University of Pennsylvania School of Medicine - Women with BRCA mutations can take hormone-replacement therapy safely after ovary removal

CHICAGO) ––

Women with the BRCA1 or BRCA2 gene mutations, which are linked to a very high risk of breast and ovarian cancer, can safely take hormone-replacement therapy (HRT) to mitigate menopausal symptoms after surgical removal of their ovaries, according to new research from the Perelman School of Medicine at the University of Pennsylvania which will be presented Monday, June 6 during the American Society for Clinical Oncology's annual meeting (Abstract #1501). Results of the prospective study indicated that women with BRCA mutations who had their ovaries removed and took short-term HRT had a decrease in the risk of developing breast cancer...............

Domchek says some of the confusion about the role of HRT in cancer risk elevation comes from the fact that the risks and benefits associated with HRT depend on the population of women studied. In this group of women – who have BRCA1/2 mutations and who have had their ovaries removed while they are quite young – HRT should be discussed and considered an option for treating menopausal symptoms. "People want to make hormone replacement therapy evil, so they can say 'Don't do it,'" she says. "But there isn't one simple answer. The devil is in the details of the studies."

By contrast, Penn researchers and their collaborators in the PROSE consortium have shown definitively that oophorectomy reduces ovarian and breast cancer incidence in these women, and reduces their mortality due to those cancers. But paying attention to the role that hormone depletion following preventive oophorectomy plays in women's future health (blogger's note: eg. cardiovascular) is also important............"

Changes in Oncology Practice Could Save Billions

press release: Pfizer Licenses PARP Inhibitor To Clovis Oncology (PF-01367338)

"...PF-01367338 would be developed by Clovis as both a monotherapy and in combination with chemotherapeutic agents for the potential treatment of selected cancer patients.
PF-01367338 is currently in a Phase 1 clinical trial examining the maximum tolerated dose of oral PF-01367338 that can be combined with intravenous platinum chemotherapy in the treatment of solid tumors.
Supplementing this trial are two ongoing trials, currently using the IV formulation, a Phase 1/2 study in germline BRCA-mutant (gBRCA) breast and ovarian cancer and a Phase 2 study in the adjuvant treatment of triple negative breast cancer. Clovis intends to replace the IV formulation with the oral formulation in these studies.
Clovis was founded by former executives of Pharmion Corp., which was acquired by Celgene Corporation in 2008. The company is headquartered in Boulder, Colorado, and has additional offices in San Francisco and London."

Medical News: Group Issues Gyn Cancer Follow-Up Guidance - MedPage Today

For ovarian (epithelial)  cancer, the committee recommended:

• Physical exam and review of symptoms: Every three months for two years, followed by increasing intervals
• Pap test: Not indicated
• CA-125: Optional
• Radiographic imaging: Insufficient data to support routine use
• Suspected recurrence: CT and/or PET, plus CA-125

The recommendations differ for non-epithelial ovarian cancer:

• Physical exam and review of symptoms: Every two to four months for two years, then every six months or annually depending on histology
• Serum tumor markers: Every two to four months for two years, then every six months for sex-cord stromal tumors but no longer indicated for germ-cell tumors
• Radiographic imaging: Generally, not indicated or data lacking to support routine use
• Suspected recurrence: CT and tumor markers

Noting a trend toward transitioning more patients from oncologists to primary care physicians, the committee pointed to evidence that many primary care physicians do not feel comfortable with post-treatment surveillance, particularly during the first two years after treatment. (blogger's note: search blog for past papers on these issues, also the 2 years post treatment is based on old data)


Moreover, a survey of primary care providers showed that respondents believed transition of oncology patients could be improved with individualized patient summaries, guidelines for surveillance, and expedited referral for suspected recurrence, the committee members noted.

"Thus, the provision of up-to-date information and the education of both patients and physicians are mandatory," they wrote.

"Action Points

Point out that this report indicates that there is very little evidence that either routine cytologic procedures or imaging are sufficiently useful to detect ovarian and endometrial cancer recurrence and alter response rates to salvage therapy.

Note that this report suggests that the most effective method to detect recurrences is a taking a thorough history, performing a detailed physical examination, and educating patients about relevant symptoms."

SGO sets new standards to monitor recurrence of gynecologic cancer more effectively

"The article is “Post treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology recommendations: by Ritu Salani, MD, MBA; Floor J. Backes, MD; Michael Fung Kee Fung, MB, BS; Christine H. Holschneider, MD; Lynn P. Parker, MD; Robert E. Bristow, MD, MBA; and Barbara A. Goff, MD (doi: 10.1016/j.ajog.2011.03.008). It will appear in the American Journal of Obstetrics & Gynecology, Volume 204, Issue 6 (June 2011) published by Elsevier."

Patient Page: BRCA Genes and Breast Cancer — JAMA

PROGNOSIS With screening mammograms and breast MRIs, timely treatment, and/or prophylactic surgery, the life expectancy in BRCA carriers approaches the life span of noncarriers.

Editorial/link to paper: The Use and Misuse of ICU Telemedicine — JAMA

"....A large, multicenter study published recently showed no demonstrable clinical benefit, 4 and a recent meta-analysis found no beneficial association between ICU telemedicine and in-hospital mortality. 5 These results have left clinicians, hospital administrators, and policy makers wondering how to best use this technology, if at all."

extract only: A New Frontier in Patient Safety - McCannon and Berwick — JAMA Partnership for Patients

Note: this is a pay-per-view article ($$$)

Comparison of Effect Sizes Associated With Biomarkers Reported in Highly Cited Individual Articles and in Subsequent Meta-analyses — JAMA

Context Many biomarkers are proposed in highly cited studies as determinants of disease risk, prognosis, or response to treatment, but few eventually transform clinical practice.

Objective To examine whether the magnitude of the effect sizes of biomarkers proposed in highly cited studies is accurate or overestimated.................

Conclusion Highly cited biomarker studies often report larger effect estimates for postulated associations than are reported in subsequent meta-analyses evaluating the same associations. 

conference announcement: (UK) Molecular Diagnostics for Cancer Drug Development

Author Insights: Beware of Overestimating Biomarker Validity - JAMA

press release - UK - Targeted testing offers treatment hope for ovarian cancer patients

Public release date: 30-May-2011

Targeted testing offers treatment hope for ovarian cancer patients 
 
Women with ovarian cancer could be helped by a new test that identifies the specific type of tumour they have, a conference will hear this week.
Researchers at the University of Edinburgh hope this improved diagnosis will help doctors to personalise treatment programmes so that patients receive the most effective drugs.
The Edinburgh team worked with scientists from Ireland to identify six subgroups of the disease, each of which had a different genetic signature.
To do this, they analysed tissue samples from more than 350 ovarian cancer patients and compared this information with the patients' medical records.
The results show how genetic profiling of ovarian cancers might predict a person's response to drug treatments.
Researchers say the development may be particularly helpful for women with an aggressive form of ovarian cancer, which is typically caught late by current diagnostic tests.
This type of aggressive – or 'high grade' – cancer can respond well to a recently-developed drug that targets the blood supply of the cancer cells. (blogger's note - it is not clear from this press release  if this is specific to serous cell type)
The team hopes that by identifying the women with this type of cancer at the earliest opportunity, they could use the drug more effectively and help to improve survival rates.
The findings will be presented at the American Society of Clinical Oncology (ASCO) conference, being held in Chicago this week.
Dr Charlie Gourley of the University of Edinburgh, who led the study, said: "This research shows that by conducting a detailed analysis of the genes of ovarian cancers we may be able to identify those patients who will respond well to new drug treatments. This could bring valuable improvements in survival rates for the disease and would help us to personalise a patient's care to ensure the greatest possible success."
Ovarian cancer is the fifth most common cancer in women, with around 6,800 women being diagnosed every year in the UK.
Of these, nearly two-thirds will not live beyond five years of their diagnosis.
Chemotherapy and surgery can be effective treatments, but women could have a greater chance of surviving the disease if it is identified earlier on.
The findings will be presented at ASCO on Saturday 4th June.

Initiatives and Resources | Psychosocial Oncology Education Opportunities Directory | Cancer View Canada

Note:  

this program includes providers, volunteers and students but does not include patients/families/caregivers
------------------------------------------------------------------

Psychosocial Oncology Education Opportunities Directory

This directory connects you with information relating to psychosocial oncology education opportunities available throughout Canada.

These include:

• courses
• field/clinical placements and field/clinical training opportunities
• research training opportunities
• other opportunities such as conferences, workshops, retreats

Canadian Cancer Statistics 2011

Canada - Ovary - incidence  2,600
Canada - Ovary - deaths      1,750
est. 5 yr survival rate ovarian cancer (all stages) 42%
est. 5 yr survival rate breast cancer 88%

* see table 2.2 for provincial stats

* see table 6 for lifetime probability of developing and dying from
ovarian cancer (1 in 69 ;  1 in 92)


(important note regarding stats - to put this in perspective,  overall incident rates of ovarian cancer is relatively low (2,600 est. women annually/national basis)  as a comparison to other cancers, however, as we know there still is no early detection test)

press release: OVARIAN CANCER (in) CANADA | Harris Decima survey shows Canadian women more aware of ovarian cancer (not so fast...)

Note: poorly written press release or;  was it the survey? the question/s ? the design?

Blogger's keypoints - in matters of full transparency:

* where are the results of the full survey? 

* demographics of repondents ?

the prior survey done in 2005 was not made available to the public either - yet funded with public/survivour funding

1) Randomized sampling = 1,010  in Canada
2) Canada's population est = 2011 - 34,409,066 

Blogger's Note: No explanation on the 51 years? exactly 51 years of age ?

"Other key study findings include:

• Awareness of ovarian cancer as a potentially fatal disease has increased (71% vs. 65%), particularly among women 51 years and older, who are at a greater risk of being diagnosed with ovarian cancer (71% vs. 58%)"

 

Expert Opinion: The Therapeutic Target Database: an Internet resource for the primary targets of approved, clinical trial and experimental drugs

Note: the full article is pay-per-view ($$$)

".....Increasing numbers of proteins, nucleic acids and other molecular entities have been explored as therapeutic targets.

A challenge in drug discovery is to decide which targets to pursue from an increasing pool of potential targets, given the fact that few innovative targets have made it to the approval list each year.

Knowledge of existing drug targets (both approved and within clinical trials) is highly useful for facilitating target discovery, selection, exploration and tool development. The Therapeutic Target Database (TTD) has been developed and updated to provide information on 358 successful targets, 251 clinical trial targets and 1254 research targets in addition to 1511 approved drugs, 1118 clinical trials drugs and 2331 experimental drugs linked to their primary targets (3257 drugs with available structure data).

This review briefly describes the TTD database and illustrates how its data can be explored for facilitating target and drug searches, the study of the mechanism of multi-target drugs and the development of in silico target discovery tools."

Evidence Updates including professional commentaries: Safety of Probiotics to Reduce Risk and Prevent or Treat Disease.

"....Existing studies primarily examined Lactobacillus alone or in combination with other genera, often Bifidobacterium.

Few studies directly compared the safety among different intervention or participant characteristics. Indirect comparisons indicated that effects of delivery vehicles (e.g., yogurt, dairy) should be investigated further.

Case studies suggested that participants with compromised health are most likely to experience adverse events associated with probiotics. However, RCTs in medium-risk and critically ill participants did not report a statistically significantly increased risk of adverse events compared to control group participants.

Conclusions. There is a lack of assessment and systematic reporting of adverse events in probiotic intervention studies, and interventions are poorly documented. The available evidence in RCTs does not indicate an increased risk; however, rare adverse events are difficult to assess, and despite the substantial number of publications, the current literature is not well equipped to answer questions on the safety of probiotic interventions with confidence."

Evidence Updates including professional commentaries - : Acupuncture: does it alleviate pain and are there serious risks? A review of reviews.

Acupuncture is commonly used for pain control, but doubts about its effectiveness and safety remain.

This review was aimed at critically evaluating systematic reviews of acupuncture as a treatment of pain and at summarizing reports of serious adverse effects published since 2000. Literature searches were carried out in 11 databases without language restrictions. Systematic reviews were considered for the evaluation of effectiveness and case series or case reports for summarizing adverse events. Data were extracted according to predefined criteria. Fifty-seven systematic reviews met the inclusion criteria. Four were of excellent methodological quality. Numerous contradictions and caveats emerged. Unanimously positive conclusions from more than one high-quality systematic review existed only for neck pain. Ninety-five cases of severe adverse effects including 5 fatalities were included. Pneumothorax and infections were the most frequently reported adverse effects.

In conclusion, numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain. Serious adverse effects continue to be reported. Numerous reviews have produced little convincing evidence that acupuncture is effective in reducing pain.

Serious adverse events, including deaths, continue to be reported.

EvidenceUpdates + professional commentaries (numerous): Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women`s Health Initiative limited access dataset and meta-analysis

OBJECTIVES: To investigate the effects of personal calcium supplement use on cardiovascular risk in the Women`s Health Initiative Calcium/Vitamin D Supplementation Study (WHI CaD Study), using the WHI dataset, and to update the recent meta-analysis of calcium supplements and cardiovascular risk.

DESIGN: Reanalysis of WHI CaD Study limited access dataset and incorporation in meta-analysis with eight other studies.........

Conclusions: Calcium supplements with or without vitamin D modestly increase the risk of cardiovascular events, especially myocardial infarction, a finding obscured in the WHI CaD Study by the widespread use of personal calcium supplements. A reassessment of the role of calcium supplements in osteoporosis management is warranted.

Expert Opinion on Investigational Drugs -Investigational antibody drug conjugates for solid tumors Summary (Pfizer)

Note: access to the full article is payer-per-view ($$$)

"Despite the progress made in the past 20 years in understanding the molecular events leading to the formation of cancer, the success of targeted antitumor agents in solid tumors has lagged behind the scientific discoveries. The most difficult to treat patient segments are those with refractory solid tumors, resistant to standard chemotherapy, and novel therapeutic compounds with improved therapeutic indexes are needed. Antibody drug conjugates (ADCs) are poised to become an important class of cancer therapeutics, as evidenced by the promising objective response rates when administered as single agents to chemorefractory cancer patients..........Herein, we review ADCs (Antibody drug conjugates) targeting solid tumors, with the focus on 11 programs currently undergoing clinical development....)

Johns Hopkins to open new $10 million patient safety institute - media

"The medical community put a focus on patient safety more than a decade ago, when the Institute of Medicine released a report blaming medical errors for up to 100,000 patient deaths a year. Patient safety researchers and advocates say little has been done to prevent those errors, and they now believe the number of mistakes is much higher....."

forwarded by a survivor: The Cassandra Experience

".....Vision and Goals Vision: We define the prophetic voice as the one that recognizes present realities as they are, reveal to us the error of our ways, predict what may ensue if we refuse to change, and point the way toward a better life for all. We envision a world in which those who are endowed with such a voice and dare to use it openly will be revered and valued members of families, communities, countries and humanity as a whole. That we will learn to listen and learn from such a voice, rather than shun and condemn it. Our project endeavours to make a tangible and creative contribution toward such a world........"

abstract: Mucinous carcinomas of the ovary and colorectum: different organ, same dilemma : The Lancet Oncology

Mucinous carcinomas of the ovary and colorectum: different organ, same dilemma

Dr Linda E Kelemen ScD a d , Martin Köbel MD b c

Summary

Mucinous carcinomas are uncommon histological types that affect several organ sites. 

 

Primary mucinous carcinomas of the ovary are distinct from other ovarian carcinoma types, but they can pose a particular challenge for correct diagnosis from metastases, which most usually originate from the colorectum. 

 

Correct diagnosis is the mainstay of treatment, because standard practice states that protocols are tailored to the primary organ site. Little is known of mutational alterations in primary and metastatic mucinous carcinomas of the ovary, and few markers exist that can discriminate between them. 

 

We reviewed commonalities between ovarian and colorectal mucinous carcinomas with respect to aetiology, molecular alterations, differential diagnosis, and implications for treatment. 

 

Although primary mucinous carcinomas of the ovary and colorectum share similar mutational patterns and unfavourable outcomes at advanced stage, compared with their non-mucinous counterparts, important differences exist with respect to mucin localisation and specific molecular alterations.  

 

Technologies—eg, next-generation sequencing—could aid identification of additional driver molecular changes that will help clarify the relation between mucinous carcinomas from different organ sites. Perhaps, then, we can consider moving towards testing and adoption of therapeutic approaches tailored to molecular characteristics of mucinous carcinomas, irrespective of organ site, so patients' survival can be optimised.

abstract: Mitochondrial DNA genotyping reveals synchronous nature of simultaneously detected endometrial and ovarian cancers.

Abstract

Simultaneous independent primary tumors of the female genital tract occur in 1-2% of gynecological cancer patients, 50-70% of which are synchronous tumors of the endometrium and ovary. 

Guidelines for determining the nature of simultaneously detected tumors, based on surgical and histopathological findings, are often ambiguous and may require further molecular analyses.

Such approach is necessary to indicate correct prognosis and hence treatment.

We here demonstrate how mitochondrial DNA sequencing may provide a cheap and useful tool to contribute to indisputably recognize the synchronous nature of simultaneously detected endometrial and ovarian carcinomas. We further confirm our findings by means of Comparative Genomic Hybridization array analysis, which strengthens the informative potential of mitochondrial DNA genotyping in diagnosing synchrony.

abstract: Effects of bevacizumab and pegylated liposomal doxorubicin for the patients with recurrent or refractory ovarian cancers

OBJECTIVES:
Currently, pegylated liposomal doxorubicin (PLD) is regarded as one of the standard treatment options in recurrent ovarian cancers (ROC). Bevacizumab has shown significant antitumor activity for ROC in single-agent or in combination with cytotoxic agents. We have conducted a preliminary study to investigate effects of combination of bevacizumab and PLD for heavily pretreated patients with ROC.

CONCLUSION:
The present investigation suggested that combination therapy with bevacizumab and PLD was active and well tolerated for patients with ROC. We recommend the regimen be evaluated in further clinical studies.

abstract: Cost-effectiveness of combination versus sequential docetaxel and carboplatin for the treatment of platinum-sensitive, recurrent ovarian cancer

CONCLUSIONS:

Combined weekly cDC (concurrent docetaxel and carboplatin) appeared to be cost-effective compared with sDC (sequential docetaxel and carboplatin ) as treatment strategy for patients with platinum-sensitive ovarian cancer, even when accounting for slightly lower QoL during treatment.

abstract: Feasibility of a lifestyle intervention for ovarian cancer patients receiving adjuvant chemotherapy

OBJECTIVES

This study aimed to assess the feasibility of a lifestyle intervention for promoting physical activity (PA) and diet quality during adjuvant chemotherapy for ovarian cancer.

METHODS:

Patients were enrolled post-operatively and received PA and nutrition counseling, at every chemotherapy visit for six cycles. Quality of life (QoL) was measured with the Functional Assessment of Cancer Therapy (FACT-G), PA with the Leisure Score Index (LSI), dietary intake with 3-day food records, and symptom severity/distress by the Memorial Symptom Assessment Scale (MSAS). Pedometer step count was collected during chemotherapy cycles.

RESULTS:

Recruitment was 73% with 27 patients enrolled. Mean [95% confidence interval] change in minutes of PA from cycle #3 to following cycle #6 was 61min [-3, 120] p=0.063, and from baseline to after cycle #6 was 73min [-10, 15]; p=0.082. Mean change in total fruit and vegetable consumption between baseline and during chemotherapy was 0.56 [-0.09, 0.64]; p=0.090. FACT-G increased from 75.4 at baseline to 77.6 during chemotherapy and 83.9 following chemotherapy (p=0.001 for change from baseline to post-chemotherapy).


Mean total MSAS ( Memorial Symptom Assessment Scale) score was 20.6 at baseline, 26.6 at cycle #3 and decreased to 17.0 following chemotherapy (p=0.01 comparison of cycle #3 and following chemotherapy). Increased moderate to strenuous PA was correlated with higher physical well-being during chemotherapy (r=0.48, p=0.037).

CONCLUSIONS:

Lifestyle counseling during adjuvant chemotherapy for ovarian cancer is feasible and may improve PA and diet quality. Randomized controlled trials examining the effects of lifestyle counseling on quality of life and treatment outcomes in ovarian cancer patients are warranted.

Editorial - no abstract/pay-per-view: - Gynecologic Oncology : More than a biomarker: CA125 may contribute to ovarian cancer pathogenesis

Abstract

Gynecologic Oncology
Volume 121, Issue 3, 1 June 2011, Pages 429-430

---

Editorial

More than a biomarker: CA125 may contribute to ovarian cancer pathogenesis

Purchase

$ 39.95

Robert C. Bast Jr.^{a, ,} and David R. Spriggs^b

^a Department of Experimental Therapeutics, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
^b Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA

Available online 19 May 2011.

References

Corresponding author. Unit 1439, U.T. M.D. Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA. Fax: +1 713 792 7864.

Purchase

$ 39.95

Copyright © 2011 Published by Elsevier Inc.

abstract: Pyridoxine (Vitamin B6) to protect from oxaliplatin-induced neurotoxicity without compromising antitumour effect

CONCLUSIONS:

Administration of pyridoxine (Vitamin B6) , at concentrations extending across possible therapeutic plasma levels in humans, does not antagonise OHP (Oxaliplatin) antitumour effects in a range of relevant tumour cell lines.

This study provides a foundation for clinical studies to test whether pyridoxine can minimise OHP-related neurotoxicity, and clinicians can be confident that pyridoxine is very unlikely to reverse the antitumour effects of OHP, as seems to be the case with Ca/Mg infusions.

This could prove to be a cost-effective way to minimise OHP-related neurotoxicity, allowing more effective less toxic treatment and better outcomes in patients.

Women of Teal: Today was All About Cancer Research in NJ

abstract: Reducing Time to Diagnosis Does Not Improve Outcomes for Women With Symptomatic Ovarian Cancer: A Report From the Australian Ovarian Cancer Study Group

Abstract

Purpose To determine if time to diagnosis is associated with stage of disease at diagnosis or survival among women with symptomatic ovarian cancer..........

Conclusion The results of this study suggest that, once ovarian cancer is symptomatic, reducing the time to diagnosis would not greatly alter stage of disease at diagnosis or survival.

Google Books: Canadian Health Policy Failures - What's Wrong? Who Gets Hurt? Why Nothing Changes Brett J. Skinner PhD/Fraser Institute 2009

Patients' power and PACE : The Lancet - Editorial (not specfic to ovarian cancer)

"...Once every few years, we publish a paper that elicits an outpouring of consternation and condemnation from individuals or groups outside our usual reach. The latest topic to have caused such a reaction is chronic fatigue syndrome (CFS), and—more specifically—Peter White and colleagues' randomised PACE trial published on March 5, this year....The response to the trial's publication was swift and damning. “When is the Lancet going to retract this fraudulent study?” demanded a Facebook group. A 43-page complaint (now available via Wikipedia) branded the trial “unethical and unscientific”. There were 44 formal letter submissions, eight of which we publish today, together with a response from White and colleagues." cont'd

The making of a modern medic : The Lancet

"...In the past, medical students were selected on the basis of academic knowledge; it was hoped that traits such as communication skills and sound ethics would develop organically throughout the training process. Now, medical students are increasingly selected on the basis of possession of good social skills—many UK medical schools test prospective students' communication skills, and the USA is considering changing their entrance exam to test would-be students' attitudes. Further, teaching at medical school focuses on the legal, moral, and communication attributes that doctors are expected to have, and this focus continues into a doctor's training years. But do these processes produce the professional doctors that the public deserves?...."cont'd

May 2011 - short excerpts: What's new in ACS surgery (sundry topics)

MSH6 - Defects in MSH6 are the cause of (Lynch Syndrome) hereditary non-polyposis colorectal cancer type 5 (HNPCDNA mismatch repair protein Msh6 - Homo sapiens (Human)

Defects in MSH6 are the cause of hereditary non-polyposis colorectal cancer type 5 (HNPCC5) [MIM:600678]. Mutations in more than one gene locus can be involved alone or in combination in the production of the HNPCC phenotype (also called Lynch syndrome). Most families with clinically recognized HNPCC have mutations in either MLH1 or MSH2 genes. HNPCC is an autosomal, dominantly inherited disease associated with marked increase in cancer susceptibility. It is characterized by a familial predisposition to early onset colorectal carcinoma (CRC) and extra-colonic cancers of the gastrointestinal, urological and female reproductive tracts. HNPCC is reported to be the most common form of inherited colorectal cancer in the Western world. Cancers in HNPCC originate within benign neoplastic polyps termed adenomas.

Clinically, HNPCC is often divided into two subgroups. Type I: hereditary predisposition to colorectal cancer, a young age of onset, and carcinoma observed in the proximal colon. Type II: patients have an increased risk for cancers in certain tissues such as the uterus, ovary, breast, stomach, small intestine, skin, and larynx in addition to the colon. Diagnosis of classical HNPCC is based on the Amsterdam criteria: 3 or more relatives affected by colorectal cancer, one a first degree relative of the other two; 2 or more generation affected; 1 or more colorectal cancers presenting before 50 years of age; exclusion of hereditary polyposis syndromes.

MSH6 mutations appear to be associated with atypical HNPCC and in particular with development of endometrial carcinoma or atypical endometrial hyperplasia, the presumed precursor of endometrial cancer. Defects in MSH6 are also found in familial colorectal cancers (suspected or incomplete HNPCC) that do not fulfill the Amsterdam criteria for HNPCC. Ref.17 Ref.31 Ref.33 Ref.38 Ref.41 Ref.45 Ref.46

U.S. news writer requests interviews: re: drug shortages cancer patients

From: <acarrns@aol.com>
Date: Wed, May 25, 2011 at 3:05 PM

I'm a freelance writer.. This year's topic is the impact of ongoing drug shortages, and I'm seeking to interview a patient or two (or their family) who has been affected by this. Some cancer patients, for example, are having trouble getting a drug called cytarbarine, and there are a host of others in shortage too. Would you have any suggestions for reaching such patients? of course am trying to do this as soon as possible, in next week or so.
thanks


Ann Carrns for U.S. News
404-229-3523

Women's Health- Full Text - A focus on stroke in women

Brand name versus generic warfarin: a systematic review [Pharmacotherapy. 2011]

OCRF: Preview of Ovarian Cancer Research News from ASCO

Over 4,000 research abstracts will be presented, including important research about advances in ovarian cancer treatment and care.  Below is a preview of a few of the major studies of interest to ovarian cancer patients:
• Long-Term Treatment with Olaparib May Help Treat Recurrent Ovarian Cancer
• Screening Does Not Reduce Deaths from Ovarian Cancer for the General Population
• Cabozantinib Helps Manage Several Advanced Cancers (including Ovarian) and Shrink Bone Metastases
• Genetic Variations Identify Patients Sensitive to Nerve Damage from Chemotherapy
To hear in-depth information about these studies, listen to a podcast from ASCO leaders which is alsoASCO’s patient education website.

Anesthesiology News - Blood Transfusion Speeds Recurrence of Ovarian Cancer - further research required

“There are now dozens of studies that demonstrate superior patient outcomes with restrictive transfusion practices,” Dr. Ereth said. “In general, the less blood you transfuse, the better your patient outcomes. In the future we will hopefully be able to further define the mechanisms of immune modulation with transfusion and then when transfusion is absolutely necessary, be able to design interventions to limit those effects.”
Until then, however, he stressed that efforts should be made in all clinical settings to minimize blood transfusion as much as possible.

A thesis presented to the Department of Biological Sciences – Genetic CounselingCommunication of Lynch Syndrome Genetic Test Results: Strategies to Facilitate Information Sharing with At-risk Family Members

"...Results can then be used to develop new tools such as more
patient-friendly online resources similar to those offered by the hereditary breast and
ovarian cancer organization, FORCE......"

News - Marriott director Annie Brooks dies of ovarian cancer after 15 yrs

Health brief media: South Coast Gyn Oncology new study Trinova-1 (+ contact info)

Clinical studies
OVARIAN CANCER: South Coast Gynecologic Oncology is enrolling women with recurrent ovarian cancer for participation in a new clinical research study, called Trinova-1. The study is open to women 18 years or older who have been diagnosed with recurrent ovarian cancer, have undergone surgery to remove at least one ovary, and have been previously treated with chemotherapy. Visit www.TRINOVA-1.com or call 858-455-5524.

researcher/consumer - needs patient/caregiver assistance - please respond per message below - colonic stents/ovarian cancer

Can anyone - survivour and/or caregiver help here, with great thanks. A friend/researcher is looking  for specific information relating to colon stents and ovarian cancer, As I do not have any personal experience with stents,  it would be very unwise for me to comment. Your input, positive and or negative would be very helpful. If you wish, I will include your name and address when I forward on the information (permission). Please post either to the blog or  to me at: sandipn@sympatico.ca
Thanks as always.
Sandi  Pniauskas

http://ovariancancerandus.blogspot.com

request as below:

"I wonder if you can help me with some 'consumer input' into the use of stents ch stoma and no intervention eg relief with stents, for how long, eating and energy, and harmful effects

 

I am trying to do a response to a health technology assessment - for introduction of the stents.

 

I can talk about the trauma of partial and complete blockages in the late stages of cancer, but not specifically stents

 

If you have the time to jot down a few points that would be really appreciated."

abstract: Radiation-Induced Micro-RNA Expression Changes in Peripheral Blood Cells of Radiotherapy Patients

Conclusions

Exposure to ionizing radiation leads to the upregulation of the expression of a considerable proportion of the human miRNAome of peripheral blood cells. These miRNA expression signatures can be used as biomarkers of radiation exposure.

abstract: (breast cancer) Timing of Radiotherapy and Outcome in Patients Receiving Adjuvant Endocrine Therapy

2011 ovarian cancer annual conference registration | Ovarian Cancer National Alliance early bird discounts expire May 31st

OVA1 Improves Ovarian Cancer Detection Over CA 125 Blood Test and Clinical Assessment - press release - 2nd study

Second study in Obstetrics & Gynecology showcases OVA1's role in evaluating women with an ovarian mass

 "In the manuscript "Effectiveness of a Multivariate Index Assay in the Preoperative Assessment of Ovarian Tumors," physician assessment and the use of OVA1 correctly identified 70% of malignancies missed by physician assessment among gynecologists and other non-gynecologic oncologists, and 95% of malignancies missed by physician assessment among gynecologic oncologists. OVA1 also detected 76% of malignancies that would have been missed by CA 125 using ACOG-recommended guidelines......"

Comment from affiliated blog: Survivors' Debate - CANO presentation

posted comment:

arizona cancer treatment said...

Well explained. I am a researcher and these details were lot helpful for my research. Thanks for sharing. Stay in touch and keep posting.

22 May, 2011 

WELCOME - Genetic Alliance - tell your story and/or survey - DNA information

Have you ever needed or wanted to use your DNA information in making healthcare decisions? If so, I am interested in your story!

This website provides an opportunity for those of you who want to share your story including:

1. •those already using DNA information in your healthcare decisions
   

2. •those who have decided not to use DNA information
   

"Changes are underway in the way healthcare will occur - based on our own DNA, more interactive, predictive, and *personalized."

Science blogger deflates sensationalism of "Scientists cure cancer, but no one takes notice" story - Gary Schwitzer's HealthNewsReview Blog

"....So we have one popular account that is badly written and makes exaggerated claims. There is also a university press release, the source for the sloppy popular account, that doesn't contain the egregious stupidities but does tend to inflate basic research studies into an unwarranted clinical significance. And then, of course, there are the actual peer reviewed papers that describe the research and rationale, and also the reservations, on DCA. It's like a game of telephone: you can actually trace the account from the sober science paper to the enthusiastic press release to the web account with its extravagant claims of a simple, cheap cure for cancer, and see how the story is gradually corrupted. It would be funny if the final result wasn't going to dupe a lot of desperate people.

But there is a germ of truth to the story, in that DCA does have potential.
...
We should be urging further investigation of this promising drug with the beginning of clinical trials, but it's far too early to be babbling about "cancer cures". There have been lots of drugs that look great in the lab and have excellent rationales for why they should work, but the reality of cancer is that it is complicated and diverse and there are many more pitfalls between a drug that poisons cancer cells in a petri dish and a drug that actually works well in the more complex environment of a human being."

Predicting longevity and curing cancer — quackery, or mere exaggeration? > Facts & Fears > ACSH (re: DCA)

.....In another example of scientific distortion at least bordering on quackery that has infiltrated the media, a Fox News LiveScience blog chastises big pharma for their alleged reluctance to engage in cancer research involving a chemical known as dichloroacetate (DCA), due to their inability to patent it, thereby eliminating the profit motive. The piece chronicles the work of Dr. Evangelos Michelakis, a cancer researcher at the University of Alberta, whose claims that DCA can kill cancer cells are based solely on test tube experiments, animal testing and an extremely small clinical trial he conducted, which was composed of only five patients. Though even he admitted that “with the small number of treated participants in our study, no firm conclusions regarding DCA as a therapy…can be made,” he still attacks pharmaceutical companies for not investing in further research.

But not so fast. As Gary Schwitzer points out on his site, healthnewsreview.org, wherein he links to another blogger’s exposé of the DCA-conspiracy theory, the claims regarding DCA as an effective cancer treatment have been largely exaggerated: since there have been no clinical trials using the chemical, there is no basis for the researchers to allude to a cure.

And even if the claims were true, pharmaceutical companies actually could obtain protection via a “use patent.” This permits patent protection for old products (or drugs) where a new use has been discovered, explains ACSH’s Dr. Josh Bloom. “So this whole story is chock full of misinformation," he observes. "What is more likely is that Dr. Michelakis approached drug companies and they were just not interested.”...."

media: Is Big Pharma Ignoring a Potential Cancer Cure? - FoxNews.com (DCA/University of Alberta)

"......A new drug model

Small trials and case studies won't be enough, however, to prove DCA works. Further investigation into the drug's efficacy is necessary, and without the help of Big Pharma, it will have to happen in an unusual way.

"This could be a social experiment where the public funds these trials," Michelakis said. "After discovering the effect of DCA on cancer cells, I consider this the second-biggest achievement of our work: when we showed that you can bring a drug to human trials without a lot of money. If others were inspired" — his group is beginning to establish collaborations with some prominent cancer hospitals —"this could be a major achievement. Eventually the federal bodies like the National Cancer Institute would see there is enough evidence, and then they'll help with funding."

"It represents a new attitude and a new way of thinking," he added......"

full free access: Dual Pathway Inhibitor Shows Broad Activity in Multiple Tumor Types - Medscape

full free access: Informa Healthcare -Review Clinical burden of venous thromboembolism

Conclusions:

Even among high-risk groups it is not possible to identify individuals who will go on to develop VTE, and, therefore, thromboprophylaxis is a recommended component of the management of high-risk patients. Ensuring patients receive safe, effective, easily administered antithrombotic therapy both in hospital and post-discharge, for a sufficient length of time, should be central to any strategy to reduce incident or recurrent VTE and minimise the risk of long-term complications.

Patient's Opinion: Molecular Profiling

Both Jean Mckibben and Debbie Bozsa post on ACOR (Mailing List - Ovarian Cancer) about molecular profiling at The Clearity Foundation and their website:www.clearityfoundation.org multiple times this year.

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"I had my 4^th debulking surgery on 3/3/11 for my 5^th recurrence. Initially, I did not think about to do molecular profiling because I thought it will need a lot paper work, energy and money to do it.  When you go through lot of treatments for ovarian cancer, you feel that every minute counts down your life, and you just want to spend time and money for something enjoyable. Jean encouraged me to do the molecular profiling when we exchanged email privately.  I sent in my request for the test on 3/16/11, and I got my partial result in a month, and the final result on 5/16/11. I highly recommend the test. After my surgery, my chemotherapy choice was Doxil or Topotecan.  I tried Doxil first, and then molecular profiling showed I am benefit from Doxil, not benefit from Topotecan. Now my doctor treats me with the confidence based on those biomarkers. My CA125 has been going down with 2 treatments although I have skin rash and lesions due to the side effects of Doxil.

When you go to Clearity Foundation web site, there are 3 parts.

1. Caris Life Science: They do Target Now biomarkers for drugs including: paclitaxel/docetaxel, cisplatin/carboplatin, trastuzumab, letrozole, tamoxifen, doxorubicin, topotecan/irinotecan and temozolomide. They will tell you from which drug you may benefit, which not, based on your biomarkers. There is an 11 page report sent to your doctor, including biomarker description and reference. They send the bill to insurances and patients. 

2. Clarient, Inc:  They do more tests for biomarkers to compare your biomarkers to other ovarian cancer patients in their Diane Barton Database. Dr. Laura Shawver, the founder of The Clearity Foundation, will email the result to you and call you to explain the result, and may suggest some new target therapy or clinical trials. The Clarient test will be paid by Clearity Foundation. 

3. The Clearity Foundation: They help people to pay the test cost if patients have no insurance or their insurances do not pay for the test.  They have a one page grant application for patients to complete, and can approve the application by email in one day.  People working at The Clearity Foundation are very friendly and helpful. Please call 1-855-856-0654 if you have any question.  

Please know that molecular profiling is different from tumor sensitivity or resistant assay.  Tumor sensitivity or resistant assay uses fresh tissue to culture tumor cells, add different chemo drugs, and then sees which chemo drug  kills them (cancer cells).  When I had my 3^th debulking surgery for my 4^th recurrence one year ago, my doctor sent for a tumor resistant assay. However, I did not get any result from the test because my tumor cells did not grow in their cell culture. The molecular profiling test uses tumor samples from biopsy or surgery in paraffin sections. The samples do not need to be fresh, can be a few years old. They do special staining to find biomarkers."

Yi

Physicians’ Group Targets Inappropriate Tests, Treatments « news@JAMA

The top 5 lists will be distributed to all alliance physicians in their respective primary care specialties. The alliance is also planning to produce videos for patients that explain the rationale for the recommendations by showing that risks outweigh benefits for these interventions for at least some patients, and make clear the link between overuse and health insurance premium hikes.

Genetic Alliance Webinar - Suffering from Information Overload? Know When to Trust It or Trash It

Genetic Alliance Webinars offer information and discussion on a variety of topics, including hot-button issues in genetics and advocacy, public policy, and organizational development. Genetic Alliance presents a new webinar at least once a month.
Suffering from Information Overload? Know When to Trust It or Trash It
Wednesday, May 25, 2011 12 noon - 1:00 PM

How Will States and the Feds Align Medicaid and Subsidized Health Care? The Commonwealth Fund

Breast Cancer Risk Calculator Updated for Asian-Americans - NIH Research Matters - National Institutes of Health (NIH)

"...The new model can assess risk separately for American women who identify themselves as Chinese, Japanese, Filipino, Hawaiian, other Pacific Islander or other Asian. Compared with the AABCS, the researchers found, the original assessment tool overestimated risk for Chinese and Filipino women, and underestimated risk for Hawaiian women....."

Florence "Flit" McElligott - Ovarian cancer speaks softly. Listen - Times Union

abstract: Fertility-sparing surgery in young women with mucinous adenocarcinoma of the ovary.

abstract: UK - Hormone replacement therapy and women with premature menopause - A cancer survivorship issue.

Abstract

The importance of addressing survivorship issues has been emphasised in recent years. As cancer therapies improve there is a growing population of cancer survivors, which includes many women with premature menopause. Women who are premenopausal at the time of their cancer diagnosis may have specific survivorship issues to be addressed, including infertility, early menopause and sexual dysfunction. These factors can continue have a significant impact on the quality of life of these patients at long term follow up. Data for this Review were identified by searches of MEDLINE, PubMed, and references from relevant articles using the search terms 'HRT', 'women/female cancer/tumour', 'menopause' and 'survivorship'. Abstracts and reports from meetings were excluded. Only papers published in English between 1980 and 2010 were included.

The aims of this review are to: • Address the hormonal factors which impact on cancer survivorship for premenopausal women • Review the debate for the role of hormone replacement therapy (HRT) in cancer survivors • Provide information for physicians and patients regarding the management of hormonally driven survivorship issues (for different tumour types), based on current evidence

The recommendations for practice are that HRT may be offered for the alleviation of vasomotor symptoms in cancer survivors who undergo premature menopause up to the age of natural menopause (51years in the UK).

HRT (including vaginal oestrogen preparations) is contraindicated in survivors of oestrogen receptor positive breast cancer and low grade endometrial leiomyosarcoma, where non-HRT alternatives should be considered to alleviate symptoms.

abstract: Subspecialist training in surgical gynecological oncology in the nordic countries.

DISSERTATIONS.SE: Towards improved management of Lynch syndrome; ovarian cancer profiles, risk perception, knowledge and family perspectives

Note:  references  BRCA/clear cell ovarian/multiple malignancies

In summary, we have demonstrated that ovarian cancer linked to Lynch syndrome has distinct genetic profiles, that mutation carriers frequently underestimate their risk of colorectal cancer, possess a good level of knowledge about Lynch syndrome and that families are affected by learning about Lynch syndrome, though few experience adverse effects.

abstract: he impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual function in women who carry a BRCA mutation

Blogger's Note: this study would apply to all those who experience surgical menopause including those eg. Lynch Syndrome/other Syndromes - women at risk, it is unfortunate that all women undergoing cancer surgery - those affected by surgical menopause were not included in this study

 

CONCLUSIONS:

Women who undergo prophylactic salpingo-oophorectomy prior to menopause experience an increase in vasomotor symptoms and a decrease in sexual functioning. These symptoms are improved by HRT, but not to pre-surgical levels

Markman commentary: Can weekly topotecan substitute for a multi-day regimen in the treatment of ovarian cancer? Sadly, 10 years later the answer remains unknown

Gynecologic Oncology
Article in Press

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doi:10.1016/j.ygyno.2011.04.020 | How to Cite or Link Using DOI Copyright © 2011 Elsevier Inc. All rights reserved.

Permissions & Reprints

Clinical Commentary

Can weekly topotecan substitute for a multi-day regimen in the treatment of ovarian cancer? Sadly, 10 years later the answer remains unknown

Purchase

$ 39.95

Maurie Markman^a,

^a Cancer Treatment Centers of America, Eastern Regional Medical Center, 1331 East Wyoming Avenue, Philadelphia, PA 19046 USA

Received 28 March 2011; 

accepted 16 April 2011. 

Available online 12 May 2011.

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$ 39.95

abstract: MicroRNA let-7a: A potential marker for selection of paclitaxel in ovarian cancer management.

CONCLUSIONS:

The study suggests that the beneficial impact of the addition of paclitaxel on EOC survival was significantly linked to let-7a levels, and that miRNAs such as let-7a may be a useful marker for selection of chemotherapeutic agents in EOC management.

abstract:Decreased hypersensitivity reactions with carboplatin-pegylated liposomal doxorubicin compared to carboplatin-paclitaxel combination: Analysis from the GCIG CALYPSO relapsing ovarian cancer trial.

abstract: Trastuzumab and pertuzumab produce changes in morphology and estrogen receptor signaling in ovarian cancer xenografts revealing new treatment strategies.

abstract: Weekly paclitaxel as a single agent or in combination with carboplatin or weekly topotecan in patients with resistant ovarian cancer:

CONCLUSIONS:

Combination chemotherapy in platinum-resistant ROC was more toxic than weekly paclitaxel and did not significantly prolong PFS.

Cabozantinib linked to high rates of disease control, reduction of bone metastases | HemOncToday

"Cabozantinib effectively controlled advanced prostate, liver and ovarian cancers, tumors that are typically resistant to existing therapies, phase 2 results indicated....."

media - GAP-107B8 - PharmaGap makes progress toward clinical trials - Technology - Ottawa Business Journal

New Cancer Screening Studies Offer Clarity, Room For Debate - WSJ.com

May 20th Medscape - PARP Inhibitor Improves Outcomes in Ovarian Cancer - olaparib

media: End-of-life decision rests with family, not doctors - thestar.com

Family Cancer Histories Are Not Highly Accurate --Doctors Lounge ASCO

Abstract
Full Text (subscription or payment may be required)
Editorial

abstract:  
Conclusions General population reports on family history for the four major adult cancers were not highly accurate. Efforts to improve accuracy are needed in primary care and other health-care settings in which family history is collected to ensure appropriate risk assessment and clinical care recommendations. 

ASCO: Ovarian CA Screening Tools Don’t Lower Death Risk --Doctors Lounge

Systematic Reviews - new open access journal

Future Oncology - Review Imaging assessment of tumor response: past, present and future

Summary
Future Oncology
May 2011

Anatomical response assessment criteria have been in use for decades, with the WHO guidelines being replaced by Response Evaluation Criteria in Solid Tumors (RECIST), updated in 2009 to RECIST 1.1. These methods rely on a change in size of a tumor as the main response criteria, but newer cytostatic agents tend to target tumor function at a molecular level before changing the size of a lesion. Recent modifications, such as the Choi criteria, have improved assessment by taking into account density of tumor, but all of these criteria fail to utilize functional imaging parameters, which are becoming increasingly available, including perfusion CT, perfusion MRI, diffusion-weighted imaging, magnetic resonance spectroscopy, dynamic contrast-enhanced ultrasound and combined PET/computed tomography. Developments in these modalities and standardization of imaging acquisition will help to optimize the next set of response criteria, with inclusion of multiparametric, functional modalities, evaluating tumors at the same molecular level at which they are being targeted by therapeutic agents.

"From Tears to Transparency" Series - trailers, books....patient safety/care

Health of lesbian, gay, bisexual, and transgender populations : The Lancet

"In later adulthood, LGBT are less likely to have a partner or children to provide them with health and social care, resulting in their greater dependence on friends, caregivers, and LGBT organisations. There has been clinical concern about rates of diabetes, ovarian disease, and stroke among transgender older people potentially as a result of long-term hormone treatments...."

Editorial: New guidelines for early detection of ovarian cancer : The Lancet

"....NICE advises primary care professionals to measure serum concentrations of the protein CA125 if a woman (especially if older than 50 years) presents on a persistent or frequent basis with abdominal distension, feeling full or loss of appetite, pelvic or abdominal pain, or increased urinary frequency. If the blood test is positive, an ultrasound of the abdomen or pelvis should be done and, if ovarian cancer is suggested, the woman should be referred to a specialist...."

2011 ASCO Annual Meeting - Join your colleagues from around the world at the 2011 ASCO Annual Meeting - announcements regarding clinical trial session

free full access: Enabling Medication Management Through Health Information Technology

Prepared for:
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
www.ahrq.gov


Prepared by:
McMaster Evidence-based Practice Center
Hamilton, ON Canada

Conclusions.
MMIT is well-studied, although on closer examination of the literature the evidence is not uniform across phases of medication management, groups of people involved, or types of MMIT. MMIT holds the promise of improved processes; clinical and economics studies and the understanding of sustainability issues are lacking.

Secondary link (McMaster) including professional commentaries