Wednesday, February 16, 2011
"........Finally, how should we consider the use of antiangiogenic therapy in general in the adjuvant setting? Will VEGF blockade ever suffice when administered as single antiangiogenic agent in combination with chemotherapy, or will we need to combine bevacizumab with other antiangiogenic agents? Although an easy solution at this stage would be to lose interest in the therapeutic potential of antiangiogenic therapy in the adjuvant setting because of these initial disappointing results, the more challenging way forward will require a better understanding of the underlying mechanisms of why bevacizumab treatment differs so much in the adjuvant setting versus the macrometastatic setting. Only by achieving this goal will it be possible to make a more informed decision on this important matter"
abstract: Disease course patterns after discontinuation of bevacizumab (Avastin): pooled analysis of randomized phase III trials
also note: secondary link source including professional commentary
Purpose: Preclinical studies have suggested accelerated tumor growth, local invasion, and distant metastasis after withdrawal of treatment with some antiangiogenic agents. To investigate whether discontinuation of bevacizumab treatment is associated with accelerated disease progression or increased mortality, we retrospectively analyzed five randomized, placebo-controlled phase III studies in 4,205 patients with breast, colorectal, renal, and pancreatic cancer.
Supported in part by F. Hoffmann-La Roche, Basel, Switzerland.
Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.
Clinical trial information can be found for the following: NCT00738530.
CRD Summary/Commentary: Increased ovarian cancer risk associated with menopausal estrogen therapy is reduced by adding a progestin
original link source: http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12009104538
CRD Commentary: The review question was stated and appropriate inclusion criteria were defined. Limiting the search to English language published studies identified in one database plus references and linked articles may have resulted in the omission of other relevant studies and raised the potential for publication and language bias. However, no evidence of publication bias was found. Methods used to select studies and extract data were not described, so it is not known whether efforts were made to reduce reviewer errors and bias. Study validity was not assessed, so results from these studies and any synthesis may not be reliable.
Other than duration of oestrogen-only therapy/oestrogen plus progestin therapy use, no information was provided about participants. No information was provided about which potential confounders were adjusted for in individual studies. Data were pooled using meta-analysis and heterogeneity was assessed. Studies were predominantly observational and adjustments were made for potential confounders. The authors’ conclusions appeared to be supported by the evidence, but the limited search, lack of reporting of review methods and study quality, and reliance upon predominantly observational studies mean that findings should be interpreted with caution.
Randomized Phase III Clinical Trial Evaluating Weekly Cisplatin for Advanced Epithelial Ovarian Cancer — J. Natl. Cancer Inst.
Thus, increasing dose intensity of cisplatin does not improve PFS or OS compared with standard chemotherapy.
full free access: How Research Influences Policy Makers: Still Hazy After All These Years — J. Natl. Cancer Inst. Steven Lewis (author)
"Libraries have been written about the theory and practice of public policy making. Yet, this enormous scholarship has proved insufficient to lift the veil of mystery and idiosyncrasy that shrouds the art of decision making. The heady ambition to turn both clinical practice and health policy into evidence-based bastions of rationalist decision making has been downgraded; the vocabulary is now “evidence-informed,” and the realm of admissible evidence has been greatly expanded to include preferences, political contingencies, and psychology (1). This newfound conceptual modesty and nuance does not suggest that we should abandon efforts to understand decision-making processes and to enhance the role of research-based evidence in policy. It merely confirms the complexity, contingency, and messiness of the terrain............This leads to a second issue: the definition of “use.” The questionnaires simply asked whether the respondents intended to use the brief. We do not know what “use” means.." cont'd
abstract: Indication for oophorectomy during cytoreduction for intraperitoneal metastatic spread of colorectal or appendiceal origin(cytoreductive surgery/HIPEC)
METHODS: This retrospective analysis included 194 women subjected to CRS and HIPEC since 2001. The incidence of ovarian metastases, disease-free survival and disease-specific survival were analysed.
RESULTS: The histological diagnosis was colorectal cancer carcinomatosis in 108 patients, peritoneal mucinous carcinomatosis (PMCA) in 23 and disseminated peritoneal adenomucinosis (DPAM) in 63. Ninety-nine patients underwent oophorectomy during the HIPEC procedure. Ovarian metastases were confirmed in at least 52 per cent of the patients. There was a significant difference in disease-free survival between women with or without ovarian metastases in both PMCA and DPAM groups (P = 0·044 and P = 0·010 respectively). No significant differences in survival were found in the group with colorectal cancer carcinomatosis.
CONCLUSION: When peritoneal carcinomatosis of colorectal or appendiceal origin is confirmed, at least 52 per cent of ovaries will have synchronous metastases. Disease-free survival after a HIPEC procedure for PMCA or DPAM is significantly lower in women with ovarian metastases. Oophorectomy during CRS for peritoneal carcinomatosis should be strongly considered.
abstract: Metastatic neoplasms of the ovaries: a clinicopathological study of 97 cases (metastatic breast, GI neoplasms....)
METHODS: This is a retrospective study including 97 patients with pathological diagnosis of metastatic ovarian neoplasms, examined during the decade 2000-2009. The gross, microscopical and immunohistochemical characteristics as well as the clinical data (age of the patients, origin of the neoplasm, symptoms, treatment options) and 5-year survival rates were examined.
RESULTS: The mean age of the patients is 55 years (range 26-78 years). 62.89% of the tumors were metastatic from extragenital organs (from stomach 21.65%, breast 15.46%, colon 15.46%, appendix 3.09%, pancreas 2.06%, lung 1.03% and kidney 1.03%, sarcoma 1.03% melanoma 1.03%) and 37.11% tumors originated from the genital tract. The 3-year survival rates ranged from 25.39% for metastatic ovarian neoplasms originating outside the genital tract up to 29.41% for those originating from the genital tract. Tumor immunohistochemistry is a helpful aid in the differential diagnosis mainly between primary mucinous ovarian tumors and metastatic colon cancers and in the recognition of metastatic breast cancers and other neoplasms of the GI tract.
CONCLUSION: The management of metastatic ovarian neoplasms should include specific immunohistochemical methods in order to identify the primary neoplasm site. The differential diagnosis of a pelvic mass should always include metastatic neoplasms of the ovaries.
OBJECTIVE: No attention has been paid in the past to the spread pattern of right and left epithelial carcinomas of the ovaries. We aimed to investigate the incidence, spread pattern and distribution of lymph node metastasis in epithelial ovarian cancer (EOC), comparing right versus left EOC of any stage, where the contralateral ovary is apparently and histologically tumor-free.
full access: Assessing the information desire of patients with advanced cancer by providing information with a decision aid, which is evaluated in a randomized trial: a study protocol
DiscussionThis study attempts to settle the debate on the desirability of informing patients with cancer. In contrast to several earlier studies, we will actually deliver information on treatment options to patients at the point of decision making.
Trial registration: NTR1113
abstract: Clinical characteristics of borderline ovarian tumors and stage I epithelial ovarian cancer: an analysis of 143 cases
abstract: Tubal ligation and the risk of ovarian cancer: review and meta-analysis — Hum Reprod Update (serous/mucinous/endometrioid)
summary: Abagovomab: an anti-idiotypic CA-125 targeted immunotherapeutic agent for ovarian cancer phase 111 MIMOSA trial
Monday, February 14, 2011
full free access: Effect of preventive messages tailored to family history on health behaviors: the Family Healthware Impact Trial. Ann Fam Med. 2011 (includes ovarian cancer)
PURPOSE: We wanted to determine the impact of automated family history assessment and tailored messages for coronary heart disease, stroke, diabetes, colorectal, breast, and ovarian cancer on preventive behaviors compared with a standard preventive message. ....cont'd for full free access
OXiGENE Inc. (OXGN) Enters into Collaborative Agreement with NCI for Cancer Drug - Intl Business Times (Zybrestat/Avastin))
full free text: The safety implications of missed test results for hospitalised patients: a systematic review -- BMJ Quality and Safety (references World Alliance for Patient Safety)
.........All seven studies explored the impact on patient outcomes31–33 35–38 which included no negative effects,31 a delayed diagnosis from a missed x-ray report,37 one case of missed positive Chlamydia where the patient subsequently developed pelvic inflammatory disease,36 inappropriate or unnecessary antibiotics prescribed,35 missed cancer diagnoses33 and death.38.....cont'd
Sunday, February 13, 2011
ConclusionsOccult metastases were an independent prognostic variable in patients with sentinel nodes that were negative on initial examination; however, the magnitude of the difference in outcome at 5 years was small (1.2 percentage points). These data do not indicate a clinical benefit of additional evaluation, including immunohistochemical analysis, of initially negative sentinel nodes in patients with breast cancer. (Funded by the National Cancer Institute; ClinicalTrials.gov number, NCT00003830.)
Saturday, February 12, 2011
European Journal of Human Genetics - Abstract of article: On the origin and diffusion of BRCA1 c.5266dupC (5382insC) in European populations
"The BRCA1 mutation c.5266dupC was originally described as a founder mutation in the Ashkenazi Jewish (AJ) population. However, this mutation is also present at appreciable frequency in several European countries, which raises intriguing questions about the origins of the mutation. We genotyped 245 carrier families from 14 different population groups (Russian, Latvian, Ukrainian, Czech, Slovak, Polish, Danish, Dutch, French, German, Italian, Greek, Brazilian and AJ) for seven microsatellite markers and confirmed that all mutation carriers share a common haplotype from a single founder individual.............Our results illustrate that (1) BRCA1 c.5266dupC originated from a single common ancestor and was a common European mutation long before becoming an AJ founder mutation and (2) the mutation is likely present in many additional European countries where genetic screening of BRCA1 may not yet be common practice."
“They are not amateurs. They are far from being amateurs.”
full free access: Genomics and the Continuum of Cancer Care — NEJM (long article covering differing concerns)
abstract only: Update in Hormone Therapy Use in Menopause -- Journal of Clinical Endocrinology & Metabolism
abstract: HE4 and CA125 as a diagnostic test in ovarian cancer: prospective validation of the Risk of Ovarian Malignancy Algorithm
This independent validation study demonstrated similar performance indices to those recently published. However, in this study, HE4 and ROMA did not increase the detection of malignant disease compared with CA125 alone. Although the initial reports were promising, measurement of HE4 serum levels does not contribute to the diagnosis of ovarian cancer
Background: Symptoms associated with ovarian cancer are often vague and non-specific, such as abdominal bloating and pain. Presently, nothing is known about the prevalence of these symptoms among women in the community.
Aims: To identify the prevalence and correlates of symptoms associated with ovarian cancer in a nationally representative sample of Australian women. Methods: Women answered questions about symptoms associated with ovarian cancer via computer-assisted telephone interviews. Binomial regression was used to assess the association between reporting symptoms, demographic characteristics and sexual problems.
Results: Data on 2235 women aged 18-70 who had not had an oophorectomy or hysterectomy were analysed. Prevalences of symptoms were abdominal bloating 52%, abdominal pain 37%, increased abdominal size 30%, pelvic pain 29%, feeling full quickly 18% and unable to eat normally 15%. One-third of women (32%) reported three or more symptoms, 2% reported all six and 32% of women reported none. Severe symptoms were generally reported by <10% of women reporting symptoms, and symptoms usually persisted for 5 days or less a month. Older women were less likely to report symptoms, as were women who had been pregnant. There was an association between symptoms and sexual difficulties whereby women who reported multiple ovarian cancer symptoms were more likely to report sexual problems.
Conclusions: There is a high prevalence of ovarian cancer symptoms in the Australian community. Because of this, awareness campaigns will likely impact a large number of women who do not have ovarian cancer.
(no abstract) Peritoneal fibrosis leading to small bowel obstruction two years after first-line intraperitoneal chemotherapy for optimally debulked ovarian cancer Australian
Australian and New Zealand Journal of Obstetrics and Gynaecology
abstract: Changes in pre-diagnostic serum C-reactive protein concentrations and ovarian cancer risk: a longitudinal study
Define: C-reactive protein (CRP) is a protein found in the blood, the levels of which rise in response to inflammation (an acute-phase protein). ...
BACKGROUND: Evidence suggests that inflammation may be associated with increased risk of ovarian cancer but there is paucity of studies investigating this association, especially using over-time changes in inflammatory biomarkers.
MATERIALS AND METHODS: We conducted a prospective population-based case-control study nested within the Finnish Maternity Cohort (FMC). Within the FMC, 170 women with ovarian cancer who had donated serum samples to the cohort twice, ≥1 year apart, before cancer diagnoses were identified. One control per case was matched for age, parity and sampling date.
RESULTS: Comparing the highest with lowest tertiles, the odds ratio (OR) of ovarian cancer using the first set of serum samples (mean lag time to cancer diagnosis 9.0 years) was 1.62 [95% confidence interval (CI) 0.93-2.83]. However, analysis conducted using the second set of serum samples donated closer to cancer diagnosis (mean lag time 6.4 years) revealed a significantly increased risk of ovarian cancer comparing extreme tertiles of C-reactive protein (CRP) concentrations; OR 1.96 (95% CI 1.11-3.4). Over time, increases in individuals' CRP concentrations were also associated with increased risk; OR 1.90 (95% CI 1.12-3.23).
CONCLUSION: The results suggest that inflammation may precede ovarian cancer since increasing CRP concentrations, both across tertiles and longitudinally at the individual level, were associated with increased risk.
Table of Contents — January 2011, 22 (suppl 1) — Hereditary Breast and Ovarian Cancer: Risks and Challenges 10–12 September 2009: Bari, Italy
Note: numerous papers, full free access
abstract: Centralized treatment of advanced stages of ovarian cancer improves survival: a nationwide Danish survey
"...Treatment in a referral center was an independent prognostic factor for overall survival hazard ratio, 0.83 (confidence interval 0.70-0.98).
Conclusion. Patients with stage IIIC and IV ovarian cancer benefit from treatment in a tertiary referral center."
Note: other research is of the same opinions (see prior blog posts) that incident rates of ovarian cancer are in fact not reducing (eg. population...)
Conclusions. The incidence rate of borderline ovarian tumors increased significantly in Denmark in 1978-2006. In line with results from ovarian cancer, Denmark had a higher incidence rate of borderline ovarian tumors compared with the other Nordic countries in 1978-2006.
abstract: A systematic review of gynecological cancer surveillance in women belonging to Hereditary Nonpolyposis Colorectal Cancer (Lynch syndrome) fa
Currently available published studies on gynecological cancer surveillance in women with HNPCC do not adequately allow for evidence-based clinical decisions. Detection of endometrial cancer or hyperplasia in nonsymptomatic women belonging to a HNPCC family is improved by adding routine endometrial sampling along with transvaginal ultrasound for surveillance visits. No benefit was shown for ovarian cancer surveillance.
abstract: A patient presenting nasal septum perforation during bevacizumab-containing chemotherapy for advanced breast cancer (and colorectal/ovarian) see Blogger's note
nasal perforations (while rare) has been widely reported in patient social networks and vastly under-reported by institutions, as evidenced by the incidence rates per this abstract; this is not a new issue/concern
Nasal septum perforation is a rare but described complication of the anti-angiogenetic agent bevacizumab. ........ The patient denied use of cocaine or other intranasal irritants. ........ Thus far 8 other cases of bevacizumab-related nasal septum perforation have been published: 5 patients with colorectal cancer, 2 patients with breast cancer and 1 with ovarian cancer.....cont'd
CONCLUSIONS: Our data provide weak evidence in support of beneficial effects of physical activity on ovarian cancer risk and survival, but results should be interpreted cautiously because of the lack of a clear dose response relation with higher levels of exercise and the likely misclassification of self-reported activity.
abstract: Morbidity of diaphragmatic surgery for advanced ovariannext term cancer: Retrospective study of 148 cases
ConclusionsDiaphragmatic surgery achieved complete removal of the tumour but resulted in pulmonary complications in addition to complications of radical surgery.
Friday, February 11, 2011
full free access: Histotype predicts the curative potential of radiotherapy: the example of ovarian cancers — Ann Oncol (stage/cell type)
"....The Gynecology Tumour Group of our institution has elected to continue to advise the use of CRT in women with stage Ic and II endometrioid and mucinous lesions, and all stage I and II clear cell disease, on the basis of these data and a recently published analysis of histotype-specific outcomes . However, RT will be targeted to the pelvis, with consideration of extending the field to include paraaortic nodes if stage IIc (given the higher rate of occult nodal involvement reported for this stage ). RT will be dropped from our prescription for those with serous tumors.
"Oncologists are asked with increasing frequency to counsel their patients with respect to the medical, psychological and social repercussions of genetic testing for cancer susceptibility that may have been prescribed by physicians or carried out through direct-to-consumer tests. This article critically reviews the main ethical and social implications of BRCA testing, focusing on genetic responsibility and genetic discrimination. Genetic responsibility toward oneself and others is a highly debated implication of genetic testing for cancer predisposition that requires broad considerations of the boundaries between individual and community rights and a reappraisal of the notion of autonomy as relational. Physicians’ duty to warn ‘at risk’ relatives can be an ethical quandary, yet confidentiality is key to the patient–doctor relationship. Mutation carriers may be subject to different forms and degrees of genetic discrimination and many individuals at risk have forgone BRCA testing to avoid potential discrimination. The scientific and medical community, together with patients and the public, has actively engaged against genetic discrimination. The legislation in many countries now protects against genetic discrimination by insurance companies and employers. Legal and regulatory issues are not the final answer to discrimination and profound cultural changes are required to create understanding and acceptance of all differences...."
abstract: Analysis of postoperative complications associated with the use of anti-adhesion sodium hyaluronate-carboxymethylcellulose (HA-CMC) barrier after cytoreductive surgery for ovarian, fallopian tube and peritoneal cancers
ConclusionsHA-CMC adhesion barrier placement at the time of optimal cytoreductive surgery for ovarian, fallopian tube, and peritoneal cancer is not associated with major postoperative complications but may be associated with increased risk of pelvic abscess
Note: advanced ovarian cancer study
Nearly 25% of Women With Early Ovarian Cancer Not Given Recommended Biopsies - US News and World Report
Thursday, February 10, 2011
"The Lab - Avoiding Research Misconduct: (video) Office of Research Integrity: The Lab. An Interactive Video on Avoiding Misconduct
Wednesday, February 09, 2011
The ROMA (Risk of Ovarian Malignancy Algorithm) for estimating the risk of epithelial ovarian cancer in women presenting with pelvic mass: is it really useful? (HE4/CA125/pre-post menopausal)
Conclusions: The ROMA is a simple scoring system which shows excellent diagnostic performance for the detection of EOC in post-menopausal women, but not in pre-menopausal women. Moreover, the dual marker combination of HE4 and CA125 (ROMA) does not show better performance than HE4 alone.
Note: see Tables for differing countries within EU
Tuesday, February 08, 2011
full free access: Journal of Oncology — Review Article: Potential Markers for Detection & Monitoring of Ovarian Cancer Feb 8, 2011
Note: pdf file
Conclusions and Emerging Trends in Biomarkers for Ovarian Cancer
"The ultimate aim of effective screening techniques is to bring about a reduction in mortality form ovarian cancer. As early detection continues to be vital in ovarian cancer patients, biomarkers may hold the key to unlocking effective screening strategies for the general population. It is also important to identify screening techniques with low false positive rates and high positive predictive value so that the number of negative surgical interventions can be minimized. Since our currently available single markers are not highly sensitive or specific, a combination of markers may be utilized as a profile for risk assessment. The current problem with screening panels is that the improvement in sensitivity usually correlates with a decrease in specificity, making the target positive predictive value hard to obtain. The multimodal screening profiles of the genetic markers could be utilized in the future for risk assessment, early diagnosis, prognosis and response to therapeutic treatment. Recent literature reports state that the screening is only recommended for the high risk population identified as those with a family history of the disease, women with BRCA1 and BRCA2 mutations, or with hereditary non polyposis colorectal cancer. Recent literature reports also emphasize that the different subtypes of ovarian cancer may have different genetic biomarker expression profiles. Current randomized controlled screening trials are directed towards finding the best molecular and genetic markers for the specific histology of the ovarian tumor with the most impact on reduction in morbidity and mortality. The tumor markers identified in these trials may also lead to novel targets for antitumor therapy."
"This paper highlights the current experimental approaches that have been used in the field and discusses their limitations, with specific emphasis on the identification and characterisation of the CSC population in epithelial ovarian cancer."
Monday, February 07, 2011
"Patients with Peutz-Jeghers syndrome (PJS) require lifelong multidisciplinary care for gastrointestinal polyposis and increased risk of cancer.
...The cause of death was unknown in 4 patients, but was due exclusively to malignancies in all other patients, most commonly due to metastatic gynecologic cancer (5)...."
"This study suggests that BRCA1 mutations may be associated with early-onset of colorectal cancer."
abstract: Treatment-Related Mortality With (Avastin) Bevacizumab in Cancer Patients JAMA (alone vs combo)
Data Synthesis "A total of 10 217 patients with a variety of advanced solid tumors from 16 RCTs were included in the analysis...."
January 5, 2011 Gynecologic Oncology Group Survival In 2010
"In 2010, the Institute of Medicine (IOM) produced a report recommending wide-ranging changes in the Cooperative Group program and, in response the National Cancer Institute (NCI) has proposed a reorganization of the nation’s cancer Clinical Trials program that would significantly change the program’s current structure....."
Abstract/full free access: An evaluation of access to health care services along the rural-urban continuum in Canada
ConclusionInequities in access to care along the rural-urban continuum exist and can be masked when evaluation is done at a very large scale with gross indicators of rural-urban. Understanding the relationship between rural-urban and other determinants will help policy makers to target interventions appropriately: to specific demographic, provincial, community, or rural categories.
Why a journal (Emergency Medicine Australasia) decided to stop taking pharma ads - Gary Schwitzer's HealthNewsReview Blog
The full editorial making the announcement is available online.
Sunday, February 06, 2011
Australia: eMJA: Editorial - Managing patients with advanced cancer: the benefits of early referral for palliative care
If early referral for specialist palliative care were an expensive new drug, it would quite appropriately be marketed as a major advance in improving the care of patients with incurable cancer.
Saturday, February 05, 2011
abstract: Surgical-site infections and postoperative complications: agreement between the Danish Gynecological Cancer Database and a randomized clinical trial (patient safety)
Conclusions. The randomized trial reported significantly more surgical-site infections than the clinical database. The DGCD reported only 50% of the deep and organ-space infections, and hence, the low-overall agreement indicates a need for more careful database registration.
abstract: Phase II study evaluating consolidation whole abdominal intensity-modulated radiotherapy (IMRT) in patients with advanced ovarian cancer stage FIGO III - The OVAR-IMRT-02 Study
".... Recurrences of the disease occur mostly intraperitoneally. Ovarian cancer is a radiosensitive tumor, so that the use of whole abdominal radiotherapy (WAR) as a consolidation therapy would appear to be a logical strategy. WAR used to be the standard treatment after surgery before the chemotherapy era; however, it has been almost totally excluded from the treatment of ovarian cancer during the past decade because of its high toxicity. Modern intensity-modulated radiation therapy (IMRT) has the potential of sparing organs at risk like kidneys, liver, and bone marrow while still adequately covering the peritoneal cavity with a homogenous dose. Our previous phase I study showed for the first time the clinical feasibility of intensity-modulated WAR and pointed out promising results concerning treatment tolerance. The current phase-II study succeeds to the phase-I study to further evaluate the toxicity of this new treatment. Methods / design: The OVAR-IMRT-02 study is a single-center one arm phase-II trial. Thirty seven patients with optimally debulked ovarian cancer stage FIGO III having a complete remission after chemotherapy will be treated with intensity-modulated WAR as a consolidation therapy. A total dose of 30 Gy in 20 fractions of 1.5 Gy will be applied to the entire peritoneal cavity including the liver surface and the pelvic and para-aortic node regions. Organ at risk are kidneys, liver (except the 1cm-outer border), heart, vertebral bodies and pelvic bones. Primary endpoint is tolerability; secondary objectives are toxicity, quality of life, progression-free and overall survival.
DISCUSSION: Intensity-modulated WAR provides a new promising option in the consolidation treatment of ovarian carcinoma in patients with a complete pathologic remission after adjuvant chemotherapy. Further consequent studies will be needed to enable firm conclusions regarding the value of consolidation radiotherapy within the multimodal treatment of advanced ovarian cancer. Trial registration: NCT01180504.
abstract: Phase II trial of combretastatin A4 phosphate, carboplatin, and paclitaxel in patients with platinum-resistant ovarian cancer
Note: searching blog for A4 will provide further research specific to clear cell/A4
CONCLUSIONS: The addition of CA4P to paclitaxel and carboplatin is well tolerated and appears to produce a higher response rate in this patient population than if the chemotherapy was given without CA4P. A planned randomised trial will test this hypothesis.
abstract: Indication for oophorectomy during cytoreduction for intraperitoneal metastatic spread of colorectal or appendiceal origin
BACKGROUND: The incidence of ovarian metastases at the time of peritoneal carcinomatosis, and the influence of such metastases on survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), are unknown.
CONCLUSION: When peritoneal carcinomatosis of colorectal or appendiceal origin is confirmed, at least 52 per cent of ovaries will have synchronous metastases. Disease-free survival after a HIPEC procedure for PMCA or DPAM is significantly lower in women with ovarian metastases. Oophorectomy during CRS for peritoneal carcinomatosis should be strongly considered.
abstract: Whole abdominopelvic radiotherapy using intensity-modulated arc therapy in the palliative treatment of chemotherapy-resistant ovarian cancer with bulky peritoneal disease
CONCLUSION: WAPRT delivered using intensity-modulated arc therapy offers important palliation in the case of peritoneal metastatic ovarian cancer. WAPRT resolved intestinal obstruction for a substantial period.
PURPOSE: To review the role of adjuvant radiotherapy (RT) in the outcome and recurrence patterns of granulosa cell tumors (GCTs) of the ovary.
CONCLUSION: Ovarian GCTs can be indolent, with patients achieving long-term survival. In our series, adjuvant RT resulted in a significantly longer DFS. Ideally, randomized trials with long-term follow-up are needed to define the role of adjuvant RT for ovarian GCTs.
abstract: The perils of a vanishing cohort: a study of social comparisons by women with advanced ovarian cancer
Note: plain english language version??
Friday, February 04, 2011
(no abstract) How Surgeon Age Affects Surveillance After Curative-Intent Primary Treatment for Ovarian Carcinoma
How Surgeon Age Affects Surveillance After Curative-Intent Primary Treatment for Ovarian Carcinoma
No abstract is available. To read the body of this article, please view the Full Text online.
abstract: Laparoscopic Excision of Ovarian Remnants: Retrospective Cohort Study with Long-term Follow-up
Promoting genetic literacy: cancer control in the BRCA era - Cutting Edge - Cancer World (including Lynch Syndrome/spectrum of cancers)
Note: worth reading; covers a variety of concerns
- Accounting for around 5%–10% of all breast cancers, harmful mutations in BRCA1 or BRCA2 increase a woman’s chance of developing breast cancer over their lifetime by approximately five times compared to the normal population.
- Carriers of the harmful BRCA1/2 mutations are also approximately 10–30 times more likely to develop ovarian cancer, with these mutations accounting for around 10% of all ovarian cancers.
- There is no single BRCA mutation, but a wide variety of mutations on these two genes, many of which have yet to be recorded. Only some have been demonstrated to be harmful.
- BRCA mutations can also raise the risk of other cancers, including gastric, pancreatic, colon and prostate cancer, as well as melanoma and male breast cancer.
- Other ‘cancer genes’ include mutated APC genes, responsible for familial adenomatous polyposis, which lead to colon cancer, and mutated MLH1, MSH2 MSH6, or PMS2 genes, which are associated with hereditary non-polyposis colon cancer (HNPCC) (Lynch Syndrome), a syndrome that also raises the risk of endometrial (uterine), stomach, ovarian, small bowel (intestinal), urinary tract, liver, and bile duct cancers.
(2010) Slipstream - When Patients Meet Online, Are There Side Effects? - NYTimes.com (patient exploitation)
"...raises important questions about the trade-off between the benefits of information sharing and the risk of patient exploitation."
Thursday, February 03, 2011
MSKCC (Memorial Sloan Kettering) Winter 2011 newsletter Molecular Medicine for Ovarian and Endometrial Cancer - Douglas A Levine
Note: includes reference to PARP inhibitors
Download Article - Update in Gynecologic Oncology, Winter 2011
Using Quality of Life Measures in Breast Cancer Clinical Trials — J. Natl. Cancer Inst. (and all cancers)
"Both the World Health Organization and the U.S. Food and Drug Administration have endorsed quality of life, but they are not always incorporated into trials because of the additional resources needed for data collection."
CONCLUSIONS: No evidence of a Hispanic advantage was found in cancer survival. Improvement in mortality follow-up procedures for Latinos, especially for those without a valid social security number, is critical. By considering Hispanics as a whole rather than by subgroup, existing survival disparities are being missed.
abstract: Healthy eating index and ovarian cancer risk. [Cancer Causes Control. 2011] - PubMed result
The evidence for a role of diet on ovarian cancer prevention remains inconclusive.
While many studies have evaluated individual foods and food groups, the evaluation of a comprehensive dietary quality index for predicting cancer risk has received little attention.
This study investigates the association between the Healthy Eating Index (HEI), which reflects adherence to the current USDA Dietary Guidelines for Americans and ovarian cancer risk in a population-based case-control study in New Jersey. A total of 205 cases and 390 controls completed the Block 98.2 food frequency questionnaire (FFQ) in addition to reporting on potential risk factors for ovarian cancer. FFQ data were then utilized to calculate the HEI score, and cup, ounce, gram, or caloric equivalents for the 12 different food groups comprising the index. In multivariate models, the OR for the highest tertile of the HEI score compared with the lowest (reflecting a better diet compared with a worse diet) was 0.90 (95% CI: 0.55-1.47).
There was limited evidence for a statistically significant association between any of the 12 individual food components and ovarian cancer risk. Based on this study's results, neither individual food groups nor dietary quality showed potential for preventing ovarian cancer.
abstract: A non-BRCA1/2 hereditary breast cancer sub-group defined by aCGH profiling of genetically related patients (BRCAx)
Despite intense efforts to find additional high-risk breast cancer genes (BRCAx) using linkage analysis, none have been reported thus far.
Here we explore the hypothesis that BRCAx breast tumors from genetically related patients share a somatic genetic etiology that might be revealed by array comparative genomic hybridization (aCGH) profiling.
As BRCA1 and BRCA2 tumors can be identified on the basis of specific genomic profiles, the same may be true for a subset of BRCAx families. Analyses used aCGH to compare 58 non-BRCA1/2 familial breast tumors (designated BRCAx) to sporadic (non-familiar) controls, BRCA1 and BRCA2 tumors. The selection criteria for BRCAx families included at least three cases of breast cancer diagnosed before the age of 60 in the family, and the absence of ovarian or male breast cancer.
Hierarchical cluster analysis was performed to determine sub-groups within the BRCAx tumor class and family heterogeneity. Analysis of aCGH profiles of BRCAx tumors indicated that they constitute a heterogeneous class, but are distinct from both sporadic and BRCA1/2 tumors. The BRCAx class could be divided into sub-groups. One subgroup was characterized by a gain of chromosome 22. Tumors from family members were classified within the same sub-group in agreement with the hypothesis that tumors from the same family would harbor a similar genetic background. This approach provides a method to target a sub-group of BRCAx families for further linkage analysis studies.
abstract: Clear cell carcinoma of the ovary: A report from the first Ovarian Clear Cell Symposium, June 24th, 2010 (plus blogger's commentary)
Blogger's Notes: with the exception of the 2 mutations mentioned, there is nothing new in this abstract; social media can overcome past issues with patient accrual
OBJECTIVES: Recent literature has highlighted histological types of ovarian carcinoma as distinct diseases, each with unique clinical and molecular features. Historically, the diagnosis of ovarian clear cell carcinoma (CCC) has been of concern to both patients and physicians due to reports that CCC is associated with a worse prognosis than the more common serous type of ovarian carcinoma (HGSC). This review discusses the unique features of ovarian CCC.
METHODS: In June of 2010, a group of researchers and clinicians convened in Vancouver to review and discuss the clinical, pathological, molecular, and treatment-related features of CCC.
RESULTS: CCC is the second most common type of ovarian epithelial cancer, representing 5-25% of ovarian carcinomas. It is characterised by its association with endometriosis, and frequent mutations of ARID1A and PIK3CA. Low-stage CCC appears to have a better outcome than stage matched HGSC, while the opposite is true for high-stage disease, suggesting that the current standard treatments applied to HGSC (high grade serous) are ineffective for CCC.
CONCLUSIONS: Ovarian CCC is highly distinct from HGSC, and a clearer understanding of the basic biology of this disease is needed. Alternative therapies should be explored: irradiation and targeting disease-specific molecular markers should be examined in greater detail. Finally, novel approaches to clinical trial design are needed due to the smaller numbers of patients affected.
abstract: Surgical staging of early stage epithelial ovarian... [Gynecol Oncol. 2011] - PubMed result
Note: positive lymph node findings upgrade staging from early stage to advanced stage; full access is by subscription ($$$)
OBJECTIVES: The objectives of this study were to determine the adequacy of surgical staging performed on surgically treated epithelial ovarian cancer (EOC) patients with apparent early stage disease and to determine if receipt of surgical staging had an influence on survival.
METHODS: Detailed surgical staging information was collected from medical records for 721 patients diagnosed between 1998 and 2000 with EOC. Patients resided in California or New York and were identified through population-based cancer registries.
RESULTS: Nearly 90% of patients had removal of the omentum and evaluation of bowel serosa and mesentery but only 72% had assessment of retroperitoneal lymph nodes and the majority of patients did not receive biopsies of other peritoneal locations. Only lymph node assessment (as well as node assessment combined with washings and omentectomy) had a statistically significant association with improved survival. The 5-year survival for women with node sampling was 84.2% versus 69.6% for those without this surgical procedure, and patients who did not have lymph node assessment had nearly twice the risk of death as those who did. When patients were stratified by receipt of chemotherapy, lack of node sampling had an effect only on patients who also had no chemotherapy (adjusted HR=2.2, CI=1.0-4.5).
CONCLUSIONS: The results of this population-based study confirm the prognostic importance of surgical staging for women with EOC, and the important role of gynecologic oncologists in treating these patients. Adjuvant chemotherapy does not appear to further improve survival for those women who receive adequate surgical staging.
PURPOSE: To clarify the imaging characteristics of ovarian serous surface papillary borderline tumor (SSPBT), whose prognosis is far better than that of serous surface papillary adenocarcinoma (SSPC).
"The function of miR-335 in controlling whether escaped cancer cells can form a new tumor may also be important in ovarian cancer. Women with ovarian cancer who later had a relapse were more likely to be missing a copy of miR-335 in their original tumors than women who did not relapse, the team found."
in research: (miR-429) Discovery may lead to turning back the clock on ovarian cancer | Science Blog
Imedex: Great Debates & Updates in Gynecologic Malignancies April 9, 2011 New York, New York conference notice
Wednesday, February 02, 2011
"Low doses of an inexpensive, FDA-approved hypertension medication may improve the results of nanotherapeutic approaches to cancer treatment. In a report in the early edition of Proceedings of the National Academy of Sciences, Massachusetts General Hospital (MGH) investigators describe experiments showing that the generic drug losartan, by modifying the network of collagen fibers that characterizes most solid tumors, improved the effectiveness of two nanotherapeutics against several types of cancer....."
"....Experiments with two nanotherapeutics – liposomes containing the chemotherapy drug doxorubicin and a virus designed to infect and destroy cancer cells – showed that combining each treatment with losartan significantly reduced the size or delayed the growth of implanted tumors...."
Q: What are the most common types of cancer that are diagnosed in young adults?
A: Among young adults (defined here as those ages 15 to 39), the ten most common types of cancer, in order of frequency, are breast cancer, lymphoma (non-Hodgkin and Hodgkin), melanoma, sarcoma, gynecologic cancers of the ovary and cervix, thyroid cancer, testicular cancer, colorectal cancer, leukemia, and brain tumors. These types account for 90% of the cancers in this age group.
define: anthropometry - The field that involves the measurement of the dimensions and other physical characteristics of people and the application of this information to the design of things they use.
"....Neither height, weight, BMI, body fat percentage, waist- or hip circumference were associated with overall risk, nor with risk for different subtypes, differentiation grade or stage.
Conclusions: These results demonstrate that a high WHR (waist hip ratio) is associated with a decreased risk of EOC. Other anthropometric factors were not associated with EOC risk."
Conclusions Among women undergoing initial surgery for ovarian cancer, African-American patients are significantly less likely to be operated on by a high-volume surgeon and to undergo important ovarian cancer-specific surgical procedures compared to White patients.
CONCLUSION: This is an unusual case of carcinoma of the gallbladder with metastasis to the breast and ovary, which has not been documented before.
Tuesday, February 01, 2011
Improving Care Bulletin
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If you would like paper copies of this report please contact Jody White at firstname.lastname@example.org.
Cancer - Volume 117, Issue 3 - 1 February 2011 - Wiley Online Library (subscription required to view full text)
Note: this is the index of the most current volume with abstracts only without a subscription; numerous references to ovarian cancer
Polymorphism in the GALNT1 Gene and Epithelial Ovarian Cancer in Non-Hispanic White Women: The Ovarian Cancer Association Consortium
"In summary, the present analysis fails to replicate an earlier reported association of a GALNT1 variant with risk of ovarian cancer. This study highlights the need to replicate putative findings in genetic association studies."
The guidelines created to protect patients making end-of-life decisions may have the opposite effect. A Robert Wood Johnson Foundation Physician Faculty Scholar identifies problems and offers solutions
Sunday, January 30, 2011
Saturday, January 29, 2011
Lancet (abstract) Retraction: validation of gene signatures that predict the response of breast cancer to neoadjuvant chemotherapy: a substudy of the EORTC 10994/BIG 00-01 clinical trial
Note: full details available to subscribers ($$$)
ObjectiveConservative surgery followed by platinum-based chemotherapy is considered the standard approach for pure ovarian dysgerminoma (POD), except for correctly staged IA patients. The aim of study was to evaluate the outcome of IA POD patients with incomplete surgical staging in order to define the proper management.
Friday, January 28, 2011
abstract: Validation of a Self-Concept Scale for Lynch Syndrome in Different Nationalities (multinational study) Denmark, Sweden, Canada
CIHI report 2011: Multiple chronic conditions, not age, main driver of health system use by seniors - debunking the myth
Hormone replacement therapy and breast cancer.
AbstractThere is evidence that hormone replacement therapy (HRT) may both stimulate and inhibit breast cancers, giving rise to a spectrum of activities, which are frequently hard to understand. Here we summarise the evidence for these paradoxical effects and, given the current data, attempt to give an indication where it may or may not be appropriate to prescribe HRT.It is clear that administration of oestrogen-progestin (E-P) and oestrogen alone (E) HRT is sufficient to stimulate the growth of overt breast tumours in women since withdrawal of HRT results in reduction of proliferation of primary tumours and withdrawal responses in metastatic tumours. E-P, E including tibolone are associated with increased local and distant relapse when given after surgery for breast cancer. For women given HRT who do not have breast cancer the only large randomised trial (WHI) of E-P or E versus placebo has produced some expected and also paradoxical results. E-P increases breast cancer risk as previously shown in observational studies. Risk is increased, particularly in women known to be compliant. Conversely, E either has no effect or reduces breast cancer risk consistent with some but not all observational studies. Two observational studies report a decrease or at least no increase in risk when E-P or E are given after oophorectomy in young women with BRCA1/2 mutations. Early oophorectomy increases death rates from cardiovascular and other conditions and there is evidence that this may be reversed by the use of E post-oophorectomy. HRT may thus reduce the risk of breast cancer and other diseases (e.g., cardiovascular) in young women and increase or decrease them in older women.
Thursday, January 27, 2011
press release/media: For the Treatment of Second-Line Platinum Sensitive Advanced Ovarian Cancer, One-Third of Surveyed Oncologists Indicate That Paclitaxel/Carboplatin Has the Best Overall Clinical Profile When Compared to Other Currently Available Therapies
The NCI Center for Cancer Research (CCR) conducts more than 150 cancer clinical trials at theNational Institutes of Health (NIH) Clinical Center in Bethesda, Maryland. Cancer clinical trialsthat take place at the NIH Clinical Center are open to patients with cancer, regardless of where they live in the United States.
*Cancer by type/disease: Solid Tumor (Adult)
in research: Scientists Work on New System to Capture Ovarian Cancer Cells Using Magnetic Nanoparticles
Editorial (referencing Lancet article/sleep deprivation): Canadian Journal of Surgery [February 2011]
|Staff surgeon competence|
[full text in PDF]
|La compétence des chirurgiens en titre|
[full text in PDF]
Wednesday, January 26, 2011
clinical trial: Primary Tumor Harvest for the Purpose of Possible Use in a Future Clinical Trial in Patients With Ovarian, Fallopian Tube or Primary Peritoneal Cancer
The aim of this study is to determine the frequency of the three most common BRCA1 and BRCA2 genetic mutations that are commonly found in Ashkenazi Jewish patients with pancreatic cancer. Testing for BRCA1 and BRCA2 mutations in relatives of hereditary pancreatic cancer patients may have a significant impact; allowing for early screening, treatment, and resection of pre-malignant tissue or malignant lesions.
clinical trial: Anonymous Testing of Pathology Specimens for BRCA (and Lynch Syndrome MSH2) Mutations in Ashkenazi Jewish Individuals Who Have Cancer
|Extrahepatic Bile Duct Cancer|
free full access: Chemosensitivity and outcome of BRCA1- and BRCA2-associated ovarian cancer patients after first-line chemotherapy compared with sporadic ovarian cancer patients — Ann Oncol
"It seems astonishing that in the 21st century decisions on health care can still be made without a solid grounding in research evidence. This is true even in clinical research, whether for simple or complex interventions , where systematic reviews time and time again conclude that the evidence base is inadequate . It is even more true in the areas of health policy and health systems, where quality research is hampered further by a lack of shared definitions, a lack of consensus on guiding principles, poor capacity (especially in low-resource regions), and methodological challenges ,.
The World Health Report (WHR) for 2012 will be on the theme of “No Health without Research”. This flagship report from WHO will, for the first time in its history, focus on research for better health. The primary target audience of the report will be ministers of health in the WHO member states, and the goal of the report is to provide new ideas, innovative thinking, and pragmatic advice for member states on how to strengthen their own health research systems. The report will have the three following aims.
- To show that research is important for meeting health needs and improving health outcomes;
- To encourage countries to therefore invest more resources in developing and strengthening their national health research systems;
- To argue that countries should not see research as an expense or as an afterthought, but as an investment for a better, healthier future.....cont'd
Thirty-day mortality rate in women with cancer and venous thromboembolism. Findings from the RIETE Registry (abstract)
Note: different adverse events depending on cancer site
FDA review indicates possible association between breast implants and a rare cancer (see Blogger's Notes on this issue)
Blogger's Notes: for background information regarding the long standing health issues concerning breast implants do a 'litigation' search. Past research on
the issue of risk/breast implants (noncancer/cancer issues) includes many
lawsuits, the latter of which were settled by some of the manufacturers without admission of fault (guilt). The past lawsuits (class action suits) were based on the older forms of implants.
Takeda Pharmaceutical and the Takeda Oncology Company: Millennium, have commenced TRINOVA-1 Phase III clinical trial on anti-cancer agent AMG 386 in Japan
American Society of Clinical Oncology Statement: Toward Individualized Care for Patients With Advanced Cancer — JCO
Addition of Bevacizumab to Chemotherapy for Treatment of Solid Tumors: Similar Results but Different Conclusions
Table 1. Randomized Phase III Studies Comparing Chemotherapy With or Without Bevacizumab As First-Line Chemotherapy for Advanced Epithelial Cancers
Tuesday, January 25, 2011
Involving the public in healthcare policy: An update of the research evidence and proposed evaluation framework | RAND
Blogger's Note: worth reading if not, critically, somewhat old news
IAPO calls on WHO member states to involve patients at all levels to meet the health related MDGs (Millennium Development Goals)| A global voice for patients
"To do this effectively, patients must be involved in both the design and delivery of their care."
Cost recovery (handouts) trumps concerns about conflicted interest -- Canadian Medical Association Journal
Although there's widespread variation in the policies that Canadian medical schools have toward pharmaceutical and medical devices industry handouts for medical education and in some cases, seemingly no policies at all, administrators say there is no need for restrictive guidelines ....cont'd
Association Between a Name Change from Palliative to Supportive Care and the Timing of Patient Referrals -- The Oncologist
"....Because of the nature of our institution as a comprehensive cancer center
with a large patient volume, the results might not be generalizable to smaller cancer centers and oncology programs in other areas. However, the findings
of our study regarding a higher overall number of referrals and earlier
referrals in the outpatient setting confirm the findings of our previous
survey study on the attitudes and beliefs of medical oncologists and
midlevel providers regarding the term palliative care. We believe
that these findings and the difference in referral pattern after the
name change are not center specific but rather reflect perceptions
among health care professionals in the U.S. regarding the strong
associations among palliative care, hospice, and end of life."
Conclusion The name change to supportive care was associated with more inpatient referrals and earlier referrals in the outpatient setting. The outpatient setting facilitates earlier access to supportive/palliative care and should be established in more centers.
Of interest: note reference to organ transplant (not new news but under-recognized??)
In the cancer clinic, physicians and other oncology caregivers are
occasionally asked whether cancer can ever be passed along from
one individual to another. One example is the wife who asks whether
she could ever "catch" cancer from her husband with prostate cancer.
Although the answer to that one is no, the question of a man "catching"
cancer from a partner with cervical cancer is not unrealistic since
various strains of human papilloma virus are known causes of cervical
cancer as well as penile cancer. Pathogens including certain viruses,
bacteria, and parasites represent major causes of cancer in developing
parts of the world. In fact, an estimated 1.5 million cases per year or
15% of all cancers worldwide can be attributed to infectious
etiologies, mostly due to viral infections...."cont'd