OVARIAN CANCER and US

Friday, September 28, 2012

Canadian Health Reference Guide: Average Canadian family paying more than $11,000 per year for public health care insurance Fraser Institute

Prognostic Significance of Rising Serum CA-125 Levels Within the Normal Range in Patients With Epithelial Ovarian, Primary Peritoneal, and Tubal Cancers, Who, After Initial Treatment, Had a Complete Clinical Response

Objective: This study aimed to assess the ability of 3 criteria of rising CA-125 levels within the reference range to predict recurrence in patients with ovarian, primary peritoneal, and tubal carcinomas after complete clinical response to initial treatment.
Material and Methods: Included were patients diagnosed during 1998 to 2008 who fulfilled the following criteria: CA-125 levels of 35 U/mL or greater at diagnosis and recurrence, full primary treatment with a complete clinical and radiographic response, follow-up according to schedule, and at least 2 CA-125 results within the reference range during follow-up. Three criteria of rising CA-125 values within the reference range were used for the prediction of recurrence: (1) an absolute increase of 5 U/mL or higher from the nadir value at completion of chemotherapy, (2) early signal of progressive disease criterion, and (3) a rise to an absolute level of 20 U/mL or greater.
Results: Of 82 patients who satisfied study inclusion criteria, 58 (70.7%) had disease recurrence. Early signal of progressive disease and a rise to an absolute level of 20 U/mL or greater were highly statistically significant predictors of disease recurrence (odds ratio, 12.62 [95% confidence interval, 2.71–58.7], P = 0.0012; and odds ratio, 6.7 [95% confidence interval, 2.18–20.54], P = 0.001, respectively) and preceded recurrence by a median of 3 and 3.3 months, respectively.
Conclusions: Our data indicate that the early signal of progressive disease criterion and a single rise to an absolute level of 20 U/mL or greater within reference limits are highly predictive of clinical recurrence, although the latter is simpler to use. However, whether this is of practical clinical value remains to be proven.

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Preoperative Identification of Synchronous Ovarian and Endometrial Cancers: The Importance of Appropriate Workup

Objective: For treatment of patients with both endometrial and ovarian cancer, it is important to discriminate between 2 primary tumors and metastatic disease. Currently, criteria are based on postoperative findings. The aim of this study was to determine whether clinical parameters can discriminate between these groups preoperatively and whether a practical guideline could improve appropriate workup and treatment.
Methods: A total of 45 patients with a diagnosis of both endometrium and ovarian cancer between 1998 and 2009 and were included for analysis. Clinical and pathological data were obtained, and initial CA-125 was registered; patients had a diagnosis of 2 primary tumors or tumors with metastasis. All patients were reclassified according to workup and treatment.
Results: Patients with synchronous primary tumors were significantly younger, presented more often with abnormal uterine bleeding, and had a lower initial CA-125 than both metastatic groups (P < 0.05). With age and CA-125 included in a polytomic logistic regression model, 83.3% of diagnoses could be classified correctly. In 15 of 17 patients presented with adnexal mass, workup was incomplete owing to lack on information of the endometrial status. In patients presenting with abnormal uterine bleeding, 13 of 21 patients had an incomplete workup leading to staging laparotomy secondary to initial surgical treatment in 2 patients.
Conclusions: Patients with synchronous endometrial and ovarian cancers are young, often present with abnormal uterine bleeding and have a low initial CA-125. Adequate workup with attention to both ovarian and endometrial status, especially in young patients with a wish to preserve fertility, is important to make the right decision for treatment.

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A case series of low dose bevacizumab and chemotherapy in heavily pretreated patients with epithelial ovarian cancer

Abstract

Background

The addition of bevacizumab to standard chemotherapy prolongs progression free survival in the first line treatment of epithelial
ovarian cancer (EOC), but its cost/effectiveness is debated. We assessed the safety and activity of a lower dose of bevacizumab
in pretreated advanced stage EOC.

Methods

We treated 15 patients, mostly with platinum resistant EOC, who had received a median of four prior cytotoxic regimens, with
bevacizumab 5–7.5 mg/kg q21 days in combination with either carboplatin (n = 8), oral cyclofosfamide (n = 5) or weekly paclitaxel
(n = 2). Bevacizumab was administered until disease progression. Tumor response was assessed by CA125 and fusion ¹⁸ F-FDG PET/contrast enhanced CT.

Results

The median number of bevacizumab cycles was 21 (range 3–59). The median baseline CA125 was 272 U/ml and decreased to 15.2
U/ml at nadir. Tumor response was 4 complete response (CR) (26.7%) and 7 partial response (PR) (46.7%) by chemotherapy (CT),
with an overall response rate of 73.4% (95% CI, 51.0 – 95.8) according to Response Evaluation Criteria In Solid Tumors (RECIST),
and 6 CR (40%) and 4 PR (26.7%) by PET, for an overall metabolic response rate of 67% (95%CI, 42.8 – 90.6) according to PET
Response Criteria in Solid Tumors (PERCIST). Median progression free survival (PFS) was 21 months and median overall survival
(OS) was 24 months. Grade 3 adverse events related to bevacizumab were hypertension (n = 2), proteinuria (n = 1) and epistaxis
(n = 5). Treatment was delayed in five patients for nasal bleeding or uncontrolled hypertension.

Conclusions

Low-dose bevacizumab and chemotherapy was well tolerated and active in a heavily pretreated population of advanced EOC. Further
studies should assess the activity of low dose bevacizumab in EOC.

Content Type Journal Article
Category Research
Pages 1-7
DOI 10.1186/1757-2215-5-17
Authors
- Defferrari Carlotta, Unit of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa, Italy
- Campora Sara, Unit of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa, Italy
- D'Amico Mauro, Unit of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa, Italy
- Piccardo Arnoldo, Nuclear Medicine, E.O. Ospedali Galliera, Genoa, Italy
- Biscaldi Ennio, Radiology, E.O. Ospedali Galliera, Genoa, Italy

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SGI-110 in Combination With Carboplatin in Ovarian Cancer - Full Text View - ClinicalTrials.gov

A 2-part, Phase 1-2 controlled, open-label, randomized study in patients with platinum-resistant recurrent ovarian cancer. In Part 1, patients will receive SGI-110 and carboplatin. The optimum dose will be identified in Part 1 based on safety and efficacy. In Part 2, patients will be randomized to receive the dose identified in Part 1 plus carboplatin or one of three treatment of choice at the discretion of the investigator. The treatment of choice consists of topotecan, pegylated liposomal doxorubicin, or paclitaxel.

http://clinicaltrials.gov/ct2/show/NCT01696032?term=ovarian+cancer&recr=Open&lup_s=08%2F29%2F2012&lup_d=30

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Survival improving for gynaecological cancers | Oncology Update

http://www.oncologyupdate.com.au/latest-news/survival-improving-for-gynaecological-cancers

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JCO - Progress Against Solid Tumors in Danger: The Metastatic Breast Cancer Example

http://m.jco.ascopubs.org/content/30/28/3444.short?rss=1

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Sunnybrook case raises question of who decides life support - thestar.com (Toronto)

http://m.thestar.com/news/gta/article/1264124--sunnybrook-case-raises-question-of-who-decides-life-support

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Repairing Pelvic Organ Prolapse: What's Best? (mobile format)

http://www.medscape.com/viewarticle/761692?source=govdelivery

Also from FDA:

"FDA's review indicates that urogynecologic surgical mesh products are associated with serious adverse events, including mesh erosion through the vaginal wall. This complication can require multiple surgeries to repair, and sometimes the mesh cannot be completely removed, which leads to continued symptoms."

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UNMCC to investigate R-ketorolac use against ovarian cancer cells

http://www.news-medical.net/news/20120928/UNMCC-to-investigate-R-ketorolac-use-against-ovarian-cancer-cells.aspx

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What is Cancer?

The prognosis of cancer patients is most influenced by the type of cancer, as well as the stage, or extent of the disease. In addition, histologic grading and the presence of specific molecular markers can also be useful in establishing prognosis, as well as in determining individual treatments.

Siddhartha Mukherjee: explaining cancer

Just who is Siddhartha Mukherjee? This is the question many veterans of the cancer community asked as a book by this unknown author began to win critical accolades and prizes last year, including the Pulitzer Prize for non-Fiction and the Guardian First Book Award, earning Mukherjee a place among TIME magazine's 100 most influential people.

Less than two years since publication, The Emperor of All Maladies: A Biography of Cancer has sold between half a million and a million copies, is being translated into 20 languages, and continues to generate around 50 emails to the author a day. "I was completely overwhelmed by the generosity of the response," says Mukherjee, currently a practising oncologist specialising in haematological cancers at the Columbia University Medical Center in New York City. "By the size of it, by how diverse it is, by how diffuse it is. From students and general lay readers who said 'I was never interested in this question till I read the book,' to scientists at the National Institutes of Health who write thanking me for providing an overview. Different people come at it in different ways. For some people it gives them solace, for some it activates them. Young men and women write and say 'I now want to be a scientist, a cancer researcher'. This happens literally every day." His celebrity status is such that he was even approached by a group of students while on a trip with his kids to Disneyland.

Reading Mukherjee's own biographical notes will tell you that he reached his current position as assistant professor of medicine at Columbia University, in charge of a translational research lab at the University's Irving Cancer Research Center, through an academic research route, with the clinical practice coming only later. Born and educated in New Delhi, India, he went on to major in biology at Stanford University, California, where he worked in Nobel Laureate Paul Berg's laboratory defining cellular genes that change the behaviours of cancer cells. A Rhodes Scholarship took him to Oxford, where he earned a DPhil in immunology. Only then did he train as an MD at Harvard Medical School, where he completed his residency in internal medicine followed by an oncology fellowship at Massachusetts General Hospital.

His research focuses on the links between normal stem cells and cancer cells, specifically probing the microenvironment of stem cells – particularly blood-forming stem cells. It has attracted grants from many sources including a coveted Challenge Grant from the National Institutes for Health, and generated papers published in journals including Nature, Neuron and the Journal of Clinical Investigation.

Mukherjee, then, could be summed up as one of the new generation of translational researchers who is exploring one of many interesting avenues that may offer new opportunities for intervening in processes that generate and fuel certain types of cancer growth.

None of this, however, offers a clue as to why he ended up b...

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Catalysts to withdrawal from familial ovarian cancer screening for surgery and reactions to discontinued screening: a qualitative study.

Catalysts to withdrawal from familial ovarian cancer screening for surgery and reactions to discontinued screening: a qualitative study.

Fam Cancer. 2012 Sep 27;

Authors: Lifford KJ, Clements A, Fraser L, Lancastle D, Brain K

Abstract

Women at high risk of familial ovarian cancer face a potentially difficult risk management choice between unproven ovarian cancer screening (OCS) and bilateral salpingo-oophorectomy (BSO). It is not fully understood why women who initially opt for OCS may later undergo BSO, nor what the impact of this may be. This study explored the catalysts for surgery and reactions to discontinuing OCS. Semi-structured interviews were completed with 21 women who had undergone surgery having initially chosen OCS to explore their screening experiences, reasons for and feelings about surgery, and reactions to discontinuing OCS. The invasive nature and frequency of OCS were not by themselves a catalyst for surgery. A number of catalysts, including abnormal OCS test results, and secondary considerations, such as age-related factors, were found to prompt surgery. The emotional impact of discontinuing OCS following BSO varied between relief, acceptance, and loss of reassurance. OCS appears to be an acceptable risk management strategy under certain circumstances, but varying factors can prompt the decision to opt instead for BSO. The complexity of this management change decision should not be underestimated and needs to be taken into account by clinicians assisting women making choices. These findings highlight the importance of the timing of decision-making about BSO and that risk management options need routine reconsideration, through clinical discussions, information and support.

PMID: 23014947 [PubMed - as supplied by publisher]

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Thursday, September 27, 2012

Endometriosis and Infertility – a consensus statement from ACCEPT (Australasian CREI Consensus Expert Panel on Trial evidence)

Endometriosis and Infertility – a consensus statement from ACCEPT (Australasian CREI Consensus Expert Panel on Trial evidence):

Endometriosis is common in women with infertility but its management is controversial and varied. This article summarises the consensus developed by a group of Australasian subspecialists in reproductive endocrinology and infertility (the Australasian CREI Consensus Expert Panel on Trial evidence group) on the evidence concerning the management of endometriosis in infertility. Endometriosis impairs fertility by causing a local inflammatory state, inducing progesterone resistance, impairing oocyte release and reducing sperm and embryo transport. Medical treatments have a limited role, whereas surgical and assisted reproductive treatments improve pregnancy rates. The role of surgery for deep infiltrative endometriosis and repeat surgery requires further evaluation and there is insufficient evidence for the use of anti-adhesives to improve fertility. Intrauterine insemination (IUI) and in vitro fertilisation (IVF) improve pregnancy rates but women with endometriosis have lower pregnancy rates than those with other causes of infertility. The decision about whether to operate or pursue assisted reproduction will depend on a variety of factors such as the patient's symptoms, the presence of complex masses on ultrasound, ovarian reserve and ovarian access for IVF, risk of surgery and cost. Some women with infertility and endometriosis may benefit from a combination of assisted reproduction and surgery.

Open Surgery Tied to Small-Bowel Obstruction Risk : GIHN

Open Surgery Tied to Small-Bowel Obstruction Risk : GIHN

"...... Still, laparoscopic surgery did not seem to reduce the incidence of SBO in some groups, including hysterectomy patients. "One hypothesis is that this result may be related to a limited dissection in the pelvis," but the small number of laparoscopic hysterectomy patients included in the study could have affected the study’s results, the authors wrote.......

Open Surgery Tied to Small-Bowel Obstruction Risk : GIHN

Effectiveness of Multidimensional Cancer Survivor Rehabilitation and Cost-Effectiveness of Cancer Rehabilitation in General: A Systematic Review

Conclusions. The evidence for multidimensional interventions and the economic impact of rehabilitation studies is scarce and dominated by breast cancer studies. Studies published so far report statistically significant benefits for multidimensional interventions over usual care, most notably for the outcomes fatigue and physical functioning. An additional benefit of multidimensional over monodimensional rehabilitation was not found, but this was also sparsely reported on. Available economic evaluations assessed very different rehabilitation interventions. Yet, despite low comparability, all showed favorable cost-effectiveness ratios. Future studies should focus their designs on the comparative effectiveness and cost-effectiveness of multidimensional programs.

BRCA mutation frequency and patterns of treatment response in BRCA mutation-positive women with ovarian cancer: a report from the Australian Ovarian Cancer Study Group.

BRCA mutation frequency and patterns of treatment response in BRCA mutation-positive women with ovarian cancer: a report from the Australian Ovarian Cancer Study Group.:

BRCA mutation frequency and patterns of treatment response in BRCA mutation-positive women with ovarian cancer: a report from the Australian Ovarian Cancer Study Group.

Abstract
PURPOSE: The frequency of BRCA1 and BRCA2 germ-line mutations in women with ovarian cancer is unclear; reports vary from 3% to 27%. The impact of germ-line mutation on response requires further investigation to understand its impact on treatment planning and clinical trial design.
PATIENTS AND METHODS: Women with nonmucinous ovarian carcinoma (n = 1,001) enrolled onto a population-based, case-control study were screened for point mutations and large deletions in both genes. Survival outcomes and responses to multiple lines of chemotherapy were assessed.
RESULTS: Germ-line mutations were found in 14.1% of patients overall, including 16.6% of serous cancer patients (high-grade serous, 22.6%); 44% had no reported family history of breast or ovarian cancer. Patients carrying germ-line mutations had improved rates of progression-free and overall survival. In the relapse setting, patients carrying mutations more frequently responded to both platin- and nonplatin-based regimens than mutation-negative patients, even in patients with early relapse after primary treatment. Mutation-negative patients who responded to multiple cycles of platin-based treatment were more likely to carry somatic BRCA1/2 mutations.
CONCLUSION: BRCA mutation status has a major influence on survival in ovarian cancer patients and should be an additional stratification factor in clinical trials. Treatment outcomes in BRCA1/2 carriers challenge conventional definitions of platin resistance, and mutation status may be able to contribute to decision making and systemic therapy selection in the relapse setting. Our data, together with the advent of poly(ADP-ribose) polymerase inhibitor trials, supports the recommendation that germ-line BRCA1/2 testing should be offered to all women diagnosed with nonmucinous, ovarian carcinoma, regardless of family history.

PMID: 22711857 [PubMed - indexed for MEDLINE]

Cancer genomics and pathology: All Together Now

Cancer genomics and pathology: All Together Now:

Cancer develops from a single cell with stepwise accumulation of genomic alterations. Recent innovative sequencing technologies have made it possible to sequence the full cancer genome. Cancer genome sequencing has been productive and helpful in the discovery of novel cancer genes. It also has revealed previously unknown but intriguing features of the cancer genome such as chromothripsis and kataegis. However, careful comparison of these studies has suggested that analyses of most tumors still seem to be incomplete, and histopathological diagnosis/classification will be essential for refining these data. Based on the improvement of technology and the completion of the cancer gene catalog, genetic diagnosis, such as examination of all potentially druggable mutations, of individual cancers will be performed routinely together with histological diagnosis. Pathologists will play a central role in both interpreting these patho-molecular diagnoses for oncologists, and the process of decision-making necessary for individualized medicine.

Evaluation Of A Screening Tool For Ovarian Cancer That Checks For 6 Warning Signs

open access: Development of an instrument to identify symptoms potentially indicative of ovarian cancer in a primary care clinic setting

OJOG_Medicine & Healthcare_Journal_SCIRP

OJOG>Vol.2 No.3, September 2012

OPEN ACCESS

Development of an instrument to identify symptoms potentially indicative of ovarian cancer in a primary care clinic setting

Full Text

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see included tables such as:

Table 1. Patient characteristics. (age etc...)
Table 3. Relationship between patient characteristics and results of the symptom index in women who reported “current” symptoms