Medscape: (Avastin) Bevacizumab: First-Line Therapy in Ovarian Cancer?: Evidence for First-Line Therapy Dr's Markman, Burger, Swenterton

Bevacizumab: First-Line Therapy in Ovarian Cancer?: Evidence for First-Line Therapy

Editor’s Note:
 
Two phase 3 trials published in the New England Journal of Medicine on December 29, 2011, found bevacizumab to be active as first-line therapy in advanced ovarian cancer. Although both trials showed an increase in progression-free survival [PFS], not enough time has elapsed to determine whether the drug extends overall survival. Furthermore, it is unclear whether bevacizumab in ovarian cancer is best used as first-line or second-line therapy. Recently, Drs. Robert Burger and Kenneth Swenerton participated in a Medscape virtual debate via email to address this question: "Should bevacizumab be used as first-line therapy in patients with advanced ovarian cancer?" Dr. Maurie Markman served as moderator. What follows is their conversation......

reposted from Jan 2012 - worth reading - Editorial Commentary - Maurie Markman - Clinical Oncology News - Meaningful Responses To ‘We-Know-the-Answer’ Syndrome

".... The following three examples, all drawn from the field of epithelial ovarian cancer management, illustrate the dangers of simply accepting conventional wisdom, and in my opinion, serve as excellent examples of the importance of critical thinking when evaluating this type of proclamation...." (3 examples )


"Similar examples can be found in all areas of clinical oncology where conventional wisdom and “expert opinion” have inappropriately trumped the essential process of critical thinking. Unfortunately, this is not surprising: Critical thinking often is quite difficult, particularly when the outcome rejects a strong belief in some particular conventional wisdom that has been passed on by “senior leaders” or “experts in a field.”"

"....... Stressing the dangers of nonrigorously tested, overly simplistic or nonbiologically based beliefs often is not the way to win popularity contests among your peers (or within professional organizations), who may accept the conventional wisdom as being factually correct. But for those who appropriately, and even courageously, refuse to be swept up by the superficial allure and comfort of conventional wisdom, who understand that genuine progress in oncologic outcomes demands constant inquiry into our existing interpretations of biological systems and current medical practice, it is important to remember it is our patients who are the beneficiaries of our efforts........"

Case Reports in Oncology - Journal Home (Editor: M. Markman - open access journal)

Case Reports in Oncology - Journal Home

Editor(s): Markman M.  (Philadelphia, Pa.)

REPOST: CA-125: To Monitor or Not to Monitor?: Evidence Against Monitoring CA-125

 Blogger's Note: Medscape requires registration (free)

CA-125: To Monitor or Not to Monitor?: Evidence Against Monitoring CA-125

 From Medscape Hematology-Oncology

CA-125: To Monitor or Not to Monitor?

For Ovarian Cancer Patients in Remission

Gordon Rustin, MD; Beth Y. Karlan, MD; Maurie Markman, MD

Authors and Disclosures

Posted: 03/08/2012

open access: Nature Reviews: Key Advances in Medicine - Ovarian Cancer/Markman page 15-16

Key Advances in Medicine (book)


Nature Reviews Clinical Oncology  (page 15)S11 ovarian cancer | Mutations and non-inferiority analyses show a way forward Maurie Markman      (page 15-16)






Highly clinically relevant ovarian cancer clinical research in 2011 focused on an increased understanding of the biology of the malignancy, limitations of strategies for early detection and screening, and the provocative reports of alternative primary and second-line management strategies.

"Although there were a number of very interesting
preliminary reports of therapeutic
advances in ovarian cancer in 2011 (for
example, bevacizumab in the first-line and
second-line management of the malignancy,
and olaparib  (Blogger's Note: links to Olaparib (parp inhibitor) - Cancer Research UK)  as maintenance therapy for
high-grade serous cancers), as of the writing
of this commentary these studies have not
appeared in the peer-reviewed oncology literature......."

Key advances
■■ There are currently no evidence-based
data supporting the clinical utility of any
ovarian cancer screening strategy in
non‑high-risk populations1
■■ Provocative data suggest there may be a
clinically meaningful difference between
the presence of a BRCA1 or a BRCA2
mutation in influencing outcome in ovarian
cancer6
■■ Under specific circumstances (for example,
neuropathy) it might be reasonable to
substitute pegylated liposomal doxorubicin
for paclitaxel in the front-line chemotherapy
management of ovarian cancer7

Markman, M. Nat. Rev. Clin. Oncol. 9, 69–70 (2012); published online 20 December 2011; doi:10.1038/nrclinonc.2011.200

                                   ~~~~~~~~~~~~~
"The articles included in Nature Reviews Key Advances in
Medicine were originally published in the February 2012
issues of the eight clinical Nature Reviews journals. The journals’
editors commissioned international experts to write a short
essay highlighting up to five key papers that made the biggest
contribution to their field in 2011."

Clinical Oncology News - The Concept of ‘Unrealistic Optimism’ In Early-Phase Trials (Markman) - Aug issue

"Oncologists may not be fully aware of a relatively new term introduced by ethicists to describe certain patients who agree to participate in early-phase cancer clinical trials. Some researchers believe that these individuals express unrealistic optimism, which apparently means that despite understanding the limited statistical probability of experiencing clinical benefit from a particular management plan, they have a strong belief regarding their own favorable outcome.1 These researchers apparently feel such optimism poses a serious problem, with one member of this community of scholars being quoted as remarking, “We just need to realize that not all optimism is ethically benign.”2...............For it would appear that those who support the concept of unrealistic optimism, or its sister term therapeutic misconception, have not kept up with the oncology literature dealing with early-phase clinical trials........cont'd

Gynecologic Oncology: Highlights From Asco 2011

overview ASCO text + video: Bevacizumab: The Sleeping Giant in Ovarian Cancer (maintenance, PARPs, mutations/genetics/molecular testing/genetic profiles/screening/single agent Avastin/ICON7....)

Bevacizumab: The Sleeping Giant in Ovarian Cancer

Maurie Markman, MD; Gini Fleming, MD

Posted: 06/13/2011

Markman commentary: Can weekly topotecan substitute for a multi-day regimen in the treatment of ovarian cancer? Sadly, 10 years later the answer remains unknown

Gynecologic Oncology
Article in Press

---

doi:10.1016/j.ygyno.2011.04.020 | How to Cite or Link Using DOI Copyright © 2011 Elsevier Inc. All rights reserved.

Permissions & Reprints

Clinical Commentary

Can weekly topotecan substitute for a multi-day regimen in the treatment of ovarian cancer? Sadly, 10 years later the answer remains unknown

Purchase

$ 39.95

Maurie Markman^a,

^a Cancer Treatment Centers of America, Eastern Regional Medical Center, 1331 East Wyoming Avenue, Philadelphia, PA 19046 USA

Received 28 March 2011; 

accepted 16 April 2011. 

Available online 12 May 2011.

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Oncology - Interpreting Clinical Trial Results - Clinical Options in Practice

Note: requires registration (free); worth reading

Oncology - Interpreting Clinical Trial Results

Authors: Maurie Markman, MD (More Info)

Released: 11/17/10

Last Reviewed: 12/1/10

March 11/2011 Dr Maurie Markman: Prophylactic Oophorectomy and BRCA1/2 Mutations

Note: full free access/requires registration

excerpt:

 "Short- and Long-Term Effects of Surgical Menopause

Second, the performance of a bilateral oophorectomy in a premenopausal woman, so-called "surgical menopause," can result in very distressing menopausal symptoms, such as hot flashes, depression, sleep disturbances, vaginal dryness, painful intercourse, etc.^[7] It is important to acknowledge that these symptoms are often described as being substantially worse than those experienced following natural menopause. The impact of these symptoms on an individual woman's overall quality-of-life should not be underestimated.
Again, the point of noting this concern is not to deny the utility of this surgery in women with a substantial risk of developing ovarian cancer. Rather, it is to be certain that this issue is discussed with the individual woman prior to the performance of the procedure. In this way, she can include this information in her decision-making process....."

Clinical Care Options website: update includes Avastin - Ovarian Cancer

Note: full free access (requires free registration)

Authors: Maurie Markman, MD

Released: 11/17/10

Last Reviewed: 12/2/10 (What's New)

• Introduction
• BRCA Mutations in Ovarian Cancer
• Screening for Ovarian Cancer
• Symptoms of Ovarian Cancer
• Surgical Staging of Ovarian Cancer
• Primary Surgical Cytoreduction in Ovarian Cancer
• Interval Surgical Cytoreduction and Neoadjuvant Chemotherapy
• Chemotherapy for High-Risk Early-Stage Ovarian Cancer
• Primary Chemotherapy of Advanced Stage Ovarian Cancer
  • Intraperitoneal Chemotherapy of Small-Volume Residual Ovarian Cancer
  • Maintenance Therapy of Advanced Ovarian Cancer
• Second-Line Therapy of Ovarian Cancer
• Platinum-Sensitive vs Platinum-Resistant Recurrent Ovarian Cancer
• Treatment of Platinum-Sensitive Recurrent Ovarian Cancer
• Treatment of Platinum-Resistant Ovarian Cancer
• Intermediate Platinum Sensitivity
• Carboplatin Hypersensitivity Reactions
• Other Management Options in Recurrent/Resistant Ovarian Cancer
• Future Research Directions in Ovarian Cancer
• Tables and Figures
• References

short video: commentary Dr Maurie Markman - Neoadjuvant Chemotherapy for Advanced Ovarian Cancer

Continued Uncertainty Regarding Hyperthermic Intraperitoneal Chemotherapy in Malignant Peritoneal Mesothelioma -- Markman 28 (24): e418 -- Journal of Clinical Oncology

Reply to M. Markman -- Ferrandina 28 (19): e321 -- Journal of Clinical Oncology

Markman:  Serious Ethical Dilemma of Single-Agent Pegylated Liposomal Doxorubicin Employed As a Control Arm in Ovarian Cancer Chemotherapy Trials -- Markman JCO commentary

  Ferrandina Response to Markman:

http://jco.ascopubs.org/cgi/content/full/28/19/e321?cmpid=jco_etoc_1July2010
"...Overall, I think that there will be no need for institutional review boards of community-based centers or universities to take up a formal position in this context. Indeed, I think that the more and more diffuse use in the clinical practice of PLD 40 mg/m² will be, in and by itself, stronger than any regulatory rules, and that the lower and safer PLD dose level will tacitly replace the US Food and Drug Administration–approved dosage in clinical trials.

Time has already come for this change: looking through the randomized clinical trials utilizing PLD as a control arm, we found that four (NCT00976911 [ClinicalTrials.gov] , NCT00913835 [ClinicalTrials.gov] , NCT00635193 [ClinicalTrials.gov] , NCT00657878 [ClinicalTrials.gov] ) of seven of the ongoing studies are already employing the PLD dosage of 40 mg/m² instead of 50 mg/m² (www.clinicaltrials.gov."

Serious Ethical Dilemma of Single-Agent Pegylated Liposomal Doxorubicin Employed As a Control Arm in Ovarian Cancer Chemotherapy Trials -- Markman JCO commentary

"...It is essential that those reading this letter do not misinterpret its meaning. There is absolutely no intent in this discussion to vilify any individual, organization, or company involved in the oncology drug development paradigm. It is unquestionably the case that all working in this arena have as their major goal the advancement of antineoplastic strategies that are effective, relatively safe, and that improve the survival and quality of life of patients with cancer.

The role of initial maximal surgical cytoreduction in ovarian cancer still debated Dr Maurie Markman Editorial

"Although the world of surgery is not necessarily characterized by the utility of innovative clinical hypotheses being formally evaluated through the conduct of randomized phase-3 clinical trials, it will hopefully be the case that the gynecologic cancer surgical community will see the wisdom of further exploration of these important concepts in prospective well-designed and evidence-based clinical trials.
Our current and future patients deserve no less."

Clinical Care Options - CME - Dr Maurie Markman updated CME March 3, 2010

Note: requires Password/Registration (free):

Oncology - Ovarian Cancer
Authors: Maurie Markman, MD
Date Released: October 01, 2009
Last Updated: March 03, 2010

Table of Contents

• Ovarian Cancer
  • Introduction
  • BRCA Mutations in Ovarian Cancer
  • Screening for Ovarian Cancer
  • Symptoms of Ovarian Cancer
  • Surgical Staging of Ovarian Cancer
  • Primary Surgical Cytoreduction in Ovarian Cancer
  • Interval Surgical Cytoreduction and Neoadjuvant Chemotherapy
  • Chemotherapy for High-Risk Early-Stage Ovarian Cancer
  • Primary Chemotherapy of Advanced Stage Ovarian Cancer
    • Intraperitoneal Chemotherapy of Small-Volume Residual Ovarian Cancer
    • Maintenance Therapy of Advanced Ovarian Cancer
  • Second-Line Therapy of Ovarian Cancer
  • Platinum-Sensitive vs Platinum-Resistant Recurrent Ovarian Cancer
  • Treatment of Platinum-Sensitive Recurrent Ovarian Cancer
  • Treatment of Platinum-Resistant Ovarian Cancer
  • Intermediate Platinum Sensitivity
  • Carboplatin Hypersensitivity Reactions
  • Other Management Options in Recurrent/Resistant Ovarian Cancer
  • Future Research Directions in Ovarian Cancer
  • Tables and Figures
  • References

Maurie Markman, MD, explains his passion for gynecologic cancer research | HemOncToday

excerpts from article:

"What is the best advice you’ve ever received?

My earliest mentor was my family physician/internist, who, unfortunately, died of pancreatic cancer many years ago. His advice was to make sure I approached the practice of medicine as a people’s doctor. There is nothing more rewarding than that. I took his advice very seriously and I certainly agree with it.

What would you consider one of your biggest successes in your specialty?

I’ve been involved in the development of a number of strategies, including the development of intraperitoneal therapy in ovarian cancer. However, I would argue the most important thing, which I think and hope I’ve done and continue to do, is to insist upon — for myself and others — viewing and thinking critically about everything we do as physicians. It’s crucial that we absolutely strive for and base our decisions on, as much as possible, solid, evidence-based medicine and phase-3, randomized trials. I believe to my core that the future of medicine has to be evidence-based?"