still recruiting: Acute Normovolemic Hemodilution in Patients Undergoing Cytoreductive Surgery for Advanced Ovarian Cancer - clinical trial

clinical trial - full text

The purpose of this study is to help us learn how to lower the risk of a blood transfusion during surgery to remove ovarian cancer. Acute normovolemic hemodilution (ANH) is a technique performed in the operating room before the procedure begins that may reduce the risk of needing a transfusion during ovarian cancer surgery......

Fungal Infections Associated with Contaminated Methylprednisolone Injections — Preliminary Report — NEJM

open access

"There has been no systematic surveillance in the United States for adverse events that occur after glucocorticoid injections for the treatment of chronic musculoskeletal pain, but infection is a known, although probably rare, risk documented in the medical literature.1-6 Infections that develop after a procedure are usually bacterial2,7-10; fungal infections are extremely rare.11-14 We present preliminary data on a multistate outbreak of fungal meningitis and other infections associated with injections of preservative-free methylprednisolone acetate that was purchased from a single compounding pharmacy and describe the initial public health response to the outbreak.....

Cardiac safety concerns for ondansetron, an antiemetic commonly used for nausea linked to cancer treatment and following anaesthesia, Expert Opinion on Drug Safety, Informa Healthcare

Drug Safety, Informa Healthcare

Modest benefit of total parenteral nutrition and chemotherapy after venting gastrostomy tube placement

Abstract

Highlights

► Median survival was 5.6 weeks following venting gastrostomy tube placement.
► Chemotherapy and TPN were associated with a modest survival benefit measured in weeks.
► More than half of women required gastrostomy tube revision due to complications.

paywalled: Summary of the 44th Annual Meeting on Women's Cancers

Abstract

Gynecologic Oncology

Volume 129, Issue 2, May 2013, Pages 273–276

Conference Report

Summary of the 44th Annual Meeting on Women's Cancers

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Figures and tables from this article:

Table 1. Select clinical trials.

C, cisplatin; P, paclitaxel; T, topotecan; B, bevacizumab; IV, intravenous; Ca, carboplatin; SOC, standard of care chemotherapy; IP, intraperitoneal; O, olaparib; I, irinotecan

Hypercalcemia in a child with juvenile granulosa cell tumor of ovary: Report of an unusual paraneoplastic syndrome and review of the literature

open access - case reports

Highlights

► Hypercalcemia is an extremely rare paraneoplastic syndrome in children.
► Small cell carcinoma is the commonest ovarian tumor associated with hypercalcemia.
► Small cell carcinoma must be ruled out because of poor prognosis.
► We report the only third case of JGCT associated with paraneoplastic hypercalcemia.

Low-molecular-weight or Unfractionated Heparin in Venous Thromboembolism: The Influence of Renal Function

Abstract

Conclusions

In comparison with low-molecular-weight heparin, initial therapy with unfractionated heparin was associated with a higher mortality and higher rate of fatal pulmonary embolism in patients with creatinine clearance levels >60 mL/min or <30 mL/min, but not in those with levels between 30 and 60 mL/min.

As Court (U.S.) Considers Gene Patents, Case May Overlook Relevant Issues - NYTimes.com

media

"The Supreme Court is poised to take up the highly charged question of whether human genes can be patented. But another question could trump it: Has the field of genetics moved so far so fast that whatever the court decides, it has come too late to the issue?

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The case, which will come before the court on Monday, involves patents held by Myriad Genetics on two human genes, which, when mutated, give a woman a high risk of getting breast or ovarian cancer. The patents give Myriad a monopoly on testing for these mutations, a highly lucrative business......

"....But while the debate continues, some experts say patents on human genes are actually fading in importance.

“Events on the ground have overtaken the law,” said Dr. James P. Evans, a professor of genetics and medicine at the University of North Carolina. He said the impact of the Supreme Court’s decision “will be much more ideological than it will be practical.” For one thing, the Myriad patents at issue are due to expire over the next two years."....

Reviews on Cancer - Human height genes and cancer

 Blogger's Note: past research has implicated height/risk of ovarian cancer eg. "normal, body-plan master genes" but obviously it is not the only criteria for risk-based analyses

Abstract

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Body development requires the ability to control cell proliferation and metabolism, together with selective ‘invasive’ cell migration for organogenesis. These requirements are shared with cancer. Human height-associated loci have been recently identified by genome-wide SNP-association studies. Strikingly, most of the more than 100 genes found associated to height appear linked to neoplastic growth, and impose a higher risk for cancer. Height-associated genes drive the HH/PTCH and BMP/TGFβ pathways, with p53, c-Myc, ERα, HNF4A and SMADs as central network nodes. Genetic analysis of body-size-affecting diseases and evidence from genetically-modified animals support this model. The finding that cancer is deeply linked to normal, body-plan master genes may profoundly affect current paradigms on tumor development.

Patterns of chemotherapy treatment for women with invasive epithelial ovarian cancer – A population-based study

Abstract

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Highlights

► Medical records of all Australian women with ovarian cancer in 2005 were abstracted.
► Older women, those with high-grade/low-stage or mucinous cancers had less chemotherapy.
► Only 32% completed 6 cycles of carboplatin/paclitaxel without dose reduction/delay.

Objective

Ovarian cancer five-year survival is poor at < 40%. In the absence of effective screening or new treatments, ensuring all women receive optimal treatment is one avenue to improve survival. There is little population-based information regarding the primary chemotherapy treatment that women with epithelial ovarian cancer receive. This information is essential to identify potential gaps in care.

Methods

Cancer registries identified all women diagnosed with invasive epithelial ovarian cancer in Australia in 2005 (n = 1192). Histopathology, chemotherapy and comorbidity information was abstracted from medical records. Multivariable logistic regression was used to identify factors associated with chemotherapy commencement, regimen, and completion.

Results

Women > 70 years (p < 0.0001), those with high-grade, stage IA/IB cancers (vs. stages IC–IV, p = 0.003) and those with mucinous cancers (p = 0.0002) were less likely to start chemotherapy. Most treated women received platinum-based drugs (97%), but only 68% received combination carboplatin–paclitaxel and only half completed six cycles without treatment modification/delay. Approximately 19% received single-agent carboplatin: mostly those aged > 70 (p < 0.0001) and/or with co-morbidities (p < 0.0001). Age was the strongest predictor of completing six cycles of combination therapy.

Conclusions

For specific patient groups, particularly older women, there is notable variation from standard treatment. Understanding how treatment variations affect survival and determining optimal regimens for these groups are research priorities.

Analysis of secondary cytoreduction for recurrent ovarian cancer by robotics, laparoscopy and laparotomy

Abstract

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Highlights

► Minimally invasive surgery should be considered for secondary cytoreduction in selected patients with recurrent ovarian cancer.
► Perioperative and survival outcomes are similar for laparoscopy and robotics.
► Blood loss and hospital stay are improved as compared to laparotomy.

Objective

Analysis of perioperative outcomes and survival of patients with recurrent ovarian cancer undergoing secondary cytoreduction by robotics, laparoscopy, or laparotomy.

Methods

Retrospective analysis of 52 selected patients with recurrent ovarian cancer undergoing secondary cytoreduction by laparoscopy (9), laparotomy (33) or robotics (10) between January 2006 and December 2010. Comparison was made by a total of 21 factors including age, BMI, number of previous surgeries, tumor type and grade, number of procedures, and 15 types of procedures performed at secondary cytoreduction.

Results

For all patients, the mean operating time was 213.8 min, mean blood loss 657.4 ml; and mean hospital stay 7.5 days. Complete debulking was achieved in 75% of patients. Postoperative complications were noted in 36.5% of patients. Overall and progression-free survival at 3-years were 58.8% and 34.1%, respectively. Laparoscopy and robotics had reduced blood loss and hospital stay, while no differences were observed among the three groups for operating time, complications, complete debulking, and survival.

Conclusion

Selected patients with recurrent ovarian cancer benefit from a laparoscopic or robotic secondary cytoreduction without compromising survival. Robotics and laparoscopy provide similar perioperative outcomes, and reduced blood loss and shorter hospital stay as compared to laparotomy. Laparotomy seems preferable for patients with widespread peritoneal implants, multiple sites of recurrence, and/or extensive adhesions.

Prevalence and incidence of comorbidities in elderly women with ovarian cancer

Abstract

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Highlights

► Comorbidities were common among elderly U.S. women with or without ovarian cancer.
► The incidence of most comorbidities was higher in cancer than cancer-free patients.

Objective

Studies suggest comorbidity plays an important role in ovarian cancer. We characterized the epidemiology of comorbid conditions in elderly U.S. women with ovarian cancer.

Methods

Women with ovarian cancer age ≥ 66 years, and matched cancer-free women, were identified using the National Cancer Institute's Surveillance, Epidemiology, and End Results registry linked to Medicare claims. Prevalence before diagnosis/index date and 3- and 12-month incidence rates (per 1000 person-years) after diagnosis/index date were estimated for 34 chronic and acute conditions across a broad range of diagnostic categories.

Results

There were 5087 each of women with ovarian cancer and cancer-free women. The prevalence of most conditions was similar between cancer and cancer-free patients, but exceptions included hypertension (51.8% and 43.5%, respectively), osteoarthritis (13.4% and 17.3%, respectively), and cerebrovascular disease (8.0% and 9.8%, respectively). In contrast, 3- and 12-month incidence rates (per 1000 person years) of most conditions were significantly higher in cancer than in cancer-free patients: hypertension (177.3 and 47.4, respectively); thromboembolic event (145.3 and 5.5, respectively); congestive heart failure (113.3 and 28.6, respectively); infection (664.4 and 55.2, respectively); and anemia (408.3 and 33.1, respectively) at 12 months.

Conclusions

Comorbidities were common among elderly women. After cancer diagnosis, women with ovarian cancer had a much higher incidence of comorbidities than cancer-free women. The high incidence of some of these comorbidities may be related to the cancer or its treatment, but others may have been prevalent but undiagnosed until the cancer diagnosis. The presence of comorbidities may affect treatment decisions.

Obesity-associated adipokines correlate with survival in epithelial ovarian cancer

Abstract

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Highlights

► We predict that the leptin to adiponectin (L:A) ratio correlates with survival in ovarian cancer.
► We retrospectively evaluated the association between serum L:A ratio and survival.
► A high L:A ratio correlated with poor clinical outcome, but did not independently predict survival.

Objectives

Obesity impacts outcome in women with epithelial ovarian cancer (EOC), although its exact role and the molecular mechanisms remain poorly defined. Adipocytes secrete leptin and adiponectin, and the leptin to adiponectin (L:A) ratio is correlated with poor survival in other malignancies. We hypothesized that the L:A ratio is associated with survival in women with EOC.

Methods

We queried the institutional tumor registry for patients with advanced stage EOC and identified a cohort of 161 women with banked fasting prediagnostic serum samples. Patients underwent cytoredutive surgery followed by platinum-based chemotherapy. Sera were assayed for leptin and adiponectin, and clinico-pathologic data were abstracted. Standard statistical tests were performed.

HOXB8 expression in ovarian serous carcinoma effusions is associated with shorter survival

Abstract

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Highlights

► HOXB5 and HOXB8 are differentially expressed at various anatomic sites in serous ovarian carcinoma.
► HOXB5 expression is higher in post-chemotherapy disease recurrence effusions compared to pre-chemotherapy primary diagnosis effusions.
► Higher HOXB8 expression in effusions is associated with shorter overall and progression-free survival in serous ovarian carcinoma.

Objective

HOX proteins are key transcription factors in embryogenesis. HOXB5 and HOXB8 were previously shown to be overexpressed in ovarian/primary peritoneal serous carcinoma compared to breast carcinoma using gene expression arrays. The present study investigated the clinical role of HOXB5 and HOXB8 in advanced-stage (FIGO III–IV) ovarian serous carcinoma.

In vitro fertilization is associated with an increased risk of borderline ovarian tumours

Abstract

Highlights

► We examined the risk of borderline ovarian tumours in a cohort of women undergoing infertility treatment.
► Women having IVF had 2.5 times the risk of borderline tumours compared with women having infertility treatment but not IVF.
► In contrast to invasive epithelial ovarian cancer, neither birth nor hysterectomy nor sterilization appeared protective.

Objectives

To compare the risk of borderline ovarian tumours in women having in vitro fertilization (IVF) with women diagnosed with infertility but not having IVF.

Methods

This was a whole-population cohort study of women aged 20–44 years seeking hospital infertility treatment or investigation in Western Australia in 1982–2002. Using Cox regression, we examined the effects of IVF treatment and potential confounders on the rate of borderline ovarian tumours. Potential confounders included parity, age, calendar year, socio-economic status, infertility diagnoses including pelvic inflammatory disorders and endometriosis and surgical procedures including hysterectomy and tubal ligation.

Results

Women undergoing IVF had an increased rate of borderline ovarian tumours with a hazard ratio (HR) of 2.46 (95% confidence interval [CI] 1.20–5.04). Unlike invasive epithelial ovarian cancer, neither birth (HR 0.89; 95% CI 0.43–1.88) nor hysterectomy (1.02; 0.24–4.37) nor sterilization (1.48; 0.63–3.48) appeared protective and the rate was not increased in women with a diagnosis of endometriosis (HR 0.31; 95% CI 0.04–2.29).

Conclusions

Women undergoing IVF treatment are at increased risk of being diagnosed with borderline ovarian tumours. Risk factors for borderline ovarian tumours appear different from those for invasive ovarian cancer.

A comparison between an ultrasound based prediction model (LR2) and the Risk of Ovarian Malignancy Algorithm (ROMA) to assess the risk of malignancy in women with an adnexal mass

Abstract

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Highlights

► Improved preoperative discrimination of adnexal masses of LR2 over ROMA
 ► ROMA showed less utility to detect cancer in premenopausal patients compared to LR2.
► LR2 missed fewer borderline tumors and early stage invasive cancers than ROMA.

Objective

The identification of novel biomarkers led to the development of the ROMA algorithm incorporating both HE4 and CA125 to predict malignancy in women with a pelvic mass. An ultrasound based prediction model (LR2) developed by the International Ovarian Tumor Analysis (IOTA) study offers better diagnostic performance than CA125 alone. In this study we compared the diagnostic accuracy between LR2 and ROMA.

Methods

This study included women with a pelvic mass scheduled for surgery and enrolled in a previous prospective diagnostic accuracy study. Experienced ultrasound examiners, general gynecologists and trainees supervised by one of the experts performed the preoperative transvaginal ultrasound examinations. Serum biomarkers were taken prior to surgery. Accuracy of LR2 and ROMA was estimated at completion of this study and did not form part of the decision making process. Final outcome was histology of removed tissues and surgical stage if relevant.

Results

In total 360 women were evaluated. 216 women had benign disease and 144 a malignancy. Overall test performance of LR2 (AUC 0.952) with 94% sensitivity and 82% specificity was significantly better than ROMA (AUC 0.893) with 84% sensitivity and 80% specificity. Difference in AUC was 0.059 (95% CI: 0.026–0.091; P-value 0.0004). Similar results were obtained when stratified for menopausal status.

Conclusion

LR2 shows a better diagnostic performance than ROMA for the characterization of a pelvic mass in both pre- and postmenopausal women. These findings suggest that HE4 and CA125 may not play an important role in the diagnosis of ovarian cancer if good quality ultrasonography is available.

Preclinical evaluation of statins as a treatment for ovarian cancer

Abstract

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Highlights

► Continuous and prolonged exposure to simvastatin is required for ovarian cancer cell cytotoxicity.
► Exposure of cells to simvastatin prior to carboplatin is profoundly antagonistic.
► Statins exert conflicting effects on the autophagy pathway.

Objective

To evaluate the potential for statins to treat ovarian cancer.

Methods

The sensitivity of 7 ovarian cancer cell lines to either statins or statins combined with either carboplatin or paclitaxel was assessed using monolayer cultures. Sensitivity to simvastatin was also evaluated in ovarian cancer spheroids. The kinetics of cell death induced by simvastatin was evaluated by measuring Trypan Blue exclusion. Autophagy induced by simvastatin was assessed by measuring LC3-II, p62 or Rab7 by immunoblotting or immunocytochemistry.

Results

All statins except pravastatin demonstrated single agent activity against monolayers (IC₅₀ = 1–35 μM) and spheroids (IC₅₀ = 1–13 μM). This was mediated by HMG-CoAR inhibition, because either mevalonate or geranylgeraniol prevented the cytotoxic effects of simvastatin. Continuous exposure for 4 days was necessary to cause cell death. Simvastatin caused accumulation of p62 but loss of Rab7, suggesting inhibition of autophagosome trafficking. Accumulation of LC3-II was also observed, even in the presence of bafilomycin, suggesting additional stimulation of an earlier step in autophagy. Knockdown of the key autophagy regulator Atg5 caused a modest increase in the sensitivity of Ovcar-8 cells to simvastatin. Finally, additive or mild antagonist effects were observed when simvastatin was combined simultaneously with either carboplatin or paclitaxel, but when cells were exposed to simvastatin prior to carboplatin, profound antagonism was observed.

Conclusions

These observations suggest that clinical trials of statins in ovarian cancer should evaluate high doses and schedules that ensure continual inhibition of HMG-CoAR. Simvastatin has conflicting effects on the autophagy pathway and this may contribute to its cytotoxic activity.

A Randomized Phase II Trial of Maintenance Therapy with Sorafenib in Front-line Ovarian Carcinoma

Abstract

Highlights

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Results are presented for a phase II study of maintenance therapy with sorafenib in the treatment of OC.

•

Median PFS was not significantly superior for sorafenib compared with placebo.

•

Discontinuations due to AEs were more frequent with sorafenib which likely impacted assessment of efficacy.

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Background

Sorafenib, an oral multikinase inhibitor of the VEGFR/PDGFR/ Raf/MEK/ERK pathway, has shown potential activity in patients with recurrent ovarian cancer (OC). One strategy to prolong disease control and survival in patients with OC is maintenance therapy after achieving a complete response. A double-blind, randomized, placebo-controlled, phase II study to assess the efficacy and safety of maintenance therapy with sorafenib in the treatment of OC is presented.

Methods

Patients with epithelial OC or primary peritoneal cancer in complete remission were randomized to sorafenib 400 mg BID or matching placebo. The primary endpoint was progression-free survival (PFS).

Timing of end-of-life care discussion with performance on end-of-life quality indicators in ovarian cancer

Abstract
 

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Discussion of end-of-life care occurred late in the disease process and during hospital admissions in ovarian cancer patients.

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Earlier end-of-life discussions are associated with better quality of cancer care.

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Objectives

(1) To describe the prevalence, timing and setting of documented end-of-life (EOL) discussions in patients with advanced ovarian cancer; and (2) To assess the impact of timing and setting of documented end-of-life discussions on EOL quality care measures.

Primary invasive mucinous ovarian carcinoma of the intestinal type: Importance of the expansile versus infiltrative type in predicting recurrence and lymph node metastases

Abstract

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Aims

Investigate the role of expansile versus infiltrative type of primary invasive intestinal type mucinous epithelial ovarian carcinoma (mEOC) in predicting recurrence and lymph node metastases.

Four Reasons Doctors Worry About Social Media - #GetOverIt - Forbes

Forbes

Class III β-Tubulin Overexpression in Ovarian Clear Cell and Serous Carcinoma as a Marker for Poor Overall Survival after Platinum/Taxane Chemotherapy and Sensitivity to Patupilone

Abstract

Objectives

Clear cell carcinoma of the ovary (OCCC) is a distinct subtype of epithelial cancer associated with chemoresistance and poor outcome compared to serous papillary carcinomas (OSPC). Resistance to paclitaxel has been linked to overexpression of class III β-tubulin in several human cancers but inadequately characterized among OCCC. Chemoresistance has also been variably linked to the drug efflux pump p-glycoprotein. Epothilones are microtubule-stabilizing agents with putative activity in paclitaxel-resistant malignancies. In this study, we clarify the relationship between class III β-tubulin and p-glycoprotein expression in OCCC, clinical outcome, and in vitro responsiveness to patupilone and paclitaxel.

Bereaved relatives’ perspectives of the patient’s oral intake towards the end of life A qualitative study

Abstract

Background: Patients approaching death often have a decreasing oral intake, which can be distressing for relatives. Little is known about the relatives’ experiences with and perceptions of oral intake at the end of life.

Aim: This study aims to contribute to a more thorough understanding of relatives’ concerns regarding decreased oral intake of the patient at the end of life.

(ovarian cancer) Signs of post-traumatic stress disorder in caregivers following an expected death: A qualitative study

Abstract

Background: Complications of grief are an important area of investigation with potential to improve the well-being of palliative care caregivers. There has been little study of the prevalence or significance of post-traumatic stress disorder for those bereaved after an expected death.

Aim:
To identify evidence suggestive of post-traumatic stress disorder symptoms in a population of bereaved caregivers of patients who have died of ovarian cancer.

Case Reports - Vertebral artery dissection and cerebral infarction in a patient with recurrent ovarian cancer receiving bevacizumab

open access/case report