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.

Patterns of first recurrence following adjuvant intraperitoneal chemotherapy for stage IIIC ovarian cancer

blogger's note:

Table 2. Site of first recurrence.
Table 3. Pattern of first recurrence

"In conclusion, patients treated with adjuvant IP chemotherapy appear to have a different pattern of disease recurrence than patients treated with IV chemotherapy. The locations of these recurrences reflect the ability of IP chemotherapy to successfully eradicate disease within the anatomic regions of drug distribution.
Recurrent disease outside the abdominal cavity can be anticipated to occur more frequently in the current era of primary IP chemotherapy.
Further efforts should be aimed at improving IP distribution of chemotherapy to areas that may become disease sanctuaries."

Medical News: Group Issues Gyn Cancer Follow-Up Guidance - MedPage Today

For ovarian (epithelial)  cancer, the committee recommended:

• Physical exam and review of symptoms: Every three months for two years, followed by increasing intervals
• Pap test: Not indicated
• CA-125: Optional
• Radiographic imaging: Insufficient data to support routine use
• Suspected recurrence: CT and/or PET, plus CA-125

The recommendations differ for non-epithelial ovarian cancer:

• Physical exam and review of symptoms: Every two to four months for two years, then every six months or annually depending on histology
• Serum tumor markers: Every two to four months for two years, then every six months for sex-cord stromal tumors but no longer indicated for germ-cell tumors
• Radiographic imaging: Generally, not indicated or data lacking to support routine use
• Suspected recurrence: CT and tumor markers

Noting a trend toward transitioning more patients from oncologists to primary care physicians, the committee pointed to evidence that many primary care physicians do not feel comfortable with post-treatment surveillance, particularly during the first two years after treatment. (blogger's note: search blog for past papers on these issues, also the 2 years post treatment is based on old data)


Moreover, a survey of primary care providers showed that respondents believed transition of oncology patients could be improved with individualized patient summaries, guidelines for surveillance, and expedited referral for suspected recurrence, the committee members noted.

"Thus, the provision of up-to-date information and the education of both patients and physicians are mandatory," they wrote.

"Action Points

Point out that this report indicates that there is very little evidence that either routine cytologic procedures or imaging are sufficiently useful to detect ovarian and endometrial cancer recurrence and alter response rates to salvage therapy.

Note that this report suggests that the most effective method to detect recurrences is a taking a thorough history, performing a detailed physical examination, and educating patients about relevant symptoms."

SGO sets new standards to monitor recurrence of gynecologic cancer more effectively

"The article is “Post treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology recommendations: by Ritu Salani, MD, MBA; Floor J. Backes, MD; Michael Fung Kee Fung, MB, BS; Christine H. Holschneider, MD; Lynn P. Parker, MD; Robert E. Bristow, MD, MBA; and Barbara A. Goff, MD (doi: 10.1016/j.ajog.2011.03.008). It will appear in the American Journal of Obstetrics & Gynecology, Volume 204, Issue 6 (June 2011) published by Elsevier."

media item: New Clues to Treating Ovarian Cancer Relapse

New Clues to Treating Ovarian Cancer Relapse
Starting chemotherapy when first signs reappear not especially effective, study finds "This paper, the first randomized trial to look at the timing of chemo in women with recurring ovarian cancer, appears in the Oct. 2 issue of The Lancet, a special themed issue on cancer...."

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61268-8/abstract
SOURCES: Andrew Berchuck, M.D., director, division of gynecologic oncology, Duke University Medical Center, Durham, N.C.; Robert A. Burger, M.D., professor of surgical oncology, section of gynecologic oncology and director, Women's Cancer Center, Fox Chase Cancer Center, Philadelphia; Oct. 2, 2010, The Lancet

Chemotherapy Options in the Management of Platinum-Sensitive Recurrent Ovarian Cancer

Note: registration required to view (free) SPECIAL EDITION / EDUCATIONAL REVIEWS

ISSUE: AUGUST, 2010 | VOLUME: 05:08 Chemotherapy Options in the Management of Platinum-Sensitive Recurrent Ovarian Cancer

It's a choice to move forward: women's perceptions about treatment decision making in recurrent ovarian cancer

Abstract
OBJECTIVE: This research explores the treatment decision-making (TDM) experiences of women with recurrent ovarian cancer (ROC) with regard to treatment options; their understanding of risks and benefits of various treatment options; the decision-making role they want for themselves and for their oncologist; and the social context of the consultation as it pertains to the decision.
METHODS: We conducted semi-structured interviews with 26 women at the time of first recurrence. Through inductive data analysis key themes were identified.
RESULTS: Many women describe self-identifying the cancer recurrence fairly quickly due to new symptoms. Many feel that the goal for treating their recurrence is to control versus cure the cancer. They describe the subsequent process of diagnosis and TDM for ROC as quick and straightforward with all women accepting the oncologists' treatment recommendation. They feel that the type and number of treatment options are limited. They have a strong desire for physician continuity in their care. Participants feel that their doctor's recommendations as well as their previous experience with ovarian cancer are strong factors influencing their current TDM process.
CONCLUSIONS: Shared decision making is based on a simultaneous participation of both the physician and patient in TDM. When faced with ROC, women feel that their doctor's recommendation and their past experience with treatment and TDM are prominent factors influencing the current TDM process.

AJR Am J Roentgenol. 2010 Role of PET/CT in Ovarian Cancer

Abstract OBJECTIVE: The purpose of this article is to review the role of FDG PET/CT in ovarian cancer, which is the leading cause of death among gynecologic cancers. CONCLUSION: FDG PET/CT can significantly modify the assessment of the extent of primary and recurrent ovarian cancer and, hence, often alters patient management substantially. FDG PET/CT has thus become a critical tool for the preoperative evaluation of women with primary ovarian cancer and for postoperative follow-up assessment for evidence of recurrence in these patients.

Gyn Congress 2010 Webcast Case-based approaches Recurrence (4) additional presentations/free access

Session IV: Ovarian Cancer II: A Case-Based Approach to Recurrence

* Interactive clinical case: non surgical Management of platinum sensitive ovarian cancer
Andreas du Bois, MD

* Interactive clinical case: Considerations for the management of a partially platinum sensitive relapse (6-12 months)
Bradley J. Monk, MD

* Interactive clinical case: Management of platinum resistant/refractory ovarian cancer
Eric Pujade-Lauraine, MD, PhD

* Keynote Lecture: Changing standards of care: The role of CA125 in the management of Ovarian Cancer
Gordon J.S. Rustin, MD, FRCP