Thursday, July 12, 2012
Wednesday, July 11, 2012
Cisplatin plus paclitaxel and maintenance of (Avastin) bevacizumab on tumour progression, dissemination, and survival of ovarian carcinoma xenograft models
Cisplatin plus paclitaxel and maintenance of bevacizumab on tumour progression, dissemination, and survival of ovarian carcinoma xenograft models:
July 2012 doi:10.1038/bjc.2012.261
Background:
Bevacizumab is being
incorporated as first-line therapy with standard-of-care chemotherapy on
epithelial ovarian carcinoma (EOC). We investigated bevacizumab
combined with chemotherapy on tumour progression and mouse survival in
EOC xenograft models.
Methods:
Bevacizumab was administered concomitantly with cisplatin plus paclitaxel (DDP+PTX),
continued after induction (maintenance) or started after chemotherapy.
The effect on tumour progression was monitored by bioluminescence
imaging (BLI) (1A9-luc xenograft). Tumour dissemination into the
peritoneal organs and ascites formation (HOC22 xenograft) was evaluated
by histological analysis at the end of treatment (interim) and at
euthanasia (survival). The effects on overall survival (OS) were
investigated in both EOC models.
Results:
Bevacizumab with PTX+DDP
delayed tumour progression in mice bearing EOC xenografts. OS was
significantly extended, with complete responses, by bevacizumab
continued after stopping chemotherapy in the HOC22 xenograft.
Bevacizumab alone inhibited ascites formation, with only limited effect
on tumour burden, but combined with PTX+DDP reduced ascites and metastases. Bevacizumab started after induction with PTX+DDP and maintained was equally effective on tumour progression and survival on 1A9-luc xenograft.
Conclusion:
Bevacizumab
combined with chemotherapy not only affected tumour progression, but
when administered as maintenance regimen significantly prolonged
survival, reducing ascites, and tumour dissemination. We believe our
findings are consistent with the clinical results and shed light on the
potential effects of this kind of treatment on tumour progression.
paywalled: Preferences for outcomes associated with decisions to undergo or forego genetic testing for Lynch syndrome
Preferences for outcomes associated with decisions to undergo or forego genetic testing for Lynch syndrome
Abstract
BACKGROUND:
Current
guidelines recommend offering genetic testing for Lynch syndrome to
individuals whose tumors suggest this condition and to relatives of
affected individuals. Little is known, however, regarding how patients
view the prospect of such testing. In addition, data on preferences
(utilities) for the potential outcomes of testing decisions for use in
cost-effectiveness analyses are lacking.
METHODS:
Time
tradeoff utilities were elicited for 10 potential outcomes of Lynch
syndrome testing decisions and 3 associated cancers from 70
participants, representing a range of knowledge about and experiences
with Lynch syndrome.
RESULTS:
Highest
mean utilities were assigned to scenarios in which only the assessor's
sibling had Lynch-associated colorectal cancer (ranging from 0.669 ±
0.231 to 0.760 ± 0.220). Utilities assigned to scenarios in which the
assessor had Lynch-associated colorectal cancer ranged from 0.605 ±
0.252 to 0.682 ± 0.246, whereas the lowest mean utilities were assigned
to 2 of the general cancer states (0.601 ± 0.238 and 0.593 ± 0.272 for
colorectal and ovarian cancer respectively). Only 43% of the sample
assigned higher values to undergoing Lynch testing and receiving
negative results versus foregoing Lynch testing, whereas 50% assigned
higher values to undergoing rather than foregoing surgery to prevent a
subsequent cancer.
CONCLUSIONS:
Genetic
testing for Lynch syndrome, regardless of results, can have profound
effects on quality of life; the utilities we collected can be used to
incorporate these effects into cost-effectiveness analyses. Importantly,
preferences for the potential outcomes of testing vary substantially,
calling into question the extent to which patients would avail
themselves of such testing if it were offered to them. Cancer 2012. ©
2012 American Cancer Society
Podcast/RSS video: Lynch Syndrome Educational Support Workshop | Memorial Sloan-Kettering Cancer Center (68 min.)
Podcast/RSS video: Lynch Syndrome Educational Support Workshop | Memorial Sloan-Kettering Cancer Center
Runtime
68:00
Medical experts from Memorial Sloan-Kettering discuss Lynch syndrome, a genetic disorder that can cause colon and other cancers.
Tuesday, July 10, 2012
paywalled: Gynecologic Oncology Impact of Complete Cytoreduction Leaving No Gross Residual Disease Associated with Radical Cytoreductive Surgical Procedures on Survival in Advanced Ovarian Cancer
Impact of Complete Cytoreduction Leaving No Gross Residual Disease Associated with Radical Cytoreductive Surgical Procedures on Survival in Advanced Ovarian Cancer
Abstract
Background
To
analyze the impact of radical cytoreductive surgery—as part of primary
tumor debulking—on the amount of residual tumor
and survival in patients with advanced ovarian cancer
and to evaluate the prognostic significance of no gross residual disease
(RD) after surgery.
Methods
Medical
records of 203 patients with International Federation of Gynecology and
Obstetrics (FIGO) stage IIIC–IV ovarian cancer
were reviewed. All patients underwent primary
cytoreductive surgery followed by taxane- and platinum-based
chemotherapy. Various
clinicopathologic characteristics were collected.
Results
Of 203 patients, 119 patients underwent simple surgery, while radical surgery was performed in 84 patients..........
Conclusions
No gross RD is associated with improved overall survival, and radical surgery was effective for achieving no gross RD.
Monday, July 09, 2012
Medscape: Hormone Therapy and Different Ovarian Cancers
Hormone Therapy and Different Ovarian Cancers (mobile format): Abstract and Introduction
Sent using the Medscape App for iPhone®
Sunday, July 08, 2012
10 years after hormone therapy study: What doctors know now – USATODAY.com
10 years after hormone therapy study: What doctors know now – USATODAY.com
"It's been 10 years since researchers of the Women's Health Initiative, a large randomized, controlled trial on hormone therapy sponsored by the National Institutes of Health, announced their first findings: that the health risks outweighed the benefits of estrogen plus progestin hormone therapy (HT) in postmenopausal women. Since then, additional research has advanced the understanding of the benefits and risks. JoAnn Manson, one of the study's lead investigators and a professor of medicine at Harvard Medical School, is the president of the North American Menopause Society. She spoke with USA TODAY's Janice Lloyd about what women need to know to get through the challenging time and to protect their health......
Mismatch Repair Protein Deficiency - sebaceous carcinoma
Mismatch Repair Protein Deficiency is Common in Sebaceous Neoplasms and Suggests the Importance of Screening for Lynch Syndrome.
Ovarian metastases resection from extra - PubMed Mobile
http://www.ncbi.nlm.nih.gov/m/pubmed/22759383/?i=4&from=ovarian%20cancer&filter=loattrfree%20full%20text
"CONCLUSION: Ovarian metastases are more commonly seen to originate from primary gastrointestinal tract. The prognosis of ovarian metastasis is dismal and the benefit of ovarian metastatectomy is limited. Those with combined metastasis outside ovaries, locally invasion and massive intraoperative ascites were independent factors for predicting unfavorable overall survival. The identification of the primary tumor is required to plan for adequate treatment for this group of patients."
Sent from my iPhone
paywalled: Dairy foods and nutrients in relation to risk of ovarian cancer and major histological subtypes - Merritt - International Journal of Cancer - Wiley Online Library
Dairy foods and nutrients in relation to risk of ovarian cancer and major histological subtypes
Abstract
Inconsistent results for the role of dairy food intake in relation to ovarian cancer risk may reflect the potential adverse effects of lactose, which has been hypothesized to increase gonadotropin levels, and the beneficial anti-proliferative effects of calcium and vitamin D. Using data from the New England case-control study (1909 cases; 1989 controls) we examined dairy foods and nutrients in relation to risk of ovarian cancer overall, histological subtypes, and rapidly fatal versus less aggressive disease. We used logistic regression and polytomous logistic regression to estimate odds ratios and 95% confidence intervals. In models that were simultaneously adjusted for total (dietary plus supplements) calcium, total vitamin D and lactose, we observed a decreased overall risk of ovarian cancer with high intake of total calcium (Quartile 4 (Q4, >1319 mg/day) vs. Quartile 1 (Q1, <655 mg/day), odds ratio (OR)=0.62, 95% Confidence Interval (CI)=0.49 - 0.79); the inverse association was strongest for serous borderline and mucinous tumors. High intake of total vitamin D was not associated overall with ovarian cancer risk, but was inversely associated with risk of serous borderline (Q4, >559 IU/day vs. Q1, <164 IU/day, OR=0.51, 95% CI=0.34-0.76) and endometrioid tumors (Q4 vs. Q1, OR=0.55, 95% CI=0.39-0.80). We found no evidence that lactose intake influenced ovarian cancer risk, or that risk varied by tumor aggressiveness in the analyses of intake of dairy foods and nutrients. The overall inverse association with high intake of calcium, and the inverse associations of calcium and vitamin D with specific histological subtypes warrant further investigation.paywalled: Phenotype and Polyp Landscape in Serrated Polyposis Syndrome: A Series of 100 Patients From Genetics Clinics (Lynch Syndrome...)
define: hyperplastic
What is a hyperplastic colon polyp?
hyperplastic colon polyps~~~~~~~~~~~~~~~~~~~~~~~~~~
Phenotype and Polyp Landscape in Serrated Polyposis Syndrome: A Series of 100 Patients From Genetics Clinics
Abstract
Serrated polyposis syndrome (SPS), also known as
hyperplastic polyposis, is a syndrome of unknown genetic basis defined
by the occurrence of multiple serrated polyps in the large intestine and
associated with an increased risk of colorectal cancer (CRC). There are
a variety of SPS presentations, which may encompass a continuum of
phenotypes modified by environmental and genetic factors. To explore the
phenotype of SPS, we recorded the histologic and molecular
characteristics of multiple colorectal polyps in patients with SPS
recruited between 2000 and 2010 from genetics clinics in Australia, New
Zealand, Canada, and the United States. Three specialist
gastrointestinal pathologists reviewed the polyps, which they classified
into conventional adenomas or serrated polyps, with various subtypes,
according to the current World Health Organization criteria. Mutations
in BRAF and KRAS and mismatch repair protein
expression were determined in a subset of polyps. A total of 100
patients were selected for the study, of whom 58 were female and 42 were
male. The total polyp count per patient ranged from 6 to 150 (median
30). The vast majority of patients (89%) had polyposis affecting the
entire large intestine. From this cohort, 406 polyps were reviewed. Most
of the polyps (83%) were serrated polyps: microvesicular hyperplastic
polyps (HP) (n=156), goblet cell HP (n=25), sessile serrated
adenoma/polyps (SSA/P) (n=110), SSA/P with cytologic dysplasia (n=28),
and traditional serrated adenomas (n=18). A further 69 polyps were
conventional adenomas. BRAF mutation was mainly detected in
SSA/P with dysplasia (95%), SSA/P (85%), microvesicular HP (76%), and
traditional serrated adenoma (54%), whereas KRAS mutation was
present mainly in goblet cell HP (50%) and in tubulovillous adenoma
(45%). Four of 6 SSA/Ps with high-grade dysplasia showed loss of
MLH1/PMS2 expression. CRC was diagnosed in 39 patients who were more
often found to have a conventional adenoma compared with patients
without CRC (P=0.003). Patients with SPS referred to genetics clinics had a pancolonic disease with a high polyp burden and a high rate of BRAF mutation. The occurrence of CRC was associated with the presence of conventional adenoma.
Saturday, July 07, 2012
paywalled- Comparison of weekly versus every 3 weeks paclitaxel in the treatment of advanced solid tumors: A meta-analysis
Comparison of weekly versus every 3 weeks paclitaxel in the treatment of advanced solid tumors: A meta-analysis
Abstract
Background
Paclitaxel
is commonly given as a 3-h infusion every 3 weeks for a variety of
malignancies. Several randomized clinical trials comparing weekly
paclitaxel with Q3-week (Q3W) have produced mixed results in terms of
efficacy and toxicity creating controversy about the ideal dose and
schedule.
Methods
A literature search using PubMed, Cochrane Library, and Proceedings of the American Society of Clinical oncology
from 1995 to 2011 was performed..........Moderators of cancer types, ethnicity, and paclitaxel dose ratio were
analyzed for primary dependent variables.
Results
Ten trials were included....
Conclusion
Weekly paclitaxel has a favorable toxicity profile compared to the current standard of Q3W paclitaxel.
Dietary Acrylamide Intake and the Risk of Lymphatic Malignancies: The Netherlands Cohort Study on Diet and Cancer
Dietary Acrylamide Intake and the Risk of Lymphatic Malignancies: The Netherlands Cohort Study on Diet and Cancer
"..Recent analyses within the NLCS, the Nurses’ Health Study, and a Danish cohort study [11], [12], [13], [14] showed a positive association for endometrial, ovarian, and estrogen receptor-positive breast cancer, suggesting that disturbance of sex hormonal balances may be a mechanism of acrylamide carcinogenesis, which can also be suggested based on the rat carcinogenicity assays [7], [8]. Although it cannot be concluded from the present study, hormonal imbalances might be a mechanism of acrylamide carcinogenesis for lymphatic malignancies as well....
Occupational cancer in Britain - ovarian, breast and cervical
Occupational cancer in Britain
"The
following paper reviews the three cancers in women: breast, cervical
and ovarian. There is no overlap between the cancers and exposure
circumstances, and thus all are considered and described separately.
Data for male breast cancer are much more limited and will not be
considered here."
Wednesday, June 20, 2012
paywalled: Nanocarrier systems for delivery of siRNA to ovarian cancer tissues, Expert Opinion on Drug Delivery
Nanocarrier systems for delivery of siRNA to ovarian cancer tissues, Expert Opinion on Drug Delivery
Expert opinion:
Gene silencing therapy based on siRNA represents a possible opportunity
for treatment of ovarian cancer patients. However, this approach
requires selection of suitable nanocarriers that can safely and
effectively deliver siRNA to the target site to induce its effect. Very
little work has been done in this field; therefore, it is a good
direction for future development.
paywalled: Cochrane Review - Removal of nail polish and finger rings to prevent surgical infection.
Cochrane Database Syst Rev. 2012 May 16;5:CD003325.
Removal of nail polish and finger rings to prevent surgical infection.
Abstract
BACKGROUND:
Surgical wound infections may be caused by the transfer of bacteria from the hands of surgical teams to patients during operations. Surgical scrubbing prior to surgery reduces the number of bacteria on the skin, but wearing rings and nail polish on the fingers may reduce the efficacy of scrubbing, as bacteria may remain in microscopic imperfections of nail polish and on the skin beneath rings.OBJECTIVES:
To assess the effect of the presence or absence of rings and nail polish on the hands of the surgical scrub team on postoperative wound infection rates.MAIN RESULTS:
We identified: no new trials; no RCTs that compared wearing of rings with the removal of rings; and no trials of nail polish versus no nail polish that measured surgical infection rates. We found one small RCT (102 scrub nurses) that evaluated the effect of nail polish on the number of bacterial colony forming units left on hands after pre-operative surgical scrubbing. Nurses had either unpolished nails, freshly-applied nail polish (less than two days old), or old nail polish (more than four days old). There were no significant differences in the number of bacteria on hands between the groups before and after surgical scrubbing.AUTHORS' CONCLUSIONS:
No trials have investigated whether wearing nail polish or finger rings affects the rate of surgical wound infection. There is insufficient evidence to determine whether wearing nail polish affects the number of bacteria on the skin post-scrub.Characteristics and Outcomes of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Patients with Cancer Treated with Vancomycin: 9-Year Experience at a Comprehensive Cancer Center - The Oncologist
Abstract
Abstract Background. Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) can cause significant morbidity and mortality in patients with cancer. However, data
on outcomes of patients treated with vancomycin are lacking.
Methods. We identified
223 patients with cancer who developed MRSA BSIs between January 2001
and June 2009 and were treated with vancomycin.
Treatment failure was defined as death within 60
days of infection, persistent bacteremia ≥5 days, fever ≥4 days,
recurrence
or relapse, and secondary MRSA infection.
Results. The treatment
failure rate was 52% (116 of 223 patients). These patients were more
likely to have been hospitalized, been
treated with steroids within the previous 3
months, developed acute respiratory distress syndrome, required
mechanical ventilation,
required intensive care unit care, and
community-onset infections (all p < .05). Risk factors for
MRSA-associated mortality (27 of 223 patients; 12%) included hematologic
malignancy and hematopoietic
stem cell transplantation, community-onset
infection, secondary BSI, MRSA with minimum inhibitory concentration
(MIC) ≥2.0
μg/mL, mechanical ventilation, and a late switch
to an alternative therapy (≥4 days after treatment failure; all p
< .05). On multivariate analysis, mechanical ventilation and recent
hospitalization were identified as independent predictors
of vancomycin failure, and community-onset
infection, secondary BSIs, and MIC ≥2 μg/mL were identified as
significant predictors
of MRSA-associated mortality.
Conclusions. We found a
high treatment failure rate for vancomycin in patients with cancer and
MRSA BSIs, as well as a higher mortality.
A vancomycin MIC ≥2 μg/mL was an independent
predictor of MRSA-associated mortality. An early switch to an
alternative therapy
at the earliest sign of failure may improve
outcome.
paywalled: Causes of death of mutation carriers in Finnish Lynch syndrome families.
Fam Cancer. 2012 Jun 9. [Epub ahead of print]
Abstract
Lynch syndrome (LS) is an autosomal dominant cancer syndrome including increased life-long risk for colorectal (CRC) and endometrial (EC) cancer, but also for cancers of other types. The risk for CRC is up to 70-80 % and for EC up to 50-60 %. Due to screening and early diagnosing the mortality related to CRC and EC seems to be low. In spite of many studies on surveillance of mutation carriers, there is no comprehensive evaluation on causes of death in LS families. The disease history and cause of death of all the deceased, tested mutation carriers and their mutation negative relatives in the Finnish LS families (N = 179) was examined utilizing hospital records and relevant national registries. Out of 1069 mutation carriers 151 had succumbed; 97 (64 %) from cancer. Out of 1146 mutation-negative family 44 members had died; 11 (25 %) of them from cancer. In 12 (7.7 %) of the deceased mutation carriers no cancer had been diagnosed. The mean age of death from cancer was 63.2 years vs. 68.8 years from non-cancer causes. Only 7.9 % of the patients with CRC had died from CRC and 5 % of those with EC, respectively. 61 % of the cancer deaths were related to extra-colonic, extra-endometrial cancers. The cumulative overall and cancer specific death rates were significantly increased in Mut+ compared to Mut- family members. Even surveillance yields decrease in the life-long risk and mortality of the most common cancers CRC and EC in LS, almost all mutation carriers will contract with cancer, and two thirds of the deceased have died from cancer. This should be taken in account in genetic counseling. Mutation carriers should be encouraged to seek help for abnormal symptoms.Monday, June 18, 2012
paywalled - Survival of ovarian cancer patients in Germany in the early 21st century: a period analysis by age, histology, laterality, and stage
European Journal of Cancer Prevention:
Abstract
Population-based studies on ovarian cancer providing
survival estimates by age, histology, laterality, and stage have been
sparse. We aimed to derive the most up-to-date and detailed survival
estimates for ovarian cancer patients in Germany. We used a pooled
German national dataset including data from 11 cancer registries
covering 33 million populations. A total of 21 651 patients diagnosed
with ovarian cancer in 1997-2006 were included. Period analysis was
carried out to calculate the 5-year relative survival (RS) for the years
2002-2006. Trends in survival between 2002 and 2006 were examined using
model-based period analysis. Age adjustment was performed using five
age groups (15-44, 45-54, 55-64, 65-74, and 75+ years). Overall, the
age-adjusted 5-year RS in 2002-2006 was 41%. A strong age gradient was
observed, with a decrease in the 5-year RS from 67% in the age group
15-49 years to 28% in the age group 70+ years. Furthermore, the
prognosis varied markedly by histology, laterality, and stage, with the
age-adjusted 5-year RS ranging from 25% (for carcinoma not otherwise
specified) to 81% (for stromal cell carcinoma), reaching 46% for
unilateral and 32% for bilateral carcinoma and reaching 82% for
Federation of Gynecology and Obstetrics (FIGO) stages I and II, 36% for
FIGO stage III, and 18% for FIGO stage IV. No improvement in survival
could be observed for any of the subgroups in the period between 2002
and 2006. Our analyses suggest that an improvement in the 5-year RS for
ovarian cancer may have stagnated in the early 21st century and
underline the need for a more effective translation of therapeutic
innovation into clinical practice.
CDC- Cancer Survivorship Twitter Chat Tuesday, June 19th 2-3 pm EDT
Join Us! Cancer Survivorship Twitter Chat Tomorrow
Centers for Disease Control and Prevention (CDC)
CDC's Division of Cancer Prevention and
Control (DCPC) will host a Twitter chat about cancer survivorship on
Tuesday, June 19 from 2:00 to 3:00 pm EDT.
Subject matter experts Blythe Ryerson and Dr. Elizabeth Rohan will answer questions. Visit DCPC's Twitter account at twitter.com/CDC_Cancer. You can follow the chat using the hashtag #CDCCancerChat, and you can send questions for the chat using that hashtag now.
Division of Cancer Prevention and Control
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Subject matter experts Blythe Ryerson and Dr. Elizabeth Rohan will answer questions. Visit DCPC's Twitter account at twitter.com/CDC_Cancer. You can follow the chat using the hashtag #CDCCancerChat, and you can send questions for the chat using that hashtag now.
Division of Cancer Prevention and Control
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Imperfect measure of hospital safety - CIHI
Imperfect measure of hospital safety
Imperfect measure of hospital safety
The failure to include hospital-acquired infections or medication errors as a performance indicator limits the utility of
the Canadian Institute for Health Information’s (CIHI) new hospital benchmarking tool, critics say....
Predisposed to risk but not change CMAJ (genetic testing series)
......Of course, considering that the predictive power of genetic
testing tends to be underwhelming, perhaps it’s no surprise that
personalized genetic information induces more shoulder
shrugs than lifestyle changes. “One of the challenges is that people
are behaving rationally, to a degree, when they don’t
change their behaviours. These genetic tests aren’t very predictive,”
says Timothy Caulfield, a Canada Research Chair in
Health Law and Technology who teaches in the law faculty and school of
public health at the University of Alberta. “If you
find you have a health risk of 2% instead of 1%, that type of risk is
lost in the noise of risk in your life.”
Editor’s note: Sixth of a multipart series on genetic testing.
Part 1: Separating hype from reality in the era of the affordable genome (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4143).
Part 2: Popping the genetics bubble (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4142).
Part 3: Who should hold the keys to your DNA? (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4141).
Part 4: A race-based detour to personalized medicine (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4133).
Part 5: Race and genetics in the doctor’s office (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4134).
Substantially Modified Ratios of Effector to Regulatory T Cells During Chemotherapy in Ovarian Cancer Patients Return to Pre-Treatment Levels at Completion: Implications for Immunotherapy
Published: 18 June 2012
(This article belongs to the Special Issue Cancer Vaccines and Immunotherapy)
Abstract:
Ovarian
cancer is the leading cause of death from gynaecological malignancy.
Despite improved detection and treatment options, relapse rates remain
high. Combining immunotherapy with the current standard treatments may
provide an improved prognosis, however, little is known about how
standard chemotherapy affects immune potential (particularly T cells)
over time, and hence, when to optimally combine it with immunotherapy
(e.g., vaccines). Herein, we assess the frequency and ratio of CD8+
central memory and effector T cells as well as CD4+ effector and
regulatory T cells (Tregs) during the first 18 weeks of standard
chemotherapy for ovarian cancer patients. In this pilot study, we
observed increased levels of recently activated Tregs with tumor
migrating ability (CD4+CD25hiFoxp3+CD127−CCR4+CD38+ cells) in
patients when compared to controls. Although frequency changes of Tregs
as well as the ratio of effector T cells to Tregs were observed during
treatment, the Tregs consistently returned to pre-chemotherapy levels at
the end of treatment.
Tuesday, May 29, 2012
SUSTAINING ACTION TOWARD A SHARED VISION - 2012–2017 Strategic Plan - Partnership Against Cancer Canada (does not include ovarian/gyn)
Blogger's Note: search of 'ovarian'/'ovary'/'gyn' yields null results
SUSTAINING ACTION TOWARD A SHARED VISION - 2012–2017 Strategic Plan - Canada
CONTENTS
2 MESSAGE FROM THE CHAIR AND CEO
4 EXECUTIVE SUMMARY
1. 2012–2017 Strategic Plan
10 THE GROWING CHALLENGE OF CANCER
16 ADVANCING A SHARED VISION
34 2012–2017 STRATEGIC FRAMEWORK
38 STRATEGIC PRIORITIES
52 CORE ENABLING FUNCTIONS
2. 2012–2017 Business Plan
64 PLANNING FOR RESULTS
70 STRATEGIC PRIORITIES
103 CORE ENABLING FUNCTIONS
3. Moving Forward Together
122 TRANSFORMING CANCER CONTROL
Ovarian Cancer and Us - blogger's note
short sabbatical - blog postings to return in ~ one week - thanks!
Journal of Experimental & Clinical Cancer Research |- Chemotherapy and skin reactions
Journal of Experimental & Clinical Cancer Research Chemotherapy and skin reactions
Research
Chemotherapy and skin reactions
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
Journal of Experimental & Clinical Cancer Research 2012
Published: 28 May 2012Abstract (provisional)
Background
New chemotherapic agents and new protocols in oncology have led to an increasing survival
rate in patients affected by tumors. However, this increased use has been accompanied
by a growth in the incidence of cutaneous side effects and a worsening of patients'
quality of life. Appropriate management of skin toxicity associated with chemotherapic
agents is therefore necessary for suitable drug administration and to improve quality
of life and clinical outcomes.
Methods
We have clinically examined 100 patients affected by cancer, determining type, frequency,
treatment, and evolution of side effects related to chemotherapy.
Results
The prevalent cutaneous side effects in patients undergoing chemotherapy are skin
rash, xerosis, pruritus, paronychia, hair abnormality, and mucositis. The clinical
cases are reported in detail.
Conclusion
Oncological therapies have become more selective and have low systemic toxicity because
of their high specificity, but cutaneous side effects are common and may worsen the
quality of life of these patients.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
paywalled: Long-term survival in patients with clear cell adenocarcinoma of ovary treated with irinotecan hydrochloride plus cisplatin therapy as first-line
Long-term survival in patients with clear cell adenocarcinoma of ovary treated with irinotecan hydrochloride plus cisplatin therapy as first-line chemotherapy
Article first published online: 28 MAY 2012
DOI: 10.1111/j.1447-0756.2012.01884.x
© 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology
Issue
Journal of Obstetrics and Gynaecology Research
Abstract
Aim:
Several previous reports showed that irinotecan hydrochloride plus
cisplatin (CPT-P) was a candidate first-line chemotherapy regimen for
clear cell adenocarcinoma of the ovary (CCC). However, long-term
survival in CCC patients treated with CPT-P as first-line chemotherapy
remains to be determined. The aim of the present study was to evaluate
the long-term results of CPT-P as first-line chemotherapy for CCC.
Material and Methods: We performed a retrospective review of 31 patients with CCC who were treated with CPT-P between 1996 and 2004.
Results:
The median follow-up period was 91 months.........
Conclusion:
The long-term results suggest CPT-P as a candidate in first-line
chemotherapy for CCC in not only stage I, but also in optimally debulked
stage II-IV patients with pT1/pT2 disease.
HRT Risk Holds Steady Based on Updated Review - in OB/Gyn, HRT from MedPage Today
HRT Risk Holds Steady Based on Updated Review - in OB/Gyn, HRT from MedPage Today
Action Points
- A systematic review of papers published since 2002 (post-WHI study) found that the risks of hormone replacement therapy still outweighed any benefits in primary prevention of chronic conditions.
- Point out that both estrogen plus progestin and estrogen alone prevented fractures, but increased the risk of stroke, thromboembolic events, gallbladder disease, and urinary incontinence.
Earlier detection of bone loss may be in future
Earlier detection of bone loss may be in future
“Right now, pain is usually the first indication that cancer is affecting bones. If we could detect it earlier by an analysis of urine or blood in high-risk patients, it could significantly improve their care,” Fonseca said.
Monday, May 28, 2012
Bill C-38 protest has 13,000 websites going dark across Canada this June | Canada Politics - media (c-38 bill/Canadian healthcare)
Bill C-38 protest has 13,000 websites going dark across Canada this June | Canada Politics
"When it comes to politics, Canadians are generally an
apathetic bunch. Often, a controversy will brew and within a week or two
we forget about it and move on.
It appears Bill C-38 is one issue we're not willing to let go....Jobs, Growth and Long-term Prosperity Act
An Act to implement certain provisions of the budget tabled in Parliament on March 29, 2012 and other measures
C-38: What it means for health care (media)
IL-13 regulates cancer invasion and metastasis through IL-13Rα2 via ERK/AP-1 pathway in mouse model of human ovarian cancer.
IL-13 regulates cancer invasion and metastasis through IL-13Rα2 via ERK/AP-1 pathway in mouse model of human ovarian cancer
"Taken together, IL-13Rα2 is involved in cancer metastasis through activation of ERK/AP-1 and that targeting IL-13Rα2 might not only directly kill primary tumors but also prevent cancer metastasis."
Neurocognitive function impairment after whole brain radiotherapy for brain metastases: actual assessment
Neurocognitive function impairment after wholebrain radiotherapy for brain metastases: actual assessment
Conclusion
......The results of this review will enable physicians to inform
patients about benefits and risks of these two treatment options.
paywalled: Bevacizumab-induced perforation of the gastrointestinal tract: clinical and radiographic findings in 11 patients
Bevacizumab-induced perforation of the gastrointestinal tract: clinical and radiographic findings in 11 patients:
Abstract
Methods
A computerized search identified 11 patients with GI complications of bevacizumab therapy on abdominal CT (n = 11) and fluoroscopic
GI contrast studies (n = 4) who met our study criteria (including five patients with ovarian cancer, five with colon cancer,
and one with cervical cancer). The medical records and imaging studies were reviewed to determine the clinical and radiographic
findings in these patients.
Results
All 11 patients had findings of GI perforation on CT, or CT and GI contrast studies. CT revealed a localized extraluminal
collection containing gas, fluid, and/or contrast material in eight patients (73%) with focal perforation, and free abdominal
air and fluid in three (27%) with free perforation The imaging studies also revealed seven fistulas, including two colovaginal,
one rectovaginal, one enterocutaneous, one colocutaneous, one gastrocolic, and one colorectal fistula. Eight (73%) of the
11 patients died within 1 year of the development of GI perforation, and the perforation was felt to be the cause of death
in four patients (36%).
Conclusion
Abdominal CT and fluoroscopic GI contrast studies are useful imaging tests for the diagnosis of potentially life-threatening
GI perforation as a complication of bevacizumab therapy. When GI perforation is detected on abdominal imaging studies, treatment
with bevacizumab should immediately be discontinued.
Complete clinical responses to cancer therapy caused by multiple divergent approaches: a repeating theme lost in translation
Complete clinical responses to cancer therapy caused by multiple diver
Complete clinical responses to cancer therapy caused by multiple divergent approaches: a repeating theme lost in translation (click on 'pdf' for full paper; references to ovarian cancer; hormonal therapy; angiogenesis...)
Abstract:
Over 50 years of cancer therapy history reveals complete clinical responses (CRs) from remarkably divergent forms of therapies (eg, chemotherapy, radiotherapy, surgery, vaccines, autologous cell transfers, cytokines, monoclonal antibodies) for advanced solid malignancies occur with an approximately similar frequency of 5%–10%. This has remained frustratingly almost static.
However, CRs usually underpin strong durable 5-year patient survival. How can this apparent paradox be explained?
Sunday, May 27, 2012
Does HE4 have a role in the recurrence of ovarian cancer? | 2012 ASCO Annual Meeting Abstracts (+ links to related ovarian abstracts)
Does HE4 have a role in the recurrence of ovarian cancer? | 2012 ASCO Annual Meeting Abstracts
Abstract:
Background: Human epididymis protein 4 (HE4) has been recently described as a new marker for early ovarian cancer, with higher sensitivity (76.9%) compared to CA125. This is the third study in literature on the role of HE4 in recurrence of ovarian cancer and the first evaluating the sensitivity of HE4 and CA125 in these patients
Methods: Plasma was obtained 24 hours before secondary cytoreductive surgery from consecutive patients with suspicious recurrence ovarian cancer operated from November 2010 to April 2011 at University Campus Bio-Medico of Rome. CA125 levels were evaluated by a one-step "sandwich" radioimmunoassay. HE4 levels were determined using the HE4 enzymatic immune assay. The CA125 cut-off was less than 35 U/mL. Two cut-off were considered for HE4: less than 150 pmol/L (according to the manufacturer's indications) and less than 70 pmol/L.
Results: Fourteen patients were histologically confirmed as recurrence ovarian cancer. Mean Ca125 plasma concentration was 31.95 ± 22.09 U/mL (range 1.1 – 64.3). Mean HE4 plasma concentration was 225.83± 286.82 pmol/L (range 21.61- 633.6). The sensitivity of CA125 was 35.7 %. The sensitivity of HE4 was 71.4% and 28.6% above the cut-off of 70 pmol/L and 150 pmol/L, respectively. The dual marker combination of CA125 and HE4 at 70 pmol/L cut-off yielded the highest sensitivity (85.7%) to detect recurrence ovarian cancer.
Conclusions: Even if a standard cut-off point has not been determined, this study suggested that HE4 may potentially be a more sensible marker for recurrence ovarian cancer than CA125 and the association between CA125 and HE4 at cut-off of 70 pmol/L seems to yield the highest sensitivity.
Other Abstracts in this Sub-Category:| 1. Randomized
phase III study of erlotinib versus observation in patients with no
evidence of disease progression after first-line platin-based
chemotherapy for ovarian carcinoma: A GCIG and EORTC-GCG study. Meeting: 2012 ASCO Annual Meeting Abstract No: LBA5000 First Author: Ignace B. Vergote Category: Gynecologic Cancer - Ovarian Cancer | |
| 2. Olaparib
plus paclitaxel plus carboplatin (P/C) followed by olaparib maintenance
treatment in patients (pts) with platinum-sensitive recurrent serous
ovarian cancer (PSR SOC): A randomized, open-label phase II study. Meeting: 2012 ASCO Annual Meeting Abstract No: 5001 First Author: Amit M. Oza Category: Gynecologic Cancer - Ovarian Cancer | |
| 3. AURELIA:
A randomized phase III trial evaluating bevacizumab (BEV) plus
chemotherapy (CT) for platinum (PT)-resistant recurrent ovarian cancer
(OC). Meeting: 2012 ASCO Annual Meeting Abstract No: LBA5002^ First Author: Eric Pujade-Lauraine Category: Gynecologic Cancer - Ovarian Cancer | |
| More... |
Time to Ovarian Cancer Return Not Tied to BMI - in Meeting Coverage, ASCO from MedPage Today
Medical News: Time to Ovarian Cancer Return Not Tied to BMI - in Meeting Coverage, ASCO from MedPage Today
Action Points
- Note that this study was published as an abstract and will be presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
- A study found that obesity did not affect recurrence, time to recurrence, or progression-free survival in women with epithelial ovarian cancer following surgery and adjuvant chemotherapy without evidence of disease during treatment.
- Note that the approximately one-third of patients who had BMI >30 kg/m2 had similar recurrence rates and time to recurrence as the two-thirds of non-obese patients.
Saturday, May 26, 2012
PLoS ONE: Increased Expression of PITX2 Transcription Factor Contributes to Ovarian Cancer Progression (clear cell ovarian/high grade)
PLoS ONE: Increased Expression of PITX2 Transcription Factor Contributes to Ovarian Cancer Progression
"....According to FIGO grading classification, high-grade ovarian tumor cells are usually poorly histological differentiated [20], grow faster and highly metastatic [7]. In addition, prognosis of high-grade ovarian tumor is poor thereafter it often associates with poor survival rate [21], [22].The clear cell subtype ovarian cancer accounts for approximately 6% of all epithelial ovarian tumors and most cases of this subtype are high-grade tumor exhibiting an aggressive phenotype [3], [22], [23]. Our study showed that both mRNA and protein levels of PITX2 was frequently upregulated in ovarian cancer particularly in the high-grade and clear cell subtypes, indicating that PITX2may play an important role in driving aggressive phenotypes in ovarian cancer.....
see blogger's note: Medical News: More Good Data for PARP Blocker (Olaparib) in Ovarian Ca - in Meeting Coverage, ASCO from MedPage Today
Blogger's Note: see blog postings 'olaparib' (searchable) of March 27th and March 8th and others; also use NEJM search for more information on ovarian cancer/Olaparib
Medical News: More Good Data for PARP Blocker in Ovarian Ca - in Meeting Coverage, ASCO from MedPage Today
not yet recruiting: Cyclophosphamide and Vaccine Therapy in Treating Patients With Stage II-III Breast, Ovarian, Primary Peritoneal, or Fallopian Tube Cancer - Full Text View - ClinicalTrials.gov
Cyclophosphamide and Vaccine Therapy in Treating Patients With Stage II-III Breast, Ovarian, Primary Peritoneal, or Fallopian Tube Cancer - Full Text View - ClinicalTrials.gov
This study is not yet open for participant recruitment.
Verified May 2012 by Mayo Clinic
First Received on May 23, 2012.
Last Updated on May 24, 2012
History of Changes
| Sponsor: | Mayo Clinic |
|---|---|
| Information provided by (Responsible Party): | Keith Knutson, Ph.D., Mayo Clinic |
| ClinicalTrials.gov Identifier: | NCT01606241 |
Massachusetts Moves to Require End-of-Life Talks
Mass. Moves to Require End-of-Life Talks:
WBUR radio and Kaiser Health News report that the Massachusetts Senate has quietly approved a measure requiring doctors and nurses to discuss end of life options with patients who have a terminal illness. The Palliative Care Awareness bill was included as part of a sweeping health reform measure and, remarkably, was not controversial. It was supported by both Republicans and Democrats and by a wide range of advocacy groups, including leading right-to-life organizations.
Family perspectives in lynch syndrome becoming a family at risk, patterns of communication and influence on relations
Family perspectives in lynch syndrome becoming a family at risk, patterns of communication and influence on relations
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
Abstract:
Background: A growing number of individuals are diagnosed with hereditary cancer. Though increased levels of anxiety and depression have been demonstrated around the time of genetic counselling, most individuals handle life at increased risk well. Data have, however, been collected on individual basis, which led us to focus on family perspectives of hereditary cancer.
Methods: Lynch syndrome represents a major type of hereditary colorectal and gynaecological cancer. We preformed open-ended interviews with 27 informants from 9 Lynch syndrome families. Inductive content analysis revealed three major themes: transition to a risk family, patterns of communication and influence on family relations and individual roles.
Results: Family members described how learning about Lynch syndrome shifted focus from daily issues to concerns about cancer. Changes in communication related to difficulties in talking to children about heredity and informing new family members and distant relatives about an increased risk of cancer. Influence on relations was exemplified by family members taking on different roles, e.g. females often being responsible for coordinating information about heredity and providing support. Families in which members had experienced cancer at young age typically informed children soon after learning about heredity and at young age, whereas families with experience of cancer at higher age postponed information and thereby also genetic counselling.
Conclusions: Three major family perspectives are described in Lynch syndrome families; becoming a risk family, patterns of communication and influence on family relations. Since these issues are central, our findings suggests that such family perspectives should be considered during genetic counselling in order to contribute to information spread, help family members cope with the increased risk, and motivate family members at risk to undergo surveillance.
What's Hot at ASCO This Year? (Brentuximab/ovarian cancer/CD30)
What's Hot at ASCO This Year?
".... Another study that builds on a previous breakthrough screened more than 1000 patients with nonlymphoma malignancies for high CD30 expression (Abstract 3069). A drug targeting this molecular defect, brentuximab (Adcetris, Seattle Genetics), has recently been approved for Hodgkin's lymphoma, but the new study found the CD30 defect in patients with mesothelioma and in those with testicular and ovarian cancer. The next step will be to see if these patients respond to the drug, Dr. Vogelzang explained.....
Physician Group Says No to Kittens in Medical Training
Physician Group Says No to Kittens in Medical Training
The group, the Physicians Committee for Responsible Medicine (PCRM), asked a branch of the US Department of Agriculture (USDA) yesterday to investigate the use of kittens in the center's pediatric residency program. The PCRM said that the medical center is violating the Animal Welfare Act, which governs healthcare facilities that use live animals for research, testing, or training.
Squamous Cell Carcinoma of the Oral Cavity in Nonsmoking Women: A New and Unusual Complication of Chemotherapy for Recurrent Ovarian Cancer? PLD (pegylated liposomal doxorubicin)
Squamous Cell Carcinoma of the Oral Cavity in Non smokingWomen: A New and Unusual Complication of Chemotherapy for Recurrent Ovarian Cancer?
Abstract
Purpose.
To describe occurrences of oral squamous cell carcinoma (SCC) in patients who had received long-term pegylated liposomal doxorubicin (PLD) for ovarian cancer.
Patients and Methods.
In our cohort of patients on maintenance PLD for ovarian and related mullerian epithelial malignancies, we encountered two patients with invasive SCC of the oral cavity (one of them multifocal) and one with high-grade squamous dysplasia. Review of patients at our institution receiving PLD for recurrent ovarian cancer identified three additional patients. The duration of treatment, cumulative PLD dose, human papillomavirus (HPV) positivity, BRCA status, stage at diagnosis, outcome, and other characteristics are reviewed.
Results.
All five cases were nonsmokers with no known risk factors for HPV and four were negative for p16 expression. Four of the patients had known BRCA mutations whereas one tested negative. Cumulative doses of PLD were >1,600 mg/m(2) given over 30-132 months. Three had SCCs staged as T1N0 oral tongue, alveolar ridge (gingival), and multifocal oral mucosa; one had a T2N0 oral tongue; and one had dysplasia. After excision, two were given radiation but recurred shortly thereafter; the others remain well and have had no further exposure to cytotoxic drugs, including PLD.
Conclusion.
Awareness of this possible long-term complication during PLD treatment should enhance the likelihood of early detection of oral lesions in these patients. Decisions to continue maintenance PLD after complete response of the original cancer should perhaps consider the benefits of delaying ovarian cancer recurrence versus the possible risk for a secondary cancer.
The finding of oral SCC in patients on long-term PLD
maintenance should alert oncologists to have a high index of
suspicion with any oral complaints that arise, and suggests a
possible need for regular oral examinations in this treatment
population. How long to continue maintenance with PLD after
a CR has been achieved is an unanswered question. The possible
risks to patients receiving maintenance PLD beyond CR
must be weighed against the presumed benefits of delaying
ovarian cancer recurrence on an individual basis.
paywalled: Early Postoperative CT as a Prognostic Biomarker in Patients With Advanced Ovarian, Tubal, and Primary Peritoneal Cancer Deemed Optimally Debulked at Primary Cytoreductive Surgery
Early Postoperative CT as a Prognostic Biomarker in Patients With Advanced Ovarian, Tubal, and Primary Peritoneal Cancer Deemed Optimally Debulked at Primary Cytoreductive Surgery
CONCLUSION:
Our study showed that residual disease larger than 1 cm was present on early postoperative CT in almost half of the patients deemed to have optimally debulked disease at primary cytoreduction.[Biomarker for colorectal cancer] - Lynch Syndrome/MSI/KRAS/BRAF
[Biomarker for colorectal cancer]
Abstract
Discovery of usable molecular biomarkers is the step closer to a realization of personalized therapy for patients with colorectal cancer(CRC). Herein we present an update of the most recent data on promising biological prognostic and/or predictive markers, including microsatellite instability(MSI) and KRAS/BRAF mutations. Additionally, we propose a new genetic classification for CRC based on MSI and KRAS/BRAF mutation status (a 2 x 3 matrix). The 2 x 3 matrix is constructed of 6 cells that are made by [MSI/non-MSI] x [BRAF mutant/KRAS mutant/wild type of the both genes].
All of CRC including Lynch syndrome could be classified without overlapping into the 6 cells. More interestingly, each cell has each promising biological prognostic and/or predictive feature, which will help clinicians to make personalized treatment strategy for each CRC patient.
paywalled: Management and Prognosis of Clear Cell Borderline Ovarian Tumor.
Management and Prognosis of Clear Cell Borderline Ovarian Tumor.:
Abstract
BACKGROUND: The clear cell borderline ovarian tumor (CCBOT) of the ovary is a rare tumor accounting for less than 1% of BOT. Fewer than 25 cases have been reported in the literature (including details on clinical management and outcomes). The aim of this study was to determine the prognosis of a series of CCBOTs collected in 2 reference centers.
PATIENTS AND METHODS: This was a retrospective review of patients with CCBOT treated or referred to our institutions. A centralized histological review by a reference pathologist and data on the clinical characteristics, management, and outcomes of patients were required for inclusion.
RESULTS: Twelve patients were identified between 2000 and 2010. The median age of patients was 68 years (range, 36-83 years). Two had been treated conservatively and 9 radically (data unknown in 1). The tumor was unilateral in 11 cases. All patients had stage I disease. All cases were CCBOT with an adenofibromatous pattern. Stromal microinvasion or intraepithelial carcinoma was histologically associated in 2 and 3 cases, respectively. Four of the 12 patients had synchronous endometrial disorders (but no endometrioid carcinoma). No cases were histologically associated with endometriosis. Four patients were lost to follow-up. Among 8 other patients, after a median period of 28 months (range, 2-129 months), no recurrence had occurred (1 patient had died of another disease).
CONCLUSION: Clear cell borderline ovarian tumor carries a good prognosis. All tumors are (blogger's note - 'were' in this study of 12 pts) stage I; therefore, surgical staging is not necessary in most of the cases. Conservative treatment could be proposed to young patients, but uterine curettage would then be required in cases of uterine preservation.
paywalled: Comparability of stage data in cancer registries in six countries: lessons from the international cancer benchmarking partnership - Walters - International Journal of Cancer - Wiley Online Library
Comparability of stage data in cancer registries in six countries: lessons from the international cancer benchmarking partnership
Abstract
The
International Cancer Benchmarking Partnership is investigating cancer
survival differences between six high-income nations using
population-based cancer registry data. Differences in overall survival
are often explained by differences in the stage at diagnosis and
stage-specific survival. Comparing stage at diagnosis using cancer
registry data is challenging because of different regional practices in
defining stage, despite the existence of international staging
classifications such as TNM. This paper describes how stage data may be
reconciled for international analysis. Population-based cancer registry
data were collected for 2.4 million adults diagnosed with colorectal,
lung, breast (women) or ovarian cancer during 1995-2007 in Australia,
Canada, Denmark, Norway, Sweden and the United Kingdom. The stage data
received were coded to a variety of international systems, including the
TNM classification, Dukes' for colorectal cancer, FIGO for ovarian
cancer, and to national 'localised, regional, distant” categorisations.
To optimise comparability for analysis, a rigorous and repeatable
process was defined to produce a final stage variable for each patient.
An algorithm was also defined to map TNM, Dukes' and FIGO to a
“localised, regional, distant” categorisation. We recommend how stage
data should be recorded and processed to optimise comparability in
population-based international comparisons of stage-specific cancer
outcomes. The process we describe to produce comparable stage data forms
a benchmark for future research. The algorithm to convert between TNM
and a “localised, regional, distant” categorisation should be valuable
for international studies, until global consensus is achieved to adhere
to a single staging system like TNM.
Is Renal Thrombotic Angiopathy a Potential Problem in the Chronic Treatment of Ovarian Cancer?
UNC Kidney Center: thrombotic microangiopathy
~~~~~~~~~~~~~~~~~~
Is Renal Thrombotic Angiopathy a Potential Problem in the Chronic Treatment of Ovarian Cancer?
"Treatments for recurrent ovarian cancer result in clinical
benefit and prolongation of survival times. However, our findings suggest that platinums, PLD (in large cumulative doses), bevacizumab, and possibly gemcitabine may result in cumulative kidney damage. Awareness of these long-term complications should open the way for studies on treatment strategies designed to minimize renal complications."
Abstract
Abstract Background and Objective
Ovarian
cancer is usually diagnosed at an advanced stage, with most patients
undergoing surgery followed by platinum- and
taxane-based chemotherapy. After initial
clinical remission, the majority recur, leading to additional
treatments, including
not only platinums and taxanes but also
pegylated liposomal doxorubicin (PLD), gemcitabine, topotecan, and, more
recently,
bevacizumab, which may extend survival times.
PLD, in particular, has been extensively studied by our group, with
encouraging
therapeutic results. We, however, observed
instances of chronic kidney disease (CKD) developing among patients who
received
long-term treatment for recurrent ovarian
cancer. To document the frequency and contributing factors to the
emergence of CKD,
we initiated a retrospective review at two
institutions.
(Kidney damage was defined by pathologic abnormalities
or markers of damage, including abnormalities on blood
and urine tests and radiologic studies.)
(Kidney damage was defined by pathologic abnormalities
or markers of damage, including abnormalities on blood
and urine tests and radiologic studies.)
Patients and Methods.
Fifty-six
consecutive patients with recurrent ovarian cancer receiving treatment
at New York University Cancer Institute were
reviewed for the presence of renal disease in
1997–2010. At Shaare Zedek Medical Center, 73 consecutive patients with
ovarian
cancer were reviewed in 2002–2010. Patients were
diagnosed with CKD if they had an estimated GFR <60 mL/minute per
1.73 m2 for >3 months and were staged according to the National Kidney Foundation guidelines.
Results.
Thirteen
patients (23%) developed stage ≥3 CKD. Three patients had renal biopsies
performed that showed thrombotic microangiopathy.
Conclusions.
CKD (chronic kidney disease) is emerging as a potential long-term consequence of current chemotherapy for recurrent ovarian cancer.
PLoS ONE: The KRAS-Variant Is Associated with Risk of Developing Double Primary Breast and Ovarian Cancer (study of pts with both ovarian and breast cancers)
Blogger's Note: the other cancers (KRAS mutations) referred to beyond ovarian and breast cancers include references to lung and melanoma cancers; KRAS mutations have been established in colorectal cancers, however, there are no references on this particular subject within this research article regarding Lynch Syndrome -
an ongoing area of specific research (re: KRAS/Lynch Syndrome/blog posting of May 16, 2012 Jnl ASCP)
~~~~~~~~~~~~~~~~~~~
PLoS ONE: The KRAS-Variant Is Associated with Risk of Developing Double Primary Breast and Ovarian Cancer
Table 1. The KRAS-variant is significantly associated with uninformative breast and ovarian cancer patients.
doi:10.1371/journal.pone.0037891.t001
Purpose
A germline microRNA binding site-disrupting variant, the KRAS-variant (rs61764370), is associated with an increased risk of developing several cancers. Because this variant is most strongly associated with ovarian cancer risk in patients from hereditary breast and ovarian families (HBOC), and with the risk of premenopausal triple negative breast cancer, we evaluated the association of the KRAS-variant with women with personal histories of both breast and ovarian cancer, referred to as double primary patients.Conclusions
These findings further validate the importance of the KRAS-variant in breast and ovarian cancer risk, and support the association of this variant as a genetic marker for HBOC families previously considered uninformative.Introduction
Hereditary breast and ovarian cancer (HBOC) syndrome is an inherited cancer-susceptibility syndrome marked by an increased risk of developing both ovarian cancer and breast cancer [1]. Families generally considered as having HBOC syndrome are those with multiple family members that have one of these cancers, especially at young ages, or an individual with a cancer in both organs, a “double primary” patient. While this is a relatively rare presentation, a substantial number of women develop both breast and ovarian primaries over their lifetime. While BRCA1 and BRCA2 are strongly associated with HBOC syndrome [2], a large number of HBOC families and women with double primary cancer do not have detectable genetic mutations (herein referred to as “uninformative” patients).The chances of identifying a mutation causative for HBOC increase when testing individuals diagnosed with double breast/ovarian primaries [3]–[5]. However, a recent report suggests that the rates of BRCA mutations are not higher in a patient with a double primary without a family history than that for isolated first degree relative pairs with single primaries (14% versus 17% with mutations, respectively) [4]. This supports the importance of family history even in patients with double primary cancers. Although BRCA mutations were found in 49% of double primary patients in this recent analysis, it should be noted that this indicates that over half of double primary patients do not have a known genetic cause for their disease. This is consistent with other reports of these patients [3], [5].............The goal of this study was to determine the association of the KRAS-variant with women with double primary breast and ovarian cancer, to further validate the association of this variant with HBOC families. Findings here support the importance of the KRAS-variant in uninformative HBOC families as well as in predicting the risk of multiple primary cancers in women.......
Association of the KRAS-variant with Multiple Cancers in All Patients
Because the KRAS-variant has been found to be associated with an increased risk for other cancers besides breast and ovarian cancer [11], [15] we tested the hypothesis that the KRAS-variant would predict for an increased risk of developing additional cancers in this double primary cohort, regardless of BRCA mutation status. For 183 of the patients in our study where this information was available, 79.2% (n = 145) had reported just the two cancers (breast and ovarian), 12.0% (n = 22) had two separate primary breast cancers and also ovarian cancer, and 8.7% (n = 16) had cancer in an additional organ outside of the breast and ovary (triple primary).Friday, May 25, 2012
Full-Exon Pyrosequencing Screening of BRCA Germline Mutations in Mexican Women with Inherited Breast and Ovarian Cancer
Full-Exon Pyrosequencing Screening of BRCA Germline Mutations in Mexican Women with Inherited Breast and Ovarian Cancer:
Hereditary breast cancer comprises 10% of all breast cancers. The most prevalent genes causing this pathology are BRCA1 and BRCA2 (breast cancer early onset 1 and 2), which also predispose to other cancers. Despite the outstanding relevance of genetic screening of BRCA deleterious variants in patients with a history of familial cancer, this practice is not common in Latin American public institutions. In this work we assessed mutations in the entire exonic and splice-site regions of BRCA in 39 patients with breast and ovarian cancer and with familial history of breast cancer or with clinical features suggestive for BRCA mutations by massive parallel pyrosequencing. First we evaluated the method with controls and found 41–485 reads per sequence in BRCA pathogenic mutations. Negative controls did not show deleterious variants, confirming the suitability of the approach. In patients diagnosed with cancer we found 4 novel deleterious mutations (c.2805_2808delAGAT and c.3124_3133delAGCAATATTA in BRCA1; c.2639_2640delTG and c.5114_5117delTAAA in BRCA2). The prevalence of BRCA mutations in these patients was 10.2%. Moreover, we discovered 16 variants with unknown clinical significance (11 in exons and 5 in introns); 4 were predicted as possibly pathogenic by in silico analyses, and 3 have not been described previously. This study illustrates how massive pyrosequencing technology can be applied to screen for BRCA mutations in the whole exonic and splice regions in patients with suspected BRCA-related cancers. This is the first effort to analyse the mutational status of BRCA genes on a Mexican-mestizo population by means of pyrosequencing.
How Much Weight Should Anecdotes Really Have In Health Policy?
How Much Weight Should Anecdotes Really Have In Health Policy?:
By D. Brad Wright
There’s something compelling about the personal narrative that vast mountains of quantitative data cannot rival. Anecdotes are, quite simply, powerful. They tap into our shared humanity, making something seem somehow more real by putting a face on it. This is why, if you follow politics for very long, you will find numerous cases of policymakers championing issues that have touched their own lives in some way. For example, Senator X doesn’t care about issue Y, until they discover that their son or daughter is affected by it. Then, almost overnight, they seem to care more about issue Y than almost anything else. Such a shift is completely understandable, but often out of proportion to the true scale of the issue in society.
Surgical site infection prevention: a survey to identify the gap between evidence and practice in University of Toronto teaching hospitals - Can J Surg. 2012 Jun 1
Blogger's Note: surgical site infections safety checklist: WHO (World Health Organization) program in patient safety
Surgical site infection prevention: a survey to identifythe gap between evidence and practice in University of Toronto teaching hospitals
"Surgical site infections (SSIs) are the most common
complication following surgery, with reported rates
ranging from 5% to 30%.1 The attributable morbidity
and mortality is significant, with patients who experience
SSIs being 60% more likely to spend time in the
intensive care unit, 5 times more likely to be readmitted to
hospital and twice as likely to die than patients without
SSIs.2 Whereas many risk factors for the development of
SSIs are related to patient characteristics that cannot be easily
modified, there are a variety of system or hospital factors
that can be manipulated. These include improper selection
and administration of antibiotic prophylaxis, intraoperative
hypothermia and intraoperative hyperglycemia.3
Despite clear evidence and guidelines to direct SSI prevention
strategies, compliance is uniformly poor......
paywalled: The risk of metachronous cancers in patients with small-intestinal carcinoid tumors: a US population-based study
Blogger's Note: while rare, and there is no specific reference in this abstract, carcinoid ovarian cancer tumors do exist so this research will be of interest for those diagnosed, this blog has some research on ovarian carcinoid tumors
The risk of metachronous cancers in patients with small-intestinal carcinoid tumors: a US population-based study
"In conclusion, almost one-third of patients with SICs have an associated metachronous primary tumor. When these primaries occur prior to (but not after) the SIC diagnosis, the prognosis is worse than with an initial SIC. The type of malignancies associated with SICs may guide future screening efforts.."
paywalled: Evolutionary Pathways in BRCAl-Associated Breast Tumors
Evolutionary Pathways in BRCAl-Associated Breast Tumors
Abstract
BRCAl-associated breast tumors display loss of BRCA1 and frequent somatic mutations of PTEN and TP53.
Here we describe the analysis of BRCA1, PTEN, and p53 at the single
cell level in 55 BRCA1-associated breast tumors and computational
methods to predict the relative temporal order of
somatic events, on the basis of the frequency of cells with single or
combined
alterations. Although there is no obligatory order
of events, we found that loss of PTEN is the most common first event and
is associated with basal-like subtype, whereas in
the majority of luminal tumors, mutation of TP53 occurs first and mutant PIK3CA is rarely detected. We also observed intratumor heterogeneity for the loss of wild-type BRCA1 and increased cell proliferation
and centrosome amplification in the normal breast epithelium of BRCA1 mutation carriers. Our results have important implications for the design of chemopreventive and therapeutic interventions
in this high-risk patient population.
SIGNIFICANCE: Defining
the temporal order of tumor-driving somatic events is critical for early
detection, risk stratification, and the
design of chemopreventive therapies. Our combined
experimental and computational approach reveal that the loss of
wild-type
BRCA1 may not be the first event in the majority of
BRCA1-associated breast tumors and may not be present in all cancer
cells
within tumors.
Cancer Discov; 2(6); 1–9. ©2012 AACR.
Bionomics launches ovarian cancer trial - BNC105 Australia/U.S. (134 women/18 locations)
Bionomics launches ovarian cancer trial - clinical trials, cancer, Bionomics, Biotechnology - Australian Life Scientist
Bionomics (ASX:BNO) has launched a clinical trial of its BNC105 cancer treatment candidate in women with ovarian cancer.
The Phase I/II trial will involve up to 134 women across 18 sites in Australia, New Zealand and the US.
In
Australia, the trial be conducted by the Australian and New Zealand
Gynaecological Oncology Group in conjunction with the National Health
and Medical Research Council Clinical Trials Centre.
Patients will receive BNC105 in conjunction with standard chemotherapy drugs carboplatin and gemcitabine......
Interval colon cancer in a Lynch syndrome patient under annual colonoscopic surveillance: a case for advanced imaging techniques? (including Lynch Syndrome background information/research)
Blogger's Note: worth reading even for those without colorectal cancer but with a familial interest in Lynch Syndrome cancers, discusses research on surveillance timing, discordance in mutation carriers, risk variances (% risk) etc...
Background
Lynch syndrome confers increased risk for various malignancies, including colorectal cancer.
Colonoscopic surveillance programs have led to reduced incidence of colorectal cancer and reduced mortality from colorectal cancer. Colonoscopy every 1–2 years beginning at age 20– 25, or 10 years earlier than the first diagnosis of colorectal cancer in a family, with annual colonoscopy after age 40, is the recommended management for mutation carriers. Screening programs have reduced colon cancer mortality, but interval cancers may occur.
Lynch syndrome is defined as the presence of a germline mutation in a DNA mismatch repair gene [1]. Mutation carriers have increased risk for various malignancies, including carcinomas of the colorectum (CRC), endometrium, ovary, small bowel, stomach, biliary tract, bladder, ureter and renal pelvis [2].
Interval colon cancer in a Lynch syndrome patient under annual colonoscopic surveillance: a case for advanced imaging techniques?
"This report highlights several features of Lynch syndrome. First, individuals carrying deleterious mutations in a DNA mismatch repair gene (MLH1, MSH2, MSH6, PMS2) deserve annual colonoscopic examinations with a careful search for, and removal of, all mucosal lesions. Second, adenoma is the precursor lesion for CRC in Lynch syndrome.....
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