conference notice: Prevention and Early Detection of Ovarian Cancer -- NY - May 2013

Memorial Sloan-Kettering Cancer Center and Johns Hopkins University present 4th Annual Ovarian Cancer Symposium
Prevention and Early Detection of Ovarian Cancer
May 13-14, 2013

Prevention and Early Detection of Ovarian Cancer

CME

The past decade has seen rapid growth of research into the prevention and early detection of ovarian cancer. Screening studies have been met with mixed results and the newly identified putative precursor lesions within the distal fallopian tube have become well accepted. This conference is an outreach of the Department of Defense-sponsored ovarian cancer research consortium on early molecular changes associated with disease. This symposium will bring together leading researchers to discuss progress made toward prevention and early detection of ovarian cancer. Only through understanding the origins of ovarian cancer is progress likely to be made in these important areas.

Learning Objectives

Upon conclusion of this program, participants should be able to:

1. Understand the current molecular approaches to prevention and early detection of ovarian cancer
2. Obtain an update on the latest molecular findings implicating the distal fallopian tube as the site of origin for most ovarian cancer
3. Learn how current laboratory research will impact future prevention and treatment

Call for Abstracts

As part of the 4th Annual Ovarian Cancer Symposium, which will take place on May 13 and 14, 2013, it is our pleasure to invite you to submit an abstract for poster presentation. Abstracts for presentation will be selected on merit, with priority given to early detection and prevention, in accordance with the symposium theme; however, abstracts related to any area of ovarian cancer research will be considered. Abstract submission is open to individuals of all professional and academic levels involved in ovarian cancer research. Travel expenses are the responsibility of the individual, but registration fees will be waived for poster presenters.
Abstracts should be submitted as a double-spaced, single-page (or less) word document in standard abstract format, accompanied by the contact information of the presenter. Please submit your abstract by E-mail to: gynbreast@mskcc.org no later than May 1, 2013. Presenters of accepted abstracts will be notified on May 3, 2013. Poster boards are 5’ x 6’.

Event Information

Date & Time(s)

May 13, 2013 and May 14, 2013

Description

This course consists of didactic lectures with question and discussion periods.

Sponsor(s)

This activity is co-sponsored by Memorial Sloan-Kettering Cancer Center and Johns Hopkins University.

Speaker(s)

Course Directors:
Douglas A. Levine, MD
Memorial Sloan-Ketterring Cancer Center
Robert A. Soslow, MD
Memorial Sloan-Kettering Cancer Center
Robert J. Kurman, MD
Johns Hopkins University
Ie-Ming Shih, MD, PhD
Johns Hopkins University

Audience

This activity is designed for gynecologists, gynecologic oncologists and other physicians and other healthcare professionals.

Agenda

 

Symposium Agenda

Credit

Memorial Sloan-Kettering Cancer Center is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Memorial Sloan-Kettering Cancer Center designates this live activity for a maximum of 8.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Location Information

Memorial Sloan-Kettering Cancer Center
Rockefeller Research Laboratories
430 East 67th Street
Between First and York Avenues
New York, NY 10065

Accommodations

Memorial Sloan-Kettering Cancer Center has negotiated special rates and amenities at select hotels in Manhattan. When making your room arrangements, please mention that you are attending a Memorial Sloan-Kettering CME even to avail of the corporate contracted rate.
Learn more about the special rates and amenities.

Contact Information

Phone

646-227-2025

E-mail

brodheap@mskcc.org

Registration Information

Registration Details

Registration for Fellows, Residents, and Other Healthcare Professionals is free. For free registration, please e-mail johnsonf@mskcc.org.

Payment Information

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$25.00 - Physicians (MD, PhD, DO)

Free Admission (Fellows, Residents, and Other Healthcare Professionals)

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In Cancer Treatment, New DNA Tools - NYTimes.com

In Cancer Treatment, New DNA Tools - NYTimes.com

"To guide doctors and their patients, many tools are on the market, including one created by Dr. Pao and colleagues: the Web site My Cancer Genome. The site, which started two years ago, is maintained by 51 contributors from 20 institutions. It lists mutations in different types of cancer, as well as drug therapies that may or may not be of benefit. Most of the drugs are in clinical trials; a few have been approved by the Food and Drug Administration.

The typical user of this information is an oncologists....

Nadir CA-125 level as prognosis indicator of high-grade serous ovarian cancer

open access

Published: 25 April 2013

Abstract (provisional)

Purpose: The capacity of nadir CA-125 levels to predict the prognosis of epithelial ovarian cancer remains controversial. This study aimed to explore whether the nadir CA-125 serum levels could predict the durations of overall survival (OS) and progression free survival (PFS) in patients with high-grade serous ovarian cancer (HG-SOC) from the USA and PRC.

Materials and methods: A total of 616 HG-SOC patients from the MD Anderson Cancer Center (MDACC, USA) between 1990 and 2011 were retrospectively analyzed. The results of 262 cases from the Jiangsu Institute of Cancer Research (JICR, PRC) between 1992 and 2011 were used to validate the MDACC data. The CA-125 immunohistochemistry assay was performed on 280 tissue specimens. The Cox proportional hazards model and the log-rank test were used to assess the associations between the clinicopathological characteristics and duration of survival.

Results

The nadir CA-125 level was an independent predictor of OS and PFS (p < 0.01 for both) in the MDACC patients. Lower nadir CA-125 levels (<=10 U/mL) were associated with longer OS and PFS (median: 61.2 and 16.8 months with 95% CI: 52.0--72.4 and 14.0--19.6 months, respectively) than their counterparts with shorter OS and PFS (median: 49.2 and 10.5 months with 95% CI: 41.7--56.7 and 6.9--14.1 months, respectively). The nadir CA-125 levels in JICR patients were similarly independent when predicting the OS and PFS (p < 0.01 for both). Nadir CA-125 levels less than or equal to 10 U/mL were associated with longer OS and PFS (median: 59.9 and 15.5 months with 95% CI: 49.7--70.1 and 10.6--20.4 months, respectively), as compared with those more than 10 U/mL (median: 42.0 and 9.0 months with 95% CI: 34.4--49.7 and 6.6--11.2 months, respectively). Baseline serum CA-125 levels, but not the CA-125 expression in tissues, were associated with the OS and PFS of HG-SOC patients in the MDACC and JICR groups. However, these values were not independent. Nadir CA-125 levels were not associated with the tumor burden based on second-look surgery (p = 0.09). Patients who achieved a pathologic complete response had longer OS and PFS (median: 73.7 and 20.7 months with 95% CI: 63.7--83.7 and 9.5--31.9 months, respectively) than those with residual tumors (median: 34.6 and 10.6 months with 95% CI: 6.9--62.3 and 4.9--16.3 months, respectively).

Conclusions

The nadir CA-125 level was an independent predictor of OS and PFS in HG-SOC patients. Further prospective studies are required to clinically optimize the chances for a complete clinical response of HG-SOC cases with higher CA-125 levels (>10 U/mL) at the end of primary treatment.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

A Phase II Trial of Docetaxel and Bevacizumab in Recurrent Ovarian Cancer within 12 Months of Prior Platinum-Based Chemotherapy

Abstract

Purchase $39.95

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Highlights

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Docetaxel + bevacizumab has activity in recurrent ovarian cancers.

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The combination is tolerable without new, unanticipated toxicities.

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The combination should be considered for further study or clinical use in similar patients.

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Objectives

The efficacy and safety of bevacizumab and docetaxel were evaluated in women who developed recurrent epithelial ovarian, fallopian, or peritoneal cancer within 12 months of platinum-based therapy.

Methods

Patients received docetaxel (40 mg/m²) on days 1 and 8 and bevacizumab (15 mg/kg) on day 1 of a 21-day cycle. Primary endpoint was 6-month progression-free survival (PFS).

Results

Forty-one patients were evaluable for PFS and 38 for best response; 46% had platinum-free intervals (PFI) of < 6 months and 54% between 6 and 12 months. The 6-month PFS was 43.9% (95% confidence interval (CI_95%) = 28.6-58.2%). Median PFS (months) was 5.2 (CI_95% = 4.4-7.2) for all patients, 6.2 (CI_95% = 4.1-7.4) for patients with PFI < 6 months, and 5.1 (CI_95% = 3.0-7.2) for those with PFI ≥ 6 months. Twenty-two patients showed overall response (CR + PR) (57.9%; CI_95% = 40.8-73.7%), and 32 showed clinical benefit (CR + PR + SD) (84.2%; CI_95% = 68.8-94.0%). For those with complete or partial responses, median duration of response was 4.8 months (0.7-14.5). Median overall survival was 12.4 months (CI_95% = 10.0-21.9). The most common grade 3/4 adverse events (AEs) were neutropenia (14.6% of patients), followed by leukopenia, fatigue, metabolic, and gastrointestinal, with 66% showing any grade 3/4 toxicity. Most common AEs of any grade were gastrointestinal (93%), fatigue (73%), and pain (73%). Four (10%) patients developed hypertension, 1 a gastrointestinal perforation, and another a colovesicular fistula.

Conclusions

Bevacizumab and docetaxel administered in patients with recurrent ovarian cancer is an active regimen without new unanticipated toxicities. This combination should be an option for further study or clinical use in recurrent ovarian cancer.

The role of single nucleotide polymorphisms of the ERCC1 and MMS19 genes in predicting platinum-sensitivity, progression-free and overall survival in advanced epithelial ovarian cancer

Abstract

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Highlights

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SNPs in nucleotide excision repair confer differential response to treatment and survival

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In EOC, the AA haplotype of ERCC8092A may confer large tumor burden and poor response to therapy

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Further study of MMS19 is needed in EOC

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Objective

To assess the role of polymorphisms in DNA repair genes, excision repair cross-complementation group 1 (ERCC1) and methyl-methanesulfonate sensitivity 19 (MMS19), in tumor response to platinum-based chemotherapy and survival in advanced epithelial ovarian cancer (EOC).

Methods

Single nucleotide polymorphism (SNP) analysis was performed on the paraffin-embedded tumor tissue of women with advanced EOC, treated with platinum-based chemotherapy at the University of Oklahoma Health Sciences Center. Polymorphisms from two ERCC1 (codon-118 and C8092A) and three MMS19 (rs2211243, rs2236575 and rs872106) gene loci were evaluated by real time PCR Allelic Discrimination Assay.

Results

Genotyping was performed in 107 patients, 45 platinum-sensitive and 62 platinum-resistant. ERCC1, codon-118 and C8092A genotyping was evaluable in 98 and 106 patients respectively and in all 107 patients for MMS19 polymorphisms. No differences were observed in genotype between platinum-sensitive and platinum-resistant patients. Polymorphisms in the ERCC1, codon-118 and MMS19 genes did not correlate with overall survival (OS), although a trend toward improved progression free survival (PFS) was observed in patients expressing the minor (GG) alleles of the rs872106 MMS19 gene. Women homozygous for the ERCC1-C8092A minor (AA) alleles had a significant increase in PFS compared to AC and CC patients and both AA and AC genotypes conferred improved survival over the major (CC) genotype.

Conclusions

Polymorphisms in ERCC1, codon-118 and MMS19 genes are not associated with clinical response to platinum or survival. The ERCC1-C8092A genotypes containing an “A” allele were associated with significant improvement in PFS and OS strengthening the value of this specific genotype in survival.

Recurrence patterns after extended treatment with bevacizumab for ovarian, fallopian tube, and primary peritoneal cancers

Abstract

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Highlights

•

Ovarian cancer patients treated with bevacizumab predominantly recurred in lymph nodes.

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Patients on extended bevacizumab treatment presented with fewer symptoms at time of recurrence than those receiving fewer cycles of bevacizumab.

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Radiologic imaging is superior to serum CA-125, symptoms, and physical exam for the detection of recurrent disease in patients treated with bevacizumab.

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Objective

To evaluate patterns of recurrence for ovarian, fallopian tube, and primary peritoneal cancer patients undergoing extended treatment with bevacizumab (BEV).

Methods

A retrospective review of patients with primary ovarian, fallopian tube, or peritoneal cancer treated with BEV alone or in combination with other chemotherapy from 2001 to 2011 was performed. Qualified patients were identified by chemotherapy records. Electronic medical records, labs, and imaging reports were reviewed and abstracted.

Results

Of 108 patients identified, 89 patients met study criteria by having disease progression either during treatment with BEV or after discontinuing BEV without initiating any other treatment. Patients on extended BEV therapy (> 12 cycles) were more likely to recur in extra-visceral sites (p = 0.04), especially in lymph nodes (p = 0.0002), and presented with fewer symptoms at time of recurrence (p = 0.02), compared to patients who had received ≤ 12 cycles. CA-125 becomes less reliable for the detection of recurrent disease with extended BEV therapy (p = 0.03 for ≤ 12 cycles vs. p = 0.08 for > 12 cycles). Radiology was superior to CA-125, symptom, and physical exam, in detecting recurrence with extended BEV therapy (all p < 0.0001).

Conclusions

Extended treatment with BEV in ovarian, fallopian tube, and peritoneal cancers results in alterations in the patterns of recurrence. Radiologic imaging is more reliable than CA-125, symptoms, or physical exam, in identifying recurrent disease in patients undergoing BEV treatment. As novel targeted therapies continue to be employed, guidelines for gynecologic cancer surveillance must continue to be reexamined.

☆

Presented in part at the Society of Gynecologic Oncology Annual Meeting on Women’s Cancer, Los Angeles, California, USA. March 9 – 12, 2013.

(Lynch Syndrome) Endometrial Cancer and a Family History of Cancer

Abstract

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Highlights

•

We evaluated family cancer history and EC risk in non-LS patients

•

Risk for EC was similar by MSI status suggesting limited involvement of MMR genes

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Our results support an EC-specific genetic syndrome in non-LS patients

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Objective

Lynch Syndrome (LS), an inherited genetic syndrome, predisposes to cancers such as colorectal and endometrial. However, the risk for endometrial cancer (EC) in women not affected by LS, but with a family history of cancer, is currently unknown. We examined the association between a family history of cancer and the risk for EC in non-LS patients.

Methods

This population-based case-control study included 519 EC cases and 1015 age-matched controls and took place in Alberta, Canada between 2002 and 2006. Information about risk factors, including family history of cancer in first and second degree relatives, was ascertained via in-person interviews. Microsatellite instability (MSI) status of tumor tissue was assessed to determine involvement of DNA mismatch repair genes.

Results

A first or second degree family history of uterine cancer was modestly associated with the risk for overall EC [odds ratio (OR), 1.3; 95% confidence interval (CI), 0.9,1.9], and the risks were similar for MSI + cancer (OR = 1.5, 95%CI=0.7, 3.3) and MSI- cancer (OR = 1.3, 95%CI=0.8, 2.4). Although consistent, these associations were modest and not significant. In contrast, the risk for MSI + cancer was elevated with a reported family history of colorectal cancer (OR = 1.4, 95%CI=1.0, 2.2), but not for MSI- cancer.

Conclusions

A family history of uterine cancer may be modestly associated with EC risk in non-LS patients regardless of MSI status, suggesting that risk was not related to inherited defects in the MMR gene pathway. These results provide preliminary support for an EC-specific genetic syndrome.

The significance of mismatch repair genes in gastric cancer (Lynch Syndrome/MSH2/MLH1)

open access

 Of the 156 cases, 17 cases (10.9%) did not express hMLH1. However, all cases expressed hMSH2 [Table 2].

"In gastric (stomach) cancer, the incidence of MSI varies from 15 to 39%. ^[16] Although mutations of the hMLH1 or hMSH2 are rare in gastric cancers......

Spirituality and religion in oncology

open access

Adjustment to Cancer

Research has correlated measures of spirituality and of spiritual well-being with better quality of life (QOL) and/or psychosocial functioning in the context of prostate cancer,[6-8] breast cancer,[9-11] oncology-related anxiety and depression,[12, 13] radiation therapy,[14] and gynecologic cancer.[15, 16] In a study by Steinhauser et al,[17] patients viewed “being at peace with God” and “freedom from pain” as the most important characteristics of QOL in terminal illness. Similarly, religious coping has been associated with better patient psychological well-being and overall QOL among patients with advanced cancer.[18] At least 11 studies of posttraumatic growth have shown links to R/S, most of them beneficial.[19] Investigators have found positive religious coping, readiness to face existential questions, religious participation, and intrinsic religiousness to be typically associated with posttraumatic growth.

However, distress or struggle over spiritual concerns (eg, feeling abandoned by God) has been found to be prevalent among patients with advanced cancer.[18, 20-23] In a study of 100 patients with advanced cancer in an outpatient palliative care clinic in Texas, most of whom considered themselves both spiritual and religious, spiritual pain was both common and associated with lower self-perceived religiosity and QOL.[24] In a Boston-based study of 75 patients with advanced cancer, the majority (86%) endorsed at least one spiritual concern, with a median of 4 concerns noted per patient. Younger age was associated with a greater burden of spiritual concerns, and increased spiritual concerns were associated with worse psychological QOL.[18] A longitudinal study of women with breast cancer[25] suggested that women who are less spiritually/religiously involved prior to the onset of breast cancer and who attempt to mobilize these resources under the stress of diagnosis may experience a process of spiritual struggle and doubt that can influence their long-term adjustment. In an effort to identify patterns of differences, Kristeller et al[26] distinguished 4 clusters within a study of 114 cancer patients: those with high R/S (45%), who showed the lowest levels of depression; those with low R/high S (25%), who also demonstrated good adjustment; negative religious copers (14%), who were found to have the highest levels of depression; and those with low R/S, who demonstrated the poorest adjustment to cancer.

Qualitative studies of oncology patients concerning the role of R/S in their illness[9, 21, 27-29] have identified a number of recurring themes. The study by Alcorn et al[21] of 68 randomly selected US patients with advanced cancer found 5 primary themes: coping, practices, beliefs, transformation, and community (Table 1)...........

(U.S.) Comparative Effectiveness Review: Epoetin and Darbepoetin for Managing Anemia in Patients Undergoing Cancer Treatment: Comparative Effectiveness Update

open access

 Prepared for:
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
540 Gaither Road
Rockville, MD 20850
www.ahrq.gov

Future Research
Given the current state of evidence, unanswered questions, and balance of benefit and harms, how should future research be considered? Given the magnitude of relative mortality increase and underlying mortality rates in this patient population, it is clear that attempts to reduce
uncertainty in relative risk of mortality through clinical trials would require very large samples.
The confidence and credible intervals for the estimated relative increase in mortality span a range of values—the true relative increase in risk for adults could be higher or lower than 1.17 estimated here. Still these data do establish with sufficient certainty that mortality rates increase.
Questions are therefore raised regarding equipoise in pursuing some “true” relative risk in further clinical trials.
At the same time these agents will continue to be used for reasons beyond the scope of this review—for example, patient preference, availability of blood, possible emergence of infectious agents in the blood supply. It is therefore important to address whether there are patient subgroups with low risk of harm and how dosing practices influence harms. Unfortunately, these questions present complexities not addressed even in the most carefully designed trials. The
fundamental complexity concerns time-varying treatment and confounding—ESA dose is typically varied depending on the hemoglobin level achieved. It is well known that traditional analytical approaches fail to correctly estimate treatment effects under these conditions.139,204
Accordingly, it is unlikely that any future meta-analysis or systematic review will be able to inform these questions.
Still, there is a compelling rationale to examine observational data (e.g., carefully conducted registries) using methods appropriate to these questions—whether there is a subgroup and dosing strategy accompanied by some lower risk. A large registry with accurate and precise information on ESA dose (amount, frequency, duration, escalation), hemoglobin (baseline, and all recorded values preferably at times specified by protocol), stage of malignancy, treatment regimen and
response, and outcomes (including but not limited to thromboembolism, myocardial infarction, death including underlying and contributory causes) would provide the best opportunity to examine these questions. The Dosing and Outcomes Study of Erythropoiesis-Stimulating
Therapies (DOSE) is one example.205 While deriving conclusions from appropriate analytical methods—inverse probability weighting, G-methods, and marginal structural models—requires some assumptions for inference, they are approaches most able to address unanswered questions.
Lastly, we found many registered completed trials without clearly or readily identified results. The goals of trial registration fall short when results from completed trials are difficult to
identify. Investigators and trials registries must adopt effective procedures to assure timely reporting of results in registries.
In summary, a large collection of trials examining ESA use in patients undergoing cancer treatment provides evidence sufficient to conclude that hemoglobin levels are improved and transfusions avoided together with higher rates of thromboembolic events and mortality.
Whether there are subgroups at higher and lower risk of adverse events and mortality is unclear.
Future research to address the unanswered questions should be limited to examination of observational data collected during the course of usual patient care.

Toward understanding the genetics of regulatory T cells in ovarian cancer

open access

Abstract:

Tumor-infiltrating regulatory T cells (Tregs) promote immune evasion and are associated with poor disease outcome in patients affected by various malignancies. We have recently demonstrated that several, inherited single nucleotide polymorphisms affecting Treg-related genes influence the survival of ovarian cancer patients, providing novel insights into possible mechanisms of immune escape......

April 16, 2013

Provisional Full-Text corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions containing any author galley corrections will be made available soon. When Provisional Full Text is displayed, it will always be open access.

Full Text

Despite considerable progresses in our understanding of the factors that influence ovarian cancer progression, the survival rate of patients affected by this deadly cancer has not yet appreciably improved. Multiple factors influence patient survival in this setting, including the histological subtype of the tumor, stage at diagnosis and genetic predisposition.¹ It has become clear that different histological subtypes of ovarian cancer represent distinct diseases, bearing specific genetic lesions, responding differently to chemotherapy and exhibiting dissimilar survival rates. Many studies have focused on serous ovarian cancers or have grouped all other subtypes together, hence failing to take into account the heterogeneous nature of the disease and obscuring subtype-specific relevant results.^1......

The doctor–patient relationship: capturing the ideal : The Lancet

The Lancet

Illegal Online Sellers Fuel Global Spread of Fake and Substandard Medications

USNewswire

April 26, 2013 /PRNewswire-USNewswire/ -- The National Association of Boards of Pharmacy^® (NABP^®) today issued a report emphasizing that the global distribution of counterfeit and substandard medications, fueled by illegal online sellers, demands an international response. As detailed in the Internet Drug Outlet Identification Program Progress Report for State and Federal Regulators: April 2013, NABP has partnered with regulatory authorities, industry leaders, and stakeholder groups worldwide to address the issue of rogue Internet drug sellers in order to protect the global public health. At the center of these efforts is NABP's application – submitted with the support of a global coalition of stakeholders – to own and operate the .PHARMACY domain registry, an initiative intended to provide a safe online space for consumers around the world to order medications.

NABP continues to review and monitor Web sites selling prescription drugs to patients in the United States and its findings are also presented in the report released today – of more than 10,000 Web sites analyzed, nearly 97% operate out of compliance with pharmacy laws and practice standards established in the US, and many other developed countries, to protect public health....

Novartis Pharmaceuticals Corporation disputes allegations in two US Government lawsuits and looks forward to a fair discussion of the facts

PRNewswire

Fast-acting fentanyl preparations and pain management

abstract

"Cancer-related pain is a common clinical problem, experienced by ∼90% of patients with cancer. The mainstay of treatment remains opioids and the WHO analgesic ladder. Following the principles of the analgesic ladder, 80% of patients can achieve pain control. However, breakthrough pain remains a form of cancer-related pain that is particularly difficult to manage in both specialist and generalist settings. The focus of this article is the mismatch between the temporal characteristics of the majority of cancer-related breakthrough pain which is fast onset and resolution, with the pharmacological profile of oral morphine. The contribution of fast-acting fentanyl preparations to the treatment of breakthrough pain and the evidence for the various commercially available preparations will be considered."

Hereditary Cancer in Clinical Practice - journal information

journal

Editors-in-Chief

• Jan Lubinski, Pomeranian Medical University
• Rodney J. Scott, University of Newcastle
• Rolf Sijmons, University Medical Center Groningen

Editorial Board | Instructions for authors | FAQ

Hereditary Cancer in Clinical Practice is the official journal of the International Hereditary Cancer Centre and is published under the auspices of International Union Against Cancer.

(Turkey) Acute infusion reactions to chemotherapeutic drugs: a single institute experience.

 Blogger's Note:  10.8% is rare?? (severe reactions/study of 2213 patients)

Abstract

"The severity of reactions was determined in accordance with NCI toxicity criteria."

Results: Of the 2213 patients receiving chemotherapy during the study period, 138 (62%) developed an infusion reaction to the treatment. Among 138 patients most commonly treated types of carcinoma included breast (39.2%), lung (17.8%), colorectal (10%), and ovarian (8.5%) cancers. Docetaxel administration resulted in the largest number of infusion reactions, though most reactions were mild to moderate and did not require the cessation of treatment. Patients with mild to moderate reactions (89.2%) were able to continue treatment, while those who developed severe reactions (10.8%) could not continue treatment with the same agent.  



 Conclusion: Although severe reactions are rare, the incidence of mild to moderate reactions against taxanes, platinum compounds, and monoclonal antibodies is quite high. Clinical symptoms do not vary widely among the agents, though the onset time of symptoms does vary. While reactions against platinum agents were of type 1 anaphylactic reactions, reactions against taxanes and monoclonal antibodies during the first infusion and in the following minutes suggest the activation of different mechanisms.

Korean Cancer Association:: Feasibility of Oxaliplatin, Leucovorin, and 5-Fluorouracil (FOLFOX-4) Chemotherapy in Heavily Pretreated Patients with Recurrent Epithelial Ovarian Cance

Cancer Research and Treatment 

Materials and Methods Clinical data were reviewed in 28 patients who received FOLFOX-4 as more than the second-line chemotherapy

Ovarian Cancer Regimens | Merrimack Pharmaceuticals (MM-121 + taxol/ErbB3)

Merrimack Pharmaceuticals

"Through this approach we hope to generate additional knowledge on how ErbB3 signaling affects response to therapy, and then apply this understanding to identify patients that will most likely benefit from treatment regimens that include MM-121."

Are Genes Patentable? An Insider's Review of the ACLU's Supreme Court Argument on Gene Patenting | American Civil Liberties Union

ACLU

Perforation and mortality after cleansing enema for acute constipation

open access

 Conclusion: Enema for the treatment of acute constipation is not without adverse events, especially in the elderly, and should be applied carefully. Perforation, hyperphosphatemia (after Fleet Enema), and sepsis may cause death in up to 4% of cases. Guidelines for the treatment of acute constipation and for enema administration are urgently needed.

Cancer Survivors Also Live With Distress including commentary (public)

Medscape

"To say that a diagnosis of cancer can be stressful for patients is putting it mildly, and the rigors of treatment often add to the burden. Yet more than half of adult cancer survivors report that they have never used or been offered professional counseling, support groups, or other services to help them cope with psychologic distress.
To assess this aspect of cancer care, Laura P. Forsythe, PhD, from the Patient-Centered Outcomes Research Institute in Washington, DC, and colleagues used data on 1777 cancer survivors from the 2010 National Health Interview. The results were published online April 22 in the Journal of Clinical Oncology.....



comment

Nurse - Anesthesiology:

 

"Forget about providing psychosocial care. Get the nurses to start acknowledging that patients may have pain and problems outside the expected window for these complaints. I have been told by several oncology nurses that I "shouldn't have pain at the site of my sentinel node dissection two years after the surgery" and yet I have cording and daily pain. And my radiation oncologist tells me I "shouldn't have heat and swelling this long after radiation" but I do. And you think these folks are ready to address my psychosocial needs... They can't even adequately address my physical symptoms in an appropriately compassionate manner. And I'm a nurse practitioner. You'd think they'd be ashamed to show their ignorance to me but no... Imagine if I tried telling one of my seizure patients that they shouldn't be having seizures because I had them on the "right medicine". It would be a disgrace. So let's not get ahead of ourselves. I go to therapy that I arrange for myself, I know I need it and I go and get it. At diagnosis I was offered a fellow cancer patient as my counselor, I declined. And I go to a big urban Cancer Center, that is apparently what they can offer. There is a lot of talk and hot air but so far all I can see is you are made to feel that you had better be grateful you are alive and get on with it. And absolutely no complaining, or deviating from the expected norm. Or else."

Oncologist Compensation Slips Slightly, Paperwork Mounts

Medscape

Medscape Physician Compensation Report 2013

Report 2013

".......while endocrinologists and oncologists noted a slight decline."

U.S. Files 2nd Lawsuit Accusing Novartis of Kickbacks

Medscape