After years of maintaining the status quo in ovarian cancer treatment, a number of recent advances have challenged the paradigm based on intravenous (IV) taxane and platinum as the therapy of choice for advanced ovarian cancer. These new data are summarized concisely by Liu and Matulonis in this issue.[1]
Interestingly, a review of recent history reveals that a major milestone in ovarian cancer chemotherapy is reached about every 10 years. The publication of Gynecologic Oncology Group (GOG) protocol 47 in 1986 provided randomized evidence of a 4-month improvement in overall survival with the addition of cisplatin to the previous standard of doxorubicin and cyclophosphamide.[2] In 1996, GOG 111 was published, documenting a 14-month improvement in overall survival with the addition of paclitaxel to cisplatin.[3] GOG 172 was published in 2006, becoming the third in a series of GOG trials to demonstrate a survival advantage with the use of combined IV and intraperitoneal (IP) chemotherapy.[4] Despite a 17-month improvement in overall survival that triggered an NCI alert commenting on the results, combined IV/IP therapy has yet to be broadly accepted as a new standard of care.[5] Widespread acceptance of the GOG 172 regimen has been limited by the relative complexity of the treatment (especially when compared to IV paclitaxel/carboplatin); the increased potential for toxicity; the requirement for IP port placement and maintenance; and the relative lack of experience in community centers with IP chemotherapy administration. Perhaps the most challenging part about incorporating IV/IP treatment into routine management of ovarian cancer is the idea that a route of administration—rather than a particular drug, such as cisplatin in the 1980s and then paclitaxel in the 1990s—appears to be the advance.
Concurrent with the evolution of the IP chemotherapy story has been the development of targeted or biologic therapy, particularly the antiangiogenic agent bevacizumab. Results from a phase II trial in women with recurrent ovarian cancer were published in 2007 and revealed a response rate of 21%, made more remarkable by a 51.6% stable disease rate.[6] This level of activity in recurrent disease led to a randomized phase III trial in the frontline setting, GOG 218, which tested the inclusion of bevacizumab both with IV paclitaxel/carboplatin and as a maintenance strategy. Preliminary results from GOG 218 were presented at ASCO 2010, showing a significant improvement in progression-free survival in the arm where patients received bevacizumab maintenance after their initial six cycles of chemotherapy plus bevacizumab, but not in the arm where patients received bevacizumab only during their initial chemotherapy.[7] The improvement was somewhat disappointing at 3.8 months, however, making it a difficult question of whether, despite the added toxicity and expense, bevacizumab merits inclusion in frontline regimens. The overall survival data from GOG 218, when mature, as well as the results from the ongoing ICON study with a comparable design, will help inform that question. In the meantime, oncologists caring for women with ovarian cancer have been left with the decision of whether to prioritize IV/IP therapy or bevacizumab in treatment plans.
Liu and Matulonis point to the GOG's attempt to incorporate both of these treatment advances in the current phase III trial, GOG 252. An additional confounder has been introduced by recent Japanese results, which showed a benefit from weekly IV paclitaxel compared to the traditional IV dose given every 3 weeks.[8] GOG 252 incorporates bevacizumab into IV/IP therapy, while also trying to address the toxicity issue by comparing a modified GOG 172 regimen to an IP carboplatin regimen. It also addresses the dose-density issue by utilizing weekly paclitaxel in the IV arm.
Besides the renewed hope for meaningful improvement in outcomes with advanced ovarian cancer that these trials have provided, we are witnessing another development that has the potential to advance ovarian cancer care on an even more fundamental level. The pathogenesis of ovarian cancer has been exhaustively investigated but never fully elucidated. The identification of the BRCA1 and BRCA2 genes in the early 1990s, however, has allowed a population at high risk for the development of ovarian cancer to be clearly defined. These women, in turn, have been able to undergo risk-reducing bilateral salpingo-oophorectomy to manage their risk. Studies of the specimens collected at the time of prophylactic surgeries have identified an unexpectedly high rate of tubal cancers.[9] Further study of serous cancers thought to be ovarian in origin has shown the unexpectedly frequent presence of fallopian tube dysplasia (termed tubal intraepithelial neoplasia or TIC).[10] Although larger-scale confirmation of these studies is needed, the high-risk population has provided a potential insight into the development of sporadic ovarian cancer. As we move to a more mechanistic understanding of cancer therapy and its targets, these insights into the BRCA pathway may well provide the next big advance in ovarian cancer care through manipulation with agents such as PARP inhibitors. For a disease that saw only halting advances for too long, ovarian cancer is now on the verge of being better understood and more effectively treated than ever before.
—Kristin K. Zorn, MD
Friday, July 30, 2010
2010 Cochrane Collaboration Review: Drug therapy for the management of cancer-related fatigue
Blogger's disclaimer/comments:
1) consumer reviewer of this Cochrane Collaboration review;
2) a special appreciation to our own ovarian cancer survivors for their input/opinions on this issue
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Note: included in the review were recent studies on the side effects of
erythropoietin and darbopoetin
Abstract
Background
This is an updated version of the original Cochrane review published in issue 1 2008 (Minton 2008). Cancer-related fatigue (CRF) is common, under-recognised and difficult to treat. There have been studies looking at drug interventions to improve CRF but results have been conflicting depending on the population studied and outcome measures used. No previous reviews of this topic have been exhaustive or have synthesised all available data.
Objectives
To assess the efficacy of drugs for the management of CRF.Authors' Conclusions
There is increasing evidence that psychostimulant trials provide evidence for improvement in CRF at a clinically meaningful level. There is still a requirement for a large scale RCT of methylphenidate to confirm the preliminary results from this review. There is new safety data which indicates that the haemopoietic growth factors are associated with increased adverse outcomes. These drugs can no longer be recommended in the treatment of CRF. Readers of the first review should re-read the document in full.
Plain language summary
Drugs for cancer-related fatigue
Fatigue associated with cancer is a significant problem. It can occur because of side effects of treatment or because of the disease itself. It can have a significant impact on a person's ability to function. The causes of fatigue are not fully understood and so it is very difficult to treat appropriately. This review has examined drug treatment for fatigue as it represents one of the ways this problem can be tackled. The review authors looked at trials in all types of cancer and at all stages of treatment. Fifty studies met the inclusion criteria but only 31 (7104 participants) were deemed suitable for detailed analysis as they explored fatigue in sufficient detail. They found mixed results with some drugs showing an effect on fatigue - most notably drugs that stimulate red blood cell production and also drugs that improve levels of concentration. Methylphenidate, a stimulant drug that improves concentration, is effective for the management of cancer-related fatigue but the small samples used in the available studies mean more research is needed to confirm its role. Erythropoietin and darbopoetin, drugs that improve anaemia, are effective in the management of cancer-related fatigue. However safety concerns and side effects from these drugs mean that they can no longer be recommended to treat cancer fatigue.
Thursday, July 29, 2010
abstract: Continued chemotherapy after complete response to primary therapy among women with advanced ovarian cancer (meta-analysis)
CONCLUSIONS
Although individual studies have not yet convincingly shown a survival advantage with maintenance chemotherapy in OC, this meta-analysis demonstrates that continued chemotherapy after completion of primary therapy for OC improves PFS and OS. Benefits are greatest in patients with advanced stage OC who reach complete clinical or pathologic response after primary therapy.
Ranking prestige of medical diseases | KevinMD.com blogger + link to the study abstract Album/Westin authors
Note: the ranking list includes ovarian cancer but interestingly not breast
Soc Sci Med. 2008 Jan;66(1):182-8. Epub 2007 Sep 12.
Do diseases have a prestige hierarchy? A survey among physicians and medical students.
University of Oslo, Oslo, Norway. dag.album@sosiologi.uio.no
Abstract
Surveys have shown that the prestige of medical specialities is ordered hierarchically. We investigate whether similar tacit agreement in the medical community also applies to diseases, since such rankings can affect priority settings in medical practice. A cross-sectional survey was performed in three samples of physicians and medical students in Norway in 2002. A questionnaire was sent to 305 senior doctors (response rate, 79%), 500 general practitioners (response rate, 65%) and 490 final-year medical students (response rate, 64%). Outcome measures were ratings on a 1-9 scale of the prestige these respondents believed most health personnel would accord to a sample set of 38 different diseases as well as 23 medical specialities. Both diseases and specialities were clearly and consistently ranked according to prestige. Myocardial infarction, leukaemia and brain tumour were among the highest ranked, and fibromyalgia and anxiety neurosis were among the lowest. Among specialities, neurosurgery and thoracic surgery were accorded the highest rank, and geriatrics and dermatovenerology the lowest. Our interpretation of the data is that diseases and specialities associated with technologically sophisticated, immediate and invasive procedures in vital organs located in the upper parts of the body are given high prestige scores, especially where the typical patient is young or middle-aged. At the other end, low prestige scores are given to diseases and specialities associated with chronic conditions located in the lower parts of the body or having no specific bodily location, with less visible treatment procedures, and with elderly patients.abstract: (repost) Differences in tumor type in low-stage versus high-stage ovarian carcinomas
Int J Gynecol Pathol. 2010
Köbel M, Kalloger SE, Huntsman DG, Santos JL, Swenerton KD, Seidman JD, Gilks CB; Cheryl Brown (ovarian cancer survivour/deceased) Ovarian Cancer Outcomes Unit of the British Columbia Cancer Agency, Vancouver BC.
Department of Pathology, University of Calgary, Calgary AB, Canada T2N 2T9. martin.kobel@cls.ab.ca
Abstract
Although there are recognized differences in the type of ovarian carcinomas between those tumors diagnosed at low versus high stage, there is a lack of data on stage distribution of ovarian carcinomas diagnosed according to the current histopathologic criteria from large population-based cohorts. We reviewed full slide sets of 1009 cases of 2555 patients diagnosed with ovarian carcinoma that were referred to the British Columbia Cancer Agency over a 16-year period (1984 to 2000).
On the basis of the reviewed cases we extrapolated the distribution of tumor type in low-stage (I/II) and high-stage (III/IV) tumors. We then compared the frequencies with those seen in a large hospital practice.
The overall frequency of tumor types was as follows: high-grade serous-68.1%, clear-cell-12.2%, endometrioid-11.3%, mucinous-3.4%, low-grade serous-3.4%, rare types-1.6%. High-grade serous carcinomas accounted for 35.5% of stage I/II tumors and 87.7% of stage III/IV tumors.
In contrast, clear-cell (26.2% vs. 4.5%), endometrioid (26.6% vs. 2.5%), and mucinous (7.5% vs. 1.2%) carcinomas were relatively more common among the low-stage versus high-stage tumors.
This distribution was found to be very similar in 410 consecutive cases from the Washington Hospital Center. The distribution of ovarian carcinoma types differs significantly in patients with low-stage versus high-stage ovarian carcinoma when contemporary diagnostic criteria are used, with consistent results seen in 2 independent case series. These findings reflect important biological differences in the behavior of the major tumor types, with important clinical implications.
Vascular Endothelial Growth Factor Is a Promising ... [Mol Cancer Ther. 2010] - PubMed result
Mol Cancer Ther. 2010 Jul 27. [Epub ahead of print]
Vascular Endothelial Growth Factor Is a Promising Therapeutic Target for the Treatment of Clear Cell Carcinoma of the Ovary.
Mabuchi S, Kawase C, Altomare DA, Morishige K, Hayashi M, Sawada K, Ito K, Terai Y, Nishio Y, Klein-Szanto AJ, Burger RA, Ohmichi M, Testa JR, Kimura T.
Authors' Affiliations: 1Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine; 2Department of Obstetrics and Gynecology, Osaka Police Hospital; 3Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan; 4Women's Cancer Program, 5Cancer Genetics and Signaling Program, and 6Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania; and 7Department of Obstetrics and Gynecology, Kansai Rosai Hospital, Amagasaki, Japan.
Abstract
This study examines the role of vascular endothelial growth factor (VEGF) as a therapeutic target in clear cell carcinoma (CCC) of the ovary, which has been regarded as a chemoresistant histologic subtype. Immunohistochemical analysis using tissue microarrays of 98 primary ovarian cancers revealed that VEGF was strongly expressed both in early-stage and advanced-stage CCC of the ovary. In early-stage CCCs, patients who had tumors with high levels of VEGF had significantly shorter survival than those with low levels of VEGF. In vitro experiments revealed that VEGF expression was significantly higher in cisplatin-refractory human CCC cells (RMG1-CR and KOC7C-CR), compared with the respective parental cells (RMG1 and KOC7C) in the presence of cisplatin. In vivo treatment with bevacizumab (Avastin) markedly inhibited the growth of both parental CCC cell-derived (RMG1 and KOC7C) and cisplatin-refractory CCC cell-derived (RMG1-CR and KOC7C-CR) tumors as a result of inhibition of tumor angiogenesis.The results of the current study indicate that VEGF is frequently expressed and can be a promising therapeutic target in the management of CCC. Bevacizumab may be efficacious not only as a first-line treatment but also as a second-line treatment of recurrent disease in patients previously treated with cisplatin.
Mol Cancer Ther; 9(8); OF1-12. (c)2010 AACR.
Prevalence of lymph node metastasis in primary mucinous carcinoma of the ovary
Abstract
OBJECTIVE:: To estimate the prevalence of lymph node involvement in women with primary mucinous ovarian carcinomas.
METHODS:: A retrospective study was performed of patients with primary mucinous ovarian carcinomas evaluated at a single institution between 1985 and 2007. A gynecologic oncology pathologist evaluated all cases. Patients with tumors of low malignant potential and mucinous carcinomas metastatic to the ovary from other primary sites were excluded.
RESULTS:: Patients with primary mucinous ovarian carcinomas were identified (n=107). All patients underwent primary surgery. At time of surgery, 93 patients (87%) had tumors that grossly appeared to be confined to the ovary, and 14 patients (13%) had evidence of extraovarian disease. Of the 93 patients with tumors that grossly appeared to be confined to the ovary at surgical exploration, 51 (55%) underwent lymphadenectomy (n=27 pelvic and paraaortic, n=19 pelvic only, n=5 paraaortic only). Of these 51 patients, none had metastatic disease to the pelvic or paraaortic lymph nodes. In addition, there were no significant differences in progression-free survival and overall survival rates between the patients who underwent lymphadenectomy and those who did not.
CONCLUSION:: There were no cases of isolated lymph node metastases among women with primary mucinous carcinoma grossly confined to the ovary, suggesting that routine lymphadenectomy may be omitted in these patients.
LEVEL OF EVIDENCE:: III.
(link to 'levels of evidence': http://www.cancer.gov/cancertopics/pdq/levels-evidence-adult-treatment
Wednesday, July 28, 2010
Future Oncology -- Summary: Palonosetron for the prevention of chemotherapy-induced nausea and vomiting in patients with cancer
Drug Evaluation
Palonosetron for the prevention of chemotherapy-induced nausea and vomiting in patients with cancer
Rudolph M Navari1,2
Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life. The emetogenicity of the chemotherapeutic agents, repeated chemotherapy cycles and patient characteristics (e.g., female gender, younger age, low alcohol consumption and history of motion sickness) are the major risk factors for CINV. This article provides a detailed description of palonosetron, a second-generation 5-hydroxytryptamine-3 (5-HT3) receptor antagonist, which has been approved for the prevention of acute CINV in patients receiving either moderately or highly emetogenic chemotherapy and for the prevention of delayed CINV in patients receiving moderately emetogenic chemotherapy...... palonosetron in combination with dexamethasone demonstrated better control of delayed CINV in patients receiving highly emetogenic chemotherapy and had a similar safety profile. Owing to its efficacy in controlling both acute and delayed CINV, palonosetron may be very effective in the clinical setting of multiple-day chemotherapy and bone marrow transplantation.
Editorial: The Elusive Goal of Maintaining Population (Breast) Cancer Screening: It Is Time for a New Paradigm JNCI
"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."
Team Continuum - Home - "What We're About" - (NY/Marathon)
Note: the Mission Statement is worthy of note, as a FYI.
What We're About
Team Continuum is dedicated to helping cancer patients and their families minimize the disruptions, hardships and uncertainties of everyday life so that they can focus on crucial medical care. We provide immediate and vital assistance - both practical and personal - every step of the way, such as paying household expenses, offering friendship and moral support, and funding health care facilities to enhance the delivery of care, communications and educational services.
Study Indicates Ginkgo biloba Does Not Reduce the Risk of Cancer [NCCAM Research Results]
Note: age specific/comments
Racial differences in stage at diagnosis and survival from epithelial ovarian cancer: A fundamental cause of disease approach
Social Science & Medicine
abstract:
Associations between race, socioeconomic status (SES) and health outcomes have been well established. One of the ways in which race and SES affect health is by influencing one’s access to resources, which confers ability to avoid or mitigate adverse outcomes. The fundamental cause of disease approach argues that when a new screening tool is introduced, individuals with greater resources tend to have better access to the innovation, thus benefiting from early detection and leading to better survival.
Conversely, when there is no established screening tool, racial and SES differences in early detection may be less pronounced.
Most ovarian cancer is diagnosed at advanced stages, because of the lack of an effective screening tool and few early symptoms. However, once detected, racial differences may still be observed in mortality and survival outcomes. We examined the racial differences in diagnosis and survival among ovarian cancer cases diagnosed during 1994–1998, in Cook County, Illinois (N = 351). There were no racial differences in the stage at diagnosis: 51.7% of white and 52.9% of black women were diagnosed at later stages (III and IV). Only age was associated with the stage at diagnosis. Tumor characteristics also did not differ between white and black women. Compared to white women, black women were less likely to be married, less educated, more frequently used genital powder, had tubal ligation, and resided in higher poverty census tracts. As of December 31, 2005, 44.3% of white and 54.5% of black women had died of ovarian cancer. Controlling for known confounding variables, the hazard ratio for ovarian cancer death between black and white women was 2.2. The findings show that fundamental cause perspective provides a potential framework to explore subtleties in racial disparities, with which broader social causes may be accounted for in explaining post diagnosis racial differences.
Genetic Risk Score Associated With Breast Cancer Risk; Predictive of Type of Disease
>“In this large study including 10,306 women with breast cancer and 10,393 without the disease, we confirm that some of the more important common genetic variants for breast cancer have different effects on different tumor types.”
PLoS ONE: Functional Exploration of the Adult Ovarian Granulosa Cell Tumor-Associated Somatic FOXL2 Mutation p.Cys134Trp (c.402C>G)
Conclusions/Significance
Here, we confirm the specificity of the FOXL2 c.402C>G mutation in adult OGCTs and begin the exploration of its molecular significance. This is the first study demonstrating that the p.Cys134Trp mutant does not have a strong impact on FOXL2 localization, solubility, and transactivation abilities on a panel of proven target promoters, behaving neither as a dominant-negative nor as a loss-of-function mutation. Further studies are required to understand the specific molecular effects of this outstanding FOXL2 mutation.
2010 Conference | Ovarian Cancer National Alliance - video, pics, information
"In case you missed this year’s Conference, we have provided with you educational materials for you to print and disseminate in your local communities. You can also find video clips and pictures from the Conference using the teal button above. Please check back as this will be updated in the next few days."
Canadian Medicine: Little sympathy for lung cancer patients "Can't we do better?"
blogger's Note: really the question is not can we do better, but why we have not (aside from stigmatization aka: judging others) given:
1) science's apparent apolitical stance;
2) decision-makers' rationale (evidence based??);
3) politicization of science/results
"...Heather McQuaid, an oncology social worker maintains that lung cancer patients feel stigmatized. The superficial attitude that gives way to this stigma may very well be the reason why $25 million was invested in breast cancer research in 2007, compared with a paltry $8 million towards lung cancer, directly “impacting on the support these cancer victims receive, particularly from the healthcare system,” according to CEO and President of the Canadian Lung Association, Heather Borquez. Can’t we do better?"
full access: Risk of urothelial bladder cancer in Lynch syndrome is increased, in particular among MSH2 mutation carriers
"In eight out of 21 patients with bladder cancer, this was their first cancer diagnosis, whereas at this stage five of them developed another Lynch syndrome associated cancer at an older age. Therefore, early diagnosis of Lynch syndrome may prevent development of a second primary cancer..."
Recommendations for urothelial carcinomas surveillance in Lynch syndrome
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Surveillance with a combination of ultrasound of the bladder and upper urinary tract, urinary cytology and sediment.
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In every MSH2 mutation carrier
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From age 40 and up
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Performed every 1–2 years
Indications and approach to surgical resection of lung metastases
J Surg Oncol. 2010
Aug 1;102(2):187-95.
Indications and approach to surgical resection of lung metastases.
Section of Surgical Oncology, Department of
Surgery, Penn State Hershey Cancer Institute, Penn State College of
Medicine, Hershey, Pennsylvania.
Abstract
Pulmonary metastasectomy is a curative option for selected patients with cancer spread to the lungs. Complete surgical removal of pulmonary metastases can improve survival and is recommended under certain criteria. Specific issues that require consideration in a multidisciplinary setting when planning pulmonary metastasectomy include: adherence to established indications for resection, the surgical strategy including the use of minimally invasive techniques, pulmonary parenchyma preservation, and the role of lymphadenectomy.J. Surg. Oncol. 2010;102:187-195. (c) 2010 Wiley-Liss, Inc.
PMID: 20648593
[PubMed - in process]
Health Canada Warns Canadians about Buying Prescription Drugs Online from www.globalpharmacycanada.com - Health Canada Advisory 2010-07-27
Note: if your server (ISP) is from Canada then you are blocked from the globalpharmacycanada link Health Canada is informing Canadians about the potential dangers of buying prescription drugs online from www.globalpharmacycanada.com. The company responsible for the website recently removed Canadian access to it, but Canadians may have purchased from this website in the past. For more information, please visit: http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2010/2010_127-eng.php
The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research — Palliat Med
Abstract
Spirituality and spiritual care are gaining increasing attention but their potential contribution to palliative care remains unclear. The aim of this study was to synthesize qualitative literature on spirituality and spiritual care at the end of life using a systematic (‘meta-study’) review.
Eleven patient articles and eight with healthcare providers were included, incorporating data from 178 patients and 116 healthcare providers, mainly from elderly White and Judaeo-Christian origin patients with cancer. Spirituality principally focused on relationships, rather than just meaning making, and was given as a relationship. Spirituality was a broader term that may or may not encompass religion. A ‘spirit to spirit’ framework for spiritual care-giving respects individual personhood. This was achieved in the way physical care was given, by focusing on presence, journeying together, listening, connecting, creating openings, and engaging in reciprocal sharing. Affirmative relationships supported patients, enabling them to respond to their spiritual needs. The engagement of family caregivers in spiritual care appears underutilized. Relationships formed an integral part of spirituality as they were a spiritual need, caused spiritual distress when broken and were the way spiritual care was given. Barriers to spiritual care include lack of time, personal, cultural or institutional factors, and professional educational needs. By addressing these, we may make an important contribution to the improvement of patient care towards the end of life.
Attitudes towards weight and weight assessment in oncology patients: survey of hospice staff and patients with advanced cancer — Palliat Med
"...A little over half of hospice staff, 81/146 (56%) considered that weighing could cause patients to be upset.
However, 124/129 (96%) of patients with advanced cancer reported that they had never found the experience of being weighed in a healthcare facility upsetting.
Some 95/129 (74%) of patients weighed themselves at home and 89% would want to know if their weight was changing.
While there is reluctance on the part of many hospice staff to weigh patients, most patients with advanced malignancy in the hospital setting do not report weight measurement to be upsetting."
Incidental Adnexal Masses Detected at Low-Dose Unenhanced CT in Asymptomatic Women Age 50 and Older: Implications for Clinical Management and Ovarian Cancer Screening - Radiology (abstract)
Results: One hundred eighteen women (mean age, 56.2 years), representing 4.1% of the screening cohort, had an indeterminate adnexal mass (108 unilateral, 10 bilateral; mean size, 4.1 cm) at prospective CT interpretation......No ovarian cancers were prospectively identified, although four cases of ovarian cancer developed subsequent to a negative adnexal finding at CT examination during a 15–44-month interval among the remaining 2751 women. cont'd
Materials and Methods: This study was institutional review board approved and HIPAA compliant. Informed consent was waived. The fate of indeterminate adnexal lesions identified at unenhanced CT in 2869 consecutive women (mean age, 57.2 years; age range, 50–97 years) undergoing colonography screening between April 2004 and December 2008 was evaluated.
Conclusion:
Incidental indeterminate adnexal lesions were relatively common at unenhanced CT (4.1%), but subsequent work-up revealed no ovarian cancers. Furthermore, a normal finding at CT was not protective against short-term development of ovarian cancer. More sophisticated risk factor assessment is needed to identify women at higher risk.
Tuesday, July 27, 2010
Colorectal adenomas in the lynch syndromes: Results of a colonoscopy screening program
Abstract
Forty-four asymptomatic putative Lynch syndrome patients participated in a colonoscopy screening program. There were 18 men and 26 women; mean age was 44 yr. Thirty percent of Lynch syndrome patients had at least one adenoma; 20% had multiple adenomas. In 18% of the patients, adenomas were discovered proximal to the splenic flexure. In a reference group of 88 age- and sex-matched patients, 11% had adenomas, 4% had multiple adenomas, and 1% had right-sided adenomas. Twenty-one Lynch syndrome patients had follow-up colonoscopies. Of 7 patients with adenomas on initial examinations, 6 had adenomas at follow-up. Of 14 patients with negative initial examination results, 3 had adenomas at follow-up. The prevalence of adenomas in the Lynch syndromes is greater than in an unselected reference group. The adenomas are more proximally located, corresponding to the site of cancer distribution in the Lynch syndromes. A high rate of synchronous and metachronous lesions is found. Our findings support the hypothesis that adenomatous changes are the premalignant lesion in the Lynch syndromes. We also found evidence of heterogeneity among Lynch syndrome families in adenoma incidence.
One to 2-Year Surveillance Intervals Reduce Risk of Colorectal Cancer in Families With Lynch Syndrome
Conclusions
With surveillance intervals of 1–2 years, members of families with Lynch syndrome have a lower risk of developing CRC than with surveillance intervals of 2–3 years. Because of the low risk of CRC in non-Lynch syndrome families, a less intensive surveillance protocol can be recommended.Risk and Epidemiological Time Trends of Gastric Cancer in Lynch Syndrome Carriers in The Netherlands
" Lifetime risk of developing gastric cancer was 8.0% in males vs 5.3% in females and 4.8% and 9% for MLH1 and MSH2 carriers, respectively."
Conclusions
Lynch syndrome mutation carriers have a substantial risk for gastric cancer, in particular patients with an MLH1 or MSH2 mutation. Family history for gastric cancer is a poor indicator for individual risk. Surveillance gastroscopy for Lynch syndrome patients carrying an MLH1 or MSH2 mutation should therefore be considered.MabCure, Inc. Announces Positive Results For New Ovarian Cancer Diagnostic Blood Test -- HASSELT, Belgium, July 27 - press release
"...MabCure will soon commence a follow-on study in collaboration with one of the foremost experts in women's cancers, Ignace Vergote, M.D., Head of the Department of Obstetrics and Gynaecology and Gynaecologic Oncology at the Catholic University of Leuven, Belgium. The study will access a large number of previously collected clinical blood samples stored at the Bio-bank of the Catholic University Hospital, Leuven.
Following the conclusion of this study, MabCure plans to launch a multi-center prospective trial in Europe and in the U.S., as well as initiate commercialization of its diagnostic ovarian cancer MAbs in Europe through strategic partnerships and licensing. In parallel, MabCure plans to embark on the regulatory process for obtaining marketing approval in the U.S.
MabCure is currently evaluating the diagnostic potential of it MAbs in detecting ovarian cancer in high-risk patients in a clinical study in Thailand...."
NCI Cancer Bulletin - Expert Panel Reports on Knowledge Gaps for 20 Suspected Carcinogens
In a monograph released July 15, a coalition of leading health organizations called for more research into the possible cancer-causing effects of exposure to 20 chemical agents. Some of the named agents are commonly found in the environment, whereas others are more often limited to occupational exposures. A summary paper in Environmental Health Perspectives provides an overview of the technical report.
The monograph, titled Identification of research needs to resolve the carcinogenicity of high-priority IARC carcinogens, summarizes available evidence and provides specific guidance on the appropriate studies needed to definitively classify these agents. Several overarching issues were identified that pertain to multiple agents, including recognizing that carcinogenic agents can act through multiple pathways and mechanisms of toxicity.
“This report highlights the importance of conducting research in occupational settings to identify human carcinogens,” said Dr. Debra Silverman, a co-author of the report and chief of the Occupational and Environmental Epidemiology Branch in NCI’s Division of Cancer Epidemiology and Genetics. “Findings from such occupational studies often allow experts to extrapolate the possible effects of low-level exposure to these agents in the general environment.”
“There is significant concern among the public about substances or exposures in the environment that may cause cancer, and there are some common occupational agents and exposure circumstances where evidence of carcinogenicity is substantial but not yet conclusive for humans,” added the report’s lead author, Dr. Elizabeth Ward, from the American Cancer Society (ACS).
The project originated as part of the National Institute for Occupational Safety and Health’s National Occupational Research Agenda to enhance occupational cancer research, and it involves collaboration with NCI, the International Agency for Research on Cancer (IARC), the ACS, and the National Institute of Environmental Health Sciences.
NCI Cancer Bulletin The Evolving Science of Cancer Stem Cells
".....The CSC concept is “a work in transition,” said Dr. William Matsui, from the Johns Hopkins School of Medicine, whose lab studies the role of stem cells in hematologic cancers. “To me, as a clinical person, the ideal model is one where you can find something that is going to work in humans. We’re far from that.”.."cont'd
Genomics in our own hands : The Lancet Neurology
Note: the paper is freely accessible (requires registration (free)
CaringBridge - Zaida
"Zaida's disease is stable, and has been for about a year! Her last CA-125 (from a couple weeks ago) was 24.9...."
Monday, July 26, 2010
Radiation Therapy for Cancer - National Cancer Institute
Note: lists different forms of radiation therapy
CTV Montreal - Power of one: Laptops for cancer patients (apparently Canadian Cancer Society doesn't have time.......)
Note: maybe then, based on this article, the Canadian Cancer Society could have funded the project ?? "I first approached the Canadian Cancer Society and asked them if they had any projects [for] computers in cancer wards," she recounts. "They said that they didn't have the time, but thought it was a great idea, so maybe I could start something."
HealthNewsReview.org Tips for Understand Studies
subject areas covered:
Tips for Understand Studies
* Does The Language Fit The Evidence? - Association Versus Causation
* "Off-label" Drug Use and Marketing
* 7 Words (and more) You Shouldn't Use in Medical News
* News from Scientific Meetings
* Absolute vs. Relative Risk
* Number Needed to Treat (NNT)
* Commercialism
* Single Source Stories
* FDA Approval Not Guaranteed
* Phases of Drug trials
* Medical Devices
* Animal & Lab Studies
Sunday, July 25, 2010
127 women seek separate suits against Scarborough doctor - media (update) gynecologist Richard Austin
Note: this is an update from a prior investigation which is ongoing but of particular importance is the fact that 3 similar incidents in the GTA have occurred in the past ~decade.
Saturday, July 24, 2010
Obesity is associated with improved survival in patients with organ-confined clear-cell kidney cancer (see 'Note')
Note: while not ovarian cancer specific (noting the common cell type of clear cell) the conclusion is interesting
CONCLUSION: We identified overweight as an independent prognostic marker of improved cancer specific survival in patients with organ-confined but not advanced RCC. Basic research is required to resolve the dilemma of why, if a higher BMI predisposes to RCC, it concurrently prolongs survival after patients have undergone (partial) nephrectomy.
EPGM-Munich | prIME Oncology - numerous (free) ovarian cancer presentations
Program Slides
Interactive Case #1—Primary ovarian cancer: What’s optimal surgery?Interactive Case #2—Initial systemic therapy for ovarian cancer
Interactive Case #3—Recurrent ovarian cancer: Partially platinum–sensitive (Recurrence after 6-12 months)
Interactive Case #4—Stage IIIB ovarian cancer: Recurrence >12 months following completion of induction chemotherapy
—Progress report on novel & targeted therapies for ovarian cancer
Interactive Case #5—Platinum resistant/refractory ovarian cancer: Optimizing quality of life
media: - Cancer research renaissance in our own backyard (B.C.)
".....In the first of a series of major breakthroughs in this past year, a pioneering team of ovarian cancer researchers, led by the Agency’s Dr. David Huntsman, found the single genetic mutation or “spelling mistake” in the three billion “letters” that make up the genetic code of an ovarian tumour cell.
This was a true eureka moment for Huntsman’s team. They recognized that this one consistent mutation could be the bull’s eye target in developing new treatments for all patients with this particular cancer. Their game-changing discovery was published in the prestigious New England Journal of Medicine and widely acknowledged in the global cancer community.
The next-generation computer technology provided by the BC Cancer Agency’s Genome Sciences Centre that decoded and sequenced the tumour cell’s three-billion-letter genome is another milestone achievement. A genomic task of this magnitude was unfathomable, in terms of both cost and complexity, even two years ago."
NEJM -- Mutation of FOXL2 in Granulosa-Cell Tumors of the Ovary
Primary ovarian trabecular carcinoid tumor: a case report and literature review
INTRODUCTION: Carcinoid tumors are uncommon neoplasms in the diffuse peripheral endocrine system. Ovarian carcinoids are rare and can be primary or transplanted. Primary ovarian carcinoids make up approximately 0.5-1.7% of all carcinoid tumors.
.....The immunohistochemical study revealed a neuroendocrine origin with strong positivity for NSE, CgA and Syn. Other markers, such as a-inhibin and Calretinin, were negative. Finally, the case was diagnosed as a primary ovarian trabecular carcinoid tumor.
CONCLUSION: Primary ovarian trabecular carcinoid tumors are very rare. The patients lack clinical indicators, and final diagnosis depends on pathological examination, special staining and inmmunohistochemistry staining to confirm the neuroendocrine differentiation.
International distribution and age estimation of the Portuguese BRCA2 c.156_157insAlu founder mutation
"We recommend that all suspected HBOC families from Portugal or with Portuguese ancestry are specifically tested for this rearrangement (BRCA2 c.156_157insAlu)."
Friday, July 23, 2010
Life Beyond Cancer Foundation - applications for November 18-21st event
-
Upcoming Events
Applications are here (CLICK) for the 2010 Life Beyond Cancer Retreat will be held at Lakeway Resort in beautiful Austin, TX – November 18-21. This popular event fills up quickly. . .
Self Help Resource Centre - seminar for self help individuals/groups (Toronto area)
TO ALL PEER SUPPORT GROUPS IN THE GTA
During Self-Help Awareness Week, Sept. 20th to 25th, 2010, the Self-Help Resource Centre will be hosting a two-day information fair at the Yonge-Eglinton Centre to raise the profile of peer support in the City of Toronto. This is an opportunity for an agency which hosts a peer support group or a community peer support group to get the word out about their issue and provide information to the general public about how to become involved.
The fair will be held over a two day period - Fri. Sept. 24th and Sat. Sept 25th - and agencies hosting peer support groups and community peer support groups are invited to sign up for either of the two days. We do ask that representatives from the groups commit to staffing their table from 10 am to 4 pm, with coverage during the lunch hour.
Groups would be encouraged to display and give away any materials about their issue or group. Peer support groups listed on the Self-Help Resource Centre's website would be offered a printout from our database listing all their basic information for display at their table.
If interested in having your group represented at the info fair, please get in touch as soon as possible to confirm your participation. Space is limited. For more information or to register for a table, please contact Rick Henry at shrc@selfhelp.on.ca or call (416) 487-4355 ext. 21, and he will return your call as soon as he is able.
Peer Support Group Info Fair
When: Fri. Sept. 24th 10 am - 4 pm
Sat. Sept. 25th 10 am - 4 pm
Where: Yonge-Eglinton Centre,
Upper Mezzanine (Toys 'R Us level)
Who: Agencies hosting peer support groups and
Community peer support groups are invited to participate
Disease Information from NORD, National Organization for Rare Disorders, Inc.
"In the United States, there are between 6,000 and 7,000 diseases considered rare, according to the National Institutes of Health. To be classified as "rare", a disease must be believed to affect fewer than 200,000 Americans. This is the definition used by the Food and Drug Administration and by the National Institutes of Health. Since many of these diseases are genetic, many of the patients are children. It is believed that more than two thirds of the individuals affected by rare diseases in the U.S. are children.
Furthermore, most rare diseases are serious and chronic or lifelong. Many are life threatening....."cont'd
New Advances in Ovarian Cancer - Cancer Network
Note: registration for this site is required/free
Conclusion
Significant advances in the understanding of the pathogenesis and management of both newly diagnosed and recurrent ovarian cancer have occurred over the past few years, making the possibility of better outcomes for women with advanced ovarian cancer a reality. Recent studies have raised the question of the ideal timing of cytoreductive surgery for newly diagnosed disease and demonstrated benefit with alternative weekly paclitaxel dosing, while ongoing studies continue to clarify the roles of IP chemotherapy and biological agents in this setting. In the setting of recurrence, new chemotherapy combinations are being explored, and investigation of the activity of various targeted agents, including anti-angiogenic agents, PARP-inhibitors, and PI3K/AKT pathway inhibitors, remains an area of active interest.
This article is reviewed in the following articles:
Ovarian Cancer Care: It’s Time for “Personalized” Approaches
Challenges to the Paclitaxel/Carboplatin Algorithm in Ovarian Cancer Treatment - Cancer Network
ONCOLOGY. Vol. 24 No. 8
THE LIU/MATULONIS ARTICLE REVIEWED
Challenges to the Paclitaxel/Carboplatin Algorithm in Ovarian Cancer Treatment
By
Kristin K. Zorn, MD
Gynecologic Cancer Program
Magee-Womens Hospital of UPMC
Pittsburgh, Pennsylvania
| July 22, 2010
Kristin K. Zorn, MD
Gynecologic Cancer Program
Magee-Womens Hospital of UPMC
Pittsburgh, Pennsylvania
| July 22, 2010
- Email this article
- Print this article *
- PDF of article *
- Request article reprints
- Stumbleupon
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* membership required
Financial Disclosure: The author has no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.
abstract: Examining the potential relationship between multidisciplinary cancer care and patient survival: An international literature review
CONCLUSIONS: Due to methodological limitations, this review is unable to assert a causal relationship between multidisciplinary care and patient survival
Thursday, July 22, 2010
Ovarian Cancer Care: It’s Time for “Personalized” Approaches - Cancer Network
Note: requires registration to view (free)
ONCOLOGY. Vol. 24 No. 8
THE LIU/MATULONIS ARTICLE REVIEWED
Ovarian Cancer Care: It’s Time for “Personalized” Approaches
Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement abstract only/multinational statement - Journal of Clinical Endocrinology & Metabolism
Conclusions: The major conclusions related to the overall benefits and risks of MHT expressed as the number of women per 1000 taking MHT for 5 yr who would experience benefit or harm. Primary areas of benefit included relief of hot flashes and symptoms of urogenital atrophy and prevention of fractures and diabetes. Risks included venothrombotic episodes, stroke, and cholecystitis. In the subgroup of women starting MHT between ages 50 and 59 or less than 10 yr after onset of menopause, congruent trends suggested additional benefit including reduction of overall mortality and coronary artery disease. In this subgroup, estrogen plus some progestogens increased the risk of breast cancer, whereas estrogen alone did not. Beneficial effects on colorectal and endometrial cancer and harmful effects on ovarian cancer occurred but affected only a small number of women. Data from the various Women’s Health Initiative studies, which involved women of average age 63, cannot be appropriately applied to calculate risks and benefits of MHT in women starting shortly after menopause. At the present time, assessments of benefit and risk in these younger women are based on lower levels of evidence.
in research: The Cognitive Effects of Conjugated Equine Estrogens Depend on Whether Menopause Etiology Is Transitional or Surgical -- Endocrinology
Note: abstract only/$$$ full access
"Type of menopause, surgical vs. transitional, impacts cognitive outcome in women. However, whether type of menopause impacts cognitive effects of HT has not been methodically tested in women or an animal model...........That we now show surgical vs. transitional modes of menopause result in disparate cognitive effects of HT has implications for future research and treatments optimizing HT for menopausal women."
Wednesday, July 21, 2010
full access: Risk Factors for Colorectal Cancer in Patients with Multiple Serrated Polyps: A Cross-Sectional Case Series from Genetics Clinics-multi-national study
Introduction
Familial non-syndromic
colorectal cancer (CRC) constitutes one of the most difficult and
diverse patient groups encountered in a genetics clinic, with no
apparent germline mutation, an often-indeterminant mode of inheritance,
and questions arising as to how to manage the probands, and how to
identify which family members are also at risk for CRC........ The clinical significance of HPS is that it is associated with an
increased personal and familial risk of CRC ,
and extra-colonic cancers in the wider family setting .
Conclusion
A
decreased odds for CRC was identified in females with multiple serrated
polyps who currently smoke, independent of age and the presence of a
traditional adenoma. Investigations into the biological basis for these
observations could lead to non-smoking-related therapies being developed
to decrease the risk of CRC and colectomy in these patients.
Technology Review: Fine-tuning Cancer Treatments
Scientists at the Wellcome Trust Sanger Institute and Massachusetts General Hospital will test 400 compounds, including chemotherapy drugs and molecularly targeted treatments, on 1,000 cancer cell lines containing cancer-related genetic mutations in an effort to advance personalized medicine. The findings are expected to help drugmakers design clinical studies that include only patients who are most likely to benefit from experimental cancer drugs.
"...While a number of molecularly targeted cancer drugs, such as gleevec and herceptin, are already on the market, the effectiveness of most of these drugs depends on a single genetic mutation or molecular marker in the tumor. Scientists say that incorporating the diversity of cancer genomics in much greater detail will enable more personalized treatment for a broader number of patients...cont'd
Toward Improving the Quality of Cancer Care: Addressing the Interfaces of Primary and Oncology-Related Subspecialty Care
Note: excerpt with numerous related references/$$$ article
Brain tumor headaches: from bedside to bench. (abstract)
Note: abstract gives very limited information while noting 80 years of research on this issue
Comparative effectiveness of screening and prevention strategies among BRCA1/2-affected mutation carriers
Conclusion: Our analysis suggested that among BRCA1/2 mutation carriers, prophylactic surgery would dominate or be cost effective compared to chemoprevention and screening. Annual screening with MRI and mammography was the most effective strategy because it was associated with the longest quality-adjusted survival, but it was also very expensive.
Tuesday, July 20, 2010
What the Doctor Is Really Thinking - WSJ.com
"The year-long OpenNotes study, funded with a $1.5 million grant from the Robert Wood Johnson Foundation, involves 25,000 patients and their primary-care physicians at Beth Israel Deaconess, Geisinger Health System in Danville, Pa., and Harborview Medical Center in Seattle. "We want to break down an important wall that currently separates patients from those who care for them," says lead investigator Tom Delbanco, a Harvard Medical School professor who treats patients at Beth Israel."
"Patients have a legal right to see their entire medical record including doctor's notes."
Lynch Syndrome symposium (free) Saturday August 28th, 2010 Indianapolis IN
see brochure (pdf file) for registration details:
www.stvincent.org/.../Cancer/LynchCMESymposium_Brochure.pdf
St.Vincent Cancer Care
Attention: Heather Tibbs
8402 Harcourt Road, Suite 324
Indianapolis, IN 46260
317-338-3188
317-583-2325 (fax)
hrtibbs@stvincent.org
sponsors:
AmeriPath; Myriad
Vanderbilt First to Use Specialized PET/CT Scan to Uncover Cancerous Tumors
"....The 68Ga-DOTATATE PET/CT scan offers higher resolution and sensitivity locating tumors. Although performed in Europe, this specialized type of radiologic scan has been viewed in the U.S. as offering only limited benefit to a small number of cancer patients. However a recent increase of neuroendocrine cancers seen at Vanderbilt led Walker and his associates to more widely apply usage of this new technology...."
Transparency Through Open Notes: The Risks And Rewards Of Inviting Patients To Review Their Medical Records-media article
"In “Open Notes: Doctors and Patients Signing On,” published in the July 20 issue of the Annals of Internal Medicine, researchers speculate about the risks and rewards of making clinicians’ notes transparent to patients."
Understanding Prognosis and Cancer Statistics - National Cancer Institute
"Because survival rates are based on large groups of people, they cannot be used to predict what will happen to a particular patient. No two patients are exactly alike, and treatment and responses to treatment vary greatly."
Understanding risk : Cancer Research UK
Understanding risk
Every week it seems that there’s a news story about something that increases or cuts the risk of cancer.Often, these reports are full of numbers - 11 per cent lower risk, 65 per cent increased risk, double the risk - but what do they actually mean?
To make things clearer, there’s a detailed explanation of risk on our Healthy Living pages.
Read our other top tips:
abstract: Presenting the Results of Cochrane Systematic Reviews to a Consumer Audience: A Qualitative Study
Results. Participants preferred results presented as words, supplemented by numbers in a table. There was a lack of understanding regarding the difference between a review and an individual study, that the effect is rarely an exact number, that evidence can be of low or high quality, and that level of quality is a separate issue from intervention effect.
Conclusion. Through testing and iteration the authors identified and addressed several problems, using explanations, rephrasing, and symbols to present scientific concepts. Other problems remain, including how best to present confidence intervals and continuous outcomes. Future research should also test information elements in combination rather than in isolation. The new Plain Language Summary format is being evaluated in a randomized controlled trial.
Weight, Physical Activity, Diet, and Prognosis in Breast and Gynecologic Cancers --JCO (abstract)
ABSTRACT
Diet, physical activity, and weight may affect prognosis among women who are diagnosed with breast or gynecologic cancer. Observational studies show associations between being overweight or obese and weight gain with several measures of reduced prognosis in women with breast cancer and some suggestion of poor prognosis in underweight women. Observational studies have shown an association between higher levels of physical activity and improved breast cancer–specific and all-cause mortality, although a dose-response relationship has not been established. One large randomized controlled trial reported increased disease-free survival after a mean of 5 years in patients with breast cancer randomly assigned to a low-fat diet versus control. However, another trial of similar size found no effect from a high vegetable/fruit, low-fat diet on breast cancer prognosis. The few reported studies suggest that obesity negatively affects endometrial cancer survival, while the limited data are mixed for associations of weight with ovarian cancer prognosis. Insufficient data exist for assessing associations of weight, physical activity, or diet with prognosis in other gynecologic cancers. Associations of particular micronutrient intake and alcohol use with prognosis are not defined for any of these cancers. The effects of dietary weight loss and increase in physical activity on survival or recurrence in breast and gynecologic cancers are not yet established, and randomized controlled trials are needed for definitive data.
A review of PARP inhibitors: from bench to bedside — Ann Oncol
Conclusion: PARP inhibitors show promise as a powerful therapeutic tool, especially in the management of BRCA-associated breast and ovarian cancers but also in tumours where BRCA genes may be dysfunctional. Clinical studies are ongoing and many translational questions remain unanswered that will help clarify how to determine the best way to use PARP inhibitors.
abstract: Cochrane Collaboration review: DNA-repair pathway inhibitors for the treatment of ovarian cancer (PARP inhibitors)
"Our objective was to compare effectiveness and side effects of PARP inhibitors compared to conventional chemotherapy in women with ovarian cancer. The identification of a safe dose of AZD2281 (a PARP inhibitor) has been found by small non randomised trials, with encouraging results. For ovarian cancer, there are currently two ongoing RCTs, but outcome data are not yet available. Results of these trials are awaited to determine if DNA repair inhibitors have a role in addition to conventional chemotherapy in the treatment of ovarian cancer."
Main results
The search strategy identified 473 unique references of which 461 were excluded on the basis of title and abstract. The remaining 12 articles were retrieved in full, but none satisfied the inclusion criteria. However, two ongoing randomised phase II clinical trials were identified from the clinical trials databases that met our inclusion criteria, but no preliminary data were available.
Authors' conclusions
There are to date no published RCT data on the effectiveness and side effects of DNA-repair pathways inhibitors used alone or in association with conventional chemotherapy in the treatment of ovarian cancer. On-going trials have been identified and results are awaited and will be included in future updates of this review.
Identifying Adverse Drug Reactions Associated with Drug-Drug Interactions: patient/drug safety
Conclusions: This study validates that spontaneous reporting, despite its limitations, can be an important resource for detecting ADRs associated with the concomitant use of interacting drugs. Moreover, our data confirm that DDIs could be a real problem in clinical practice, showing that more than one in five patients exposed to a potential DDI (drug-drug-interaction) experienced a related ADR (adverse drug reaction).
Overcoming TRAIL resistance in ovarian carcinoma
CONCLUSION: Continued efforts with combination therapy designed to target multiple steps in apoptotic pathways may not only improve the efficacy of TRAIL-mediated therapies, but may also improve quality of life for ovarian cancer patients by reducing toxicity associated with cancer therapy.
abstract: Measuring the effect of including multiple cancers in survival analyses using data from the Canadian Cancer Registry
Background: In survival analyses using cancer registry data, second and subsequent primary cancers diagnosed in individuals are typically excluded.
Conclusion: Inclusion of second and subsequent primary cancers in the analysis tended to lower estimates of relative survival, the extent of which varied by cancer and age and depended in part on the proportion of first primary cancers.
Monday, July 19, 2010
Saturday, July 17, 2010
Abstract/full acess: Hypertension and hand-foot skin reactions related to VEGFR2 genotype and improved clinical outcome following bevacizumab and sorafenib
Background: Hypertension (HT) and hand-foot skin reactions (HFSR) may be related to the activity of bevacizumab and sorafenib. We hypothesized that these toxicities would correspond to favorable outcome in these drugs, that HT and HFSR would coincide, and that VEGFR2 genotypic variation would be related to toxicity and clinical outcomes.
METHODS
Patients and treatment
The analyses were performed on genomic DNA from 178 patients (143 males and 35 females) with solid tumors who received sorafenib (VEGFR2 inhibitor) and/or bevacizumab (anti-VEGF) with or without other agents....cont'd (excerpt from pdf file)
Conclusions: This study suggests that HT and HFSR may be markers for favorable clinical outcome, HT development may be a marker for HFSR, and VEGFR2 alleles may be related to the development of toxicities during therapy with bevacizumab and/or sorafenib.
Drug Watch a heads-up on pharmaceuticals in late-stage development
New drugs Product type/proposed indication FDA status/notes
abagovomab
Menarini Group
an anti-idiotype antibody, able to mimic a tumor antigen
highly expressed by ovarian cancer cells/used to prevent
or delay the tumor relapse in patients whose disease
responded to the first-line chemotherapy by activating
an immune response toward cancer cells
phase 2/3
karenitecin/BNP1350
BioNumerick Pharmecuticals
in the camptothecin class of chemotherapy drugs/
treatment of advanced ovarian cancer
phase 3
pazopanib (Votrient)
GlaxoSmithKline
multi-kinase angiogenesis inhibitor/maintenance therapy
for the treatment of ovarian cancer
phase 3
references/sources:
Friday, July 16, 2010
Cancer Statistics, 2010. now online (U.S.)
Statistics
Now Published Online!
Cancer Statistics, 2010
View the Abstract or read the full-text PDF today!
Ovary incident rate: 21,880
Cancer Statistics, 2010
View the Abstract or read the full-text PDF today!
Ovary incident rate: 21,880
Ovary deaths 13,850
http://cacancerjournal.org/
in research: Magnetic nanoparticles remove ovarian cancer cells from the abdominal cavity
| (Nanowerk News) A major complicating factor in the treatment of ovarian cancer is that malignant cells are often shed into the patient's abdominal cavity. These cells can then spread to other tissues, seeding new tumors that make effective therapy difficult. To overcome this problem, researchers at the Georgia Institute of Technology created magnetic nanoparticles that can selectively bind to and remove ovarian tumor cells from abdominal cavity fluid. John F. McDonald led the research team that reported their work in the journal Nanomedicine ("Selective removal of ovarian cancer cells from human ascites fluid using magnetic nanoparticles"). | |
| Research by other investigators had identified a protein known as EphA2 as a highly selective marker for free-floating ovarian cancer cells. Dr. McDonald and his collaborators coated magnetic cobalt-iron oxide nanoparticles with a molecular mimic of the natural ligand for this protein, a molecule known as ephrin-A1, to serve as a trap for ovarian cancer cells floating in ascites fluid, the liquid found in the intestinal cavity. The idea behind this approach is that the nanoparticles could be added to ascites fluid and then trapped with a magnetic, removing any ovarian cancer cells that had bound to the eprhin-A1 mimic. | |
| They first tested their nanoparticles using ascites fluid from mice with human ovarian tumors and found that they could trap free-floating tumor cells using magnetic separation. They then repeated this experiment using ascites fluid obtained from four women with ovarian cancer, and again showed that they could remove all of the EphA2-positive cells from the intestinal fluid samples. The researchers suggest that these nanoparticles could be used in a system that removes ascites fluid from the intestinal cavity, using a relatively non-invasive method akin to dialysis, in conjunction with standard ovarian cancer therapy. |
repost: full text Angiogenesis Inhibitors: Current Strategies and Future Prospects
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
, and c-kit
and -The Big Flap About Pathway Genomics and Walgreen's: Topol on Genomics
A few weeks ago, Pathway Genomics, a consumer genomics company, had planned to have its saliva kits at all US Walgreen's drug stores. The FDA put a stop to it. Congress is now investigating the matter. What is going on here?
http://www.nytimes.com/2010/06/12/health/12genome.html?scp=1&sq=pathway%20genomics&st=cse
Search of: parp | Open Studies - List Results - ClinicalTrials.gov
Found 33 studies with search of: parp | Open Studies
Second primary cancers following borderline ovarian tumors (abstract)
Note: (in the abstract) the onset of a basal cell carcinoma of the eyelid (genetics?)
CONCLUSIONS: These findings do not suggest increased risk of subsequent cancers in patients with BOT. However, population-based studies are needed for evaluating exact risk of developing second primary malignancies in women with BOTs
A double-blind, randomized trial of pyridoxine versus placebo for the prevention of pegylated liposomal doxorubicin-related hand-foot syndrome in gyne
Blogger's Note: in the absence of full access to the article, this conclusion 'needs more research'
"CONCLUSIONS:: Pyridoxine as administered in the current study did not prevent HFS in patients who received PLD. It is possible that QOL is not compromised in patients with HFS because they may have increased social well being while coping with their disease."
6-Thioguanine Selectively Kills BRCA2-Defective Tumors and Overcomes PARP Inhibitor Resistance
"Altogether, our data show that 6TG efficiently kills BRCA2-defective tumors and suggest that 6TG may be effective in the treatment of advanced tumors that have developed resistance to PARP inhibitors or platinum-based chemotherapy. Cancer Res; 70(15); OF1-9. (c)2010 AACR."
abstract: Clinical syndromes associated with ovarian neoplasms: a comprehensive review
Radiographics. 2010 Jul-Aug;30(4):903-19.
Functional ovarian neoplasms have unique clinical manifestations related to hormone overproduction and may give rise to a broad spectrum of clinical syndromes.
Sex cord-stromal tumors, the most common functional ovarian neoplasms, are associated with either hyperestrogenism (as in granulosa cell tumor and thecoma) or hyperandrogenism (as in Sertoli-Leydig cell tumor and Leydig cell tumor). Other, less common ovarian neoplasms that may have endocrine or nonendocrine syndromic manifestations include germ cell tumors associated with the excessive production of human chorionic gonadotropin (eg, choriocarcinoma, dysgerminoma), monodermal teratomas (eg, carcinoid tumor, struma ovarii) associated with carcinoid syndrome and hyperthyroidism, and primary epithelial ovarian cancers associated with paraneoplastic syndromes.
The application of diagnostic algorithms based on patient demographic information, clinical manifestations, laboratory findings, and cross-sectional imaging features may help identify ovarian neoplasms in complex clinical settings.
Thursday, July 15, 2010
FDA Alert: Angiotensin Receptor Blockers (ARBs): Ongoing Safety Review for Cancer Risk
BACKGROUND: ARBs are used in patients with high blood pressure and other conditions. Brand names include Atacand, Avapro, Benicar, Cozaar, Diovan, Micardis, and Teveten
Genetics And Ovarian Cancer - Beth Israel Deaconess Medical Center (new) News Story
Note: brief recap of BRCA 1/2 & Lynch Syndrome
Genetic Tests and FDA (U.S.)
FDA will convene a public meeting next week to hear from companies that make direct-to-consumer genetic tests, before it begins an overhaul of its regulations on genetic diagnostic testing,
Wednesday, July 14, 2010
abstract - ScienceDirect - Gynecologic Oncology : Cognitive functions in long-term survivors of ovarian cancer
Conclusions
In this study, neuropsychological test performance did not differ significantly between ovarian cancer survivors who were in remission and patients with recurrent disease and receiving treatment. Cognitive impairment was evident in a subset of patients, although group means test scores were within the average range. Additional research using prospective longitudinal designs is needed to clarify the contribution of disease, chemotherapy, hormonal therapy, and other risk factors to cognitive outcome in this clinical population.
abstract - ScienceDirect - Gynecologic Oncology : Cognitive functions in long-term survivors of ovarian cancer
Conclusions
In this study, neuropsychological test performance did not differ significantly between ovarian cancer survivors who were in remission and patients with recurrent disease and receiving treatment. Cognitive impairment was evident in a subset of patients, although group means test scores were within the average range. Additional research using prospective longitudinal designs is needed to clarify the contribution of disease, chemotherapy, hormonal therapy, and other risk factors to cognitive outcome in this clinical population.
Some ovarian tumors can be safely followed on ultrasound - Cancer Network
"Once thought a risk for malignancy, septated ovarian cystic tumors are actually mostly benign. A study at the University of Kentucky changes the standard of care for those patients."
Recruiting: Positron Emission Tomography/Computed Tomography (PET/CT) for the Diagnosis of Recurrent Cancer: a Feasibility Study - Full Text View - ClinicalTrials.gov (PETREC)
Ontario Clinical Oncology Group (OCOG)
| Condition | Intervention |
|---|---|
| Non-small Cell Lung Cancer Breast Cancer Head and Neck Cancer Ovarian Cancer Esophageal Cancer Lymphoma |
Other: PET/CT scan |
Abstract/full free access: Managing clinical trials
"Managing clinical trials, of whatever size and complexity, requires efficient trial management. Trials fail because tried and tested systems handed down through apprenticeships have not been documented, evaluated or published to guide new trialists starting out in this important field. For the past three decades trialists have invented and re-invented the trial management wheel. The authors suggest that to improve the successful, timely delivery of important clinical trials, for patient benefit, it is time to produce standard trial management guidelines and develop robust methods of evaluation."
Gyn Clinical Spotlights | slides/interviews: Dr's Fleming, Monk, Birrer
| 7 JUNE 2010 | ||
These Clinical Spotlight interviews, with accompanying eNewsflash and downloadable slides, discuss the topic of targeting angiogenesis in the treatment of ovarian cancer with a focus on the following data release: #LBA1: Phase III trial of bevacizumab (BEV) in the primary treatment of advanced epithelial ovarian cancer (EOC), primary peritoneal cancer (PPC), or fallopian tube cancer (FTC): A Gynecologic Oncology Group study The first interview is an expert analysis with Gini Fleming, MD, from the University of Chicago, Illinois in the United States, and Bradley Monk, MD, from the University of California Irvine, Orange, California, United States The second interview is a supplemental perspective and discussion with Bradley Monk, MD, from the University of California Irvine, Orange, California, United States, and Michael Birrer, MD, PhD, from the Massachusetts General Hospital, Boston, Massachusetts in the United States. View the Primary Expert Analysis with Gini Fleming, MD, and Bradley Monk, MD, and access downloadable slides  View the Supplemental Perspectives and Discussion with Bradley Monk, MD, and Michael Birrer, MD, PhD, and access downloadable slides |
Editorial: Challenge of Managing Cancer-Related Fatigue JCO
"...Ultimately, the best intervention for CRF will be the development of a personalized treatment plan based on the identification of the main contributing factors to fatigue in a given patient followed by evidence-based combined therapies.
One more important contribution of this study by Moraska et al7**
is that it demonstrates that clinical trials of agents for the management
of fatigue can be successfully completed by cooperative clinical trial
groups. This is of great importance for the development of a body of
knowledge on supportive and palliative interventions for patients
with cancer."
** 7. Moraska AR, Sood A, Dakhil SR, et al: Phase III, randomized, double-blind,placebo-controlled study of long-acting methylphenidate for cancer-related fatigue:NCCTG Trial NO5C7. J Clin Oncol doi: 10.1200.JCO.2010.28.1444
JAMA -- Learning Accountability for Patient Outcomes, July 14, 2010, Pronovost 304 (2): 204
| Commentary |  | |
|---|---|---|
| | Learning Accountability for Patient Outcomes JAMA. 2010;304(2):204-205. doi:10.1001/jama.2010.979
Each year, an estimated 100 000 patients die of health care–associated infections, another 44 000 to 98 000 die of other preventable errors, and tens of thousands more die of diagnostic errors or failure to receive recommended therapies.1-3 Physicians are overconfident about the quality of care they provide, believing things will go right rather than wrong, assuming they provide higher-quality care than the evidence suggests, and thinking they alone have sufficient knowledge and skills to provide care. Teamwork failures are common contributors to harmful errors. In many cases, someone knew something was wrong and either did not speak up or spoke up and was ignored. It is unclear how many teamwork and communication failures result from arrogance. Most clinicians have personal stories of arrogance causing patient harm. My own involved a patient who had classic signs of a latex allergy, but for whom the operating surgeon refused to Author Affiliations: Departments of Anesthesiology and Critical Care Medicine and Surgery, School of Medicine, and Department of Health Policy and Management, Bloomberg School of Public Health, and School of Nursing, Johns Hopkins University, Baltimore, Maryland. | |||||||||||||
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