Wednesday, November 12, 2014
Promising treatment option (Olaparib) and improved survival rates for patients with ovarian, breast, pancreatic, and prostate cancers - Medical News Today
medical news
....For the majority of patients in the study, olaparib was at least their third different cancer therapy. Based on the new data, the authors say olaparib warrants further investigation in phase III trials.....
(Roswell) RPCI researchers identify two novel candidate prognostic markers for ovarian cancer
Rmedical news
...."There is a lot of interest right now in what to do with the human genome," says Kevin Eng, PhD, an Assistant Professor of Oncology in the Department of Biostatistics and Bioinformatics at RPCI who was first author on both studies. "We are focused on finding the gene or combination of genes that are going to predict how long a woman's ovarian cancer is going to remain in remission or what treatment is best for her cancer." ......
OvMark: a user-friendly system for the identification of prognostic biomarkers in publically available ovarian cancer gene expression datasets
open access
Research
1
Molecular Therapeutics for Cancer Ireland, National Institute for
Cellular Biotechnology, Dublin City University, Glasnevin, Dublin 9,
Ireland
2 UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin 4, Ireland
3 Department of Histopathology, St James’ Hospital and Trinity College Dublin, Dublin 8, Ireland
4 Department of Medical Oncology, Beaumont Hospital, Beaumont Road, P.O. Box 1297, Dublin 9, Ireland
7 Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
2 UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Dublin 4, Ireland
3 Department of Histopathology, St James’ Hospital and Trinity College Dublin, Dublin 8, Ireland
4 Department of Medical Oncology, Beaumont Hospital, Beaumont Road, P.O. Box 1297, Dublin 9, Ireland
5
Department of Systems Biology, The University of Texas MD Anderson
Cancer Center, Houston, Tx, USA
6 Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Tx, USA
7 Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
The electronic version of this article is the complete one and can be found online at: http://www.molecular-cancer.com/content/13/1/241
TP53 oncomorphic mutations predict resistance to platinum‑ and taxane‑based standard chemotherapy in patients diagnosed with advanced serous ovarian carcinoma
abstract
.....Since mutations in TP53 occur in nearly all ovarian tumors, the objective of this study was to determine the relationship of oncomorphic TP53 mutations with patient outcomes in advanced serous ovarian cancer patients.....
Tuesday, November 11, 2014
Correspondence: Combination of Bevacizumab and Chemotherapy for Platinum-Resistant Recurrent Ovarian Cancer:(AURELIA Trial)
open access
Combination of Bevacizumab and Chemotherapy for Platinum-Resistant Recurrent Ovarian Cancer: Some Observations About the AURELIA Trial
(BRCAPRO) Misreported Family Histories and Underestimation of Risk
open access
To the Editor:
The study by Daniels et al1 focused on women with high-grade serous ovarian cancer and showed that carrier probabilities provided by risk prediction
model BRCAPRO2 are too low among low-risk patients. This important observation agrees with earlier reports, including probands with both
ovarian and breast cancers,2
in which the ratio of observed to expected cases (O/E) in low-risk
groups was substantially greater than one. As genetic
testing becomes more affordable and appropriately
broadens to segments of the population who are at lower prior risk, this
limitation deserves serious consideration........
Evaluation of 30-Day Hospital Readmission After Surgery for Advanced-Stage Ovarian Cancer in a Medicare Population
abstract
Conclusion
Early readmission after surgery for ovarian cancer is common. There is a significant association between 30-day readmission and 1-year mortality. These findings may catalyze development of targeted interventions to decrease early readmission, improve patient outcomes, and control health care costs.
Recurrent BRCA1 and BRCA2 mutations in Mexican women with breast cancer
abstract
Background: Germline mutations in the BRCA1 and BRCA2 genes confer an estimated 58-80% lifetime risk of breast cancer. In general, screening is done for cancer patients if a relative has been diagnosed with breast or ovarian cancer. There are few data on the prevalence of mutations in these genes in Mexican women with breast cancer and this hampers efforts to develop screening policies in Mexico. Methods: We screened 810 unselected women with breast cancer from three cities in Mexico (Mexico City, Veracruz and Monterrey) for mutations in BRCA1 and BRCA2, including a panel of 26 previously reported mutations.
Results: Thirty-five mutations were identified in 34 women (4.3% of total) including 20 BRCA1 mutations and 15 BRCA2 mutations. Twenty-two of the 35 mutations were recurrent mutations (62.8%). Only five of the 34 mutation carriers had a first-degree relative with breast cancer (three with BRCA1 and two with BRCA2 mutations). Conclusion: These results support the rationale for a strategy of screening for recurrent mutations in all women with breast cancer in Mexico, as opposed to restricting screening to those with a sister or mother with breast or ovarian cancer. Impact: These results will impact cancer genetic testing in Mexico and the identification of at-risk individuals who will benefit from increased surveillance.
A phase I study of farletuzumab, a humanized anti-folate receptor α monoclonal antibody, in patients with solid tumors
Abstract
Farletuzumab (MORAb-003) is a humanized monoclonal antibody against folate receptor α (FRA). The
purpose of the study is to assess safety and tolerability, the
pharmacokinetic (PK) profile, and preliminary antitumor effect. Patients
with ovarian cancer
(OC) or FRA-expressing solid tumors who are resistant to standard
treatments were eligible for the study.
Case-control estimation of the impact of oncolytic adenovirus on the survival of patients with refractory solid tumors
abstract
Oncolytic immunotherapy with cytokine armed replication competent viruses is an emerging approach in cancer treatment. In a recent randomized trial an increase in response rate was seen but the effect on overall survival is not known with any virus.
Monday, November 10, 2014
Sunday, November 09, 2014
Lynch Syndrome: Identification of a novel MSH6 germline variant in a family with multiple gastro-intestinal malignancies
abstract
The
identification of germline variants that predispose to cancer is
important to further our understanding of tumorigenesis, guide patient
management, prevent disease in unaffected relatives, and inform best
practice for health care. We describe a kindred with multiple
gastrointestinal malignancies where a novel MSH6 germline susceptibility
variant was identified by exome sequencing after eluding serial routine
testing in multiple affected members. This case fosters discussion of
our current understanding of DNA mismatch repair deficiency, the
management of Lynch Syndrome, and the emerging role of next generation
sequencing in laboratory medicine to identify rare pathogenic germline
variants in a comprehensive, unbiased fashion.
2014 Dietary Supplement Use and Colorectal Adenoma Risk in Individuals with Lynch Syndrome
open access
In conclusion, in this prospective cohort study no associations between dietary supplement use and colorectal adenoma risk among individuals with Lynch syndrome were indicated. Further research is warranted to determine whether or not dietary supplement use is associated to colorectal adenoma and colorectal cancer risk in MMR gene mutation carriers.
Risk Factors for Pancreatic Neuroendocrine Tumors
Note: abstract does not detail BRCA or Lynch Syndrome - and/or which would depend on the study population
abstract
Objectives
Pancreatic neuroendocrine tumors (PNETs) are uncommon, and little is known about their risk factors and association with other cancers. We evaluated whether the following risk factors known to be associated with pancreatic adenocarcinoma are also associated with PNETs: smoking, alcohol use, family history of PNET, and other cancers, and personal history of diabetes as potential risk factors.
Methods
Patients with PNETs seen at Mayo Clinic Rochester between 2000 and 2011 were compared with controls seen for a general medical evaluation. Patients and controls completed the same questionnaires. After excluding insulinoma and high-grade PNETs, 355 cases were evaluated, and 309 were matched to 602 controls (2:1) on age, sex, and region of residence.
Results
Personal smoking history was not associated with PNETs. Alcohol use was less common among cases (54% vs 67%, P < 0.001). Cases were more likely to report a family member with sarcoma (P = 0.02), PNET (P = 0.02), gallbladder cancer (P = 0.02), ovarian cancer (P = 0.04), and gastric cancer (P = 0.01). There was no association with other cancers in family members. Diabetes was more commonly reported by cases than controls (19% vs 11%, P < 0.001).
Conclusions
With the exception of diabetes, risk factors that are associated with pancreatic adenocarcinoma are not risk factors for PNETs.
Pancreatic neuroendocrine tumors (PNETs) are uncommon, and little is known about their risk factors and association with other cancers. We evaluated whether the following risk factors known to be associated with pancreatic adenocarcinoma are also associated with PNETs: smoking, alcohol use, family history of PNET, and other cancers, and personal history of diabetes as potential risk factors.
Methods
Patients with PNETs seen at Mayo Clinic Rochester between 2000 and 2011 were compared with controls seen for a general medical evaluation. Patients and controls completed the same questionnaires. After excluding insulinoma and high-grade PNETs, 355 cases were evaluated, and 309 were matched to 602 controls (2:1) on age, sex, and region of residence.
Results
Personal smoking history was not associated with PNETs. Alcohol use was less common among cases (54% vs 67%, P < 0.001). Cases were more likely to report a family member with sarcoma (P = 0.02), PNET (P = 0.02), gallbladder cancer (P = 0.02), ovarian cancer (P = 0.04), and gastric cancer (P = 0.01). There was no association with other cancers in family members. Diabetes was more commonly reported by cases than controls (19% vs 11%, P < 0.001).
Conclusions
With the exception of diabetes, risk factors that are associated with pancreatic adenocarcinoma are not risk factors for PNETs.
2014 Transparency in Interim Monitoring
open access - article
To the Editor:
Most phase III randomized clinical trials
(RCT) in oncology are designed to change clinical practice by
convincingly demonstrating
whether a new (often toxic) treatment provides
meaningful improvement in outcome relative to an active standard
treatment
or best supportive care. To protect patients and
resources, RCTs should use formal interim monitoring so that trials can
be
stopped early once the study question has been
answered. Accordingly, in addition to stopping for convincing evidence
of new
treatment benefit, futility/inefficacy (lack of
benefit) interim monitoring should be included to allow an RCT to be
stopped
if it becomes clear that the new treatment is
unlikely to provide tangible improvement. In particular, to demonstrate
lack
of benefit, there is no need to establish that a
new treatment is significantly worse than the control treatment;
instead,
ruling out meaningful benefit is sufficient to
address the study goal while maintaining a proper balance between
patient interests
and the need to acquire scientific evidence.1,2
Vergote et al3 report an RCT in patients with ovarian carcinoma and no progression after first-line chemotherapy; the study evaluated the
addition of 2 years of erlotinib maintenance treatment versus observation.......open access - response
REFERENCES
Risk for borderline ovarian tumours after exposure to fertility drugs
abstract
LIMITATIONS, REASONS FOR CAUTION:
Although we tried to minimize the effects of the underlying infertility, the severity of infertility might have affected our risk estimates, as women with more severe fertility problems may receive more treatment. The results from the subgroup analyses, e.g. the findings of an elevated risk for borderline ovarian tumours associated with increased time since first use of progesterone and with increased number of treatment cycles, should be interpreted with caution as these analyses are based on a limited number of women with borderline ovarian tumours.
WIDER IMPLICATIONS OF THE FINDINGS:
Although this study, which is the largest to date, provides reassuring evidence that there is no strong link between the use of fertility drugs and risk for borderline ovarian tumours, the novel observation of an increased risk for serous tumours after use of progesterone should be investigated in large epidemiological studies. The results of the present study provide valuable knowledge for clinicians and other health care personnel involved in the diagnosis and treatment of fertility problems.Metastatic ovarian carcinoma to the brain: An approach to identification and classification for neuropathologists
abstract
Brain metastasis is an uncommon but increasing manifestation of ovarian epithelial carcinoma and neuropathologists' collective experience with these tumors is limited. We present clinicopathological characteristics of 13 cases of brain metastases from ovarian epithelial carcinoma diagnosed at two academic institutions. The mean ages at diagnosis of the ovarian carcinoma and their subsequent brain metastases were 58.7 and 62.8 years, respectively. At the time of initial diagnosis of ovarian carcinoma the majority of patients had an advanced stage and none had brain metastases as their first manifestation of malignancy. Brain metastases tended to be multiple with ring-enhancing features on neuroimaging. Primary tumors and their brain metastases were all high-grade histologically and the histologic subtypes were: nine high-grade serous carcinoma (HGSC) cases, two clear cell carcinoma (CCC) cases and a single case each of carcinosarcoma and high-grade adenocarcinoma. A recommended histo- and immunopathological approach to these tumours are provided to aid neuropathologists in the recognition and classification of metastatic ovarian carcinoma to the brain.
2014 Cigarette smoking and risk of ovarian cancer: a pooled analysis of 21 case–control studies
open access
Cancer Causes Control
Results
Current
cigarette smoking increased the risk of invasive mucinous (OR = 1.31;
95 % CI: 1.03–1.65) and borderline mucinous ovarian tumors (OR = 1.83;
95 % CI: 1.39–2.41), while former smoking increased the risk of
borderline serous ovarian tumors (OR = 1.30; 95 % CI: 1.12–1.50). For
these histological types, consistent dose– response associations were
observed. No convincing associations between smoking and risk of
invasive serous and endometrioid ovarian cancer were observed, while our
results provided some evidence of a decreased risk of invasive clear
cell ovarian cancer.
Conclusions
Our
results revealed marked differences in the risk profiles of
histological types of ovarian cancer with regard to cigarette smoking,
although the magnitude of the observed associations was modest. Our
findings, which may reflect different etiologies of the histological
types, add to the fact that ovarian cancer is a heterogeneous disease.
"....In conclusion, in this large pooled analysis, we observed moderate increases in risk of invasive and borderline mucinous tumors and borderline serous tumors associated with cigarette smoking. For each of these histological types, the risk increased with increased daily cigarette consumption and duration of smoking. This dose–response relationship supports a causal association between smoking and ovarian cancer. In contrast, our results suggest that smoking is not likely to importantly increase the risk of invasive serous ovarian cancer. There was a decreased risk of invasive clear cell ovarian cancer in relation to smoking. Thus, our results indicate that differences in risk profiles with regard to cigarette smoking are not only present between mucinous and non-mucinous ovarian tumors but across the major histological types of invasive ovarian cancer. These findings further underscore the importance of histological subtype analyses in epidemiological, genetic, and clinical investigations of ovarian cancer, due to the vast heterogeneity in this disease."
"....In conclusion, in this large pooled analysis, we observed moderate increases in risk of invasive and borderline mucinous tumors and borderline serous tumors associated with cigarette smoking. For each of these histological types, the risk increased with increased daily cigarette consumption and duration of smoking. This dose–response relationship supports a causal association between smoking and ovarian cancer. In contrast, our results suggest that smoking is not likely to importantly increase the risk of invasive serous ovarian cancer. There was a decreased risk of invasive clear cell ovarian cancer in relation to smoking. Thus, our results indicate that differences in risk profiles with regard to cigarette smoking are not only present between mucinous and non-mucinous ovarian tumors but across the major histological types of invasive ovarian cancer. These findings further underscore the importance of histological subtype analyses in epidemiological, genetic, and clinical investigations of ovarian cancer, due to the vast heterogeneity in this disease."
Intermediate clinical endpoints: A bridge between progression-free survival and overall survival in ovarian cancer trials + Editorial (link)
abstract
Intermediate clinical endpoints: A bridge between progression-free survival and overall survival in ovarian cancer trials
Cancer
Review Article
Ovarian
cancer patients are usually diagnosed at an advanced stage, experience
recurrence after platinum-based chemotherapy, and eventually develop
resistance to chemotherapy. Overall survival (OS), which has improved in
recent years as more active treatments have been incorporated into
patient care, is regarded as the most clinically relevant endpoint in
ovarian cancer trials. However, although there remains a significant
need for new treatments that prolong OS further without compromising
quality of life, it has become increasingly difficult to detect an OS
benefit for investigational treatments because of the use of multiple
lines of chemotherapy to treat ovarian cancer. Progression-free survival
(PFS), which measures the time to disease progression or death, is
unaffected by postprogression therapies but does not evaluate the
long-term impact of investigational treatments on tumor biology and
responses to future therapies. Recent clinical trials of targeted agents
in relapsed ovarian cancer have shown improvements in PFS but not OS,
and this is possibly reflective of the long postprogression survival
(PPS) period associated with this disease. Intermediate endpoints such
as the time to second disease progression or death and the time to
second subsequent therapy or death may provide supportive evidence for
clinically meaningful PFS improvements and may be used to determine
whether these improvements persist beyond the first disease progression
and throughout subsequent lines of therapy. For clinical trials that
have settings with a long PPS duration and/or involve multiple rounds of
postprogression therapy, a primary endpoint of PFS supported by
intermediate clinical endpoints and OS may provide a more comprehensive
approach for evaluating efficacy.
also see editorial
Assessing benefit in trials: Are we making progress in assessing progression in cancer clinical trials?
also see editorial
Assessing benefit in trials: Are we making progress in assessing progression in cancer clinical trials?
Bringing PROMIS to practice: Brief and precise symptom screening in ambulatory cancer care (EHR)
The rise in metastasectomy across cancer types over the past decade
abstract
CONCLUSIONS
From 2000 through 2011, the performance of metastasectomy increased substantially across common cancer types, notwithstanding various advances in systemic therapies. Metastasectomy was performed more safely, despite increasing patient comorbidity. High-volume institutions appeared to drive practice patterns.
Keywords:
- metastasectomy;
- colorectal cancer metastasectomy;
- lung cancer metastasectomy;
- breast cancer metastasectomy;
- melanoma metastasectomy;
- surgical trends
Saturday, November 08, 2014
Simultaneous pet/mri for whole-body staging in patients with recurrent gyn malignancies of the pelvis: a comparison to whole-body mri alone
Simultaneous positron emission tomography/magnetic resonance imaging for whole-body staging in patients with recurrent gynecological malignancies of the pelvis: a comparison to whole-body magnetic resonance imaging alone
abstract
Cytoreductive Surgery Under Aminolevulinic Acid-Mediated Photodynamic Diagnosis Plus Hyperthermic Intraperitoneal Chemotherapy in Patients with Peritoneal Carcinomatosis from Ovarian Cancer and Primary Peritoneal Carcinoma: Results of a Phase I Trial
Cytoreductive Surgery Under Aminolevulinic Acid-Mediated Photodynamic Diagnosis Plus Hyperthermic Intraperitoneal Chemotherapy in Patients with Peritoneal Carcinomatosis from Ovarian Cancer and Primary Peritoneal Carcinoma: Results of a Phase I Trial
open access
Thursday, November 06, 2014
Breast Cancer Following Ovarian Cancer in BRCA Mutation Carriers
Brabstract
At a median follow-up of 6.3 years, 4 of the 12 patients (33.3%) died of recurrent EOC after a diagnosis of breast cancer. The overall 10-year survival rate for the entire cohort of 135 patients was 17.0%.
Features of ovarian cancer in Lynch syndrome (Review) - open access
open access
The lifetime risk for ovarian cancer in families with Lynch syndrome is ~8%, which is lower than colorectal and endometrial cancers, and ovarian cancer is not listed in the Amsterdam Criteria II. More than half of sporadic ovarian cancers are diagnosed in stage III or IV, but ≥80% of ovarian cancers in Lynch syndrome are diagnosed in stage I or II.
Contemporary phase III clinical trial endpoints in advanced ovarian cancer: assessing the pros and cons of objective response rate, progression-free survival, and overall survival - Gynecologic Oncology
abstract
Acceptance of PFS as the optimal endpoint for ovarian cancer trials by investigators and regulatory agencies is crucial to further advances in management because effective post-progression therapy has rendered differences in OS virtually impossible to assess reliably.
Tuesday, November 04, 2014
Outcomes for patients with the same disease treated inside and outside of randomized trials: a systematic review and meta-analysis
Open access
Limitations
Although 68% of the studies included
here employed identical follow-up protocols for both “insiders” and
“outsiders,” some
studies did not explicitly state whether
“outsiders” included all eligible patients or only those for whom data
could be obtained.
If “outsiders” are more likely to become lost to
follow-up, in part because they have died or suffered other adverse
events,
true trial advantages might be missed.
Conclusion
We found no evidence to support either
clinically important harm or clinically important benefit when
patients’ illnesses
were managed inside or outside an RCT. These
results can inform discussions between clinicians and the patients to
whom they
are offering entry into peer-reviewed, ethically
conducted RCTs. These results are also relevant to the policies,
procedures
and actions of institutions, ethics committees
and granting agencies that permit and support the execution of RCTs.
Our findings and conclusions are only as good as the publication base of relevant RCTs, and we look forward to the day when
the proposals of Vickers160 and Altman and Cates161 are fully realized, with all trials registered and reported and with raw trial data made readily available. When that day
arrives, our study should be repeated to determine the validity of the conclusions reached here.
Monday, November 03, 2014
Saturday, November 01, 2014
2014 Radiation-Induced Small Bowel Disease
open access
- What Is Radiation-Induced Small Bowel Disease?
- Pathogenesis
- Clinical Assessment
- Prevention of Radiation-Induced Small Bowel Disease
- Treatment of Acute Radiation-Induced Small Bowel Disease
- Treatment of Chronic Radiation-Induced Small Bowel Disease
- Secondary Effects of Chronic Radiation-Induced Small Bowel Disease
- Conclusion
(feed) http://ovariancancerandus.blogspot.com/feeds/posts/default
JCO -- Collected Resources : Art of Oncology Articles (popular series)
Sunday, October 26, 2014
Sunday, October 19, 2014
Whole exome sequencing of muscle-invasive bladder cancer identifies recurrent mutations of UNC5C and prognostic importance of DNA repair gene mutations on survival
open access
".....Patients who were carriers of somatic mutations in DNA repair genes (one or more of ATM, ERCC2, FANCD2, PALB2, BRCA1 or BRCA2) had a higher overall number of somatic mutations (p=0.011)....
(other cancers - increased risk from variations of the ATM gene
- Research suggests that people who carry one mutated copy of the ATM gene in each cell may have an increased risk of developing several other types of cancer. In particular, some studies have shown that cancers of the stomach, bladder, pancreas, lung, and ovaries occur more frequently in ATM mutation carriers than in people who do not carry these mutations. The results of similar studies, however, have been conflicting. Additional research is needed to clarify which other types of cancer, if any, are associated with ATM mutations.)
Friday, October 17, 2014
Thursday, October 09, 2014
Thursday, October 02, 2014
Sunday, September 28, 2014
open access: Assessment of adnexal masses using ultrasound: a practical review
IJWH
Published Date September 2014 Volume 2014:6 Pages 857—863
DOI http://dx.doi.org/10.2147/IJWH.S47075
Received 7 May 2014, Accepted 15 July 2014, Published 23 September 2014
Department of Obstetrics and Gynecology, Assaf HaRofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Abstract: Pelvic ultrasound is commonly used as part of the routine gynecologic exams, resulting in diagnosis of adnexal masses, the majority of which are functional or benign. However, due to the possible complications involving benign adnexal cysts (ie, adnexal torsion, pelvic pain) and the utmost importance of early diagnosis and treatment of ovarian cancer, the correct ultrasound diagnosis of adnexal masses is essential in clinical practice. This review will describe the typical ultrasound appearance of the common physiologic, benign, and malignant adnexal masses with the aim of aiding the clinician to reach the correct diagnosis.
Download Article [PDF]
Wednesday, August 20, 2014
What do patients and carers WANT from health apps? Survey (closes Fri, 24th Oct 2014)
Note: survey includes many options for country locations
Survey
http://ovariancancerandus.blogspot.com/feeds/posts/default
The Histomorphology of Lynch Syndrome–associated Ovarian Carcinomas: Toward a Subtype-specific Screening Strategy
Abstract
Women with Lynch syndrome (LS) are at increased risk
for the development of epithelial ovarian cancer (OC). Analogous to
previous studies on BRCA1/2 mutation carriers, there is
evidence to suggest a histotype-specific association in LS-associated
OCs (LS-OC). Whereas the diagnosis of high-grade serous carcinoma is an
indication for BRCA1/2 germline testing, in contrast, there are
no screening guidelines in place for triaging OC patients for LS
testing based on histotype. We performed a centralized pathology review
of tumor subtype on 20 germline mutation-confirmed LS-OCs, on the basis
of morphologic assessment of hematoxylin and eosin–stained slides, with
confirmation by immunohistochemistry when necessary. Results from
mismatch-repair immunohistochemistry (MMR-IHC) and microsatellite
instability (MSI) phenotype status were documented, and detailed
pedigrees were analyzed to determine whether previously proposed
clinical criteria would have selected these patients for genetic
testing. Review of pathology revealed all LS-OCs to be either pure
endometrioid carcinoma (14 cases), mixed carcinoma with an endometrioid
component (4 cases), or clear cell carcinoma (2 cases). No high-grade or
low-grade serous carcinomas or mucinous carcinomas of intestinal type
were identified. Tumor-infiltrating lymphocytes were prominent (≥40 per
10 high-powered fields) in 2 cases only. With the exception of 1 case,
all tumors tested for MMR-IHC or MSI had an MMR-deficient phenotype.
Within this cohort, 50%, 55%, 65%, and 85% of patients would have been
selected for genetic workup by Amsterdam II, revised Bethesda
Guidelines, SGO 10% to 25%, and SGO 5% to 10% criteria, respectively,
with <60% of index or sentinel cases detected by any of these
schemas. To further support a subtype-driven screening strategy, MMR-IHC
reflex testing was performed on all consecutive non-serous OCs
diagnosed at 1 academic hospital over a 2-year period; MMR deficiency
was identified in 10/48 (21%) cases, all with endometrioid or clear cell
histology. We conclude that there is a strong association between
endometrioid and clear cell ovarian carcinomas and hereditary
predisposition due to MMR gene mutation. These findings have
implications for the role of tumor subtype in screening patients with OC
for further genetic testing and support reflex MMR-IHC and/or MSI
testing for newly diagnosed cases of endometrioid or clear cell ovarian
carcinoma."
Commentary/Research: Obesity: a certain and avoidable cause of cancer - the Lancet
Note: both open access; note strengths/weaknesses of study for clarity
Commentary: The Lancet
The Study (the Lancet) Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults
http://ovariancancerandus.blogspot.com/feeds/posts/default
Friday, August 15, 2014
Wednesday, August 06, 2014
Cancer biomarkers: Written in blood : Nature News
full text
DNA circulating in the bloodstream could guide cancer treatment — if researchers can work out how best to use it.
Tuesday, August 05, 2014
The electronic self report assessment and intervention for cancer: promoting patient verbal reporting of symptom and quality of life issues in a randomized controlled trial
Full text
Conclusions
Adding electronically-delivered, self-care instructions and communication coaching to ESRA-C promoted specific patient descriptions of problematic SxQOL issues compared with ESRA-C assessment alone. However, clinician verbal responses were no different and subsequent symptom distress group differences were not mediated by the patients' reportsSunday, August 03, 2014
Wednesday, November 20, 2013
Dying at home – is it better: A narrative appraisal of the state of the science
abstract
Background: Achieving home care and home death is increasingly used as an outcome measure of palliative care services.
Aim: To appraise the state of the science on dying at home.
Methods: Appraisal and
narrative review developed from a plenary presentation at the European
Association for Palliative Care (EAPC)
2012 meeting examining the research on
variations and trends in place of death, factors associated with dying
in the preferred
place, presenting evidence on outcomes for those
dying at home and suggesting future research questions.
Results: Meeting patients’ preferences and creating home-like environments has been a major concern for hospice and palliative care
since its inception. During the 20th
century, in many countries, hospital deaths increased and home deaths
reduced. Despite the fact that this trend has been
halted or reversed in some countries (notably
the United States, Canada and, more recently, the United Kingdom) in the
last
5–20 years, a home death is still a distant
reality for the majority, even though evidence shows it is the most
commonly preferred
place to die. Epidemiological studies identified
factors associated with home death, including affluence, patients’
preferences,
provision of home care and extended family
support. Evidence about the benefits of home care is conflicting, but
recent data
suggest that holistic well-being may be greater
at home.
Implications: We call
for further analyses of variations in place of care and place of death
and robust studies on how patients and families
formulate and change preferences over time.
Regular monitoring of outcomes, quality and costs of palliative home
care is urged.
Psychological distress in women with breast and gynecological cancer treated with radical surgery
abstract
Objectives
The
objective of this study is to compare psychological distress (body
image disturbance, self-esteem, depression, and anxiety) in women with
breast or gynecological cancer treated by radical surgery. Additionally,
another objective is to analyze the association between psychological
distress and sociodemographic characteristics, medical history, and
social support to produce a prediction model for the outcome measures.
Methods
A
cross-sectional study was carried out with 100 women who had undergone
radical surgery for breast or gynecological cancer. Both groups were
divided into the following: younger than 50 years old and 50 years old
or older. Body Image Scale, Rosenberg's Self-Esteem Scale, Beck
Depression Inventory, and Beck Anxiety Inventory were used.
Results
Age
had a significant main effect on psychological distress but the type of
cancer did not. Younger women showed significantly greater distress
than older women (p-values < 0.001). A significant
interaction between age and type of cancer was found, indicating that
older women with breast cancer had worse body image and more depression
than those with gynecological cancer (p-values < 0.001); no significant differences were found between younger groups.
The
prediction model for increased body image disturbance and depression
included the joint effect of the following variables: being younger,
inactive occupational status, and post-adjuvant therapy side effects.
For lower self-esteem, the variables were: being younger, post-adjuvant
therapy side effects, and dissatisfaction with social support. And for
higher anxiety, the sole variable included was post-adjuvant therapy
side effects.
Conclusions
Both mastectomy and hysterectomy/oophorectomy cause similar psychological distress in younger women, but mastectomy causes greater distress in older women than hysterectomy/oophorectomy.Debulking Surgery and Intraperitoneal Chemotherapy Are Associated With Decreased Morbidity in Women Receiving Neoadjuvant Chemotherapy for Ovarian Cancer
abstract
Objective: The aims of this study were to compare the
rate of completion of optimal debulking and/or 6 cycles of
intraperitoneal (IP) chemotherapy in women with International Federation
of Gynecologists and Obstetricians stage III/IV ovarian cancer
undergoing neoadjuvant chemotherapy (NACT) versus primary surgery (PS)
and to compare morbidity between these 2 groups.
Methods: Ninety-six subjects with stage III/IV ovarian
cancer who underwent either NACT or PS were identified. Data comparisons
include rate of optimal debulking and completion rate of 6 cycles of IP
chemotherapy. Other data collected included surgical times, length of
stay, intensive care unit admissions, blood transfusions, bowel
resections, major complications, and dose reductions. SigmaStat version
2.0 was used for statistical analysis.
Results: Of the 96 subjects, 38 received NACT and 58 had
PS. All 14 subjects with stage IV disease received NACT, and all
experienced resolution of pleural effusion, based on computed
tomographic imaging. Thirty-five (92%) of 38 NACT subjects versus 47
(81%) of 58 PS subjects were optimally debulked (P = 0.08). Thirty-six
(95%) of 38 NACT subjects versus 37 (64%) of 58 PS subjects completed IP
chemotherapy (P < 0.001). Length of stay was 3.26 (NACT) versus 5.08
(PS) days (P < 0.001). Intensive care unit admissions were 1 of 38
(NACT) versus 12 of 58 (PS) (P < 0.001). Bowel resections were done
in 2 of 38 (NACT) versus 14 of 38 (PS) (P < 0.05). Duration of
surgery was 96 minutes (NACT) versus 138 minutes (PS) (P < 0.001). A
trend to fewer dose reductions occurred in NACT (1/38) versus PS (8/58)
(P = 0.056).
Conclusions: The NACT subjects were more likely to
complete IP chemotherapy and had decreased length of stay, intensive
care unit admissions, bowel resections, and duration of surgery. Both
optimal debulking and dose reductions were numerically but not
statistically associated with NACT versus PS. This likely reflects a
relatively high overall rate of optimal debulking and low rate of dose
reductions in these subjects and would require a larger group to
determine significance.
Angiosarcomas of Primary Gynecologic Origin: A Clinicopathologic Review and Quantitative Analysis of Survival
Abstract
Objective: Angiosarcomas are aggressive, malignant soft tissue neoplasms of endothelial origin and occur rarely in the female genital tract. There is lack of consensus on risk factors for poor outcome and optimal treatment. To this end, we performed a clinicopathologic review and survival analysis.
Conclusions: This review supports the use of surgical and adjuvant radiotherapy for angiosarcomas of the vulva, vagina, and uterus. Cytoreductive surgery and adjuvant chemotherapy remain the primary treatment of angiosarcomas of the ovary.
(2009) KRAS mutation analysis in ovarian samples using a high sensitivity biochip assay
Full text
Conclusion
In summary, KRAS mutation is a common event in ovarian cancer and is more frequently present in carcinoma
of lower grade, lower FIGO stage, and in lesions of mucinous histotype. Our results
support earlier findings from other groups in a very large number of samples. KRAS mutation was not found to be of prognostic value for patients under standard therapy,
but these mutations could emerge as an important factor for individually tailored
anti-EGFR therapies.
“Undruggable” Mutation Meets Its Match (K-Ras mutation)
news
“K-Ras is considered to be the most important oncogene in cancer and is widely believed to be ‘undruggable,’” said Shokat. “We report the discovery of a new pocket on K-Ras that is druggable. We believe this has real translational implications for patients.”...
Health system costs not incurable but preventable | Evidence Network (Canada)
Evidence Network
"The tsunami metaphor is more and more often used in commentaries about the effect of aging on health care spending in Canada. It musters up images of devastation and irresistible strength submersing any levees the system might try to mount to oppose it. It is a powerful but misleading metaphor.
There is a worrying rise in health care spending in Canada, but it doesn’t have much to do with population aging. To stay with the oceanographic metaphor, aging might be, at most, a modest tidal wave. The real tsunami of health spending is the result of changes in the way all patients are treated in the system......
Extreme Nutrition: Can It Beat Cancer?
medscape
Editor's Note:
In this 2-part series, Medscape looks at diet as an essential therapeutic strategy for cancer patients. Part 1 focuses on the nutritional assessment of cancer patients, foods that help patients cope with side effects, and ways to make fortifying foods more appealing to the cancer-dulled appetite. Part 2 looks at extreme nutrition and the growing interest in fighting cancer with food....
Endometrioid ovarian carcinoma during pregnancy presenting with acute rupture
abstract
Background:
Endometrioid ovarian carcinoma is rarely diagnosed during pregnancy and
is generally asymptomatic. We present a case of endometrioid ovarian
carcinoma during pregnancy that presented with acute rupture, and
discuss options for management.
Case: A primigravid woman presented at 26 weeks' gestation with severe abdominal pain. At laparotomy, an adnexal mass was found to have ruptured. The mass was identified postoperatively as an endometrioid ovarian carcinoma. The decision was made to perform Caesarean section with fertility-sparing surgical management at 34 weeks to maximize maternal and fetal outcomes.
Conclusion: To our knowledge, this is the first reported case of endometrioid ovarian carcinoma presenting with rupture in pregnancy. The differential diagnosis of severe abdominal pain during pregnancy should include rupture of ovarian malignancy.
Case: A primigravid woman presented at 26 weeks' gestation with severe abdominal pain. At laparotomy, an adnexal mass was found to have ruptured. The mass was identified postoperatively as an endometrioid ovarian carcinoma. The decision was made to perform Caesarean section with fertility-sparing surgical management at 34 weeks to maximize maternal and fetal outcomes.
Conclusion: To our knowledge, this is the first reported case of endometrioid ovarian carcinoma presenting with rupture in pregnancy. The differential diagnosis of severe abdominal pain during pregnancy should include rupture of ovarian malignancy.
Emotional and physical effects of cancer in life after treatment. ESCO conference highlight
video
Dr Annette Hasenburg talks to ecancer at the 2013 ESGO meeting about the psychological and physical effects of living with cancer and life after treatment.
Dr Hasenburg emphasises the need for more discussion between doctors and patients about the complexities of life after cancer and the changes to a patient’s personal life.
Update on the management and the role of intraperitoneal chemotherapy for ovarian cancer
abstract
PURPOSE OF REVIEW:
Ovarian cancer is the commonest gynaecological cancer and the fifth leading cause of cancer death in women worldwide. The majority of patients with ovarian cancer present at an advanced stage, and up to 70% of those treated with a curative approach eventually recur and succumb to their disease. This article examines the management of ovarian cancer over the years and the role of intraperitoneal chemotherapy in the treatment algorithm.RECENT FINDINGS:
The surgical paradigm for ovarian cancer has changed and the goal is optimal cytoreduction with no residual disease. Intraperitoneal chemotherapy has been found to be superior to intravenous treatment alone, and the combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has produced encouraging results with improved disease-free and overall survivals at acceptable morbidity and mortality rates.SUMMARY:
The most important prognostic factor for ovarian cancer survival is the ability to achieve optimal cytoreduction with no residual disease. CRS and HIPEC should be considered as an option for the management of advanced ovarian cancer and further trials are required to determine its role in both the primary and recurrent settings.Prevalence and differentiation of hereditary breast and ovarian cancers in Japan
abstract
BACKGROUND:
We assembled needed data on the prevalence and characteristics of BRCA1/2 in Japan.MATERIALS AND METHODS:
Our study of BRCA1/2 collected data at eight institutions in Japan on 320 individuals with a strong family history of breast cancer, according to the NCCN guidelines, by the end of March 2012.RESULTS:
Among 260 proband cases, 46 (17.7 %) were positive for BRCA1, and 35 (13.5 %) were BRCA2-positive. Therefore, the total pathological mutation rate was 30.7 %. Pathology data after breast surgery were obtained from 37 cases of BRCA1 mutation, 23 (62.2 %) of which were triple negative (TN). On the other hand, 29 cases (82.9 %) of BRCA2 mutations were Luminal type. The most prevalent BRCA1 mutation site was L63X, found in 10 families. L63X was reported previously by studies in Japan, and it may be a founder mutation. We found two cases of large deletion detected by multiplex ligation-dependent probe amplification. One was an entire deletion of exon 20 and the lacked exons 1-9. TN with a family history of ovarian cancer was 11/20 (55 %). TN under 40-year-old (y.o.) 15/23 (65.2 %) and TN with one or more breast cancers in family history 17/32 (53.1 %) showed higher incidences of BRCA1 mutation.CONCLUSION:
Hereditary breast and ovarian cancer (HBOC) may have nearly the same prevalence in Japan as in the US or Europe. If TN cases are taken into account, the ratio of BRCA1 is higher. L63X may be one of the founder mutations in Japan. A nationwide database of HBOC is important to develop risk models for BRCA1/2 carriers in Japan.Risk-reducing surgery increases survival in BRCA1/2 mutation carriers unaffected at time of family referral
abstract
The
aim of this study was to establish if risk-reducing surgery (RRS)
increases survival among BRCA1/2 carriers without breast/ovarian cancer
at the time of family referral. Female BRCA1/2 carriers were identified
from the Manchester Genetic Medicine Database. Those patients alive and
unaffected at the date of first family ascertainment were included in
this study. Female first-degree relatives (FDRs) without predictive
genetic testing who otherwise met eligibility criteria were also
included. The effect of breast and ovarian RRS on survival was analysed.
The survival experiences of RRS and non-RRS patients, stratified by
BRCA status, were examined with Kaplan-Meier curves and contrasted using
log-rank tests and Cox models. 691 female BRCA1/2 mutation carriers
without breast or ovarian cancer at time of family ascertainment were
identified; 346 BRCA1 and 345 BRCA2. 105 BRCA1 carriers and 122 BRCA2
carriers developed breast cancer during follow-up. The hazard of death
was statistically significantly lower (P < 0.001) following RRS
versus no RRS. 10-year survival for women having RRS was 98.9 %
(92.4-99.8 %) among BRCA1 and 98.0 % (92.2-99.5 %) among BRCA2 carriers.
This survival benefit with RRS remained significant after FDRs were
added. Women who had any form of RRS had increased survival compared to
those who did not have RRS; a further increase in survival was seen
among women who had both types of surgery. However, formal evidence for a
survival advantage from bilateral mastectomy alone requires further
research.
Tuesday, November 19, 2013
External validation of three prognostic models for overall survival in patients with advanced-stage epithelial ovarian cancer
Abstract
Background:
For
various malignancies, prognostic models have shown to be superior to
traditional staging systems in predicting overall survival. The purpose
of this study was to validate and compare the performance of three
prognostic models for overall survival in patients with advanced-stage
epithelial ovarian cancer.
Methods:
A
multi-institutional epithelial ovarian cancer database was used to
identify patients and to evaluate the predictive performance of two
nomograms, a prognostic index and FIGO (International Federation of
Obstetrics and Gynecology) stage. All patients were treated for
advanced-stage epithelial ovarian cancer between January 1996 and
January 2009 in 11 hospitals in the eastern part of The Netherlands.
Results:
In
total, 542 patients were found to be eligible. Overall performance did
not differ between the three prognostic models and FIGO stage. The
discriminative performance for Chi’s model was moderately good (c
indices 0.65 and 0.68) and for the models of Gerestein and Teramukai
reasonable (c indices between 0.60 and 0.62). The c indices of FIGO
stage ranged between 0.54 and 0.62. After recalibration, the three
models showed almost perfect calibration, whereas calibration of FIGO
stage was reasonable.
Conclusion:
The
three prediction models showed general applicability and a reasonably
well-predictive performance, especially in comparison to FIGO stage. To
date, there are no studies available that analyse the impact of these
prognostic models on decision-making and patient outcome. Therefore, the
usefulness of these models in daily clinical practice remains to be
investigated.
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Analysis of the contribution of immunologically-detectable HER2, steroid receptors and of the "triple-negative" tumor status to disease-free and overall survival of women with epithelial ovarian cancer
Abstract
We assessed associations between steroid receptors including: estrogen-alpha, estrogen-beta, androgen receptor, progesterone receptor, the HER2 status and triple-negative epithelial ovarian cancer (ERα-/PR-/HER2-; TNEOC) status and survival in women with epithelial ovarian cancer. The study included 152 women with primary epithelial ovarian cancer. The status of steroid receptor and HER2 was determined by immunohistochemistry. Disease-free and overall survival were calculated and compared with steroid receptor and HER2 status as well as clinicopathological features using the Cox Proportional Hazards model. A mean follow-up period of 43.6 months (interquartile range=41.4 months) was achieved where 44% of patients had serous tumor, followed by mucinous (23%), endometrioid (9%), mixed (9%), undifferentiated (8.5%) and clear cell tumors (5.3%). ER-alpha staining was associated with grade II-III tumors. Progesterone receptor staining was positively associated with a Body Mass Index≥25. Androgen receptor positivity was higher in serous tumors. In stand-alone analysis of receptor contribution to survival, estrogen-alpha positivity was associated with greater disease-free survival. However, there was no significant association between steroid receptor expression, HER2 status, or TNEOC (ERα-/PR-/HER2-; TNEOC) status, and overall survival. Although estrogen-alpha, androgen receptor, progesterone receptor and the HER2 status were associated with key clinical features of the women and pathological characteristics of the tumors, these associations were not implicated in survival. Interestingly, women with TNEOC seem to fare the same way as their counterparts with non-TNEOC.
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