The Royal College of Physicians of London roars : The Lancet

The Royal College of Physicians of London roars : The Lancet

abstract: Serum HE4 as a diagnostic and prognostic marker for lung cancer (study included ovarian cancer patients)

Abstract

We evaluated the diagnostic and prognostic efficacy of human epididymis protein 4 (HE4) for lung cancer patients by using our novel enzyme-linked immunosorbent assay (ELISA) system. We measured serum HE4 levels of cancer patients including 49 lung cancer and 18 ovarian cancer patients. Furthermore, we evaluated the relationship between serum HE4 levels and overall survival after chemotherapy of 24 lung cancer patients. Serum HE4 levels were significantly higher for non-small, small cell lung cancer and ovarian cancer patients than for healthy controls. The area under the receiver operating characteristic curve (AUC) was calculated for differentiation of lung cancer patients and healthy controls. AUC for serum HE4 was 0.988 for differentiating lung cancer patients from healthy controls, with a cutoff value of 6.56 ng/ml (sensitivity = 89.8%, specificity = 100%).
Serum HE4 levels were elevated in 36/40 (90.0%) non-small cell lung cancer patients, 8/9 (88.9%) small cell lung cancer patients and 8/18 (44.4%) ovarian cancer patients. High levels of serum HE4 (>15 ng/ml) after chemotherapy were significantly correlated with worse overall survival after the treatment. These findings suggest that serum HE4 is a potential diagnostic and prognostic marker for lung cancer patients.

abstract: Role of Neoadjuvant Chemotherapy in the Management of Stage IIIC-IV Ovarian Cancer: Survey Results from the Members of the European Society of Gynecological Oncology

Int J Gynecol Cancer. 2012 Mar;22(3):407-16.

Abstract

OBJECTIVE:

The aim of this study is to evaluate the current opinion of the members of the European Society of Gynecological Oncology (ESGO) on the use of neoadjuvant chemotherapy (NACT) in stage IIIC and IV ovarian cancer.

METHODS:

A link to a 21-item questionnaire, with questions about the management of patients with stage IIIC and IV ovarian cancer, was sent 3 times to the ESGO members (N = 1177).

abstract: Unopposed estrogen and estrogen plus progestin menopausal hormone therapy and lung cancer risk in the NIH-AARP Diet and Health Study Cohort

Abstract

PURPOSE:

Previous studies have reported that lung cancer risk may be decreased, increased, or unaffected by prior use of menopausal hormone therapy (MHT).

CONCLUSIONS:

Our results failed to support any substantial alterations in lung cancer risk associated with use of either unopposed estrogen or estrogen plus progestin MHT, even when detailed exposure measures and other risk predictors were considered.

Cancer misdiagnosis claim refuted (From The Oxford Times)

"HOSPITAL bosses have disputed claims that three ‘serious’ cases were misdiagnosed by gynaecological departments in Oxford.
The claim was made by an anonymous GP in a survey by a doctors’ magazine.
He told GP journal Pulse he knew of three ‘serious’ cases which had been misdiagnosed by the gynaecological department at the John Radcliffe Hospital – including one of a patient with ovarian cancer.
He said: “We wrote a letter. All we wanted was something back saying ‘let’s look at this’. Instead we got a five-sentence reply saying ‘under Nice guidelines we did nothing negligent’.”.......

still recruiting: A (phase 11) Study of MK-1775 in Combination With Paclitaxel and Carboplatin Versus Paclitaxel and Carboplatin Alone for Participants With Platinum-Sensitive Ovarian Tumors With the P53 Gene Mutation (MK-1775-004) - Full Text View - ClinicalTrials.gov

Official Title:
A Randomized, Phase II Study Evaluating MK-1775 in Combination With Paclitaxel and Carboplatin Versus Paclitaxel and Carboplatin Alone in Adult Patients With Platinum Sensitive p53 Mutant Ovarian Cancer

 Criteria

Inclusion Criteria:

• Histologically confirmed non-low grade, non-borderline (low malignant potential) ovarian cancer which has progressed after paclitaxel / carboplatin therapy.
• Platinum-sensitive disease. The earliest evidence of progression must have occurred at least 6 months following the completion of the most recent platinum-based treatment.
• Measurable disease.
• Available tumor sample(s).
• Performance status of ≤1 on the Eastern Cooperative Oncology Group (ECOG) Performance Scale.
• Adequate organ function.

Comment on Keeping Up With Science : InTech Publishes 49 New Books For You To Get Hold Of Right Now by sandipniauskas

Comment on Keeping Up With Science : InTech Publishes 49 New Books For You To Get Hold Of Right Now by sandipniauskas:

Thanks on behalf of our ovarian cancer communities, families and friends for your book on Ovarian Cancer and in particular the section by Dr Yi Pan (neuropathy). Yi is a favourite and does so very much for many patients.

PCORI Paddles the Potomac (healthcare systems/dysfunction....)

By Merrill Goozner
Merrill Goozner has been writing about economics and health care for many years. The former chief economics correspondent for the Chicago Tribune, Merrill has written for a long list of publications including the New York Times, The American Prospect, The Washington Post and The Fiscal Times. You can read more pieces by him at GoozNews.

PCORI Paddles the Potomac:

Cynics say Washington is the city where good ideas go to die. A promising strategy for holding down health care costs in the Obama administration’s reform bill – providing patients and doctors with authoritative information on what works best in health care – should provide a classic test of that proposition, assuming the law survives the next election.
Experts estimate anywhere from 10 to 30 percent of the health care that Americans receive is wasted. It is either ineffective or does more harm than good. To put that in perspective, waste costs anywhere from $250 billion and $750 billion a year, or as much as three-fourths of the annual federal deficit.
Yet every effort to curb wasteful spending (health care fraud, though pervasive, is estimated at less than a quarter of the total) has come up short.

Correspondence: Emergency Hospitalizations for Adverse Drug Events — NEJM

To the Editor:

"We commend Budnitz and colleagues (Nov. 24 issue)1 for their contribution to our understanding of emergency hospitalizations caused by adverse drug events. However, as a result of detection bias, it is likely that the relative contribution of bleeding and hypoglycemic manifestations of adverse drug events have been overestimated and that the overall burden of disease has been underestimated. This is because the case-finding methods at institutions participating in the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project rely on coders who use a short list of symptoms that include “bleeding” and “hypoglycemia” to identify adverse drug events.2 Other commonly found manifestations of adverse drug events, such as neuropsychiatric, gastrointestinal, and cardiovascular symptoms, are not listed as triggers and therefore are less likely to be identified.3
In addition, emergency physicians frequently do not attribute emergency department presentations to adverse drug events, which leads to a lack of documentation in hospital records.4 Validation of the triggers in the NEISS-CADES project against a prospective criterion standard would enable a better estimate of the sensitivity of such measures. Prospective case-finding methods may yield more accurate data on the frequency and causes of adverse drug events and on the relative contribution of various adverse drug events to the overall disease burden."

open access - 4 articles: Shared Decision Making — The Pinnacle of Patient-Centered Care NEJM

Perspective

Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm

D.B. Reuben and M.E. Tinetti

• Free Full Text
• Comments

Shared Decision Making — The Pinnacle of Patient-Centered Care

M.J. Barry and S. Edgman-Levitan

• Free Full Text
• Audio Interview
• Comments

Defining “Patient-Centered Medicine”

C.L. Bardes

• Free Full Text
• Comments

What’s the Alternative? The Worldwide Web of Integrative Medicine

R. Srivastava

open access: Shared Decision Making — The Pinnacle of Patient-Centered Care — NEJM

Nothing about me without me.

— Valerie Billingham, Through the Patient's Eyes, Salzburg Seminar Session 356, 1998

"Caring and compassion were once often the only “treatment” available to clinicians. Over time, advances in medical science have provided new options that, although often improving outcomes, have inadvertently distanced physicians from their patients. The result is a health care environment in which patients and their families are often excluded from important discussions and left feeling in the dark about how their problems are being managed and how to navigate the overwhelming array of diagnostic and treatment options available to them..........If we can view the health care experience through the patient's eyes, we will become more responsive to patients' needs and, thereby, better clinicians. Recognition of shared decision making as the pinnacle of patient-centered care is overdue. We will have succeeded in building a truly patient-centered health care system when an informed woman can decide whether to have a screening mammogram and an informed man can consider whether to have a screening prostate-specific–antigen test without their clinicians labeling the decision “wrong” on the basis of different values and preferences.

open access: Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm — NEJM

"Ultimately, good medicine is about doing right for the patient. For patients with multiple chronic diseases, severe disability, or limited life expectancy, any accounting of how well we're succeeding in providing care must above all consider patients' preferred outcomes."

A phase II trial (AGO 2.11) in platinum-resistant ovarian cancer: a randomized multicenter trial with sunitinib (SU11248) to evaluate dosage, schedule, tolerability, toxicity and effectiveness of a multitargeted receptor tyrosine kinase inhibitor monotherapy

A phase II trial (AGO 2.11) in platinum-resistant ovarian cancer: a randomized multicenter trial with sunitinib (SU11248) to evaluate dosage, schedule, tolerability, toxicity and effectiveness of a multitargeted receptor tyrosine kinase inhibitor monotherapy:

Background:
.....This phase II study was conducted to evaluate sunitinib, an oral antiangiogenic multitargeted tyrosin kinase inhibitor, in this setting.

Material and methods:
The primary end point of this randomized phase II trial was the objective response rate according to RECIST criteria and/or Gynecologic Cancer InterGroup CA125 response criteria to sunitinib in patients with recurrent platinum-resistant ovarian cancer who were pretreated with up to three chemotherapies. A selection design was employed to compare two schedules of sunitinib (arm 1: 50 mg sunitinib daily orally for 28 days followed by 14 days off drug; and arm 2: 37.5 mg sunitinib administered daily continuously).

Results:
Of 73 patients enrolled, 36 patients were randomly allocated to the noncontinuous treatment arm (arm 1) and 37 patients were randomly allocated to the continuous treatment arm (arm 2). The mean age was 58.8 and 58.5 years, respectively. We observed six responders (complete response + partial response) in arm 1 (16.7%) and 2 responders in arm 2 (5.4%). The median progression-free survival (arm 1: 4.8 [2.9–8.1] months; arm 2: 2.9 [2.9–5.1] months) and the median overall survival (arm 1: 13.6 [7.0–23.2] months; arm 2: 13.7 [8.4–25.6] months) revealed no significant difference. Adverse events included fatigue as well as cardiovascular, gastrointestinal and abdominal symptoms, hematologic and hepatic laboratory abnormalities. Pattern and frequency of adverse events revealed no substantial differences between both treatment groups.

Conclusions:
Sunitinib treatment is feasible and moderately active in relapsed platinum-resistant ovarian cancer. The noncontinuous treatment schedule should be chosen for further studies in ovarian cancer.

Risk of serious toxicity in 1181 patients treated in phase I clinical trials of predominantly targeted anticancer drugs: the M. D. Anderson Cancer Center experience

Risk of serious toxicity in 1181 patients treated in phase I clinical trials of predominantly targeted anticancer drugs: the M. D. Anderson Cancer Center experience:

Background:

This study assessed toxicity in advanced cancer patients treated in a phase I clinic that focuses on targeted agents.

Patients and methods:

An analysis of database records of 1181 consecutive patients with advanced cancer who were treated in the phase I program starting 1 January 2006 was carried out.

Results:

All patients were treated on at least 1 of the 82 phase I clinical trials. Overall, 56 trials (68.3%) had only targeted agents, 13 (15.9%) only cytotoxics, and 13 (15.9%) targeted and cytotoxic agents. Rates of grade 3 and 4 toxicity that were at least possibly drug related were 7.1% and 3.2%, respectively, and 5 of the 1181 patients (0.4%) died from toxicity that was at least possibly drug related. The most common grade 3 or more toxic effects were neutropenia, thrombocytopenia, anemia, dehydration, infection, altered mental status, bleeding, vomiting, nausea, and diarrhea. Eastern Cooperative Oncology Group (ECOG) performance status greater than zero and use of a cytotoxic agent were selected as independent factors associated with serious toxicity.

Conclusion:

Phase I trials of primarily targeted agents showed low rates of toxicity, with 10.3% of patients experiencing grade 3 or 4 toxicity and a 0.4% rate of death, at least possibly drug related.

Grants.gov - Opportunity Synopsis - OCRP Ovarian Cancer Academy

The synopsis for this grant opportunity is detailed below, following this paragraph. This synopsis contains all of the updates to this document that have been posted as of 02/27/2012 . If updates have been made to the opportunity synopsis, update information is provided below the synopsis.
If you would like to receive notifications of changes to the grant opportunity click send me change notification emails . The only thing you need to provide for this service is your email address. No other information is requested.

Any inconsistency between the original printed document and the disk or electronic document shall be resolved by giving precedence to the printed document.

Document Type:	Grants Notice
Funding Opportunity Number:	W81XWH-12-OCRP-OCA
Opportunity Category:	Discretionary
Posted Date:	Feb 27, 2012
Creation Date:	Feb 27, 2012
Original Closing Date for Applications:	Jul 18, 2012
Current Closing Date for Applications:	Jul 18, 2012
Archive Date:	Aug 17, 2012
Funding Instrument Type:	Cooperative Agreement Grant
Category of Funding Activity:	Science and Technology and other Research and Development
Category Explanation:
Expected Number of Awards:	2
Estimated Total Program Funding:	$2,400,000
Award Ceiling:
Award Floor:
CFDA Number(s):	12.420 -- Military Medical Research and Development
Cost Sharing or Matching Requirement:	No

Eligible Applicants

Unrestricted (i.e., open to any type of entity above), subject to any clarification in text field entitled "Additional Information on Eligibility" Additional Information on Eligibility:

Agency Name

Dept. of the Army -- USAMRAA

Description

The OCRP Ovarian Cancer Academy, which was initially created in FY09, is intended to be a unique, interactive virtual academy providing intensive mentoring, national networking, and a peer group for junior faculty. The overarching goal of the Ovarian Cancer Academy is to develop successful, highly productive ovarian cancer researchers in a collaborative research training environment. The current Ovarian Cancer Academy is a virtual career development and research training platform consisting of seven Early-Career Investigator/Designated Mentor pairs from different institutions and one Academy Dean. The Academy Dean serves as a resource for the Early-Career Investigators and Mentors, assesses the progress of the Early-Career Investigators, and facilitates communication and collaboration among all of the Early-Career Investigators and Mentors.

Link to Full Announcement