbert Irving Comprehensive Cancer Center at The New York-Presbyterian Hospital. Free. Topics to be discussed include: Women facing recurrence; Highlights of some new targeted molecular therapies with a focus on a clinical trial that includes the role of Bevacizumab (Avastin) in the treatment of ovarian cancer; and the role of bio markers and molecular profiling. Participants will have the opportunity to ask questions, interact with one another and share common life experiences. A Support Connection Peer Counselor will facilitate the discussion.
Secondary lymphedema is a debilitating, chronic, progressive condition that commonly occurs after the treatment of breast cancer. The purpose of the current study was to perform a systematic review and meta-analysis of the oncology-related literature excluding breast cancer to derive estimates of lymphedema incidence and to identify potential risk factors among various malignancies.
A total of 47 studies (7779 cancer survivors) met inclusion criteria: melanoma (n = 15), gynecologic malignancies (n = 22), genitourinary cancers (n = 8), head/neck cancers (n = 1), and sarcomas (n = 1). The overall incidence of lymphedema was 15.5% and varied by malignancy (P < .001): melanoma, 16% (upper extremity, 5%; lower extremity, 28%); gynecologic, 20%; genitourinary, 10%; head/neck, 4%; and sarcoma, 30%. Increased lymphedema risk was also noted for patients undergoing pelvic dissections (22%) and radiation therapy (31%). Objective measurement methods and longer follow-up were both associated with increased lymphedema incidence.
Lymphedema is a common condition affecting cancer survivors with various malignancies. The incidence of lymphedema is related to the type and extent of treatment, anatomic location, heterogeneity of assessment methods, and length of follow-up.
Review: Cochrane Collaboration - Palliative surgery versus medical management for bowel obstruction in ovarian cancer
Surgery compared to non-surgical treatment to relieve symptoms of bowel obstruction in ovarian cancerAuthors' conclusions
Chemotherapeutic agents such as topotecan can be used to treat ovarian cancer. The effects of using topotecan as a therapeutic agent have not been previously been systematically reviewed.
To evaluate the effectiveness and safety of topotecan for the treatment of ovarian cancer.
Participants were more likely to respond to topotecan on a 21-day cycle as opposed to a 42-day cycle (RR 7.23, 95% CI 0.94 to 55.36). Small tumor diameter, sensitivity to platinum-based chemotherapy was associated with better prognosis. Small sample size, methodological flaws and poor reporting of the included trials made measurement bias of the trials difficult to assess.
Plain language summary
Topotecan is an active second line chemotherapeutic drug, used to treat patients with relapsed ovarian carcinoma
It appears to have a similar level of effectiveness as paclitaxel and pegylated liposomal doxorubicin, though with different patterns of side effects. Larger, well-designed randomised controlled trials (RCTs) are required to define an optimal regime.
Abstract: Which staging system to use for gynaecological cancers: a survey with recommendations for practice in the UK
There are two commonly used staging systems for gynaecological cancers, namely Federation Internationale de Gynecologie et d'Obstetrique (FIGO) and TNM. The authors wished to ascertain which staging system is most commonly used in dealing with gynaecological cancers in the UK.
The authors undertook a survey among participants in the National Gynaecological Pathology EQA scheme to investigate whether gynaecological pathologists in the UK use FIGO or TNM staging in their routine reporting of gynaecological cancers.
There were 105 respondents out of 278 participants (38%). Of the analysed results, a majority of respondents (64%) use FIGO staging, while 32% use both FIGO and TNM. 80% of respondents stated that their multidisciplinary team meeting uses FIGO staging, while 18% use both FIGO and TNM. Only an extremely small minority of pathologists and multidisciplinary team meetings use TNM alone. A survey of members of the British Gynaecological Cancer Society revealed similar findings.
Since FIGO and TNM are not always equivalent, and there may be confusion when more than one staging system is used, it is recommended that FIGO staging be used for gynaecological cancers. The survey revealed support for the use of TNM, as well as FIGO, only for cervical cancer, since FIGO does not take the lymph node status into account. Given the prevalent practice in the UK, the British Association of Gynaecological Pathologists, British Gynaecological Cancer Society and gynaecological clinical reference group of the National Cancer Intelligence Network recommend that FIGO staging be used for gynaecological cancers with recording of the lymph node status for cervical cancer. This may be done by providing a TNM stage for this cancer type only or by recording the lymph-node status at the multidisciplinary team meeting.
Cancer Patients' Roles in Treatment Decisions: Do Characteristics of the Decision Influence Roles? JCO
Patients with more active roles in decisions are more satisfied and may have better health outcomes. Younger and better educated patients have more active roles in decisions, but whether patients' roles in decisions differ by characteristics of the decision itself is unknown.
Patients making decisions about treatments for which no evidence supports benefit and decisions about noncurative treatments reported more physician control, which suggests that patients may not want the responsibility of deciding on treatments that will not cure them. Better strategies for shared decision making may be needed when there is no evidence to support benefit of a treatment or when patients have terminal illnesses that cannot be cured.
Monday, August 16, 2010
Care for Caregivers: Groups Offer a Unique Support for Caregivers - Cancerwise | Cancer blog from MD Anderson Cancer Center
While friends and family may try to offer assistance and support, a feeling of "you don't know what it's like for me" is both common and reasonable.
Research uncovers possible new targets for attacking ovarian cancer - Cancerwise | Cancer blog from MD Anderson Cancer Center
Note: in research
Two studies led by scientists at MD Anderson open new areas of research that could potentially improve ovarian cancer treatment.
The discoveries published today in the journal Cancer Cell are preclinical - they employ laboratory experiments to better understand the molecular processes that drive formation and growth of cancer. Both studies found previously unknown roles for two proteins, singling them out for further research and possible drug development. ...cont'd
Understanding Patient Perspectives on Communication About the Cost of Cancer Care: A Review of the Literature — JOP
Conclusion: To my knowledge, patient preferences surrounding discussion of cost of cancer care have gone largely unstudied and are thus unknown. If the goal is to provide high-quality care while controlling rising health care costs, more research is needed to better understand patient perspectives on communication surrounding the cost of oncologic care, particularly given the significant impact such discussions may have on cancer outcomes, cost, and overall patient satisfaction.
Interview with Gilles Frydman, Founder and President of ACOR
"It is less clear where its medication and patient safety work will go, since the government has already announced that it will be scrapping the National Patient Safety Agency as part of its bid to reduce the number of arms length bodies in the health service."
A phase II study of sunitinib in patients with recurrent epithelial ovarian and primary peritoneal carcinoma: an NCIC Clinical Trials Group Study
Note: in research; see Table 1 for references to ovarian cancer/cisplatin
"Methylation of FANCF has been found in 20% of primary ovarian cancers not previously exposed to cisplatin, but the correlation between chemosensitivity and FANCF methylation in primary tumors remains to be determined."
define: heterogeneity - diverse and not comparable
ResultsNine studies examined symptom assessment, quality-of-life assessment, or symptom indexes for various gynecologic cancers. Studies varied in design, patient profiles, symptoms assessed, and outcomes measured. Meta-analysis was not performed due to heterogeneity in the studies.
ConclusionAlthough pain is well-studied and well-characterized, other disease-specific and general systemic symptoms of gynecologic cancers need better understanding and assessment. Accordingly, assessment of symptoms throughout the course of disease is crucial for treatment decisions and outcomes monitoring for patients with gynecologic cancer. This is especially true for survivors of gynecologic cancer, for patients whose treatment was unsuccessful, or for choosing between treatments with comparable survival outcomes. However, measurement and assessment of cancer-related symptoms is challenging because of the complex interaction between disease progression, multi-modality treatments, and symptoms. In this review, we evaluate the currently available symptom assessment tools for gynecologic cancers, along with quality-of-life assessment tools that include symptom items, and we give recommendations for further research.
Informa Healthcare - Summary: Standardized FDG uptake as a prognostic variable and as a predictor of incomplete cytoreduction in primary advanced ovar
FDG uptake in the primary tumor of patients with advanced ovarian cancer was not a prognostic variable and the FDG uptake did not predict complete cytoreduction after primary surgery. Future prospective clinical trials will need to clarify if other PET tracers can serve as prognostic variables in ovarian cancer.
Sunday, August 15, 2010
Chemotherapy Options in the Management of Platinum-Sensitive Recurrent Ovarian Cancer
abstract: Expert Opinion on Drug Metabolism & Toxicology - Effects of herbal products on the metabolism and transport of anticancer agents
What the reader will gain: Potential interactions of herbal medicines with anticancer agents have become a safety concern in cancer chemotherapy.
Take home message: Further studies are warranted to investigate the efficacy and safety profiles of herbal medicines commonly used by cancer patients.
full free access: A KRAS-Variant in Ovarian Cancer Acts as a Genetic Marker of Cancer Risk — Cancer Res
Note: in research; discusses HBOC (BRCA/mutation not found); KRAS has been studied extensively in colorectal cancer but not mentioned in this research eg. Lynch Syndrome
Medicine, Health Care and Philosophy A European Journal Editorial: The language of medicine and bioethics
"...The contributions in this section clearly show the new stage in the development of global bioethics, with an increasing body of documents, guidelines, publications at the level of international law. The language of human rights is becoming the new language of bioethics."
Randomized clinical trials are the gold standard ; Mixed bag of evidence to determine drug safety
The Cancer Biomarker Conundrum: Too Many False Discoveries
14 Aug 2010
"The boom in cancer biomarker investments over the past 25 years has not translated into major clinical success. The reasons for biomarker failures include problems with study design and interpretation, as well as statistical deficiencies, according to an article published online August 12 in The Journal of the National Cancer Institute...".cont'd including several references to ovarian cancer
Saturday, August 14, 2010
What the reader will gain: KRAS mutations in mCRC and NSCLC primary tumors predict resistance to EGFR-targeted therapy. In pancreatic cancer, KRAS may prove useful as a diagnostic biomarker to screen for early neoplasia. Furthermore, quantitative KRAS mutation analysis could have the potential to distinguish pancreatic cancer from other conditions such as chronic pancreatitis.
With respect to ovarian and endometrial cancer, further studies should focus on determining reliable biomarkers for predicting response to EGFR-targeted therapy. Besides EGFR inhibition, KRAS may also serve as a diagnostic and predictive biomarker for evolving therapies directed against mutant RAS proteins.
Take home message: KRAS has been recognized as an outstanding predictive biomarker to select mCRC and NSCLC patients for EGFR-targeted therapies; however, multi-determinant approaches including other molecular markers should facilitate the identification of patients likely to respond to such therapies.
Wednesday, July 21, 2010
The reposted blog includes commentaries from a number of well known ovarian cancer advocates/survivors/family and is open for comment
To assess the beneficial and harmful effects of vitamin D supplementation for prevention of cancer in adults.
This is the protocol for a review and there is no abstract. The objectives are as follows:
To assess the beneficial and harmful effects of vitamin D supplementation for prevention of cancer in adults.
Why it is important to do this review
The available evidence on vitamin D and cancer incidence is intriguing but inconclusive. Results of recently completed randomised clinical trials testing the influence of vitamin D supplementation for cancer prevention are inconsistent. Lappe et al found that vitamin D supplementation is associated with significantly decreased cancer incidence (Lappe 2007). On the contrary, another large randomised clinical trial found no effect of vitamin D and calcium supplementation on cancer incidence (Wactawski-Wende 2006). A recent meta-analysis by Autier and Gandini of 18 randomised clinical trials found significantly lower mortality in vitamin D supplemented participants (Autier 2007). We have been unable to identify any systematic reviews of randomised trials on vitamin D supplementation for cancer prevention.
full access: Ovarian Cancer Metastatic to the Breast Presenting as Inflammatory Breast Cancer: A Case Report and Literature Review - Journal of Cancer
Conclusion. Although ovarian metastasis to the breast presenting as inflammatory breast cancer is rare, it should be included in the differential diagnosis for any patient with a personal history of ovarian cancer. Accurate differentiation is necessary because treatment differs significantly for patients with ovarian metastasis to the breast, as compared with patients with primary inflammatory breast cancer. Ovarian metastasis to the breast confers a poor prognosis...cont'd
Friday, August 13, 2010
Technique to Preserve Fertility in Young Women May Be Unsafe for Patients With Leukemia (AML/CML)-- press release
Note: study of 18 patients (AML/CML)
WASHINGTON, Aug. 13 /PRNewswire-USNewswire/ --
Although the use of ovarian tissue cryopreservation and transplantation has lead to 13 live births in women with lymphoma or solid tumors, this method of fertility preservation may be unsafe for patients with leukemia, according to a recent study published online in article: Blood, the journal of the American Society of Hematology "Reimplantation of cryopreserved ovarian tissue from patients with acute lymphoblastic leukemia is potentially unsafe". The method involves removing and freezing ovarian tissue before the patient undergoes aggressive chemotherapy and radiotherapy, and then reimplanting the tissue once the cancer has been brought under control. One major concern with leukemia patients is the risk that their frozen-thawed ovarian tissue might harbor malignant cells that could induce a recurrence of the disease after reimplantation.
"Our study provides clear evidence that cancer cells in women with acute and chronic leukemias can contaminate the ovaries," said Marie-Madeleine Dolmans, MD, professor at the Universite Catholique de Louvain in Brussels and lead author of the study. "If this tissue is reimplanted in these women when they're ready to have children, there's a good possibility that the cancer will come back." ...cont'd
"Moreover, chemotherapy before ovarian cryopreservation does not exclude malignant contamination. Finally, reimplantation of cryopreserved ovarian tissue from ALL and CML patients puts them at risk of disease recurrence."
Take home message: There are extensive preclinical studies with transformed cells in culture and tumor-bearing animal models, as well as limited clinical studies reported to date, which indicate that HDAC inhibitors will be most useful when used in combination with cytotoxic or other targeted anticancer agents.
Patient Empowerment Blog
Here's an example of Dr. Berwick's point of view. From the IHI website, this is the No Needless List:
No needless deaths
No needless pain or suffering
No helplessness in those served or serving
No unwanted waiting
No one left out
Assessing Women at High Risk of Breast Cancer: A Review of Risk Assessment Models: Abstract and Introduction
".......In addition to increasing the risks of breast and ovarian cancers, germline mutations in BRCA1 and BRCA2 are associated with an increased risk of prostate cancer and BRCA2 mutations are associated with increased risks of pancreatic and gastric cancers and melanoma. BRCA mutations tend to cluster within certain ethnic groups, such as Ashkenazi Jews,[13–15] and in some populations, such as those in the Netherlands, Iceland,[17,18] and Sweden. Germline mutations that are associated with familial breast cancer have been identified in other genes, including TP53, PTEN, ATM, CHEK2, NBS1, RAD50, BRIP, and PALB2, and others are suspected.[20,21]"
Women who are at high risk of breast cancer can be offered more intensive surveillance or prophylactic measures, such as surgery or chemoprevention. Central to decisions regarding the level of prevention is accurate and individualized risk assessment. This review aims to distill the diverse literature and provide practicing clinicians with an overview of the available risk assessment methods. Risk assessments fall into two groups: the risk of carrying a mutation in a high-risk gene such as BRCA1 or BRCA2 and the risk of developing breast cancer with or without such a mutation. Knowledge of breast cancer risks, taken together with the risks and benefits of the intervention, is needed to choose an appropriate disease management strategy. A number of models have been developed for assessing these risks, but independent validation of such models has produced variable results. Some models are able to predict both mutation carriage risks and breast cancer risk; however, to date, all are limited by only moderate discriminatory accuracy. Further improvements in the knowledge of how to best integrate both new risk factors and newly discovered genetic variants into these models will allow clinicians to more accurately determine which women are most likely to develop breast cancer. These steady and incremental improvements in models will need to undergo revalidation....cont'd
Note: references studies - WHI (Women's Health Initiative) and California Teachers Study
Clinicians vary in their approaches to HT, said Dr. Ursin. "Certain gynecologists are very careful with finding the right dose for each woman, and some even prescribe [estrogen] alone for women who have a uterus, but then monitor the uterus carefully. Please keep in mind that the risk of breast cancer associated with EPT is relatively moderate. The risk of endometrial cancer with [estrogen] alone is much higher — a more than 4-fold increase in risk in this same population of California teachers," she said.
Note: cell 'lines' (test tube) vs patient tumors
"....But with all the effort and money being put into pharmacogenomics research using cancer cell lines, it is appropriate to ask: how faithfully do cancer cell lines represent the tumors that they are being used to model?"
"Next, do cancer cell lines behave similarly to the tumors they are intended to model to be useful for pharmacogenomics research? First, cancer cell lines are more appropriate for assessing the response to cytotoxic anticancer drugs, rather than the response to newer biologic agents which exert their anti-tumor effects via mechanisms other than eliciting cell death. Second, an important consideration to keep in mind when using cancer cell lines for pharmacogenomics research is that cell lines are generally more sensitive to cytotoxic agents than solid tumors.
"Another important question is: how well does testing in cancer cell lines predict responses in clinical trials with real world patients? When assessing whether there is a correlation between drug activity in Phase II clinical trials and preclinical activity in cancer cell line models, one study found that preclinical activity did not correlate with Phase II response, with the exception of non-small-cell lung cancer .
However, ..........It is becoming more and more apparent that the process of culturing cells in vitro alters the genetic make-up of the cancer cell lines."
Note: Correspondence (in full), still early days in research but progress noted
"In an article just published in Genome Biology, Steven Jones and colleagues at the British Columbia Cancer Agency have used next generation sequencing to monitor the development of a tumor as it metastasized and used the genomic information to inform treatment.
Cancers are known to accumulate mutations as they progress, and there are several mutations characteristic of metastases. However, even the most well-characterised of tumor types show genetic heterogeneity, and there are few data available for rare tumor types. The recent advent of next generation sequencing technology, allowing rapid and inexpensive genome sequencing, has made it possible to explore the genomic landscape of tumors in more detail.
In this study, a man presented with an unusual cancer of the tongue. He received surgery and radiotherapy, but was subsequently found to have metastases in the lungs. The patient was initially treated with the EGFR inhibitor erlotinib, but the lung metastases continued to grow. Sequencing of the metastases uncovered amplification of the RET oncogene, which explained the resistance to erlotinib, and also suggested the use of the RET inhibitor sunitinib. This drug reduced the size of the lung lesions for a few months, before they started to grow again. A skin metastasis was also detected, and sequencing uncovered seven new mutations that were present in neither the lung metastases nor the original tongue tumor. It appeared that the tumor had upregulated the AKT signalling pathway to compensate for the inhibition of the RET pathway.
This eloquent study demonstrates nicely both how tumors respond to treatment with compensatory changes and also how genomics can be used to guide medical treatment.
Thursday, August 12, 2010
With a handful of possible exceptions, Diamandis wrote, "very few, if any, molecules have been identified that are expressed only by a cancer tissue but not by the corresponding normal tissue."
Cancer biomarkers are missing in action despite the availability of "highly sophisticated and powerful technologies" to discover them, as well as large investments, Diamandis wrote, adding that the last biomarker approved by the FDA -- in 2009 -- was HE4 protein, indicated for monitoring recurrence but not early detection of ovarian cancer."
- Note that this commentary documents the hazards of reports on promising biomarkers for cancer screening.
- The author points out that one of the major problems is finding biomarkers released in significant amounts from asymptomatic (usually small) tumors, but not from normal tissues.
INDEPENDENT CONFERENCE COVERAGE
*CCO is an independent medical education company that provides state-of-the-art medical information to healthcare professionals through conference coverage and other educational programs.
While attending the clinical oncology meeting in Chicago, Illinois, I met with Bradley J. Monk, MD, to review the clinical implications of recent studies in ovarian cancer. Our discussion is available on the Clinical Care Options Web site as a CME/CE-certified Expert Analysis.
Select topics include:
To review this CME/CE-certified Expert Analysis, click here.
This Expert Analysis is located online at:
Institutional financial conflicts of interest policies at Canadian academic health science centres: a national survey - full free access
Note: so far I have scanned the article as below which includes references to ovarian cancer;
Tip: click on the titles below and then go to link clicking on the website which will bring you to the document :
- Treatment of thromboembolism in cancer patients
Marina Panova-Noeva, Anna Falanga
To view this in your browser, click here: http://informahealthcare.msgfocus.com/q/18HKWto1lavLlBA/wv
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Note: to cancer patients and their families this is not a surprise, I would suspect via media reports, past and present, that the public is wiser as well (aka: "the Wisdom of Crowds")
"To many Canadians this finding might come as a surprise."
Read more: http://www.vancouversun.com/health/Disadvantaged+face+hardest+fight+against+cancer/3384687/story.html#ixzz0wMeKYWYt
Wednesday, August 11, 2010
Note: this journal requires subscription ($$$), abstracts available free
FAIRFAX, Va., Aug 10, 2010 (BUSINESS WIRE) -- SRA International, Inc. , a leading provider of technology and strategic consulting services and solutions to government organizations and commercial clients, today announced that the Department of Defense (DoD) awarded the company a re-compete contract to support the receipt and scientific review of research grant applications for DoD's Congressionally Directed Medical Research Programs (CDMRP). The contract has a potential total dollar value of $100 million over five years, if all options are exercised.
SRA has provided a vast range of services supporting scientific and technical merit review of the thousands of research grant applications received by the U.S. Army Medical Research and Materiel Command's (USAMRMC) CDMRP. Research initiatives supported by SRA have included breast, prostate and ovarian cancers; chronic myelogenous leukemia; osteoporosis; neurofibromatosis; tuberous sclerosis complex; autism spectrum disorder, amyotrophic lateral sclerosis, post traumatic stress disorder, traumatic brain injury, prion diseases; and initiatives related to the health and readiness of military personnel...cont'd
"Half a million when you're broke?" Snyder said at Saratoga, where he's sleeping in a tack room in the barn near his horse. "That's a lot of money. But she's not for sale -- at any price. This is a personal thing for me."
This year, the American Association for Cancer Research will host its third conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved at the Loews Miami Beach Hotel in Miami, Fla.
Findings presented at this year’s meeting will include:
• proven communication methods for reaching minority populations;
• strategies to increase enrollment in clinical trials;
• prognosis in lung cancer affected by race;
• breast cancer trends in Arab and Israeli Jewish women;
• the importance of social support and physical activity in survivors; and,
• socioeconomics and access to health care.
To help you plan your coverage of the conference, the program schedule is available online at
"...A physician or nurse making rounds can locate and page through a 200-page reference book that lists the possible adverse events that may occur to patients in a clinical trial, or can instead keep all the same information in their pocket, in a 4-ounce iPhone. For many in healthcare, that’s an easy choice.The classifications of adverse events originated in the National Cancer Institute as a way to help standardize record-keeping of side effects occurring in patients enrolled in clinical trials. Printed out, the Institute’s Common Terminology Criteria for Adverse Events (CTCAE) is a 200-page handbook in its most recent edition, version 4.0..cont'd
media reporting issues = watch the word 'extremely' (94 patients in study); comment on symptoms/early stage;
also note the research comment regarding lack of access to ovarian cancer patients/study ?? (needs 500 pts)
“The caveat is we don’t currently have 500 patients with the same type of ovarian cancer, so we’re going to look at other types of ovarian cancer,” said Fernandez. “It’s possible that there are also signatures for other cancers, not just ovarian, so we’re also going to be using the same approach to look at other types of cancers. We’ll be working with collaborators in Atlanta and elsewhere.”
comments in the media item:
In addition to having a relatively low prevalence ovarian cancer is also asymptomatic in the early stages. Therefore, if further testing confirms the ability to accurately detect ovarian cancer by analyzing metabolites in the serum of women, doctors will be able detect the disease early and save many lives.
“This is evidence that the story is complicated,” said Tanmai Saxena, an M.D./Ph.D. student at the Keck School of Medicine at the University of Southern California. “The benefits of hormone therapy for relief of postmenopausal symptoms among women are clear, but the risks are more complicated than we had previously thought.”
phase 11 - RO4929097 in Treating Patients With Recurrent and/or Metastatic Epithelial Ovarian Cancer, Fallopian Tube Cancer, or Primary Peritoneal Cancer - Full Text View - ClinicalTrials.gov (location: PMH Toronto)
Tuesday, August 10, 2010
Carolyn's Ovarian Cancer Awareness Stamp petition
Together we can make an OvCa stamp a reality. Since 2001, Carolyn Benivegna had led the national effort to petition for the creation of an Ovarian Cancer Awareness Postage Stamp. The hope is that a postage stamp will increase awareness of the disease to improve the chances of early detection. If you would like to support our goals, please sign (or re-sign) our online petition; we will continue each year to submit a request to the U.S. Postal Service along with the signatures that share in our quest to make this a reality.
Don't forget to send this link to your family and friends, too!