Friday, October 01, 2010
full free access: Ovarian cancer: relevant therapy, not timing, is paramount : The Lancet
Note: registration required to view (free)
The impact of systematic para-aortic and pelvic lymphadenectomy on survival in patients with optimally debulked ovarian cancer
Abstract Aim: The objective of this study was to verify the impact of systematic retroperitoneal lymphadenectomy on survival in patients with ovarian cancer.
Medscape: No Benefit for Early Tx of Ovarian Cancer Relapse
Note: article discusses the concerns/issues/study etc
media item: New Clues to Treating Ovarian Cancer Relapse
New Clues to Treating Ovarian Cancer Relapse
Starting chemotherapy when first signs reappear not especially effective, study finds "This paper, the first randomized trial to look at the timing of chemo in women with recurring ovarian cancer, appears in the Oct. 2 issue of The Lancet, a special themed issue on cancer...."
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61268-8/abstract
SOURCES: Andrew Berchuck, M.D., director, division of gynecologic oncology, Duke University Medical Center, Durham, N.C.; Robert A. Burger, M.D., professor of surgical oncology, section of gynecologic oncology and director, Women's Cancer Center, Fox Chase Cancer Center, Philadelphia; Oct. 2, 2010, The Lancet
Wednesday, September 29, 2010
free full access: Sept 2010 Pegylated liposomal doxorubicin in the management of ovarian cancer
"This review aims at summarizing the available evidence and the new perspectives for the clinical role of PLD in the management of patients with epithelial ovarian cancer."
(U.S.) S. 1674: Improving Access to Clinical Trials Act of 2010 (GovTrack.us)
Text:
Summary
Status:
Occurred: Introduced Sep 15, 2009
Occurred: Referred to Committee View Committee Assignments
Occurred: Passed Senate Aug 5, 2010
Occurred: Passed House Sep 23, 2010
Not Yet Occurred: Signed by President ...
Having passed in identical form in both the House and Senate, this bill now awaits the signature of the President before becoming law. [Last Updated: Sep 29, 2010 9:33PM]
Last Action:
Sep 24, 2010: Presented to President.
Related:
See the Related Legislation page for other bills related to this one and a list of subject terms that have been applied to this bill. Sometimes the text of one bill or resolution is incorporated into another, and in those cases the original bill or resolution, as it would appear here, would seem to be abandoned.
Votes:
Aug 5, 2010: This bill passed in the Senate by Unanimous Consent. A record of each senator’s position was not kept.
Sep 23, 2010: This bill passed in the House of Representatives by voice vote. A record of each representative’s position was not kept.
free full access: Integrating Supportive and Palliative Care in the Trajectory of Cancer: Establishing Goals and Models of Care — JCO
"......One of the key barriers to early referral is the misunderstanding that palliative care is only provided at the end of life once patients have exhausted all cancer treatment options. Some oncologists have expressed the concern that a referral to palliative care would destroy a patient's hope. It is important to recognize that patients do not need to choose between cancer treatments and supportive/palliative care. Rather, they can take advantage of the expertise of both the oncology and the palliative care teams in optimizing quantity and quality of life under a simultaneous care model......"
Tuesday, September 28, 2010
Mayo Collaboration Finds Source of Breast Drug Side Effect - Drugs.com MedNews (aromatase inhibitors/arthritis/bone pain)
Mayo Collaboration Finds Source of Breast Drug Side Effect
Pharmacogenomic discovery allows for improved cancer therapy
ROCHESTER, Minn. — Mayo Clinic researchers and their international colleagues have discovered genetic variants that lead to severe arthritis for a subset of women when taking aromatase inhibitors to treat their breast cancer. This serious side effect is so painful that many women halt their lifesaving medication. The findings appear today in the online issue of Journal of Clinical Oncology.
Read more: http://www.drugs.com/clinical_trials/mayo-collaboration-finds-source-breast-10214.html#ixzz10seG0Pnb
Quality of pathology reports for advanced ovarian cancer: Are we missing essential information? An audit of 479 pathology reports from the EORTC-GCG 5
Quality of pathology reports for advanced ovarian cancer: Are we missing essential information? An audit of 479 pathology reports from the EORTC-GCG 55971/NCIC-CTG OV13 neoadjuvant trial
CONCLUSION: This audit of ovarian cancer pathology reports reveals that in a substantial number of reports basic pathologic data are missing, with possible adverse consequences for the quality of cancer care. Specialisation by pathologists and the use of standardised synoptic reports can lead to improved quality of reporting. Further research is needed to better define pre- and post-operative diagnostic criteria for ovarian cancer treated with neoadjuvant chemotherapy.
Declaration: The World Cancer Declaration - A call to action from the global cancer community | Union for International Cancer Control
Targets: by 2020
- Sustainable delivery systems will be in place to ensure that effective cancer control programmes are available in all countries
- The measurement of the global cancer burden and the impact of cancer control interventions will have improved significantly
- Global tobacco consumption, obesity and alcohol intake levels will have fallen significantly
- Populations in the areas affected by HPV and HBV will be covered by universal vaccination programmes
- Public attitudes towards cancer will improve and damaging myths and misconceptions about the disease will be dispelled
- Many more cancers will be diagnosed when still localized through the provision of screening and early detection programmes and high levels of public and professional awareness about important cancer warning signs
- Access to accurate cancer diagnosis, appropriate cancer treatments, supportive care, rehabilitation services and palliative care will have improved for all patients worldwide
- Effective pain control measures will be available universally to all cancer patients in pain
- The number of training opportunities available for health professionals in different aspects of cancer control will have improved significantly
- Emigration of health workers with specialist training in cancer control will have reduced dramatically
- There will be major improvements in cancer survival rates in all countries
Monday, September 27, 2010
Prognostic value of microsatellite instability (MSI) and PTEN expression in women with endometrial cancer: results from studies of the NCIC Clinical Trials Group (NCIC CTG)
Abstract
AIM: The impact of PTEN status and microsatellite instability (MSI) on the prognosis of women with endometrial cancer is controversial. The aim of this study was to investigate MSI and PTEN expression in two patient populations using data from NCIC CTG studies.METHODS: Archival paraffin embedded tumour from women with endometrial cancer enrolled in NCIC CTG studies: EN5 (stage I/II) and IND 126, 148 and 160 (advanced/recurrent disease) were examined for MSI using BAT25/26 and for PTEN expression using immunohistochemistry. PTEN and MSI status were correlated with clinicopathologic variables and survival using data from NCIC CTG trial databases.
RESULTS: PTEN and MSI results were available from 128 and 163 patients, respectively. MSI+ tumours were more common in women enrolled in EN5 compared to the IND studies (p=0.01). PTEN negative tumours were associated with improved survival in both univariate (hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.32-0.94; p=0.03) and multivariate (adjusted HR 0.54, 95% CI 0.30-0.96; p=0.03) analyses in women enrolled in IND studies. Microsatellite stable tumours were associated with an improved prognosis in univariate (HR 0.18, 95% CI 0.06-0.51; p<0.0001)>
CONCLUSIONS: PTEN negative tumours in women with advanced disease are associated with improved survival. MSI+ tumours are more common in early stage disease and in this group of women are associated with a worse prognosis
abstract: Will designated patient navigators fix the problem? Oncology nursing in transition
Abstract
With increasing concern for equity and access across the cancer care system, we have seen expanding enthusiasm for various forms of designated patient "navigators" to facilitate coordination. While the intention is laudable, many of the popular implementation strategies risk accentuating strain upon the system and further complicating the coordination problem. These authors claim the motivation underlying the navigator movement can be reframed as an emerging recognition of the value of nursing work when it is optimally positioned to support patients, as they experience the cancer care system. This paper calls on Canadian oncology nurses to critically challenge navigation strategies, and adopt only those consistent with the significant reforms required to ensure a cancer care system so effective that external navigators are no longer necessary.
abstract: Will designated patient navigators fix the problem? Oncology nursing in transition
Abstract
With increasing concern for equity and access across the cancer care system, we have seen expanding enthusiasm for various forms of designated patient "navigators" to facilitate coordination. While the intention is laudable, many of the popular implementation strategies risk accentuating strain upon the system and further complicating the coordination problem. These authors claim the motivation underlying the navigator movement can be reframed as an emerging recognition of the value of nursing work when it is optimally positioned to support patients, as they experience the cancer care system. This paper calls on Canadian oncology nurses to critically challenge navigation strategies, and adopt only those consistent with the significant reforms required to ensure a cancer care system so effective that external navigators are no longer necessary.
BRCA1 mutations and colorectal cancer in Poland
Abstract
Evidence to date that germline mutations in the tumor suppressor gene BRCA1 increase the incidence of colorectal cancer is mixed, and both positive and negative results have been reported. To establish whether or not inherited variation in BRCA1 influences the risk of colorectal cancer, we genotyped 2,398 unselected patients with colorectal cancer and 4,570 controls from Poland for three BRCA1 founder mutations (C61G, 4153delA and 5382insC). A BRCA1 mutation was present in 0.42% of unselected cases of colorectal cancer and in 0.48% of controls (OR = 0.8; P = 0.8). The mutation frequency was slightly higher (0.93%) in 321 cases who reported a family history of colon cancer in a first- or second-degree relative (OR = 1.9; P = 0.5). A BRCA1 mutation was also seen in excess (0.82%) in 851 cases who were diagnosed with colorectal cancer at age 60 or earlier (OR = 1.7; P = 0.3). The mean age at onset in carriers was 7 years younger than in non-carriers (57.0 years vs. 64.0) and the difference was significant (P = 0.05). This study suggests that BRCA1 mutations may be associated with early-onset of colorectal cancer.
Mucosal carcinoma of the fallopian tube coexists with ovarian cancer of serous subtype only: a study of Japanese cases
Abstract
Previous studies in Western countries have revealed that mucosal carcinoma of the fallopian tube frequently coexists with pelvic (ovarian, tubal, and peritoneal) serous carcinomas, and early tubal carcinoma is now regarded as a possible origin of these tumors. However, the relationship between early tubal carcinoma and non-serous ovarian cancer, such as clear cell adenocarcinoma, has not been studied in detail. In this study, we sought to examine the coexistence of mucosal carcinoma of the fallopian tube in Japanese ovarian cancer cases. We submitted the fallopian tubes in toto for histological examination in 52 ovarian carcinoma cases and three peritoneal serous carcinoma cases. The ovarian tumors included 12 serous adenocarcinomas, 23 clear cell adenocarcinomas, nine endometrioid adenocarcinomas, three mucinous adenocarcinomas, and four mixed epithelial carcinomas. Mucosal carcinoma of the fallopian tube did not coexist with non-serous adenocarcinoma (n = 40). In contrast, mucosal carcinoma of the fallopian tube was observed in six cases of ovarian serous adenocarcinoma and one case of peritoneal serous adenocarcinoma. In these cases, the p53 immunophenotypes were similar in tubal lesions and invasive ovarian or peritoneal carcinomas. Tumors were negative for p53 in four of seven cases, and one of the p53-negative serous adenocarcinomas showed low-grade morphology. We believe that some ovarian and peritoneal serous adenocarcinomas develop from early tubal carcinomas. However, it should be noted that early tubal carcinomas are not always p53-positive immunohistochemically. Finally, it is unlikely that early tubal lesions are involved in the carcinogenesis of clear cell adenocarcinoma and other non-serous adenocarcinomas.
Overview of Neuroendocrine Tumors: Focus on Carcinoid Tumors and Syndrome
Overview of Neuroendocrine Tumors: Focus on Carcinoid Tumors and Syndrome
Neuroendocrine tumors (NETs)
NETs: A common and heterogenous group of solid malignant tumors »
Carcinoid tumors: A frequently occurring GI malignancy »
NETs: Survival rates are correlated with extent of disease and tumor differentiation »
The rising incidence of carcinoid tumors »
Sept 27th: Lots of Epogen and Procrit Recalled Due to Glass Flakes in Vials
"According to the manufacturer, the lamellae result from the interaction of the formulation with glass vials during the shelf life of the product. However, the company states that it has found that the lamellae have a low potential to affect patients who may have received the recalled product. "To date, there have been no complaints or adverse events reported which can be directly attributed to the presence of glass lamellae," the company notes."
(full free access) Decisions, Decisions: Family Doctors as Gatekeepers to Prescription Drugs and Diagnostic Imaging in Canada
Decisions, Decisions: Family Doctors as Gatekeepers to Prescription Drugs and Diagnostic Imaging in Canada
O U R F I N D I N G S:
The Health Council of Canada is unable to conclusively determine if the use of family physician services has increased, decreased or remained stable over the past decade, despite a rise in the number of practising family physicians in Canada. This is due to the growing variety of physician practice models across the country and the way data are collected,(or not) to reflect the services provided.
Editorial :: Cochrane in the United States of America - The Cochrane Collaboration (background/2010 Keystone, Colorado conference)
Note: The Gynecologic Cancer Review Group section of the Cochrane is based out of the UK. Consumer reviewers may participate irrespective of geographic location as the Cochrane is primarily internet-based.
"On 18 October 2010, the first joint Colloquium between the Campbell and Cochrane Collaborations opens in Keystone, Colorado, USA. The USA last hosted the Cochrane Collaboration Colloquium and annual meeting in 1998 in Baltimore, Maryland. The Colloquium's return to the USA comes on the heels of President Obama's signing of historic health care reform legislation. As reported, "the reforms, which will cost an estimated USD 940 billion over 10 years, will expand the provision of care to 32 million more people, predominantly the poorest, and will result in the country achieving 95% coverage" (MacAskill 2010). At the same time The American Recovery and Reinvestment Act of 2009 has provided USD 1.1 billion for Comparative Effectiveness Research (CER), and established the Patient-Centered Outcomes Research Institute (PCORI). PCORI will make a major annual investment in CER, through the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ).
The US contribution to the development of The Cochrane Collaboration has been considerable. US-based researchers represented 7/84 (8.3%) of the pioneers attending the first Cochrane Colloquium in October 1993........."cont'd
Sunday, September 26, 2010
part 111: International patient charters are often nonbinding or feature fuzzy metrics -- Canadian Medical Association Journal (patient charter of rights)
Last of a three-part series on patient charters
Part I: Patients charters: the provincial experience (www.cmaj.ca/cgi/doi/10.1503/cmaj.109-3339)
Part II: Patient charters all buzz and no bite, advocates say (www.cmaj.ca/cgi/doi/10.1503/cmaj.109-3340)
(repeat) abstract: SGO White Paper on ovarian cancer: etiology, screening and surveillance
Abstract: Ovarian cancer is a heterogeneous, rapidly progressive, highly lethal disease of low prevalence. The etiology remains poorly understood. Numerous risk factors have been identified, the most prominent involving an inherited predisposition in 10% of cases. Women with germline mutations associated with Hereditary Breast/Ovarian Cancer and Lynch syndromes have dramatically elevated risks (up to 46% and 12%, respectively). Risk-reducing salpingo-oophorectomy is the best method to prevent ovarian cancer in these high-risk women. Significant risk reduction is also seen in the general population who use oral contraceptives. Since up to 89% patients with early-stage disease have symptoms prior to diagnosis, increased awareness of the medical community may facilitate further workup in patients who otherwise would have had a delay. Despite enormous effort, there is no proof that routine screening for ovarian cancer in either the high-risk or general populations with serum markers, sonograms, or pelvic examinations decreases mortality. Further evaluation is needed to determine whether any novel biomarkers, or panels of markers, have clinical utility in early detection. Prospective clinical trials have to be designed and completed prior to offering of any of these new diagnostic tests. CA125 is currently the only biomarker recommended for monitoring of therapy as well as detection of recurrence. This commentary provides an overview on the background, screening and surveillance of ovarian cancer.
media - NICE issues first GP ovarian cancer guidance highlighting four red flags
Detecting ovarian cancer in primary care
• Refer urgently if physical examination identifies a pelvic or abdominal mass and/or ascites.
• Investigate if a woman reports any of the following more than 12 times a month: abdominal distension, difficulty eating and/or feeling full, pelvic or abdominal pain or increased urinary urgency and/or frequency
• Also consider testing woman with abnormal vaginal bleeding, unexplained weight loss, abdominal distension, fatigue or changes in bowel habit.
• Send women with a serum CA125 35 IU/ml for an ultrasound scan and refer with a positive scan urgently for further investigation.
• Advise any woman who has normal serum CA125, or a normal ultrasound, to return to her GP for re-assessment if her symptoms persist or become more frequent.
Source: The recognition and initial management of ovarian cancer, draft NICE guideline, September 2010
Saturday, September 25, 2010
U.S. - Stanford study of program for cancer survivors needs participants
Now, researchers at the Stanford University School of Medicine are looking for participants for a study on the program, which was designed to help people get the most out of life while living with cancer. This study is specifically for patients who have had cancer more than once.
Participants are needed who have had at least two bouts of cancer and have completed major treatment in the past five years. Participants can live anywhere in the United States but need access to a computer with an Internet connection and an e-mail account.
Those who are interested in participating should visit http://cancersurvivors.stanford.edu or e-mail cancersurvivors@stanford.edu.
“Cancer: Thriving and Surviving” is a six-week, Internet-based workshop intended to help people living with cancer deal with their unique problems and concerns, which can include fear of reoccurrence, depression, fatigue and a sense of isolation. Each workshop brings together online about 25 people and is facilitated by two trained moderators — at least one of whom is a cancer survivor, like Gaynor Watson.
The study will assess the workshop’s effectiveness.
The workshop is an adaptation of a chronic-disease-management program developed by Kate Lorig, DrPH, professor emeritus of immunology and rheumatology, that has been shown to be effective at improving health and well-being for participants.
To evaluate this new program, Lorig and colleagues at the University of Hawaii previously enrolled 400 first-time cancer survivors in the cancer course; now the study has been expanded to include patients with a recurring or second cancer.
Gaynor Watson said past participants have benefited from the sense of camaraderie with their online peers and from the ability to communicate with others who relate to what they’re doing. Her hope, she said, is that they also walk away with “a sense of self-empowerment and the skills to live a quality life.”
During the study, survivors will be randomly assigned to participate in a workshop, or to wait six months to take the workshop. Those enrolled in the online program will have access to a Web-based learning center and online discussion boards to address such topics as healthy eating, physical activity, stress and fatigue management, communication and emotional strategies. They’ll be asked to log on two or three times for a total of about two hours each week over the six-week period; all participants will complete two online questionnaires about their health over a six-month period.
The study, which is being conducted in the Stanford Patient Education Research Center, is funded by the Stanford Cancer Center.
Australian women's awareness of ovarian cancer symptoms, risk and protective factors and estimates of own risk - abstract
Blogger's Note: similar studies and public polls over the past few years, irrespective of country, have noted the same results. As in the past, the conclusion/s beg many questions regarding not only funding/donations but the reality of existing campaigns.
Australian women's awareness of ovarian cancer symptoms, risk and protective factors, and estimates of own risk.
Centre for Health Initiatives, University of Wollongong, Wollongong, 2522, Australia, sandraj@uow.edu.au.
Abstract
OBJECTIVE: To examine Australian women's perceived risk of ovarian cancer, reasons for perceived risk levels, and knowledge of ovarian cancer symptoms at two timepoints (2003 and 2007).METHODS: A computer-assisted telephone (CATI) survey of 2,954 Australian women with no history of ovarian cancer was conducted.
RESULTS: Approximately 60% of women perceived their risk of ovarian cancer was similar to other women of their age; 10% indicated an increased risk, and 30% indicated a lower risk. These figures were similar in 2003 and 2007. Logistic regression found that lower income, increased age, being born overseas, and being retired were significantly associated with lower perceived risk (accounted for only 7.5% of the variance). Common reasons for higher perceived risk included family history of ovarian/other cancers, increasing age, and having had other types of cancer or health problems. Reasons for lower than average risk included absence of family history, having a hysterectomy, and having regular Pap smears (indicating confusion between ovarian and cervical cancer). There appeared to be substantial confusion in women's understanding of ovarian cancer symptoms; this was similar in 2003 and 2007.
CONCLUSION: The observed misperceptions and confusion regarding ovarian cancer symptoms and risk factors suggest ongoing public education campaigns are needed to improve knowledge and awareness.
Friday, September 24, 2010
Wednesday, September 22, 2010
Search of: msh2 - List Results - ClinicalTrials.gov
| Found 4 studies with search of: | msh2 |
| 1 | Recruiting | Methotrexate in Metastatic Colorectal Cancer With MSH2 Deficiency
| ||||
| 2 | Recruiting | Study of Genes and the Environment in Patients With Endometrial Cancer in the East Anglia, Oxford, Trent, or West Midlands Regions of the United Kingdom
| ||||
| 3 | Recruiting | Study of Genes and the Environment in Patients With Colorectal Cancer in the East Anglia Region of the United Kingdom
| ||||
| 4 | Recruiting | Anonymous Testing of Pathology Specimens for BRCA Mutations in Ashkenazi Jewish Individuals Who Have Cancer
|
carcinoma vs adenocarcinoma - definitions
Definitions of carcinoma on the Web:
- any malignant tumor derived from epithelial tissue; one of the four major types of cancer
wordnetweb.princeton.edu/perl/webwn - A
carcinoma is any cancer that arises from epithelial cells. Carcinomas
invade surrounding tissues and organs and may metastasize, or spread, to
lymph nodes and other sites.
en.wikipedia.org/wiki/Carcinoma
pathology2.jhu.edu/PANCREAS/agloss.cfm - A
malignancy arising from a tissue that lines a body cavity. Skin, gut,
breasts, prostate are epithelial lining cell cancers and constitute the
most common form of cancers in the human body.
www.sharedexperience.org/Glossary.lasso - A
subtype of cancer that develops from tissues covering or lining organs
or glands of the body, such as skin, colon, lung, or breast. Most of the
cancers are carcinomas. Some cancers that arise from connective tissues
like bone are called sarcomas. ...
medicineworld.org/cancer/descriptions.html - A malignant tumor that begins in the lining layer (epithelial cells) of organs. At least 80% of all cancers are carcinomas.
www.americanbrachytherapy.org/aboutBrachytherapy/glossary.cfm - This term refers to cancer of cells that line various organs. This category is the largest and the most common type of cancer.
www.oncothyreon.com/about/glossary.html
Definitions of adenocarcinoma on the Web:
- malignant tumor originating in glandular epithelium
wordnetweb.princeton.edu/perl/webwn - Any of several forms of carcinoma that originate in glandular tissue
en.wiktionary.org/wiki/adenocarcinoma - The form of cancer that most people are talking about when they
refer to "cancer of the pancreas." These tumors account for 75% of all
pancreas cancers. Microscopically, adenocarcinomas form glands. These
tumors can grow large enough to invade nerves which can cause back pain.
...
pathology2.jhu.edu/PANCREAS/agloss.cfm - Cancerous
cell growth in a glandular or glandlike pattern. This cancer can occur
in various organs and is the most common cancer of the pancreas (also
referred to as adenocarcinoma of the pancreas).
www.gemzar.com/pat/pat930_glossary.jsp
CBC.ca News - Charities paid $762M to private fundraisers
Note: also see blog "BSB4uD", this article focuses on external fundraisers but the focus should be fundraising costs irrespective of source
"If a charity's not going to be transparent with you on how it's spent money in the past, why would you give it a donation?" she asked.
Money paid by charities spending more than 50% of their revenues on external fundraisers, by province, in 2008:
| Province | # of charities | Amount raised ($) | Amount paid to fundraisers ($) | Net revenue for charity ($) |
| B.C. | 38 | 4,976,236 | 3,436,926 | 1,539,310 |
| Alta. | 27 | 19,529,677 | 16,434,884 | 3,094,793 |
| Sask. | 4 | 537,703 | 384,954 | 152,749 |
| Man. | 3 | 561,674 | 307,378 | 254,296 |
| Ont. | 100 | 38,223,556 | 25,024,532 | 13,199,024 |
| Que. | 28 | 8,477,161 | 7,113,096 | 1,364,065 |
| N.B. | 5 | 750,874 | 588,702 | 162,172 |
| N.S. | 2 | 406,617 | 322,806 | 83,811 |
| N.L. | 3 | 118,969 | 88,337 | 30,632 |
| P.E.I. | 4 | 346,448 | 264,157 | 82,291 |
full free access: PLoS Medicine: Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up? Cochrane Collaboration
"To meet the needs of patients, clinicians, and policymakers, unnecessary trials need to be reduced, and systematic reviews need to be prioritised. Streamlining and innovation in methods of systematic reviewing are necessary to enable valid answers to be found for most patient questions. Finally, clinicians and patients require open access to these important resources."
Women with Cancer: Talking Teal with Cancer Advocate Rebecca Esparza
Note: Rebecca can also be found on FB
abstract: Resident Participation Does Not Affect Surgical Outcomes, Despite Introduction of New Techniques
Abstract
BACKGROUND: Surgical operations at academic medical centers typically involve a resident physician performing cases together with, and/or under the supervision of, an attending physician. Although this is a widely accepted practice, recent emphasis on patient safety has led to scrutiny about this educational model. There are few studies evaluating whether complication rates, independent of patient risk factors, are affected by resident participation in operations.STUDY DESIGN: We identified 295 patients (590 breasts) who had undergone bilateral reduction mammoplasty led by a single attending surgeon between October 1, 1997 and September 30, 2008 at the University of Michigan Health System. In all cases, the attending operated on the right breast and the resident operated on the left breast under the supervision of the attending, allowing each patient to act as their own control. Their charts were retrospectively reviewed and major complications were defined as those requiring either an operation or hospitalization to treat.
RESULTS: Twenty-three patients (7.8%) had a major complication after their breast reduction. Ten of these complications occurred in the left breast, 9 in the right breast, and 4 in both breasts. Statistical analysis revealed no differences in major complication rates between the side operated on with the primary surgeon being the resident versus the attending (4.7% versus 4.4%; p = 1.00).
CONCLUSIONS: In the context of this single surgical operation, resident participation does not substantially affect major complication rates. The common residency training paradigm provides clinical experience and supervision without necessarily impacting patient safety. Analysis of additional operations in different settings will be necessary.
ICR (UK) - Lynch Syndrome mutation MSH2 - 60-Year-Old Drug Shows New Promise for Inherited Cancer
"....Methotrexate is similar to a normal molecule called folinic acid, which is required for copying DNA. The drug prevents cells from making and repairing DNA - a process needed for cancer growth. It was one of the first chemotherapy drugs to be invented in the 1940s and is still used to treat a number of cancers today. But until now, it has not commonly been used to treat people with HNPCC.
Professor Alan Ashworth, who led this Cancer Research UK-funded study at the ICR, said: "The MSH2 gene plays a vital role in repairing DNA damage but if it is faulty, mistakes accumulate in cells and increase the risk of cancer developing.
"What's exciting about methotrexate is that it selectively destroys the cells lacking the MSH2 function. This indicates that it may make an excellent treatment for patients with the genetic alteration. With our colleagues at The Royal Marsden Hospital, we have set up clinical trials to test this."...cont'd
A whisper-game perspective on the family communication of DNA-test results: a retrospective study on the communication process of BRCA1/2-test results
"...Unclassified-variants were most frequently misinterpreted by probands and relatives, and had the largest differences between probands' and relatives' perceptions...."
What I wish I'd known before surgery: BRCA carriers' perspectives after bilateral salipingo-oophorectomy (abstract)
"This study illustrates that while health care providers are discussing selected side effects of PBSO, women undergoing this surgery have other concerns that should be addressed..."
Microbubble-enhanced US in Body Imaging: What Role? (abstract)
Note: CE US = contrast enhanced ultrasound
Abstract
Contrast agents for ultrasonography (US) comprise microscopic bubbles of gas in an encapsulating shell. They are unique in that they interact with the imaging process, oscillating in response to a low-intensity ultrasound field and disrupting in response to a high-intensity field. New contrast-specific imaging modes allow US to show exquisite vascularity and tissue perfusion in real time and with excellent spatial resolution. In Europe, Asia, and Canada, to name only the most obvious, characterization of focal liver masses is the first and best established use of contrast-enhanced (CE) US, allowing for the noninvasive diagnosis of commonly encountered liver masses with comparable accuracy to that of computed tomography and magnetic resonance studies. CE US is a preferred modality for the difficult task of diagnosis of liver nodules detected on surveillance scans in those at risk for hepatocellular carcinoma. Newer body applications include the guidance of ablative intervention, monitoring activity of bowel inflammation in Crohn disease, characterization of kidney masses, especially cystic renal cell carcinoma, diagnosis of prostate cancer, and monitoring the response of tumors to antivascular drug therapies. Microbubble contrast agents are easy to use and robust; their use poses no risk of nephrotoxicity and requires no ionizing radiation. CE US plays a vital and expanding role that improves management and patient care.
Home : Nature Genetics re: BRCA 1/breast cancer/ polymorphisms (SNP's - international genome study)
Latest highlights
Advance Online Publication
Genetics of breast cancer
Letter by Antonius AntoniouFergus Couch and colleagues report a genome-wide association study for modifiers of breast cancer susceptibility in BRCA1 mutation carriers with breast cancer and BRCA1 mutation carriers without breast cancer. They identify a locus at 19p13 associated with breast cancer risk in BRCA1 mutation carriers, and replication studies show that this locus associates with estrogen receptor-negative breast cancer in the general population.
Advance Online Publication
Simon Gayther and colleagues report a genome wide association study for ovarian cancer. They identify two new susceptibility loci at 2q31 and 8q24. Separately, Paul Pharoah and colleagues report a genome-wide association study for survival time after diagnosis of epithelial ovarian cancer. They identify a locus at 19p13 associated with susceptibility to the serous subtype of epithelial ovarian cancer.
health media: BRCA1 Breast Cancer Risk Linked To Other Genes
"...People who carry certain mutations of the BRCA1 gene are known to have a higher risk of developing breast cancer.
Couch told the media that their findings should be "useful in helping determine individual risk for breast cancer in BRCA1 carriers".
"It also provides insights into hormone-receptor-negative breast cancer in the general population," he added.
For the study, Couch and colleagues conducted four phases of genome-wide association studies (GWAS) that altogether involved 20 research centers in 10 North American and European countries and Israel.
For the first phase, to identify candidate gene variants, they scanned the genomes of 1,193 carriers of BRCA1 mutations who were under 40 and had invasive breast cancer and compared them to scans of about the same number of controls: BRCA1 carriers of similar age who did not have breast cancer.
In comparing the genomes from the two populations the researchers examined over half a million genetic alterations. They found 96 pieces of DNA called SNPs, or "snips", short for single nucleotide polymorphisms, that they thought would be likely candidates because they differed between the two populations...."cont'd
full free access: eMJA: Pathways to the diagnosis of epithelial ovarian cancer in Australia
Note: excerpts below, the tables included in the paper provide interesting information including patients with borderline tumours, 24% of patients in this study had a prior hysterectomy etc...
Objective:
To describe the diagnostic pathways experienced by a large,
representative group of Australian women with ovarian cancer, and to
document the time between first presentation to a medical professional
and clinical diagnosis.
Conclusions:
Despite anecdotal suggestions to the contrary, most women with ovarian
cancer in Australia are investigated and diagnosed promptly. The
diagnostic process is more protracted for a minority of women, and the
factors we found to be associated with diagnostic delay warrant further
investigation.
"........The numbers of symptoms reported, doctors seen and total doctor visits were all highly skewed. These variables were therefore summarised....."
"........The numbers of symptoms reported, doctors seen and total doctor visits were all highly skewed. These variables were therefore summarised....."
Maven Semantic: Ovarian Cancer Research Database - media
Note: see website/link for details by individual name and/or country etc
DUBLIN--(BUSINESS WIRE)--Maven Semantic (http://www.mavensemantic.com) announces updates to their Ovarian Cancer research database.
The new database is now available to marketing, business development, competitor intelligence, KOL, medical affairs and related departments in the life sciences sector.
The database currently tags 42,000 individuals working in Ovarian Cancer. http://bit.ly/d0aEsH
EvidenceUpdates- A randomized controlled trial of home-based exercise for cancer-related fatigue in women during and after chemotherapy with or without radiation therapy
CONCLUSIONS: Our home-based exercise intervention had no effect on fatigue or related symptoms associated with cancer treatment. The optimal timing of exercise remains to be determined.
IMPLICATIONS FOR PRACTICE: Clinicians need to be aware that some physical activity is better than none, and there is no harm in exercise as tolerated during cancer treatment. Further analysis is needed to examine the adherence to exercise. More frequent assessments of fatigue, sleep disturbance, depression, and pain may capture the effect of exercise.
Comments from Clinical Raters
Oncology - Gynecology
Impact will be muted, as this is a negative trial: exercise is not harmful but doesn't seem to improve any of the outcomes measured, including fatigue.
Tuesday, September 21, 2010
Monday, September 20, 2010
HealthNewsReview.org | Independent Expert Reviews of News Stories | Holding Health and Medical Journalism Accountable
http://healthnewsreview.org/did-you-know.php
What is HealthNewsReview.org?
HealthNewsReview.org is a website dedicated to:
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What is HealthNewsReview.org?
HealthNewsReview.org is a website dedicated to:
- Improving the accuracy of news stories about medical treatments, tests, products and procedures.
- Helping consumers evaluate the evidence for and against new ideas in health care.
- The U.S. Preventive Services Task Force is considered the gold standard of preventive health recommendations - including on screening tests. It.s a good source for journalists and consumers.
- About 70% of the stories reviewed from 2006-9 failed to adequately discuss costs, or to explain how big (or small) are the potential benefits and harms of treatments, tests, products and procedures.
- We have documented a disturbing trend of news stories taking an advocacy stance, promoting certain screening tests outside the boundaries of scientific evidence.
- Stories on new technologies like Cyberknife, DaVinci robotic surgery systems, and proton beam cancer therapy often fail to scrutinize the evidence and/or to discuss the costs involved.
- Rather than suggesting that everyone should be screened for everything, news stories could explain: "All screening tests cause harm; some may do good."
- The first 38 network TV network morning health news stories reviewed in 2009 earned an average score of 1.2 stars. 13 of the 38 stories got ZERO stars.
- Both TIME magazine and BusinessWeek have published terrific stories explaining the importance of the Number Needed to Treat - or NNT.
- Knowing relative risk reduction is like knowing you have a 50% off coupon but not knowing whether it's for a Lexus or a lollipop. Absolute risk reduction tells you what the "coupon" is worth. Read more.
- The website NoFreeLunch.org posts "a database of health care professionals who have pledged to accept no gifts from industry and to rely on non-promotional sources of information."
- To help journalists cover stories responsibly, we post a list of independent experts who state that they do not have financial ties to drug or medical device manufacturers.
- We apply the same ten standardized criteria to the review of every story.
- We have about 30 story reviewers. Each story is reviewed by 3 different people.
- Gary Schwitzer's seven words you shouldn't use in medical news: cure, miracle, breakthrough, promising, dramatic, hope, victim. Read why.
- Our reviewers include two former CNN medical reporters and a former editor of the Washington Post health section.
full free access: The Role of In Vitro Directed Chemotherapy in Epithelial Ovarian Cancer
Epithelial ovarian cancer (EOC) continues to be the most lethal gynecologic malignancy. Efforts to personalize chemotherapy treatments by utilizing in vitro tumor assays to predict chemotherapeutic response have been tested in both the primary and recurrent treatment setting. To date, several retrospective studies have suggested improved response rates to predicted chemotherapeutic agents. However, a prospective, controlled trial merely found equivalence between in vitro prediction and empirical treatment selection. This review summarizes the current data regarding in vitro directed chemotherapy in EOC.
Conclusions: In vitro chemotherapy sensitivity and resistance testing may still hold promise for clinical decision-making, improved survival, and limiting unnecessary toxicity in the treatment of EOC. Given the current limitations and lack of randomized, controlled results, these assays are best used in the setting of a clinical trial.
Sorafenib in Combination With Gemcitabine in Recurrent Epithelial Ovarian Cancer: A Study of the Princess Margaret Hospital Phase II Consortium
Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; †Juravinski Cancer Centre, McMaster University,Hamilton, Ontario, Canada; ‡Fox Chase Cancer Center, Philadelphia, PA; and §National Cancer Institute, Bethesda, MD.
Abstract
OBJECTIVES: Antiangiogenic strategies have demonstrated efficacy in epithelial ovarian cancer (EOC). Sorafenib is a novel multitargeted kinase inhibitor with antiangiogenic activity. Gemcitabine has known activity against EOC. A phase 1 clinical trial of this combination suggested activity in ovarian cancer with no dose-limiting toxicity. This phase 2 study was designed to examine the safety and efficacy of gemcitabine and sorafenib in patients with recurrent EOC.CONCLUSION: This trial of gemcitabine and sorafenib in recurrent EOC did not meet its primary efficacy end point, but the combination was associated with encouraging rates of prolonged stable disease and CA-125 response.
Risk factors for non-invasive lesions of the fallopian tube in BRCA mutation carriers (study of 173 BRCA mutation carriers)
Objective
To identify risk factors for the presence of a non-invasive lesion of the fallopian tube in women with a BRCA1 or BRCA2 mutation.Conclusion
The prevalence of tubal p53 signature and TIC (a tubal intra-epithelial carcinoma (TIC)) increases with age at salpingectomy and with BMI. Oral contraceptive use is associated with a decrease in the prevalence of TICs.A phase I trial of dose-dense (biweekly) carboplatin combined with paclitaxel and pegfilgrastim: A feasibility study in patients with untreated Stage III and IV ovarian, tubal or primary peritoneal cancer: GOG study (serious side effects)
Purpose
Dose-dense regimens have been shown to improve outcome when given as adjuvant therapy to patients with breast cancer compared with their three weekly counterparts. We investigated the feasibility of a dose-dense regimen with carboplatin/paclitaxel followed by pegfilgrastim in patients with advanced ovarian cancer. We also investigated the toxicities including the percentage of patients with grade 2 or greater peripheral neurotoxicity and the clinical response of this regimen.Conclusion
Dose-dense carboplatin/paclitaxel appears to be effective. However, based on dose limiting toxicities occurring when administering 6 cycles of treatment, it is not feasible. Given the neuropathy and thrombocytopenia, we do not recommend 6 cycles of this regimen without modification.Genetics University of Utah - Tour of the Basics - Understanding Genes, Chromsomes
What is DNA?
What is a Gene?
What is a Protein?
What is Hereditary?
What is a Trait?
Scientists ID 5 Gene Variants Linked to Ovarian Cancer
"...The researchers analyzed the DNA of more than 10,000 women with ovarian cancer and more than 13,000 women without the disease. They found five genetic variants in regions of the genome (chromosomes 2, 3, 8, 17 and 19) associated with ovarian cancer risk.
"I think that the most important message women can take away from this work is that we are making progress in understanding ovarian cancer," Paul Pharoah, of Cancer Research UK Center for Genetic Epidemiology at Cambridge University, and senior author on two of the studies, said in the news release.....cont'd
Sunday, September 19, 2010
Terry Fox & the Terry Fox Foundation - the Marathon of Hope
Terry Fox & the Terry Fox Foundation
Terry Fox was born in Winnipeg, Manitoba, and raised in Port Coquitlam, British Columbia, a community near Vancouver on Canada's west coast. An active teenager involved in many sports, Terry was only 18 years old when he was diagnosed with osteogenic sarcoma (bone cancer) and forced to have his right leg amputated 15 centimetres (six inches) above the knee in 1977.While in hospital, Terry was so overcome by the suffering of other cancer patients, many of them young children, that he decided to run across Canada to raise money for cancer research.
He would call his journey the Marathon of Hope.
It was a journey that Canadians never forgot.
After 18 months and running over 5,000 kilometres (3,107 miles) to prepare, Terry started his run in St. John’s, Newfoundland on April 12, 1980 with little fanfare. Although it was difficult to garner attention in the beginning, enthusiasm soon grew, and the money collected along his route began to mount. He ran 42 kilometres (26 miles) a day through Canada's Atlantic provinces, Quebec and Ontario. However, on September 1st, after 143 days and 5,373 kilometres (3,339 miles), Terry was forced to stop running outside of Thunder Bay, Ontario because cancer had appeared in his lungs. An entire nation was stunned and saddened. Terry passed away on June 28, 1981 at the age 22.The heroic Canadian was gone, but his legacy was just beginning.
To date, close to $500 million has been raised worldwide for cancer research in Terry's name through the annual Terry Fox Run, held across Canada and around the world.
Saturday, September 18, 2010
AGENDA: Conference September 24th: Gynecologic Cancer Conference, Regina, Saskatchewan
registration:
September 24th, 2010 AGENDA
7:45 a.m. – 8:45 a.m.
Conference Registration & Continental Breakfast
Exhibit Hall Marketplace Open
Exhibit Hall Marketplace Open
9:00 a.m. – 9:15 a.m. Welcome!
Official opening of the first Saskatchewan Gynecologic Cancer Conference
Greetings from Co-Chair Scott Livingstone, Executive Director of the Saskatchewan Cancer Agency
9:15 a.m. – 10:00 a.m. Opening Keynote Speaker -
Rosalee Longmoore, President - Saskatchewan Union of Nurses
Nurses are integral health care providers for the gynecologic cancer patient and her family, every step of the way. Ms. Longmoore will describe the dedication of nurses to the advancement of patient care and how they can add to the patient and her family’s quality of life.
Official opening of the first Saskatchewan Gynecologic Cancer Conference
Greetings from Co-Chair Scott Livingstone, Executive Director of the Saskatchewan Cancer Agency
9:15 a.m. – 10:00 a.m. Opening Keynote Speaker -
Rosalee Longmoore, President - Saskatchewan Union of Nurses
Nurses are integral health care providers for the gynecologic cancer patient and her family, every step of the way. Ms. Longmoore will describe the dedication of nurses to the advancement of patient care and how they can add to the patient and her family’s quality of life.
10:00 a.m. – 10:30 a.m. Dr. Vicki Holmes
Women’s Mid-Life Health Centre of Saskatchewan
Women’s Mid-Life Health Centre of Saskatchewan
Dr. Vicki Holmes’ presentation will focus on
the role of the General Practitioner in encouraging women to report symptoms,
interpretation symptoms, the use of appropriate diagnostic tests and
examinations of women of all ages, proper referral to specialists and support
during and post treatment. Although the patient’s primary physician at
the hospital is likely to be her gynecologic oncologist, the family doctor
still plays a key role in the patient’s care and treatment for pre diagnosis to
post treatment. New thoughts and methodologies for medical care, testing,
diagnosis and treatment have required today’s doctors to be more involved and
aware of symptoms for young girls to senior citizens.
10:30 a.m - 11:00 a.m Nutritious Break
Exhibit Hall Marketplace Open
Exhibit Hall Marketplace Open
11:00 a.m. – 12:00 p.m Panel Presentations
Andrew Gilbertson, Pharmacist – Managing
Medication
The role of your pharmacist in family health and managing your medication.
The role of your pharmacist in family health and managing your medication.
Dr. Heather Fox – Complementary/Alternative
Therapies
Presenting non-traditional methods of diagnosing, preventing and treating cancer.
Presenting non-traditional methods of diagnosing, preventing and treating cancer.
Monica Milas – Support for the emotional side
effects of cancer and treatment
The side effects of gynecologic cancer and it's affect on survivors and their partners. Learning how to overcome these issues.
The side effects of gynecologic cancer and it's affect on survivors and their partners. Learning how to overcome these issues.
12:00 noon – 1:00 p.m.
Organic Lunch
Exhibit Hall Marketplace Open
1:00 p.m. – 2:00
p.m. Scott Livingstone,
Executive Director of the Saskatchewan Cancer Agency
Gyneocology Cancer Program in Saskatchewan
Executive Director of the Saskatchewan Cancer Agency
Gyneocology Cancer Program in Saskatchewan
2:00 p.m. – 3:00 p.m. Panel Presentation
Dr. Muhammad Salim – Clinical Trials
Dr. Salim is the head of clinical trials in Saskatchewan, and the only Canadian
doctor on a team at the Mayo clinic for clinical trials – Learn about the basics of
clinical trials and their importance.
Dr. Salim is the head of clinical trials in Saskatchewan, and the only Canadian
doctor on a team at the Mayo clinic for clinical trials – Learn about the basics of
clinical trials and their importance.
Dr. Christopher Giede - When cancer returns
Learn about the medical options available to survivors facing recurrence and review
ways you can work with your medical team to make well-informed decisions about
your treatment.
Learn about the medical options available to survivors facing recurrence and review
ways you can work with your medical team to make well-informed decisions about
your treatment.
Wendi Stoeber, RN, MA, CCGC - Genetic
Counsellor
Learn about ovarian cancer genetics and how to identify families who may be at
heredity risk for the disease. Review the benefits, the risks and limitations of
genetic testing for ovarian cancer.
Learn about ovarian cancer genetics and how to identify families who may be at
heredity risk for the disease. Review the benefits, the risks and limitations of
genetic testing for ovarian cancer.
3:00 p.m. to 3:15 p.m. Nutritious Break
Exhibit Hall Marketplace Open
3:15 p.m. to 4:15 p.m. Closing Speaker – Sandi
Pniauskas
Sandi Pniauskas is an ovarian cancer survivor and is considered one of the
strongest and most vocal advocates for ovarian cancer women and their families.
Sandi Pniauskas is an ovarian cancer survivor and is considered one of the
strongest and most vocal advocates for ovarian cancer women and their families.
4:15 p.m. to 4:30 p.m.
Closing Remarks, Co-Chair Darlene Gray
Benefit Gala & Silent Auction
6:00
p.m. Cocktails & Silent Auction opens
7:00
p.m. Dinner is Served
8:00
p.m. Presentations & Dessert
8:30
p.m. An Intimate Evening with Jack Semple
media: Health care needs a cure - universal healthcare (foundation of a just society)
Universal health care in Canada is regarded as the foundation of a just society. It is so sacrosanct that schemes such as a private parallel system and user fees are considered taboo.
media (U.S.) Report Shows Significant Growth In Number Of Osteopathic Physicians
"As concerns mount over whether there will be enough physicians to meet the nation's growing demand for health care, the number of osteopathic physicians (DOs) is reaching new heights, according to a report released today from the American Osteopathic Association.
DOs are one of only two groups of physicians in the U.S.-- MDs and DOs -- who are licensed to prescribe medication and practice in all medical specialty areas, including surgery....."
The rate of the predominant Jewish mutations in the BRCA1, BRCA2, MSH2 and MSH6 genes in unselected Jewish endometrial cancer patients (study number 289 patients)
Note: MSH2/MSH6 are 2 of the Lynch Syndrome genes
Objectives
The genes associated with familial Endometrial Cancer (EC) are largely unknown. While EC is an integral part of Hereditary Non-Polyposis Colon Cancer, there is an ongoing debate if EC is indeed overrepresented in hereditary breast/ovarian cancer families.Conclusions
Our data do not support screening for BRCA1/2 mutations in consecutive EC patients.abstract: Correlates of the preoperative level of CA125 at presentation of ovarian cancer
Objective
CA125 at presentation of ovarian cancer carries important prognostic significance; but, other than tumor characteristics, little is known about factors that influence CA125 levels. We examined the effect of epidemiologic variables and tumor features on CA125 at diagnosis and their effects on survival.Methods
CA125 levels before treatment, tumor features, and questionnaire data from 805 women with ovarian cancer receiving care at Partners Hospitals were recorded. CA125 values were log-normalized and generalized linear, logistic, or Cox proportional hazards models used to identify predictors of CA125 and influence on survival in the subset of women with invasive, nonmucinous tumors.Results
The importance of histology, grade, stage, laterality, and presence of ascites on CA125 level was confirmed. For nonmucinous invasive cancers, Jewish ethnicity, parity, prior breast cancer, and family history of breast or ovarian cancer predicted higher CA125, and greater body mass index (BMI), recurrent yeast infections, colitis, and appendectomy predicted lower CA125. A quadratic model best described the relationship between CA125 and age with lower levels in youngest and oldest women. In multivariate modeling, stage, ascites, and prior breast cancer were the strongest predictors of high CA125 and appendectomy and yeast infections strongest predictors of low CA125. A model with these variables plus CA125 revealed high CA125 remains a predictor of poorer survival.Conclusions
Ovarian tumor features and presence of ascites are key determinants of CA125 at diagnosis, but epidemiologic features such as BMI, parity, prior breast cancer, and history of inflammatory conditions of the genitourinary or gastrointestinal tracts may also play a role.Randomized phase III trial of tamoxifen versus thalidomide in women with biochemical-recurrent-only epithelial ovarian, fallopian tube or primary peritoneal carcinoma after a complete response to first-line platinum/taxane chemotherapy with an evaluation of serum vascular endothelial growth factor
Antigen-specific active immunotherapy for ovarian cancer
" " Information on adverse events was frequently limited."
PLAIN LANGUAGE SUMMARY:
Epithelial ovarian cancer is the most frequently diagnosed ovarian malignancy and the leading cause of death from gynaecological cancers. Standard therapy consists of surgery followed by chemotherapy. Although initial response rates are high, the majority of patients with advanced disease relapse. No curative treatment is available for recurrent disease. The observation that the presence of certain immune cells in tumours is associated with improved survival, suggests that stimulation of anti-tumour immune responses, i.e. immunotherapy, might be a useful approach to improve prognosis of ovarian cancer. In this review, the feasibility of antigen-specific active immunotherapy is evaluated. Antigen-specific active immunotherapy aims at the induction of tumour-directed immune responses through the administration of a tumour-antigen, a molecule that is preferentially expressed by tumour cells and can induce immune responses. As immunotherapy is a novel (new) treatment strategy early phase studies were also included. Information on clinical and immunological responses, and adverse events was collected.
Thirty-six studies, which included 1780 ovarian cancer patients, were identified between 1966 and 2009. The most frequently described strategy (1505 patients in 15 studies) was administration of antibodies targeting CA-125. Most of these primarily evaluated safety and immunological responses. Five studies described severe flu-like and gastro-intestinal symptoms in 7 to 30% of patients. Antibodies and immune cells recognising CA-125 were frequently detected, albeit response rates varied between studies. Despite promising immunological responses, three large studies found equal survival rates for patients treated with placebo or CA-125 directed antibody. Because there is currently no high quality evidence of clinical benefit, antibody therapy targeting CA-125 should in its current form not be incorporated in standard treatment.
For strategies not relying on antibody administration, similar conclusions cannot be drawn as these have not yet been tested in large trials to evaluate clinical efficacy of treatment. These were generally small studies primarily investigating vaccine safety and immunogenicity. Overall, treatment was well-tolerated, with inflammatory side effects at injection site most frequently reported. Antibodies and immune cells were induced by most strategies studied, but their clinically efficacy still has to be evaluated in large trials.
Based on a lack of uniformity in included studies, we strongly advocate universal adoption of response definitions, guidelines for adverse events reporting, and directives for trial conduct and reporting. Furthermore, results from ongoing RCTs should be awaited and furhter RCTs should be conducted.
ABSTRACT:
Objectives
To assess feasibility of antigen-specific active immunotherapy for ovarian cancer. Primary outcomes are clinical efficacy
and antigen-specific immunogenicity with carrier-specific immunogenicity and side-effects as secondary outcomes.Cochrane Collaboration Ovarian Cancer reviews recently published 2010 (by title)
recent Cochrane Reviews: Ovary:
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