Friday, January 27, 2012
the Oncologist: Characteristics of Oral Mucosal Events Related to Bevacizumab (Avastin) Treatment (study of 4 patients)
Background.
Bevacizumab, a monoclonal antibody targeting a vascular endothelial growth factor (VEGF) protein, has been reported to induce mucosal toxicities. However, the clinical characteristics of these particular toxicities have not been well characterized. We aimed at providing a detailed clinical description of signs and symptoms limited to the tongue mucosa in patients treated with bevacizumab.
Conclusion. These characteristic clinical findings are consistent with geographic tongue. However, large prospective evaluations are necessary to confirm this potential relationship. If bevacizumab is indeed associated with geographic tongue, increased awareness may result in improved reporting and characterization of this particular adverse event.
"Asymptomatic geographic tongue does not necessitate
treatment or bevacizumab interruption, and patients should be
reassured about the benign nature and course of this condition.
Associated symptoms may be alleviated with topical anesthetic
agents, topical or systemic antihistamines, corticosteroids,
and anxiolytics [10, 11, 14]. Successful management
with topical tretinoin, systemic acitretin, vitamin A acid therapy,
and cyclosporin has also been reported in the non-oncologic
setting [11, 14]."
conference notice: Welcome - Bienvenue | World Cancer Congress Montreal August 27-30th (UICC World Cancer Congress)
UICC and its hosts Fondation québécoise du cancer, McGill University and Université de Montréal; are pleased to announce that the next UICC World Cancer Congress will take place from the 27-30 August 2012 at the Palais des Congrès Montréal, Canada.
Held every two years, the Congress represents a unique and ideal platform for the international cancer control community to meet, discuss, share, learn and connect in order to find solutions to reduce the impact of cancer on communities around the world. With this in mind the theme for the for the 2012 congress is "Connecting for Global Impact" and highlights the need for continued support and momentum in translating the benefits of knowledge gained through research and practice to those living with and affected by cancer.
open access: PLoS ONE: Immunohistochemical Profile for Unknown Primary Adenocarcinoma (CUP) (lung, digestive, gynecologic, prostate, liver, kidney, breast, urothelial, unclassified)
Background
Development of tailored treatment based on immunohistochemical profiles (IPs) of tumors for cancers of unknown primary is needed.
~~~~~~~~
The primary tumor sites based on the immunohistochemical profiles (IPs)
for the 71 unknown primary patients were the lung for 17 patients,
digestive organs for 13, gynecological organs for 9, prostate for 7,
liver/kidney for 6, breast for 4, urothelial for 2, and were not
unclassified for 13 patients (Table 2).Figures 2 and 3 show typical IHC results for the breast and lung profiles. ~~~~~~~~~
Methodology/Principal Findings
"We developed an algorithm based on primary known adenocarcinoma for testing sensitivity and specificity. Formalin-fixed paraffin-embedded tissue samples from 71 patients of unfavorable subsets of unknown primary adenocarcinoma were obtained. We examined 15 molecular markers using the algorithm incorporating these IPs and classified the tumours into 9 subsets based on the primary tumour site. The sensitivity and specificity of this algorithm were 80.3% and 97.6%, respectively.""Apparent primary sites were lung in 17 patients, digestive organs in 13, gynecological organs in 9, prostate in 7, liver or kidney in 6, breast in 4, urothelial organ in 2, biliary tract and pancreatic profile in none, and unclassified in 13."
Response evaluation (treatment plan) and survival analysis:
"...... Response rates by profile are listed in Table 2. A higher response rate was observed for the gynecological profile (67%) than for the other profiles...."Discussion:
"...Further, we consider gynecologic profile may not be necessary to be classified into ovary, endometrial, and cervical adenocarcinoma in the situation of adenocarcinoma of unknown primary because chemotherapies for these cancer become similar in advanced disease [32], [33]..."
The algorithm we generated for orienting primary has value:
"Immunohistochemistory is generally done in routine work for the diagnosis of adenocarcinoma of unknown primary in many cancer centers. Therefore, there is no additional skill or tool in the procedure of diagnosis [10], [25].""This study has some limitations. First, the prognostic value of each IP was potentially underpowered, as the number of patients in each subgroup was somewhat small, not allowing the response rate, PFS, and OS to be compared to historical control data. Second, the results need to be validated in a prospective manner by applying standard treatments for identified primary profiles, to go beyond simply identifying prognostic factors for unknown primary adenocarcinoma....
"In this study, we revealed the prognostic value of a panel composed of immunohistochemistry profiles for patients with adenocarcinoma of unknown primary who received platinum doublet chemotherapy. Orienting primary sites either IHC or cDNA microarray in patients with CUPs is not good enough, we need to examine survival benefit when applying organ-oriented standard chemotherapies for patients with CUPs.
Our results may encourage a prospective randomized trial to compare standard platinum doublet chemotherapy with treatment determined by the IP. This approach may assist in developing new treatment strategy compared to a single arm platinum combination trial"
open access: Diagnostic Pathology | Abstract | Carcinoma involving the gallbladder: A retrospective review of 23 cases - pitfalls in diagnosis of gallbladder carcinoma
Viewing options
- Abstract
- Provisional PDF (1.1MB)
Background
Carcinoma of the gallbladder (GBC) clinically mimics benign gallbladder diseases and
often escapes detection until advanced stage. Despite the frequency of cholecystectomy,
diagnosis of GBC remains problematic in many situations. We sought to identify pathologic
features that contribute to the difficulty in recognition of GBC.
Methods
We identified 23 patients (ranged from 45 to 86 years, male to female ratio 1:4.5)
with carcinoma involving the gallbladder referred to an academic medical center over
a period of 10 years for study. This includes 10 cases of primary GBC, 6 cases of
metastatic tumor to gallbladder, 6 cases of directly invasive adenocarcinoma arising
elsewhere in the biliary tree, and one case of unidentified origin adenocarcinoma.
Primary tumors include adenocarcinoma not otherwise specified (NOS) in 6 cases, papillary
adenocarcinoma in 2 cases, and single cases of undifferentiated carcinoma and combined
adenocarcinoma and neuroendocrine carcinoma (NEC). Metastatic tumors to gallbladder
were from a wide range of primary sites, predominantly the gastrointestinal tract.
- (included) Table 2 - Summary of case details in problematic cases:
- ref. 10. Jain V, Gupta K, Kudva R, Rodrigues GS: A case of ovarian metastasis of gallbladder carcinoma simulating primary ovarian neoplasm: diagnostic pitfalls and review of literature. Int J Gynecol Cancer 2006, 16(Suppl 1):319-321
abstract: Spectrum of (FDG-PET/CT) fluorodeoxyglucose-positron emission tomography/computed tomography and magnetic resonance imaging findings of ovarian tumors.
Abstract
The purpose of this article is to review fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) and magnetic resonance imaging (MRI) findings in a variety of benign, malignant, and borderline malignant ovarian tumors. It is advantageous to become familiar with the wide variety of FDG-PET/CT findings of this entity. Benign ovarian tumors generally have faint uptake, whereas endometriomas, fibromas, and teratomas show mild to moderate uptake. Malignant ovarian tumors generally have intense uptake, whereas tumors with a small solid component often show minimal uptake.
abstract: DICER1 in ovarian cancers : Nature Genetics (sertoli-leydig/juvenile granulosa/sex-cord stromal tumors) : Nature Publishing Group
Abstract:
"Germline mutations in DICER1 underlie a rare syndrome associated with susceptibility to pleuropulmonary blastoma, cystic nephroma and ovarian sex-cord stromal tumors. David Huntsman, Gregg Morin and colleagues (N. Engl. J. Med., published online 21 December 2011; doi:10.1056/NEJMoa1102903) now show that somatic mutations in DICER1 occur at high frequency in non–epithelial ovarian cancers. The authors performed transcriptome and exome sequencing in two Sertoli-Leydig cell tumors, four juvenile granulosa cell tumors and eight primitive germ cell tumors and identified four missense mutations in DICER1 affecting the metal-binding region of the RNase IIIb domain. They subsequently sequenced the portion of DICER1 encoding this region in 101 additional non-epithelial ovarian tumors and identified somatic mutations in 60% of Sertoli-Leydig cell tumors........ On the basis of these findings, the authors propose that these mutations result in an oncogenic miRNA profile whose pathogenicity may be restricted to specific cell types or developmental settings, thereby accounting for the high prevalence of these mutations in particular tumor types."
abstract: Long-Term Clinical Outcome of Patients With Recurrent Epithelial Ovarian Carcinoma: Is it the Same for Each Histological Type?
Abstract
Objectives: This study was conducted to estimate the long-term clinical outcome of patients with recurrent ovarian carcinoma (ROC).
Conclusions: Despite the continuous administration of treatment for ROC, survival is poor, and the extent of therapeutic progress differs according to the histological type.
intereview with Dr David M. Gershenson: Clinical Challenges of Low-Grade (serous) Ovarian Cancer (includes comment on BRAF mutations, borderline tumors, age...)
Editor's Note:
About 10% of all serous ovarian carcinomas are low grade. Recent research indicates that these tumors differ in major ways from high-grade serous ovarian carcinomas. David M. Gershenson, MD, who holds the J. Taylor Wharton, MD, Distinguished Chair in Gynecologic Oncology at The University of Texas MD Anderson Cancer Center in Houston, Texas, discussed with Medscape current approaches to low-grade serous carcinoma of the ovary and peritoneum................................................................
Blogger's Note: a selected item below - read full article for more information:
Medscape: What is the next step for LGSC clinical research?
Dr. Gershenson: The major finding in the GOG 0239 study was a higher response with the MEK inhibitor than with conventional chemotherapy or hormonal therapy, so these drugs need to be studied further. They should also be tested in conjunction with drugs that block the PI3-kinase/Akt pathway. Dual pathway blockade may be required to produce a more robust response.
In the GOG 0239 trial, we saw a response rate of slightly over 15%, which is about 3-fold higher than with conventional chemotherapy and about 50% higher than with hormonal therapies in the recurrent setting. Unlike the situation with melanoma, there was no correlation with mutational status. That was something of a surprise and suggests that we don't understand what the impact of having a mutation is. I was certainly disappointed that there was not a correlation. We are looking at other markers in that pathway using data from that trial, and that analysis has not yet been completed..........
....Finally, the principal advance over the past decade is the recognition of LGSC as a distinct entity[9] -- very different from the typical high-grade ovarian cancers. Women with this subtype deserve separate clinical trials and treatment options.
Cochrane Review: abstract - Robotic assisted surgery for gynaecological cancer.
Abstract
BACKGROUND:
Robotic surgery is the latest innovation in the field of minimally invasive surgery. Robotic surgical systems have been used to perform surgery for endometrial, cervical cancer and ovarian cancer. There is mounting evidence which demonstrates the feasibility and safety of robotic surgery for gynaecological oncology.OBJECTIVES:
To evaluate the evidence for and against robotic assisted surgery in gynaecological cancer.MAIN RESULTS:
No studies were found that met the inclusion criteria. Controlled clinical trials (CCTs) are summarised and analysed, but are not discussed in the main body of the review as they present a high risk of bias.
AUTHORS' CONCLUSIONS:
Well-designed RCTs are required as only low quality evidence from CCTs is available. These studies support the use of robotic assisted surgery for endometrial cancer and cervical cancer, but these findings present a high risk of bias.Common Gastro Disease Occurs Even With High-Fiber Diet - Drugs.com MedNews
FRIDAY Jan. 27, 2012 -- Eating a high-fiber diet does not lower a person's risk of diverticulosis, but a low-fiber diet might, according to a new study that contradicts what doctors have believed for decades....
abstract: Phase I clinical trial of alternating belotecan and oral etoposide in patients with platinum-resistant or heavily treated ovarian cancer (total 6 patients/phase 1)
Abstract:
This study was designed to determine the maximum tolerated dose and toxicity profile of belotecan in combination with oral etoposide in patients with platinum-resistant or heavily treated ovarian cancer, fallopian tubal cancer, and primary peritoneal cancer.
"....Thus, the maximum tolerated dose was reached (50 mg of oral etoposide) and the trial was terminated. The response was evaluable in nine patients and an objective response was observed in four patients (44%) including two complete responses."
medical press: study - Researchers analyze doctor-patient email interactions
“.......There were some very interesting findings in how practitioners use email versus how patients use it,” Geana said....."
"Treatments and lab tests were the most common topics of discussion for both patients and providers."
"Patient to physician email communication is slowly growing as a means of communication within health care. But it is still underutilized and not well-integrated into electronic health records systems,” Greiner said. “Many physicians are still resisting email interactions with patients out of fear of being overwhelmed by a large number of patients. This concern will only be ameliorated when the health care system moves from bricks and mortar, hospital-centered care, to more patient-centered approaches. Understanding the content of doctor-patient emails now, should help us build systems that take advantage of all new communication technologies."
abstract: Implementing an online tool for genome-wide validation of survival-associated biomarkers in ovarian-cancer using microarray data from 1287 patients.
Abstract
"The validation of prognostic biomarkers in large independent patient cohorts is a major bottleneck in ovarian cancer research. We implemented an online tool to assess the prognostic value of the expression levels of all microarray quantified genes in ovarian cancer patients. First, a database was set up using gene expression data and survival information of 1,287 ovarian cancer patients downloaded from GEO and TCGA (Affymetrix HGU133A, HGU133A 2.0 and HGU133+2 microarrays).After quality control and normalization only probes present on all three Affymetrix platforms were retained (n=22,277). To analyze the prognostic value of the selected gene, the patients are divided into two groups according to various quantile expressions of the gene. These groups are then compared using progression free survival (n=1,090) or overall survival (n=1,287). A Kaplan-Meier survival plot is generated and significance is computed. The tool can be accessed online at www.kmplot.com/ovar. We used this integrative data analysis tool to validate the prognostic power of 37 biomarkers identified in the literature.
Of these, CA125 (p=3.7e-5, HR=1.4), CDKN1B (p=5.4e-5, HR=1.4), KLK6 (p=0.002,HR=0.79), IFNG (p=0.004, HR=0.81), P16 (p=0.02, HR=0.66) and BIRC5 (p=0.00017, HR=0.75) were associated with survival. The combination of several probe sets can further increase prediction efficiency.
In summary, we developed a global online biomarker validation platform that mines all available microarray data to assess the prognostic power of 22,277 genes in 1,287 ovarian cancer patients.
We specifically used this tool to evaluate the effect of 37 previously published biomarkers on ovarian cancer prognosis."
not yet recruiting: Trial of (neoadjuvant) Chemotherapy in Ovarian, Fallopian Tube and Peritoneal Carcinoma - Full Text View - ClinicalTrials.gov
Trial of Chemotherapy in Ovarian, Fallopian Tube and Peritoneal Carcinoma
This study is not yet open for participant recruitment.
Verified January 2012 by University of Kentucky
First Received on January 18, 2012. Last Updated on January 26, 2012 History of Changes
Purpose
Purpose
This is a prospective study to evaluate the hypothesis that platinum-based neoadjuvant chemotherapy followed by interval surgical debulking with platinum-based adjuvant chemotherapy is associated with improved maximal surgical cytoreduction rates, comparable survival, decreased morbidity, and increased quality of life in patients with International Federation of Gynecologic Oncology stages IIIC and IV ovarian, primary peritoneal, or fallopian tube cancer when compared to historical controls and to evaluate the hypothesis that cancer induced inflammation is a predictor of poor prognosis and response to therapy in this group of ovarian cancer patients.
CCR Clinical Trials at NIH: Clinical Research: Search for Clinical Trials at NIH
There are 31 clinical trials at NIH that match your search criteria
- Cancer by type/disease: Solid Tumor (Adult)
CCR Clinical Trials at NIH: Clinical Research: Search for Clinical Trials at NIH
There are 14 clinical trials at NIH that match your search criteria:
Cancer by type/disease: Ovarian Cancer
open access: Evaluation of Genomic Applications in Practice and Prevention (EGAPP) (breast, ovarian, Lynch Syndrome...)
Evaluation of Genomic Applications in Practice and Prevention (EGAPP): Implementation and Evaluation of a Model Approach
The EGAPP initiative was launched by the CDC Office of Public Health Genomics
in the fall of 2004. The initiative's goal is to establish and evaluate a systematic, evidence-based process for assessing genetic tests and other applications of genomic technology in transition from research to clinical and public health practice. EGAPP also aims to integrate: - existing recommendations on implementation of genetic tests from professional organizations and advisory committees.1,2,3,4
- knowledge and experience gained from existing processes for evaluation and appraisal (e.g., US Preventive Services Task Force, CDC’s Task Force on Community Preventive Services), previous CDC initiatives (e.g., the ACCE process for assembling and analyzing data on genetic tests; http://www.cdc.gov/genomics/gtesting/ACCE/FBR/index.htm) 5, and the international health technology assessment experience.
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Working Group: Topics
Completed Topics | Topics Under Review | Topics Identified
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