Friday, July 09, 2010
Updated Guidelines for Human Pluripotent Stem Cell Research - CIHR (Canadian Institute for Health Research)
definition: Capable of differentiating into many cell types. For example, a cell capable of turning into bone, fat, tendon, cartilage and ligament cells, but not into brain cells or liver cells, might be considered Pluripotent.
www.stem-cell-treatment-now.com/glossary.html
abstract: The Clinical Molecular Diagnostics Laboratory and Microsatellite Instability Testing of Colorectal Cancer
Note: this abstract gives an overview of Lynch Syndrome testing eg. immunohistochemistry (testing of tumour); Microsatellite (MSI); improved survival rates, treatment options (relating to test results)
Canada: Health Region Report Cards and Ranking
Blogger's note: who qualifies as an 'other' ??
We want your feedback!
We are conducting a survey of healthcare system leaders and other stakeholders, with hopes of obtaining your views on the report cards and rankings. If you would like to participate, please contact Dr. Lockhart at Wallace.Lockhart@uregina.ca
We are conducting a survey of healthcare system leaders and other stakeholders, with hopes of obtaining your views on the report cards and rankings. If you would like to participate, please contact Dr. Lockhart at Wallace.Lockhart@uregina.ca
DNA discovery opens new door to develop tools, therapies for hereditary cancers (in research)
"....Errors in DNA can arise from many types of damage including external harm, such as UV radiation or carcinogens, as well as by intrinsic cellular processes such as DNA replication. Failure to correct these errors leads to mutations, which results in cancer or a number of severe genetic disorders."
“The reason why it can lead to cancer is because if you don’t have mismatch repair proteins that correct these errors, you’re going to accumulate mutations,” said GuarnĂ©. “People with defective mismatch repair genes develop cancers at very early ages. You would see a family that in their 30s has colorectal cancer and in their 40s they have it again. There’s no way you can prevent that – you can’t correct your DNA. As you grow older, you’re going to accumulate mutations.”
interactive map: human genome/dna - the 'A T,C and G's' of the human genome (BBC) plus video
Note: #3 'junk dna' - there is still much to be learned in those 'junk dna'
(maybe not 'junk' after all)
Introduction All the biological instructions needed to make a human being can be written in just four letters. But the book of those instructions is over three billion letters long. Here, BBC News Online shows how you go from A, T, G and C to a whole person.
also: short video on 'junk dna'
Human genome: bust or boon? - media health report (worth reading/4 professional opinions)
Note: this is actually a very good and easy-to-read article with (over)views from 4 researchers
Women's Health Matters Network: News - Early menopause may be linked to increased future heart disease risks
"Early menopause was defined as either natural or surgical menopause."
"Although the observational study found a significant relationship between early menopause and heart disease, it does not prove that early menopause is an underlying cause of heart disease. However, the relationship suggests that modifiable lifestyle factors that affect heart disease risk, such as diet and exercise, may be particularly important to women who enter menopause early. The research was presented at the Endocrine Society annual meeting in San Diego on June 21, 2010"
full free access: Genomic aberrations in borderline ovarian tumors
Note: this paper is long and technical but of importance given, in part, the connection to Lynch Syndrome (MSI testing, microsatellite). Microsatellite testing is a test commonly used for suspected Lynch Syndrome patients. Specific research regarding ovarian cancer (epithelial) /MSI is limited.
Background
"According to the scientific literature, less than 30 borderline ovarian tumors have been karyotyped and less than 100 analyzed for genomic imbalances by CGH."
Women's Health Matters Network: News - Study finds almost half of breast cancer patients did not complete hormone therapy
"The study was published online in the Journal of Clinical Oncology on June 28, 2010."
Shorter Telomere Length Again Linked to Cancer: MedlinePlus
Note: medical news article including reference to ovarian cancer
"TUESDAY, July 6 (HealthDay News) -- People who have white blood cells with shorter telomeres may be at a higher risk of developing cancer, especially aggressive cancers that are more likely to kill, new research suggests. Telomeres are the "shoelace ends" that cap and protect your chromosomes and naturally get shorter as you age. Right now, the findings aren't likely to have any clinical usefulness, said Dr. Stefan Kiechl, senior author of a paper appearing in the July 7 issue of the Journal of the American Medical Association. But in the future, he added, "telomere length may well become a component of risk scores for cancer manifestation and, eventually, cancer prognosis......"
Genetic Variation in TYMS in the One-Carbon Transfer Pathway Is Associated with Ovarian Carcinoma Types in the Ovarian Cancer Association Consortium — Cancer Epidemiology, Biomarkers & Prevention
Conclusions: TYMS rs495139 may be associated with a differential risk of ovarian carcinoma types, indicating the importance of accurate histopathologic classification.
Note: (abstract) mucinous as opposed to negative for other cell types.
Reply to H.W.M. van Laarhoven et al --
Letter of response from Balboni et al to van Laarhoven et al
1. van Laarhoven HWM, Schilderman J, Verhagen CA, et al: Spiritual care in patients with advanced cancer: What does it imply? J Clin Oncol 28:e332; 2010.
2. Balboni TA, Paulk ME, Balboni MJ, et al: Provision of spiritual care to patients with advanced cancer: Associations with medical care and quality of life near death. J Clin Oncol 28:445–452, 2010.
Letter: Spiritual Care in Patients With Advanced Cancer: What Does It Imply? JCO
in reference to:
1. Balboni TA, Paulk ME, Balboni MJ, et al: Provision of spiritual care to patients with advanced cancer: Associations with medical care and quality of life near death. J Clin Oncol 28:445–452, 2010.
Thursday, July 08, 2010
Comparison of Anticancer Drug Coverage Decisions in the United States and United Kingdom: Does the Evidence Support the Rhetoric? -- Mason et al. 28 (20): 3234 -- Journal of Clinical Oncology
Conclusion
Anticancer drug coverage decisions that consider cost effectiveness are associated with greater restrictions and slower time to coverage. However, this approach may represent an explicit alternative to rationing achieved through the use of patient copayments.
Microsatellite Instability and Adjuvant Fluorouracil Chemotherapy: A Mismatch? -- Ng and Schrag 28 (20): 3207 -- Journal of Clinical Oncology
Note: this Editorial will be of interest to Lynch Syndrome families/patients
Filling the Gap: Development of the Oncology Nurse Practitioner Workforce — JOP
click here for link to paper: Filling the Gap: Development of the Oncology Nurse Practitioner Workforce
plus related article:
New line in your job description: Nurse Practitioner Educator
Cancer Statistics, 2010 -- U.S.
FIGURE 5 Annual Age-Adjusted Cancer Death Rates* Among Females for Selected Cancers, United States, 1930 to 2006.
U.S. - States Requiring Coverage of Clinical Trial Costs - National Cancer Institute
A growing number of states have passed legislation or instituted special agreements requiring health plans to pay the cost of routine medical care you receive as a participant in a clinical trial......
.......updated with information about Florida, Iowa, and South Carolina.
As of July 1, 2010, these states have implemented legislation or voluntary agreements requiring health plans to pay the cost of routine medical care for participants in certain clinical trials. More than 30 states now require such coverage through legislation or special voluntary agreements. View website…
Links on this page
* Use this map or this alphabetical list.
* Overview of the issue.
* Other resources.
(full free access) "Physician As Typist" -- from the series: The Art of Oncology
"I stare at the primary care physician’s note in front of me. I have been concerned about our mutual patient’s hypertension. I believe it has been exacerbated by the use of bevacizumab, and I have referred her back for additional management. All I need is an acknowledgment of the problem and a treatment plan. The note that I have received is three pages long and is filled with unrelated laboratory values, scan results, and jumbled-up text....."
Disclosing a Diagnosis of Cancer: Where and How Does It Occur? -- Figg et al., 10.1200/JCO.2009.24.6389 -- Journal of Clinical Oncology
Abstract:
"Forty-four percent of patients reported discussions of 10 minutes or fewer..."
Conclusion
Physicians should disclose a cancer diagnosis in a personal setting, discussing the diagnosis and treatment options for a substantial period of time whenever possible.
Search of: ovarian cancer | Open Studies | received from 06/15/2010 to 07/07/2010 - List Results - ClinicalTrials.gov
Found 7 studies with search of: ovarian cancer | Open Studies | received from 06/15/2010 to 07/07/2010
1 Not yet recruiting Study of JI-101 in Patients With Advanced Head and Neck Cancers, Ovarian Cancers or K-RAS Mutant Colon Cancers
Conditions: Cancer; Head & Neck Cancer; Ovarian Cancer; Colon Cancer
Interventions: Drug: JI-101; Drug: Everolimus
2 Not yet recruiting Veliparib and Liposomal Doxorubicin Hydrochloride in Treating Patients With Recurrent Ovarian Cancer, Fallopian Tube Cancer, or Primary Peritoneal Cancer or Metastatic Breast Cancer
Conditions: Breast Cancer; Fallopian Tube Cancer; Ovarian Cancer; Peritoneal Cavity Cancer
Interventions: Drug: pegylated liposomal doxorubicin hydrochloride; Drug: veliparib; Other: laboratory biomarker analysis; Other: pharmacological study
3 Not yet recruiting Safety Study of MGAH22 in HER2-positive Carcinomas
Conditions: Breast Cancer; Gastric Cancer; Bladder Cancer; Ovarian Cancer; Non-small Cell Lung Cancer
Intervention: Biological: MGAH22
4 Recruiting GDC-0449 and RO4929097 in Treating Patients With Advanced or Metastatic Sarcoma
Conditions: Adult Malignant Fibrous Histiocytoma of Bone; Gastrointestinal Stromal Tumor; Kidney Cancer; Malignant Conjunctival Neoplasm; Ovarian Cancer; Sarcoma; Small Intestine Cancer
Interventions: Drug: Hedgehog antagonist GDC-0449; Drug: gamma-secretase inhibitor RO4929097
5 Recruiting Temsirolimus and Vinorelbine Ditartrate in Treating Patients With Unresectable or Metastatic Solid Tumors
Conditions: Extensive Stage Small Cell Lung Cancer; Hereditary Paraganglioma; Male Breast Cancer; Malignant Paraganglioma; Metastatic Gastrointestinal Carcinoid Tumor; Metastatic Pheochromocytoma; Pancreatic Polypeptide Tumor; Recurrent Breast Cancer; Recurrent Cervical Cancer; Recurrent Endometrial Carcinoma; Recurrent Gastrointestinal Carcinoid Tumor; Recurrent Islet Cell Carcinoma; Recurrent Neuroendocrine Carcinoma of the Skin; Recurrent Non-small Cell Lung Cancer; Recurrent Ovarian Epithelial Cancer; Recurrent Ovarian Germ Cell Tumor; Recurrent Pheochromocytoma; Recurrent Prostate Cancer; Recurrent Renal Cell Cancer; Recurrent Small Cell Lung Cancer; Recurrent Uterine Sarcoma; Regional Gastrointestinal Carcinoid Tumor; Regional Pheochromocytoma; Stage III Cervical Cancer; Stage III Endometrial Carcinoma; Stage III Neuroendocrine Carcinoma of the Skin; Stage III Ovarian Epithelial Cancer; Stage III Ovarian Germ Cell Tumor; Stage III Prostate Cancer; Stage III Renal Cell Cancer; Stage III Uterine Sarcoma; Stage IIIA Breast Cancer; Stage IIIA Non-small Cell Lung Cancer; Stage IIIB Breast Cancer; Stage IIIB Non-small Cell Lung Cancer; Stage IIIC Breast Cancer; Stage IV Breast Cancer; Stage IV Endometrial Carcinoma; Stage IV Neuroendocrine Carcinoma of the Skin; Stage IV Non-small Cell Lung Cancer; Stage IV Ovarian Epithelial Cancer; Stage IV Ovarian Germ Cell Tumor; Stage IV Prostate Cancer; Stage IV Renal Cell Cancer; Stage IV Uterine Sarcoma; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer; Thyroid Gland Medullary Carcinoma
Interventions: Drug: temsirolimus; Drug: vinorelbine ditartrate
6 Recruiting Theca Cell Function in Adolescents With Polycystic Ovary Syndrome (PCOS)
Condition: PCOS
Intervention: Drug: Dexamethasone and recombinant hCG
7 Recruiting Effects of Exercise for Overweight Women With Polycystic Ovary Syndrome
Conditions: Polycystic Ovary Syndrome; Obesity
Interventions: Other: 16-week exercise training program; Other: Control Group without PCOS
Somatic Mutations in BRCA1 and BRCA2 Could Expand the Number of Patients That Benefit From Poly (ADP Ribose) Polymerase Inhibitors in Ovarian Cancer
ABSTRACT
Purpose
The prevalence of BRCA1/2 mutations in germline DNA from unselected ovarian cancer patients is 11% to 15.3%. It is important to determine the frequency of somatic BRCA1/2 changes, given the sensitivity of BRCA-mutated cancers to poly (ADP ribose) polymerase-1 (PARP1) inhibitors and platinum analogs.
Conclusion
BRCA1/2 somatic and germline mutations and expression loss are sufficiently common in ovarian cancer to warrant assessment for prediction of benefit in clinical trials of PARP1 inhibitors.
Wednesday, July 07, 2010
Testing for CHEK2 in the cancer genetics clinic: ready for prime time?
Abstract
Narod SA.
Testing for CHEK2 in the cancer genetics clinic: ready for prime time?
The 1100delC mutation of the CHEK2 gene was found to be a cause of breast cancer in 2002. The lifetime risk of breast cancer among women with a mutation and with a family history of breast cancer is approximately 25%. These women are good candidates for screening with MRI and for chemoprevention with tamoxifen. It is reasonable to test for this single mutation when women undergo testing for BRCA1 and BRCA2.
Protein Inhibitor Revives Chemotherapy For Ovarian Patients: TGen Findings
"PD 407824 is only available for laboratory research, but other drugs inhibiting CHEK1 are already used to treat patients in the clinic," said Dr. Raoul Tibes, one of the paper's senior a co-authors and an Associate Investigator in TGen's Clinical Translational Research Division. "
A prospective, randomised, controlled, double-blind phase I-II clinical trial on the safety of A-Part(R) Gel as adhesion prophylaxis after major abdominal surgery versus non-treated group
Note: abstract/full free access/study outline/criteria:
Background
"Postoperative adhesions occur when fibrous strands of internal scar tissue bind anatomical structures to one another. The most common cause of intra-abdominal adhesions is previous intra-abdominal surgical intervention. Up to 74% of intestinal obstructions are caused by post surgical adhesions. Although a variety of methods and agents have been investigated to prevent post surgical adhesions, the problem of peritoneal adhesions remains largely unsolved. Materials serving as an adhesion barrier are much needed."
Tuesday, July 06, 2010
Q&A: Cardiac Catheterization for Cancer Patients - Cancerwise | Cancer blog from MD Anderson Cancer Center
Why is it important to have a cath lab in a cancer center?
As a result of their disease and the treatments they receive, cancer patients are different from regular cardiovascular patients.
Is it strictly for diagnostic purposes?
No, it can be used for both diagnostic purposes and treatment. It helps recognize heart failure, pulmonary hypertension and valve disease, among other heart problems. It can also be used to implant pacemakers, defibrillators and intra-aortic balloon pumps, as well as perform pericardiocentesis (a procedure that uses a needle to remove fluid surrounding the heart) and endomyocardial biopsies (a procedure for patients with possible heart failure after chemotherapy, where a minimal piece of heart muscle is analyzed under the microscope).
Shark Cartilage No Longer Considered Therapeutic Agent - Cancerwise | Cancer blog from MD Anderson Cancer Center
Note: lung cancer/shark cartilage plus Q & A on shark cartilage
High satisfaction rate ten years after bilateral prophylactic mastectomy - a longitudinal study
abstract:
Eur J Cancer Care (Engl). 2010 Jun 29
Women from families with an increased risk for breast/ovarian cancer have undergone bilateral prophylactic mastectomy (BPM) since the early 1990s at the Karolinska University Hospital in Sweden.
Perceptions of BPM as reported by the first women who underwent the procedure have previously been evaluated on a short-term basis (1-3 years). The present study aims to evaluate the long-term (10 years) physical and psychological consequences of BPM in the same cohort of women. Some of the very first women to undergo BPM participated in the present interview study (n= 13). The semi-structured interviews focused on the women's long-term experiences related to BPM and immediate breast reconstruction.
Overall, the women were satisfied with their decision to undergo BPM and perceived a negligible remaining risk of getting breast cancer. For most women, the operation had not resulted in changes in family life or lifestyle (n= 8), although some described that the relationship with their spouse was affected (8/13), either in a negative (n= 5) or positive (n= 3) way. The cosmetic results were mainly positive (n= 10).
Recurrent counselling and support during the whole process of decision, treatment and follow up is recommended.
Is adjuvant chemotherapy indicated in stage I pure immature ovarian teratoma (IT)? A multicentre Italian trial in ovarian cancer
CONCLUSIONS.: Our study suggests that chemotherapy may be withheld for primary therapy and utilized only for recurrence.
full free access: International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment
Methods:
Recognizing IBC to be a distinct entity, a group of international experts met in December 2008 at the First International Conference on Inflammatory Breast Cancer to develop guidelines for the management of IBC.
reference paper for - Table 2:
Summary of minimum recommendations
BRCA1 mRNA expression and outcome to neoadjuvant cisplatin-based chemotherapy in bladder cancer — Ann Oncol
Background:
Neoadjuvant chemotherapy has shown a modest benefit in muscle-invasive bladder cancer patients; however, the subset of patients most likely to benefit has not been identified. BRCA1 plays a central role in DNA repair pathways and low BRCA1 expression has been associated with sensitivity to cisplatin and longer survival in lung and ovarian cancer patients.
Conclusions:
Our data suggest that BRCA1 expression may predict the efficacy of cisplatin-based neoadjuvant chemotherapy and may help to customize therapy in bladder cancer patients.
The incidence of major complications after the performance of extensive upper abdominal surgical procedures during primary cytoreduction of advanced ovarian, tubal, and peritoneal carcinomas
Objective.
To assess the morbidity and mortality associated with extensive upper abdominal surgery (EUAS) performed during primary cytoreduction for advanced ovarian carcinoma.Conversations! newsletter July/August issue 2010
click here for direct access to pdf file
Note: includes stories from many longterm survivors as well as:
Ovarian Problems Discussion List
The Ovarian Problems Discussion List is a free e-mail discussion group that gives women with ovarian cancer and related problems a chance to exchange information and support daily. Supporters and family members are also encouraged to join this group, which is sponsored by the non-profit Association of Cancer Online Resources.
To SUBSCRIBE, go to www.acor.org, click on "mailing lists", and locate the Ovarian list - follow the instructions to join.
To reach the list managers for HELP, write to ovarian-request@listserv.acor.org . We now have over 1300 subscribers
Monday, July 05, 2010
Individual genomes and personalized medicine: life diversity and complexity
"Patients and tumors are unique."
Sunday, July 04, 2010
HE4 and Mesothelin: Novel Biomarkers of Ovarian Cancer
"Addition of mesothelin to this combination did not show any improvement in the sensitivity. Conclusions: As a single marker, HE4 had the highest sensitivity for detecting ovarian carcinoma specially early stage disease. Combined CA125 and HE4 was a more accurate predictor of ovarian malignancy than either alone."
Ovarian cancer test comes under fire (OvPlex/Healthlinx/Australia) media article
OvPlex also available (according to article) in Britain/Singapore
Canada playing in wrong health league - Michael Rachlis
Note: article relates to the U.S.-based Commonwealth Fund report of June 25th, 2010 (see prior blog post); this was not the first Commonwealth Fund analysis which compared different countries on a variety of indices with Canada and the U.S. coming in dead last in overall rankings.
"The report compared Canada with other countries 18 times in the text. These included two favourable comparisons and 16 unfavourable ones, including indictments for long waits, the poor management of chronic conditions (like diabetes), the lack of electronic systems, poor care coordination and the failure to involve patients in decisions about their care."
Dr. Michael Rachlis is a health policy analyst and an associate professor at the University of Toronto.
Medical News: ENDO: Society Calls for New Look at Hormone Therapy - in Meeting Coverage, ENDO
Note: this fact from the WHI was ignored by many:
"However, Santen said, the average age of the women in the WHI was 63. Only 3.4% of women in the study were ages 50 and 55, "the usual time when women would decide to take hormone therapy," he said." ---------------------------------------------------------------------------------------------------------------------------------------- The take-home message, he concluded, is that "physicians and patients need to rethink the use of menopausal hormone therapy based on these new data. "The statement suggests a change in perspective and a need to consider the risks and benefits [of hormone therapy] for women actually considering its use."
The Elusive Goal of Maintaining Population Cancer Screening: It Is Time for a New Paradigm -- Editorial (full free access)
Note: focus on breast cancer/not specific to ovarian cancer; discusses high risk (BRCA's) "In this issue of the Journal, Vernon et al. conducted a methodologically rigorous review of the literature on controlled behavioral interventions to increase repeat mammography screening among women at average risk for the disease.......The promise of breast cancer screening has fallen short of its goals because of its imprecision, failure to screen those at highest risk, lack of compliance with screening continuance over recommended periods of time, and gaps in access to or quality of diagnostic follow-up and treatment (20). It is no longer enough to simply conduct more interventions to understand which work best in motivating individuals to undergo repeat cancer screening. New paradigms, guided by evidence from modeling, novel trials, and new scientific discovery, will be needed to realize the promise of eliminating the burden of cancer."
abstract: Hormone prevention strategies for breast, endometrial and ovarian cancers
"Prospective, randomized trials, designed to control for all known variables, are mandatory to fully assess the potential for hormonal chemoprevention in breast, endometrial and ovarian cancers."
The predictive value of serum VEGF in multiresistant ovarian cancer patients treated with bevacizumab (Avastin)
Results
Thirty-eight patients were included. All patients were heavily pre-treated with a median of five prior regimens. ..... The VEGF serum level decreased during treatment in all patients. A low pre-treatment VEGF level was predictive to response.
Conclusions
Single agent bevacizumab has activity in ovarian cancer patients. Pre-treatment serum VEGF seems to have predictive value.Risk factors for carcinoma of the fallopian tube in women with and without a germline BRCA mutation
Reminder on stats: < 1.0 is decreased risk; > 1.0 is increased risk; OR=overall risk; edited some stats for ease of reading - see abstract/read more:
Conclusions
Parity and oral contraceptive use are associated with reduced risks of fallopian tube cancer. In contrast, hormone replacement therapy may be associated with an increase in the risk of fallopian tube cancer.Saturday, July 03, 2010
medical research/news item: (UK) Study finds EPB41L3 'protector gene' inactivated in 65% of ovarian cancers
Note: in research
"A new gene that normally protects againstovarian cancer is switched-off in two-thirds of cases of the disease, reveals a study published in the journal Neoplasia today.
This 'protector gene', known as EPB41L3, is inactivated in 65 per cent of ovarian cancers. And reactivating the gene halted tumour growth and triggered large numbers of the cancer cells to commit suicide. The research, co-funded by Cancer Research UK and gynaecological cancer research charity
The Eve Appeal, raises the prospect for developing therapies that mimic or restore the function of the gene to kill ovarian cancer cells in a targeted way...."
Putting research into context—revisited : The Lancet - Editorial
Note: this article is free to view; requires registration
"In July, 2005, Lancet editors wrote that “we will require authors of clinical trials submitted to The Lancet to include a clear summary of previous research findings, and to explain how their trial's findings affect this summary.
They called for the relation between existing and new evidence to be referenced to a published systematic review or meta-analysis. The CONSORT statement2 first required in 1996 that findings should be interpreted to take into account the totality of the evidence.
Michael Clarke and colleagues have been monitoring since then how the five high-impact journals (Annals of Internal Medicine, BMJ, JAMA, The Lancet, and The New England Journal of Medicine) have been doing. They report in The Lancet today their latest results for May, 2009.
Their findings are discouraging: only one of 24 reports that were not first trials placed the results in the context of an updated systematic review in the Discussion.
They conclude that there is no evidence of progress since 1997, and that editors and authors are not informing sufficiently those who have to make decisions about health care."
Clearly, clinicians and others in health care need to know what the results of research mean for patients.
Authors and editors can help them by doing exactly what CONSORT4 and Clarke and colleagues call for.
Authors need to spell out what their study adds to other work and what that means for clinical practice...."cont'd
www.icon7trial.org - Avastin trial
Data from ICON7 will be submitted for presentation at an upcoming medical meeting, Genentech said.
The ICON7 study is sponsored by the Medical Research Council (MRC) in the UK, led by the MRC Clinical Trials Unit and conducted through an international network of researchers in the Gynaecologic Cancer InterGroup (GCIG).
ICON7 is an international, multicentre, randomised, open-label, Phase III study in 1,528 women with previously untreated epithelial ovarian, primary peritoneal or fallopian tube carcinoma. The trial evaluates Avastin plus standard of care chemotherapy (carboplatin and paclitaxel) followed by the continued use of Avastin alone, compared to chemotherapy alone.
Friday, July 02, 2010
Future Medicine - Women's Health - re: EVA trial (full free access to commentary/abstract of original paper) MRI high risk familial risk breast cancer
link:
Steven A Narod
Evaluation of: Kuhl C, Weigel S, Schrading S et al.: Prospective multicenter cohort study to refine management recommendations for women at elevated familial risk of breast cancer: the EVA trial. J. Clin. Oncol. 28, 1450–1457 (2010).
"In the EVA trial, Kuhl et al. screened 687 women at high risk of breast cancer for up to 3 years with annual MRI. A total of 27 breast cancers were diagnosed, including 11 DCIS and two local recurrences. There were no interval cancers. This data suggests that MRI screening can be used to downstage breast cancers, but larger studies with longer follow-up periods are required to confirm these findings."
Prospective Multicenter Cohort Study to Refine Management Recommendations for Women at Elevated Familial Risk of Breast Cancer: The EVA Trial
full free access: - Women's Health - Ovarian cancer biomarker screening: still too early to tell
"In 2004, the US Preventive Services Task Force (amongst other countries/guidelines) recommended against routine ovarian cancer screening [102]. None of the more recent findings overide this guideline. We must await the results of the two large-scale trials. Whether the results are positive or not, these trials will yield vital data to guide the next steps in biomarker research and subsequent guidelines for practice."
Thursday, July 01, 2010
Stem cell scientists launch effort to prevent fraudulent treatment - Office of Communications & Public Affairs - Stanford University School of Medicine
"... The use of quotes from well-regarded stem cell scientists and physicians is not uncommon on unscrupulous Internet websites, according to Weissman. Frequently these experts are unaware that their names are being used, and the quotes are fabricated or taken out-of-context from some other source.
As a result of the task force’s efforts to publicize these and other abuses, the ISSCR recently launched a publicly available website (www.closerlookatstemcells.org) where patients can learn more about stem cell biology, learn what questions to ask of potential clinics, and even submit a specific website for further investigation by the ISSCR."
Miradx - "PreOvar" test (KRAS mutation
KRAS Variant Grand Round Presentation ("coming soon")
Mon, 03/08/2010 - 13:19 — admin
To learn more about PreOvar, review the On-line Grand Rounds presented by Joanne Weidhaas, M.D., Ph.D., an Assistant Professor at Yale University
in the Department of Therapeutic Radiology.
Management of rare ovarian cancers: The experience of the French website «Observatory for rare malignant tumours of the ovaries» by the GINECO group
Background
Non-epithelial ovarian cancers are rare; their natural history is poorly understood and prognostic factors remain unclear. A French website (www.ovaire-rare.org) was developed to collect clinical cases and tumour samples in order to better define prognostic factors and develop specific trials. We report the results of the first 100 patients with germ cell (GCT) and sex cord-stromal (SCT) tumours.Conclusions
This online observatory allows assessing medical practice for GCT and SCT in France. Histological discrepancies between diagnosis and second opinion confirm the need for systematic review before treatment. Extension to other rare gynaecologic malignancies is on-going.Clinical Management of Borderline Tumours of the Ovary – Experience from the “Berlin Online Tumour Conference for Gynaecological Malignancies” — Anticancer Research
Abstract
Borderline ovarian tumour (BOT) represents a rare and special tumour entity. Despite a generally favourable prognosis for patients with BOT, the presence of invasive peritoneal implants decreases the survival rate to 30-50%. In contrast to ovarian cancer, only few data exist concerning the current clinical management of patients with BOT. For this reason, the present analyses were performed for patients with BOT who were admitted into our online tumor conference for patients with gynaecological malignancies. Based on the results discussed in this article, the current aspects and problems regarding the diagnostic, surgical and conservative treatment and aftercare management of patients with BOT are considered.
Arrayit Corporation Receives Registered Trademark for OvaDx(R) - financial news
"Arrayit's OvaDx(R), the market's first comprehensive diagnostic screening test for ovarian cancer, uses approximately 100 proteomic biomarkers to identify molecular beacons of ovarian cancer that accumulate in the bloodstream as soon as an ovarian tumor begins to develop. OvaDx(R) detects both early and late stage ovarian cancer with high sensitivity and specificity using Arrayit's proprietary microarrays, which are tiny medical devices that screen large numbers of patient samples in a highly miniaturized and automated manner. OvaDx(R) leverages Arrayit's patented manufacturing technology and will be marketed and sold upon FDA approval by the company's subsidiary Arrayit Diagnostics, Inc."
Wednesday, June 30, 2010
World Cancer Research Fund International (WCRF International)/AICR (American Institute for Cancer Research)
WCRF/AICR will keep you informed with the latest updates on the Second Expert Report, Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective.
| World Cancer Research Fund International First Floor 19 Harley Street London, W1G 9QJ, UK Tel: +44-20-73434200 | Fax: +44-20-73434220 http://www.wcrf.org/ |
American Institute for Cancer Research 1759 R Street N.W. Washington, DC 20009, USA Tel: 202-328-7744 | Fax: 202-328-7226 http://www.aicr.org/ |
Characteristics and prognosis of coexisting adnexa malignancy with endometrial cancer: a single institution review of 51 cases
CONCLUSION:
Our results showed that OS and PFS of synchronous primary ovarian cancer in patients with endometrial cancer is better than those with ovarian metastasis patients. Pre- and intra-operative, intensive and careful assessment, and strict and continuous postoperative surveillance should pay attention to the endometrial cancer patients who preserved ovary for having possibility of coexisting occult ovarian lesions.
full free access: Risk of urothelial bladder cancer in Lynch syndrome is increased, in particular among MSH2 mutation carriers -- Journal of Medical Genetics
"Besides the high risk of developing colorectal carcinomas of 10–80%, Lynch syndrome family members are at increased risk of developing several extra-colonic cancers and tumours at a relatively young age: endometrial cancer, carcinomas of the ovary, small bowel and biliary tract cancer, sebaceous gland tumours and urothelial carcinomas (UC) of the upper urinary tract. The lifetime risk of upper urinary tract cancer in Lynch syndrome varies in different studies from 0.4–20%. Microsatellite instability (MSI) is present in these urothelial carcinomas of the upper urinary tract."
See Table 1
abstract/free full access: Cardiotoxicity of anthracycline agents for the treatment of cancer: Systematic review and meta-analysis of randomised controlled trials
"The majority of the studies were on women with advanced or metastatic breast cancer. Twenty-one studies included participants with myeloma, lymphoma, sarcoma or ovarian cancer, and three studies included a mixture of tumour types."
Background
We conducted a systematic review and meta-analysis to clarify the risk of early and late cardiotoxicity of anthracycline agents in patients treated for breast or ovarian cancer, lymphoma, myeloma or sarcoma.Conclusions
Evidence is not sufficiently robust to support clear evidence-based recommendations on different anthracycline treatment regimens, or for routine use of cardiac protective agents or liposomal formulations. There is a need to improve cardiac monitoring in oncology trials.Tuesday, June 29, 2010
*note comments: Study to Evaluate Families with History of Carcinoid Cancer
Note: this study is an NIH study and excludes those with a known genetic syndrome
Study to Evaluate Families with History of Carcinoid Cancer
By The Carcinoid Cancer Foundation (CCF)
The Natural History of Familial Carcinoid Tumor is recruiting participants who are interested in being part of a study that will “evaluate families with a history of carcinoid cancer to determine ways to improve early detection and to find the gene that may cause the tumors.”
If you are a member of a family in which two or more immediate blood relatives have had gastrointestinal carcinoid tumors, you may be eligible for this study. Unaffected spouses of family members diagnosed with carcinoid cancer are also requested to participate.
summary: Targeted therapies for rare gynaecological cancers : The Lancet Oncology
"Some gynaecological cancers are uncommon, such as sex cord-stromal tumours, malignant germ-cell tumours, vulvar carcinoma, melanoma of the female genital tract, clear-cell carcinoma of the ovary and endometrium, neuroendocrine tumours of the cervix, and gestational trophoblastic neoplasia. All these cancers have different clinicopathological characteristics, suggesting different molecular biological pathogeneses. Despite aggressive treatment, some cancers recur or respond poorly to therapy. Comprehensive knowledge of the molecular biology of each cancer might help with development of novel treatments that maximise efficacy and minimise toxic effects. Targeted therapy is a new treatment strategy that has been investigated in various tumours in clinical and laboratory settings. Since these cancers are rare and large clinical trials are difficult to do, molecular biological techniques might allow rapid proof-of-principle experiments in few patients. Novel targeted agents either alone or in combination with other treatments offer promising therapeutic options."
Top Cancer Doctors to speak at upcoming Power is Teal Conference - Dr's Coleman, Goff, Seiden, Armstrong (OCNA/Washington)
Power is Teal Conference
July 10 - July 13, 2010
Washington, DC
www.ovariancancer.org/conference/2010
July 10 - July 13, 2010
Washington, DC
www.ovariancancer.org/conference/2010
CONFERENCE AGENDA
HIGHLIGHTS:
Saturday, July 10
Ovarian Cancer 101
presented by Dr.
Robert Coleman of MD Anderson Cancer Center
Sunday, July 11
Research Updates
Part I
presented by Dr.
Barbara Goff of the University of Washington, School of Medicine
How Healthcare
Reform Affects this Community
presented by Tim
Westmoreland, Esq., Visiting Professor, Georgetown University School of
Law
Monday, July 12
Research Update
Part II: Mello-Abrams Lectureship Accelerating Ovarian Cancer Research:
Recent Victories, Current Opportunities, Future Challenges
presented by Dr.
Michael Seiden, President and CEO of Fox Chase Cancer Center
Recurrence
presented by Dr.
Deborah Armstrong of Johns Hopkins Kimmel Cancer Center
To view the full Power is Teal Conference
agenda and to register, visit www.ovariancancer.org/conference/2010.
abstract/free full access: Current clinical criteria for Lynch syndrome are not sensitive enough to identify MSH6 mutation carriers -- Sjursen et al. -- Journal of Medical Genetics
Conclusion:
Amsterdam criteria and each of the Bethesda criteria were inadequate for identifying MSH6 mutation-carrying kindreds. MSH6 mutations may be more common than currently assumed, and the penetrance/expression of MSH6 mutations, as derived from families meeting current clinical criteria, may be misleading. To increase detection rate of MMR mutation carriers, all cancers in the Lynch syndrome tumour spectrum should be subjected to immunohistochemical analysis and/or analysis for microsatellite instability.
Oncologist preferences for health States associated with the treatment of advanced ovarian cancer - (interview with 34 oncologists) - abstract
Objective:
"To explore oncologists' preferences for hypothetical outcome scenarios (i.e. health states) resulting from various treatment options."
Conclusions:
"These data suggest that oncologists may choose treatments that maximize clinical efficacy only when not associated with severe toxicities or low emotional well-being unless associated with a large improvement in efficacy. Physicians may prefer a more toxic chemotherapy regimen that improves survival, and are more willing to compromise emotional well-being for a large survival advantage in the setting of newly diagnosed disease. Slight improvements in clinical efficacy may not be acceptable to oncologists unless associated with higher emotional well-being for the patient."
Single-port risk-reducing salpingo-oophorectomy with and without hysterectomy: Surgical outcomes and learning curve analysis
OBJECTIVE:
Based on considerable prospective data, risk-reducing salpingo-oophorectomy (RRSO) is one of the most beneficial interventions available to reduce ovarian/breast cancer risk in BRCA carriers and high-risk women. The purpose of this study was to describe the initial surgical outcomes and learning curve analysis associated with laparoendoscopic single-site (LESS) RRSO with and without hysterectomy.
RESULTS:
A total of 58 patients were evaluated; 36 (63%) were BRCA1/2 carriers and 38 (63%) had breast cancer.
"Prospective studies are needed to assess the relative benefits of LESS compared with more conventional minimally invasive approaches."
Genomic analysis of genetic heterogeneity and evolution in high-grade serous ovarian carcinoma - jnl Oncogene
"These data show that cisplatin resistance in HGS (high grade serous) carcinoma develops from pre-existing minor clones but that enrichment for these clones is not apparent during short-term chemotherapy treatment
The prognostic significance of optimal debulking in the setting of a complete clinical response for advanced ovarian carcinoma patients receiving main
Abstract:
"CONCLUSION: In advanced ovarian cancer patients who achieve a CCR (complete clinical response) following induction chemotherapy, optimal cytoreduction may confer a greater clinical benefit from a maintenance approach compared to suboptimal cytoreduction."
abstract: Detection of inherited mutations for breast and ovarian cancer using genomic capture and massively parallel sequencing — PNAS
Abstract:
"Inherited loss-of-function mutations in the tumor suppressor genes BRCA1, BRCA2, and multiple other genes predispose to high risks of breast and/or ovarian cancer. Cancer-associated inherited mutations in these genes are collectively quite common, but individually rare or even private. Genetic testing for BRCA1 and BRCA2 mutations has become an integral part of clinical practice, but testing is generally limited to these two genes and to women with severe family histories of breast or ovarian cancer.
To determine whether massively parallel, “next-generation” sequencing would enable accurate, thorough, and cost-effective identification of inherited mutations for breast and ovarian cancer, we developed a genomic assay to capture, sequence, and detect all mutations in 21 genes, including BRCA1 and BRCA2, with inherited mutations that predispose to breast or ovarian cancer"
"There were zero false-positive calls of nonsense mutations, frameshift mutations, or genomic rearrangements for any gene in any of the test samples. This approach enables widespread genetic testing and personalized risk assessment for breast and ovarian cancer"
Early Discontinuation and Nonadherence to Adjuvant Hormonal Therapy in a Cohort of 8,769 Early-Stage Breast Cancer Patients -- Hershman et al., 10.1200/JCO.2009.25.9655 -- Journal of Clinical Oncology
blog Note: at the time of this post, full free access to the paper was available; a search of the paper for the term 'side effects' = O with the exception of references
study: "There are several limitations to our study. First,we were unable to determine the reasons for nonadherence and discontinuation."
Ovarian metastasis following gallbladder carcinoma: a case report (mucinous cell type)
Abstract
"BACKGROUND: Mucinous ovarian cancer raises problems of differential diagnoses because it is often difficult to distinguish the primary from the metastatic form. Most metastatic ovarian tumors originate from the gastrointestinal tract, mainly colorectal, gastric, pancreatic; the gallbladder is a very rare source of ovarian metastases.
CASE: We report a case of ovarian metastases from a gallbladder cancer, incidentally diagnosed more than 2.5 years earlier during a laparoscopic intervention for biliary lithiasis.
CONCLUSION: The interest of this case lies in the long progression-free survival, the venous thromboembolism syndrome that preceded by a few months the diagnosis of the ovarian mass and the discrepancy between the radiologic and the laparoscopic stage assessment."
Review: Targeting the Hedgehog pathway in cancer - abstract
"The orally available compound, GDC-0449, is the farthest along in clinical development. Initial clinical trials in basal cell carcinoma and treatment of select patients with medulloblastoma have shown good efficacy and safety."
Acupuncture as Palliative Therapy for Physical Symptoms and Quality of Life for Advanced Cancer Patients -- Dean-Clower et al. 9 (2): 158 -- Integrative Cancer Therapies
"Ambulatory patients with advanced ovarian or breast cancer were enrolled to receive treatments at an outpatient academic oncology center."
Conclusions.
This pilot study demonstrates that an 8-week outpatient acupuncture course is feasible for advanced cancer patients and produces a measurable benefit that should be evaluated in controlled trials.
Review Article: Influence of Viscum album L (European Mistletoe) Extracts on Quality of Life in Cancer Patients: A Systematic Review of Controlled Clinical Studies
Conclusions.
VAEs seem to have an impact on QoL and reduction of side effects of conventional therapies (chemotherapy, radiation) in experimental trials as well as in routine daily application. The influence on fatigue especially should be investigated further.
Selenium or No Selenium- That Is the Question in Tumor Patients: A New Controversy
Abstract:
"The essential trace element selenium, which is a crucial cofactor in the most important endogenous antioxidative systems of the human body, is attracting more attention from both laypersons and expert groups. The interest of oncologists mainly focuses on the following clinical aspects: protection of normal tissues, sensitizing in malignant tumors, antiedematous effect, prognostic impact of selenium, and effects in primary and secondary cancer prevention. Selenium is a constituent of the small group of selenocysteine-containing selenoproteins and elicits important structural and enzymatic functions. Selenium deficiency has been linked to increased infection risk and adverse mood states. It has been shown to possess cancer-preventive and cytoprotective activities in both animal models and humans. It is well established that it has a key role in redox regulation and antioxidant function, and hence in membrane integrity, energy metabolism, and protection against DNA damage. Recent clinical trials have shown the importance of selenium in clinical oncology. In 2009, a significant benefit of sodium selenite supplementation—with no protection of tumor cells, which is often suspected by oncologists— was shown in a prospective randomized trial in gynecologic cancer patients undergoing radiation therapy. More recently, concerns arose from 2 large clinical prevention trials (NPC, SELECT) that selenium may increase the risk of developing type 2 diabetes. Despite obvious flaws in both studies and good counterarguments, controversy remains on the possible advantages and risks of selenium in cancer prevention. However, in the light of the recent clinical trials the potential benefits of selenium supplementation in tumor patients are becoming obvious, even though further research is needed."
Monday, June 28, 2010
Chemotherapy resistant ovarian tumour cells "re-grow" cancer - media UK
"Shielded" ovarian cancer cells may survive chemotherapy. "The researchers compared the characteristics of cell lines from the tumour at the time of diagnosis to cell lines from the same patients once the disease had been treated and become resistant." ""By examining the characteristics of ovarian tumours we now think that cells resistant to chemotherapy grow as part of the tumour. This means that when patients have treatment, cells that respond to chemotherapy are destroyed but this leaves behind resistant cells which then form another tumour of completely resistant cells. This seems to explain why successful treatment for relapsed patients is difficult. What needs to be developed now is a therapy designed to target the resistant cells.""
abstract: Prevalence of bowel symptoms in women with pelvic floor disorders
Conclusions
"Women rarely seek urogynecologic care primarily for bowel symptoms, although they have a high prevalence of bowel symptoms."
abstract: Urinary tract injury: medical negligence or unavoidable complication?
"The incidence of urinary tract injury is low in most gynaecological operations but, if undiagnosed, is a cause of significant postoperative morbidity for the patient and litigation for the gynaecologist. A Medline search of studies of urinary tract injury at gynaecological surgery show that only one in 10 ureteral injuries and one in three bladder injuries are detected at the time of surgery without intra-operative cystoscopy. As cystoscopy is not routinely performed by the majority of gynaecologists during surgery, even in difficult cases, failure to detect injury to the urinary tract by itself should not be seen as negligence. However, all gynaecologists performing pelvic surgery should be encouraged to become competent in cystourethroscopy and perform this intra-operatively, at least in all high-risk cases of gynaecological surgery."
Reply to M. Markman -- Ferrandina 28 (19): e321 -- Journal of Clinical Oncology
Markman: Serious Ethical Dilemma of Single-Agent Pegylated Liposomal Doxorubicin Employed As a Control Arm in Ovarian Cancer Chemotherapy Trials -- Markman JCO commentary
Ferrandina Response to Markman:
http://jco.ascopubs.org/cgi/content/full/28/19/e321?cmpid=jco_etoc_1July2010"...Overall, I think that there will be no need for institutional review boards of community-based centers or universities to take up a formal position in this context. Indeed, I think that the more and more diffuse use in the clinical practice of PLD 40 mg/m2 will be, in and by itself, stronger than any regulatory rules, and that the lower and safer PLD dose level will tacitly replace the US Food and Drug Administration–approved dosage in clinical trials.
Time has already come for this change: looking through the randomized clinical trials utilizing PLD as a control arm, we found that four (NCT00976911 [ClinicalTrials.gov] , NCT00913835 [ClinicalTrials.gov] , NCT00635193 [ClinicalTrials.gov] , NCT00657878 [ClinicalTrials.gov] ) of seven of the ongoing studies are already employing the PLD dosage of 40 mg/m2 instead of 50 mg/m2 (www.clinicaltrials.gov."
Serious Ethical Dilemma of Single-Agent Pegylated Liposomal Doxorubicin Employed As a Control Arm in Ovarian Cancer Chemotherapy Trials -- Markman JCO commentary
"...It is essential that those reading this letter do not misinterpret its meaning. There is absolutely no intent in this discussion to vilify any individual, organization, or company involved in the oncology drug development paradigm. It is unquestionably the case that all working in this arena have as their major goal the advancement of antineoplastic strategies that are effective, relatively safe, and that improve the survival and quality of life of patients with cancer.
repost: abstract: (Yondelis) Trabectedin Plus Pegylated Liposomal Doxorubicin in Recurrent Ovarian Cancer. BJ Monk et al
Note: Reposted from June 9th to coincide with Editorial from JCO; multinational study plus: JCO link
Evaluating New Regimens in Recurrent Ovarian Cancer: How Much Evidence Is Good Enough? -- Cannistra 28 (19): 3101 -- Journal of Clinical Oncology
Note: speaks about PFS vs OS (progression free survival; overall survival); PLD and Trabectedin (Yondelis) study (Monk); ICON4 and more
Marjie - The support of 'family'
"...Margie is in the midst of a battle with colon, ovarian, and uterus cancer, and Saturday was her first time attending...."
abstract: Clinical Biochemistry : Nidogen-2: A new serum biomarker for ovarian cancer (multinational study)
Conclusions:
Nidogen-2 is a new biomarker for ovarian cancer which correlates closely with CA125.
Search of: ovarian cancer | Open Studies | received from 06/01/2010 to 06/27/2010 - List Results - ClinicalTrials.gov
Found 8 studies with search of: ovarian cancer | Open Studies | received from 06/01/2010 to 06/27/2010
1 Not yet recruiting Incidence of Cancer in Women at Increased Genetic Risk of Ovarian Cancer
Conditions: Breast Cancer; Fallopian Tube Cancer; Ovarian Cancer; Peritoneal Cavity Cancer
Interventions: Other: questionnaire administration; Procedure: evaluation of cancer risk factors; Procedure: quality-of-life assessment; Procedure: study of high risk factors
2 Recruiting N-acetylcysteine Given IV With Cisplatin and Paclitaxel in Patients With Ovarian Cancer
Conditions: Ovarian Carcinoma, Stage 3 or 4; Epithelial Ovarian Carcinoma; Primary Peritoneal Carcinoma
Interventions: Drug: Paclitaxel; Drug: N-acetylcysteine; Drug: Cisplatin
3 Not yet recruiting Study of JI-101 in Patients With Advanced Head and Neck Cancers, Ovarian Cancers or K-RAS Mutant Colon Cancers
Conditions: Cancer; Head & Neck Cancer; Ovarian Cancer; Colon Cancer
Interventions: Drug: JI-101; Drug: Everolimus
4 Not yet recruiting Veliparib and Liposomal Doxorubicin Hydrochloride in Treating Patients With Recurrent Ovarian Cancer, Fallopian Tube Cancer, or Primary Peritoneal Cancer or Metastatic Breast Cancer
Conditions: Breast Cancer; Fallopian Tube Cancer; Ovarian Cancer; Peritoneal Cavity Cancer
Interventions: Drug: pegylated liposomal doxorubicin hydrochloride; Drug: veliparib; Other: laboratory biomarker analysis; Other: pharmacological study
5 Not yet recruiting Safety Study of MGAH22 in HER2-positive Carcinomas
Conditions: Breast Cancer; Gastric Cancer; Bladder Cancer; Ovarian Cancer; Non-small Cell Lung Cancer
Intervention: Biological: MGAH22
6 Recruiting Assessing Fertility Potential in Female Cancer Survivors
Condition: History of Cancer
Intervention:
7 Recruiting Intraperitoneal Ropivacaine Nebulization for Pain Control After Gynecologic Laparoscopic Surgery
Condition: Ovarian Cysts
Interventions: Drug: Ropivacaine nebulization; Drug: Ropivacaine instillation
8 Recruiting Effects of Exercise for Overweight Women With Polycystic Ovary Syndrome
Conditions: Polycystic Ovary Syndrome; Obesity
Interventions: Other: 16-week exercise training program; Other: Control Group without PCOS
Friday, June 25, 2010
research: BRCA-Negative Ovarian Cancer Responds to Monotherapy With PARP Inhibitor | Cancer Survivors Network
Note: detailed article on PARP's/BRCA "....Interest in PARP inhibition was perhaps best reflected by the question an attendee at the packed session put to Dr. Gelmon.
"My problem is, as a practicing oncologist, I see these great, wonderful results, in a very difficult population of patients with ovarian cancer," he said. "I want to know when I can get my hands on some. There are patients dying today because of this lack of access.""
Guest Blog: A genome story: 10th anniversary commentary by Francis Collins
".....Already, in its pilot phase, this NIH-supported project has produced comprehensive molecular classification systems for ovarian cancer and glioblastoma, which is the most common form of brain cancer. This information may help doctors do a better job of matching individual patients with the therapies that are most likely to work well for them. What's more, the findings may lead to new therapies directed at the molecular changes underlying various subtypes of cancer.
Some of this is already happening today...."
full free access: PLoS Genetics: Consent and Internet-Enabled Human Genomics
"This month, PLoS Genetics is publishing an article from the company 23andMe reporting the first genome-wide association studies (GWAS) on multiple traits ascertained by self-reported information provided through the Internet from over 10,000 participants who pay the company for providing whole genome genotypes [1]. The paper passed through scientific review by a panel of three experts relatively quickly and is sure to attract the attention of anyone with freckles, curly hair, or an aversion to asparagus. Novel associations are described for four intrinsically interesting traits (out of 22 considered), while known associations with hair and eye color are replicated in a dynamic data-gathering context. Additionally, intriguing observations on the interaction between genetic self-knowledge and self-report of phenotypes are described. The implications of the successful application of this Internet-enabled approach to GWAS research were considered to be more than sufficient to warrant publication in the journal.
However, publication was delayed for six months while the editors sought a variety of opinions on three issues: ethical review, consent, and data access...."
Prognosis Of Stage 2 Ovarian Cancer | LIVESTRONG.COM
"Overall, Stage II ovarian cancer has a five-year survival rate of 66 percent."
(another amazing) job posting - Ovarian Cancer Canada
Note: see prior blog posting "BSB4uD" (Be Smart Before You Donate) - +$1million dollars in salaries and rising
Job Categories: Program / Project Evaluation & Development
Position Type: Part Time
Job Region: QC - Quebec City
Location(s): 4950 chemin Queen Mary
Career Level: Experienced (Non-manager)
Ad Online Since: 06/22/2010
Application Deadline: 07/06/2010
Identifying supportive care needs of women with ovarian cancer (abstract)
abstract:
Women diagnosed with ovarian cancer may experience many shortterm and long-term effects from cancer and its treatment. Cancer has more than a physical impact, yet there is a lack of information about the types of needs these women have and whether they want help in meeting their needs. The main purpose of this cross-sectional, descriptive study was to identify the supportive care needs (physical, emotional, social, informational, spiritual, psychological and practical) of women with ovarian cancer who attended a comprehensive, outpatient cancer centre. A further purpose was to determine if women wanted assistance in meeting those needs. A total of 50 women diagnosed with ovarian cancer participated in this study by completing a self-report questionnaire (The Supportive Care Needs Survey). The data indicated that a range of supportive care needs remained unmet for this patient group. Eight of the top 10 most frequently reported needs were psychosocial, such as fears about the cancer returning or spreading. The women also expressed a range of difficulty in managing their needs. However, despite this reality, significant numbers of women indicated they did not wish to have assistance from the clinic staff with some needs. Suggestions for practice and future research are offered to assist oncology nurses in providing care to these women.
The National Cancer Database report on advanced-stage epithelial ovarian cancer: Impact of hospital surgical case volume on overall survival and surgical treatment paradigm
Abstract
OBJECTIVE: To examine the effect of hospital procedure volume and other prognostic variables on overall survival outcome and likelihood of receiving standard recommended care among patients with advanced-stage epithelial ovarian cancer.CONCLUSIONS: Hospital ovarian cancer surgical volume >/=21 cases/year is associated with a higher likelihood of patients with Stage IIIC/IV epithelial ovarian cancer receiving standard treatment (surgery followed by adjuvant chemotherapy). Even after adjusting for treatment paradigm and other factors, hospital volume >/=21 cases/year was significantly predictive of improved overall survival outcome.
Impact of positron emission tomography/computed tomography in the management of patients with epithelial ovarian carcinoma after treatment.
CONCLUSIONS:
Both integrated FDG-PET/CT and contrast-enhanced multidetector CT are sensitive surveillance modalities for the detection of recurrent ovarian cancer; the use of both modalities aids decisions on treatment plans and may ultimately have a favorable impact on prognosis. However, contrast-enhanced multidetector CT is recommended for the regular follow-up for ovarian cancer patients after initial treatment.
Thursday, June 24, 2010
How Does Older Age Influence Oncologists' Cancer Management?
Conclusions.
Advanced age can deter oncologists from choosing intensive cancer therapy, even if patients are highly functional and lack comorbidities. Education on tailoring cancer treatment and a greater use of comprehensive geriatric assessment may reduce cancer undertreatment in the geriatric population.
Gender-Related Needs and Preferences in Cancer Care Indicate the Need for an Individualized Approach to Cancer Patients
"This study explored the impact of gender on cancer patients' needs and preferences, and found that, of all the patient- and disease-related factors, gender was the most important independent predictor of patient preferences."
(" gender was more important than type of cancer")
Update on Paraneoplastic Neurologic Disorders
Note: very complicated condition/conditions/subsets of conditions and requires specialist consultation/s.
"When patients with cancer develop neurologic symptoms, common causes include metastasis, infections, coagulopathy, metabolic or nutritional disturbances, and neurotoxicity from treatments. A thorough clinical history, temporal association with cancer therapies, and results of ancillary tests usually reveal one of these mechanisms as the etiology. When no etiology is identified, the diagnosis considered is often that of a paraneoplastic neurologic disorder (PND). With the recognition that PNDs are more frequent than previously thought, the availability of diagnostic tests, and the fact that, for some PNDs, treatment helps, PNDs should no longer be considered diagnostic zebras, and when appropriate should be included in the differential diagnosis early in the evaluation."
Understanding How Out-of-Pocket Expenses, Treatment Value, and Patient Characteristics Influence Treatment Choices -- U.S.
"The study used a convenience sample of patients undergoing surveillance following curative treatment for localized cancer who completed a paper survey to estimate the maximum copayment patients are willing to pay for better treatment outcomes. Results suggest that patients may be less willing to pay high copayments for treatments with modest benefit. In addition, sociodemographic factors such as education and employment status were associated with willingness to pay." "In conclusion, this study demonstrates that it is feasible to measure cancer patients' WTP (willingness to pay) for treatments in both the adjuvant and palliative settings. In addition, our results support the hypothesis that cancer patients' WTP for treatment may be influenced by both sociodemographic factors and their assessment of the treatment's value. If confirmed in a larger, more heterogeneous population, these findings suggest that insurance benefit designs based on treatment value may be feasible for cancer treatment. However, they also highlight the risk that higher out-of-pocket expenses may contribute to socioeconomic disparities in cancer care."
(Pre-)Clinical Pharmacology and Activity of Pazopanib, a Novel Multikinase Angiogenesis Inhibitor
"In a phase I trial, a generally well-tolerated dose was identified at which the majority of patients achieved pazopanib plasma concentrations above the concentration required for maximal in vivo inhibition of VEGFR-2 phosphorylation in preclinical models.
Administered as monotherapy, evidence of antitumor activity was observed in phase II studies in several tumor types, including soft tissue sarcoma, renal cell cancer (RCC), ovarian cancer, and non-small cell lung cancer.
Recently, the U.S. Food and Drug Administration granted approval for treatment with pazopanib in patients with RCC based on the longer progression-free survival time observed with this agent in a placebo-controlled, randomized trial.
------------------------------------------------------------
"Furthermore, preliminary data from a small phase II study in women with progressive, platinum-pretreated ovarian cancer showed a cancer antigen 125 response (defined as a confirmed decrease
50% from baseline) in 11 (31%) patients, with a median
duration of response of 113 days.*>"(*Annals of Oncology 19 (Supplement 8): viii211–viii216, 2008
doi:10.1093/annonc/mdn512:
PAZOPANIB (GW786034) IS ACTIVE IN WOMEN WITH
ADVANCED EPITHELIAL OVARIAN, FALLOPIAN TUBE AND
PERITONEAL CANCERS: RESULTS OF A PHASE II STUDY
M. Friedlander1, K.C. Hancock2, B. Benigno3, D. Rischin4, M. Messing5,
C.A. Stringer6, J.P. Hodge7, B. Ma7, G. Matthys7, J.J. Lager7
1Oncology Day Center, Prince of Wales Hospital, Randwick, Sydney/
AUSTRALIA, 2Oncology, Texas Oncology, Fort Worth/UNITED STATES OF
AMERICA, 3Oncology, SE Gynecologic Oncology, Atlanta/UNITED STATES OF
AMERICA, 4Oncology, Mercy Hospital for Women, Melbourne/AUSTRALIA,
5Oncology, Texas Oncology, Bedford/UNITED STATES OF AMERICA,
6Oncology, Texas Oncology, Dallas/UNITED STATES OF AMERICA, 7Scientific
Communications, GlaxoSmithKline, Research Triangle Park/UNITED STATES
OF AMERICA )
" Putting pazopanib into perspective and comparing it with other VEGFR TKIs that have been approved for a longer time are difficult and have to be done on the basis of indirect comparisons, given the lack of data from comparative trials among the several treatment options."
press release: Access Pharmaceuticals, Inc. Presents MuGard Clinical Experience at MASCC Conference - MarketWatch
"MuGard is indicated in Europe for the prevention and management of oral mucositis, and has been used by over 2,000 cancer patients globally. A total of 185 documented patients from various studies utilized MuGard in both prophylactic and curative settings"
Prevalence of BRCA1 and BRCA2 germ line mutations among women with carcinoma of the fallopian tube.(abstract)
OBJECTIVES:
The purpose of this study is to determine the prevalence of BRCA1 and BRCA2 mutations among a large series of women with carcinoma of the fallopian tube.
METHODS:
Two series of women diagnosed with carcinoma of the fallopian tube were studied. Women identified from the Ontario Cancer Registry who were diagnosed with fallopian tube cancer between 1990 and 1998 and between 2002 and 2004. A second, hospital-based series was identified at Cedars Sinai Medical Centre, Los Angeles, California. These women were diagnosed between 1991 and 2007. Each subject was approached to provide her family history and ethnic background and to provide a blood sample for genetic testing for mutations in the BRCA1 and BRCA2 genes.
RESULTS:
In total, 108 patients with fallopian tube cancer were recruited (70 from Ontario and 38 from Los Angeles). Thirty-three patients (30.6%) were found to have a deleterious mutation; 23 in BRCA1 (21.3%) and 10 in BRCA2 (9.3%). The prevalence of mutations was 55.6% in Jewish women and was 26.4% in non-Jewish women. A family history of ovarian or breast cancer was positive for 24 women (23.3%); of these, 14 had a mutation (58.3%). Fourteen (14.4%) of the patients had a previous history of breast cancer; of these, 10 (71.4%) had a mutation. 40.3% of the women who were diagnosed with fallopian tube cancer before age 60 had a mutation, compared with 17.4% of the women diagnosed at age 60 and above.
CONCLUSIONS: Approximately 30% of women with fallopian tube cancer have a mutation in BRCA1 or BRCA2. The highest frequencies of BRCA mutations were seen in women with fallopian tube cancer diagnosed under age 60, in Jewish women, in women with a family history of breast or ovarian cancer, and in women with a personal history of breast cancer. All patients diagnosed with invasive fallopian tube cancer should be considered candidates for genetic testing.
Personal history of breast cancer as a significant risk factor for endometrial serous carcinoma in women aged 55 years old or younger
Note: suggestive of Lynch Syndrome (unresolved connection between breast cancer/Lynch Syndrome??)
2010 the Commonwealth Fund report: MIRROR, MIRROR ON THE WALL: AN INTERNATIONAL UPDATE ON THE COMPARATIVE PERFORMANCE OF AMERICAN HEALTH CARE
Overall rankings: Canada and U.S. in last place, Netherlands takes 1st place
authors: Carolyn Benivegna*, Tracy Gorden*...(*with us in spirit) "Giving VOICE to Ovarian Cancer Survivors" (previously unpublished)
Sandi's notes and background on this article:
A few years ago, I was asked to write a paper on ovarian cancer specific to the Survivors' Debate. Carolyn and Tracy were enlisted to co-author the article - a team approach for those who know best. This was the final version which went unpublished.
It went unpublished mainly because editorial requests virtually 'sanitized' the article to the point where our message became close to irrelevant. At that point, I declined our involvement.
On behalf of my - our friends, Carolyn and Tracy, and with the beneficial advances brought on through social media, here is the final and unedited version.
A few years ago, I was asked to write a paper on ovarian cancer specific to the Survivors' Debate. Carolyn and Tracy were enlisted to co-author the article - a team approach for those who know best. This was the final version which went unpublished.
It went unpublished mainly because editorial requests virtually 'sanitized' the article to the point where our message became close to irrelevant. At that point, I declined our involvement.
On behalf of my - our friends, Carolyn and Tracy, and with the beneficial advances brought on through social media, here is the final and unedited version.
Giving VOICE to ovarian cancer survivors
Survivors debate
the issues
Authors:
Carolyn Benivegna*, Tracy Gorden*, Sandi Pniauskas
(*with us in spirit)
(*with us in spirit)
During her research for a presentation
concerning cancer patients’ voices in healthcare, Sandi Pniauskas
While it would be imprudent to take this
singular and remarkable quote as the “rule du jour,” this philosophy, and
others similar to it, are prevalent in both private perception and in published
literature on cancer survival.
We can be thankful for more enlightened
views, such as this example from the Journal of Health and Social Policy
that, instead, celebrates the voices and contributions of (non-medical) health
educators and activists:
The activists'
efforts wrested control of “authoritative knowledge” that had once
been the sole domain
of the “experts” with advanced medical training. They used
this knowledge to
empower “average” people with medical information…to
promote self help and
engage in civil disobedience, which led to changes in
healthcare delivery (2006;21(3):55-69).
As ovarian cancer survivors
we have learned much over the years.
Average, everyday citizens are taking active roles in their treatments
and educating themselves about this deadly disease. Yet in our view, and through the course of
shedding light on this disease and the experiences of those living with it, it
has become obvious that there is no such thing as an “average” survivor.
Ovarian cancer is not
a new disease; in fact, it has been traced back as far as Egyptian times. Advancements in research, education,
awareness and access to care have gained some momentum, but they have also hit
many roadblocks. As ovarian cancer
survivors with international grassroots connections
to, and support from, other survivors we
regularly discuss where this disease has been, and where it is going. We now feel it is time to move these
behind-the-scenes discussions to open forums.
By being informed and proactive
women with ovarian cancer, we have recognized the value and importance of
conducting our own critical analysis. Most
importantly, we have learned to shift the focus onto the human elements and
burdens of suffering that we experience each day in our communities.
Creating
a public forum for ovarian cancer survivors
As those living with this disease, we dream
of what the future holds in terms of early detection, education, research,
treatment and a cure. This dream has evolved in the form of organizing two
ovarian cancer conferences for October 2007 -- one to be held in Novi, Michigan
(US) and another in Toronto, Ontario (Canada) -- both entitled, “Survivors’ Debate: The Past Decade
in Ovarian Cancer.”
These public meetings are the result of a
collaborative effort by proactive and knowledgeable ovarian cancer survivors
with supporting oncology nurses. They will take place with the understanding
that they will be fully inclusive – everyone is welcome -- but that the focus
will remain on the experiences, needs and concerns of cancer patients and
survivors, their families and friends.
The conferences will take place in two
locations in two countries because our issues are the same: access to care,
awareness, early detection, survival rates and genetics. The directive and
focus of both conferences is to offer a place to exchange ideas honestly and
openly without judgment or bias.
Patients need an environment where they
feel encouraged to discuss the many difficulties they face. Sometimes it is very difficult to find that space
-- a place without fear of retribution, criticism or dismissive attitudes. Patient-to-patient
discussion and counseling offers this environment. It allows for in-depth
dialogue on a variety of topics that detail what strategies work for survivors
and their families and what is not effective. Healthcare settings just do not
currently lend themselves to foster the dialogue that is needed for survivors
that this new forum provides.
However, the conferences will also focus on
creating a public force to expedite change, which can only start with
communication. Born from need – an arena
for discussion for ovarian cancer survivors by survivors -- the “Survivors’
Debate” has taken form.
But while the conferences are about patients
speaking for themselves they are not speaking by themselves. With this
new forum for dialogue, debate and discussion, we can highlight the detailed
knowledge and expertise of our international ovarian cancer community with
almost a decade of experience behind us, and explain why, as a community, we
work. But we will also be able to explore the variety of reasons why what is
needed by survivors and their friends and families is not currently being translated
into caregiving.
Our ovarian cancer survivor connections and
bonds have formed through the years by enduring extreme challenges and personal
losses. The only bias we have as survivors is the bias to endure and to survive
to the best of our abilities, not only as individuals but, importantly, as a
community. To be very blunt, previously this has included much silent
suffering.
It is long past due that we take our real
issues into a public forum and encourage everyone to participate. We plan to
make some long overdue noise at these debates about ovarian cancer, and we
envision that these two scheduled events are only the beginning of a completely
new trend in ovarian cancer activism.
For more information on the Survivors’ Debate: The Past Decade in Ovarian Cancer,
visit: http://ovariancancerdebate.blogspot.com
Side-bar:
Ovarian
cancer
Ovarian cancer is a serious and under-recognized threat to women's
health which kills more women than all of the gynaecologic cancers
combined. The lifetime risk of contracting
ovarian cancer is one in seventy. Ovarian cancer is very treatable when caught early, but the
vast majority of cases are not diagnosed until too late, which means that while
it is not as common as some other cancers, it remains a woman’s cancer with a
poor survival rate.
Unfortunately, an early detection test still remains elusive and
contrary to public perception, the PAP test is not a screening test for ovarian
cancer. Efforts to diagnose ovarian cancer is through a combination of: tumor
marker test (called the CA125), a bimanual pelvic/rectal exam and transvaginal
ultrasound. Actual confirmation of the diagnosis of ovarian cancer is confirmed
with surgery and pathology reports (eg. Laboratory tests on tissues specimens).
When ovarian cancer is caught before it has spread beyond the ovaries 80-90% of
women will survive five years. When diagnosed after the disease has spread, the
chance of five-year survival drops to approximately 20-30% or less.
Symptoms of ovarian cancer are nonspecific
and mimic those of many other more common conditions. However, as a result of the original work in
1999 of Cindy Melancon
, RN Dr Barbara Goff
A consensus expert panel convened earlier
this year concluded that the following four symptoms are much more likely to
occur in women with ovarian cancer than women in the general population:
* Bloating;
* Pelvic or abdominal pain;
* Difficulty eating or feeling full quickly;
* Urinary symptoms (urgency or frequency).
Several other symptoms have been commonly
reported by women with ovarian cancer, as well; these symptoms include fatigue,
indigestion, back pain, pain with intercourse, constipation and menstrual
irregularities. A woman should consult with
a health care professional if any of these symptoms persist or feel abnormal.
What you can do
* Understand your family history (e.g., ovarian, breast, colorectal
cancer,endometrial cancers);
*
Educate yourself and understand ovarian cancer as it relates to your
specific diagnosis;
*
Communicate your concerns with your healthcare professional;
*
Recognize and support other ovarian cancer women/families in your
community;
*
Join an online support or face-to-face support group;
*
Join a cancer organization or a program in your community and/or
hospital.
Ovarian cancer
is not a silent disease – speak up and speak out
Have a look:
ACOR – Ovarian Cancer Mailing List
(ASSOCIATION OF CANCER ONLINE RESOURCES
NCI (NATIONAL CANCER INSTITUTE - U.S.
MEDLINE PLUS
CLINICAL TRIALS DATABASE
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