Wednesday, May 15, 2013
'Lynch Syndrome' Search Results 2013 ASCO Annual Meeting
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'ovarian cancer' Search Results 2013 ASCO
2013 ASCO Annual Meeting Abstracts - now online
2013 ASCO
2013 ASCO Annual Meeting abstracts
Abstracts published in the Annual Meeting Proceedings Part I will be available on this site at 6:00 PM EDT May 15, 2013. Plenary Abstracts, Late-Breaking Abstracts, and Clinical Review Abstracts (published in the Annual Meeting Proceedings Part II) will be available at 7:30 AM EDT on the date of their presentation at the 2013 ASCO Annual Meeting.
Ovarian cancer among 8,005 women from a breast cancer family history clinic: no increased risk of invasive ovarian cancer in families testing negative for BRCA1 and BRCA2 (repost)
Abstract
- Published Online First 28 March 2013
Background Mutations in BRCA1/2 genes confer ovarian, alongside breast, cancer risk. We examined the risk of developing ovarian cancer in BRCA1/2-positive families and if this risk is extended to BRCA negative families.
Patients and Methods
A prospective study involving women seen at a single family history
clinic in Manchester, UK. Patients were excluded if they
had ovarian cancer or oophorectomy
prior to clinic. Follow-up was censored at the latest date of:
31/12/2010; ovarian cancer
diagnosis; oophorectomy; or death.
We used person-years at risk to assess ovarian cancer rates in the study
population, subdivided
by genetic status (BRCA1, BRCA2, BRCA negative, BRCA untested) compared with the general population.
Results We studied 8005 women from 895 families. Women from BRCA2 mutation families showed a 17-fold increased risk of invasive ovarian cancer (relative risk (RR) 16.67; 95% CI 5.41 to 38.89).
This risk increased to 50-fold in women from families with BRCA1 mutations (RR 50.00; 95% CI 26.62 to 85.50). No association was found for women in families tested negative for BRCA1/2, where there was 1 observed invasive ovarian cancer in 1613 women when 2.74 were expected (RR 0.37; 95% CI 0.01 to 2.03).
There was no association with ovarian cancer in families untested for BRCA1/2 (RR 0.99; 95% CI 0.45 to 1.88).
Discussion This study showed no increased risk of ovarian cancer in families that tested negative for BRCA1/2 or were untested. These data help counselling women from BRCA1/2 negative families with breast cancer that their risk of invasive ovarian cancer is not higher than the general population.
Diagnostic accuracy of preoperative alpha-fetoprotein as an ovarian tumor marker in children and adolescents: not as good as we thought? (infants excluded)
Abstract
Purpose
To evaluate the
diagnostic accuracy of preoperative serum alpha-fetoprotein (AFP) levels
in predicting malignancy risk in children and adolescents presenting
with ovarian neoplasms.
Methods
In 110 girls aged 18
and below diagnosed with ovarian neoplasms, we retrospectively
correlated preoperative serum AFP levels with histological diagnosis of
germ cell tumor or immature teratoma (GCT/IT) versus non-GCT/IT, and
benign versus non-benign. We determined area under receiver-operating
characteristic curves (AUC), sensitivity, specificity, and likelihood
ratios.
Results
Twenty patients
(18.2 %) had non-benign ovarian neoplasms, of which 12 had GCT/IT
(10.9 %). In diagnosing GCT/IT versus non-GCT/IT, specificity of
preoperative serum AFP was 87.8 %, sensitivity 66.7 %, and AUC 0.853.
Excluding infants to remove the effects of increased variance in AFP in
this group, specificity improved (92.0 %), but not sensitivity (66.7 %);
AUC was 0.926. Increasing AFP cutoff to two times upper normal limit
improved specificity (94.9 %), but not sensitivity (66.7 %). For benign
versus non-benign tumors, AFP specificity was only 88.9 % and
sensitivity 50.0 %.
Conclusion
The diagnostic
accuracy of preoperative serum AFP for detecting GCT/IT in girls was
limited by poor sensitivity and positive predictive value. Excluding
infants and raising cutoff levels improved specificity marginally.
Clinicians should be aware of these limitations when using AFP in the
preoperative evaluation of childhood ovarian neoplasms.
Functional genomics identifies five distinct molecular subtypes with clinical relevance and pathways for growth control in epithelial ovarian cancer
open access
".......Although the molecular mechanisms linking TUBGCP4 or NAT10 with Stem-A growth remains to be elucidated, susceptibility to vincristine and vinorelbine underscores the importance of tubulin polymerization in Stem-A cells. Both drugs are well-established chemotherapeutic agents that block cell proliferation by inhibiting microtubule assembly through its interaction with tubulin heterodimers (Lobert et al, 1996); however, they are not standard chemotherapeutic reagents for the treatment of EOC, unlike paclitaxel (Armstrong et al, 2006; McGuire et al, 1996). The molecules implicated in the tubulin polymerization pathway may provide us with a potential platform to more effectively target Stem-A ovarian cancer. As such, the survival of patients with ovarian cancer could be improved by the stratification and targeting strategy described in this study."
A Young Woman With Bilateral Breast Cancer: Identifying a Genetic Cause and Implications for Management (BRCA1/2; Li-Fraumeni syndrome....)
Blogger's Note: of interest to those who may have had negative genetic testing results but with family histories of differing cancers; ovarian cancer is also a risk factor for LFS but potentially underreported in this syndrome
open access
"... Women with LFS have a greater than 90% lifetime risk of cancer,9 and most commonly develop sarcomas (bone and soft tissue), premenopausal breast cancer, acute leukemia, brain tumors, adrenocortical carcinoma, choroid plexus carcinoma, colon and pancreatic cancer, or melanoma.7,10,11.....
Phenotypic heterogeneity of hereditary gynecologic cancers (BRCA1, BRCA2, MLH1, MSH2, MSH6)
Abstract
"To determine the
validity of observations suggesting a significant dichotomy of
gynecologic cancers determined by linkage to specific genetic defects
associated with two major autosomal dominant hereditary cancer
syndromes; the Creighton University Hereditary Cancer Registry was
searched for female carriers of germ line mutations in BRCA1 and BRCA2, associated with the Hereditary Breast Ovarian Cancer syndrome, and in the mismatch repair (MMR) genes MLH1, MSH2 and MSH6,
associated with Lynch syndrome, who were registered with invasive
uterine, ovarian, fallopian tube or peritoneal cancers between January
1, 1959 and December 31, 2010. From 217 such cases, a total of 174
subjects, consisting of 95 BRCA1 and BRCA2
mutation carriers and 79 carriers of mutations in MMR genes, were
identified who had current signed Health Insurance Portability and
Accountability Act forms and complete primary diagnostic pathology
reports and clinical records. Data meticulously extracted from these
cases were categorized and statistically analyzed. There were highly
significant differences between carriers of BRCA1 and BRCA2
mutations and carriers of MMR gene mutations in the proportion of
serous carcinomas compared with endometrioid carcinomas of the uterus,
including cervix and endometium (p < 0.002), ovaries (p < 0.001) and overall, including fallopian tube and peritoneum cancers (p < 0.001). Endometrioid carcinoma was found in one and transitional carcinoma in another of the 14 BRCA1
mutation carriers with fallopian tube cancer, and endometrioid
carcinoma was found in two of four MMR gene mutation carriers with
fallopian tube cancers. All other fallopian tube cancers were serous
carcinomas. Seven BRCA1 and one BRCA2
mutation carriers were diagnosed with primary peritoneal serous
carcinoma; no peritoneal carcinomas were registered in MMR gene mutation
carriers. Nine of 14 gynecologic cancers with associated endometriosis
in mutation carriers were endometrioid or endometrioid mixed carcinomas
compared with just three of other histologic types. Primary breast
cancers, that characterize the HBOC syndrome, were much more frequent in
BRCA1 and BRCA2
mutation carriers; while multiple gynecologic cancers and associated
colorectal and urinary tract cancers, which are features of Lynch
syndrome, were more common in MMR gene mutation carriers. Both serous
and endometrioid carcinomas were diagnosed in MMR gene mutation carriers
at significantly younger ages than in BRCA1 and BRCA2 mutation carriers (p < 0.0006).
These findings confirm a clear dichotomy of uterine, ovarian and
fallopian tube cancers associated with inheritance of mutations in BRCA1 and BRCA2
contrasted with inheritance of MMR gene mutations. This opens
possibilities for new approaches to molecular genetic research into
carcinogenic pathways and raises important new considerations regarding
counseling, screening, prophylaxis and treatment of mutation carriers.
Angelina Jolie - Should You Get Genetic Testing? - Forbes (and other considerations)
Forbes
"....These (BRCA 1/ BRCA 2) aren’t the only genetic mutations associated with reproductive cancers, though. There is a fairly long list of known genetic mutations that up breast and ovarian cancer risk. Those listed by the National Cancer Institute and Memorial Sloan-Kettering Cancer Center are CHEK2, PALB2, TP53, PTEN, STK11/LKB1, CDH1, ATM, MLH1, and MSH2 )(MLH1/MSH2=Lynch Syndrome - education)...........
BMJ calls for new and stronger partnerships to improve healthcare
press release
Public release date: 14-May-2013
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Contact: Emma Dickinson
edickinson@bmj.com
44-020-738-36529
BMJ-British Medical Journal
Patients can improve healthcare: it's time to take partnership seriously
The journal says it is committed to "stepping up its commitment to patient partnership" and wants to "develop a strategy for patient partnership that will be reflected across the entire journal."In an editorial, BMJ editors along with Professor Victor Montori and Dave Paul at the Mayo Clinic in the US, argue that the preservation of institutional bureaucracies, as well as professional and commercial vested interests, "have consistently trumped the interests of patients." They say clinicians and patients need to work in partnership "if we are to improve healthcare and challenge deeply ingrained practices and behaviours."
Earlier this year, the BMJ launched a 'Too Much Medicine' campaign to help tackle the threat to health and the waste of money caused by unnecessary care. The journal will also partner at an international conference Preventing Overdiagnosis to be held in September in the USA.
Partnering with patients "must be seen as far more than the latest route to healthcare efficiency," they write. "It's about a fundamental shift in the power structure in healthcare and a renewed focus on the core mission of health systems."
They add: "We need to accept that expertise in health and illness lies outside as much as inside medical circles and that working alongside patients, their families, local communities, civil society organisations, and experts in other sectors is essential to improving health."
Several accompanying articles discuss "shared decision making" as part of a new social movement for healthcare reform.
Correspondence: Colombo to Friedlander - Time to think differently?
open access
REFERENCES
1. Friedlander ML, Stockler MR, Butow P, et al: Clinical trials of palliative chemotherapy in platinum-resistant or -refractory ovarian cancer: Time to think differently? J Clin Oncol doi: 10.1200/JCO.2012.47.7927
2. Colombo N, Kutarska E, Dimopoulos M, et al: Randomized, open-label, phase III study comparing patupilone (EPO906) with pegylated liposomal doxorubicin in platinum-refractory or -resistant patients with recurrent epithelial ovarian, primary fallopian tube, or primary peritoneal cancer. J Clin Oncol 30:3841-3847, 2012
Correspondence: Time to think differently? Spriggs to Friedlander
open access
Correspondence:
"In a recent letter, Friedlander et al1 discuss the role of symptom
benefit in platinum-resistant or -refractory ovarian cancer. Qualityof-
life (QoL) assessments are of extreme importance in this patient
population and particularly in this setting of platinum-resistant, recurrent ovarian cancer. For this reason, evaluation of patient-reported
symptoms and QoL by the Functional Assessment of Cancer Therapy-
Ovary (FACT-O) and FACT-O Symptom Index were secondary objectives
in the phase III study that compared patupilone with pegylated
liposomal doxorubicin in this patient population, and the results were
published online as supplementary material.2 ...........
REFERENCES
1. Friedlander ML, Stockler MR, Butow P, et al: Clinical trials of palliative chemotherapy in platinum-resistant or -refractory ovarian cancer: Time to think differently? J Clin Oncol doi: 10.1200/JCO.2012.47.7927
2. Spriggs DR: Drug development for chronic cancers: Time to think differently? J Clin Oncol 30:3779-3780, 2012
3. Colombo N, Kutarska E, Dimopoulos M, et al: Randomized, open-label, phase III study comparing patupilone (EPO906) with pegylated liposomal doxorubicin in platinum-refractory or -resistant patients with recurrent epithelial ovarian, primary fallopian tube, or primary peritoneal cancer. J Clin Oncol 30:3841-3847, 2012
Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update
Blogger's Note: read paper for full details - ovarian cancer is considered high risk (Table 5)
open access
Recommendations
Most hospitalized patients with cancer require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for outpatients with cancer. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low–molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major cancer surgery should receive prophylaxis, starting before surgery and continuing for at least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those with high-risk features. LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term (6 months) secondary prophylaxis. Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE. Anticoagulation should not be used for cancer treatment in the absence of other indications. Patients with cancer should be periodically assessed for VTE risk. Oncology professionals should provide patient education about the signs and symptoms of VTE...........
LIMITATIONS
These recommendations are based on data identified by a systematic
review of the literature. Some key questions are, as yet, unanswered.
The potential benefits and harms of thromboprophylaxis in patients
with cancer receiving chemotherapy in the outpatient setting and the
utility of risk assessment require additional research. Future thromboprophylaxis trials in outpatients receiving chemotherapy may benefit from the identification of high-risk groups in whom the balance of benefits and harms favors prophylaxis.
Tuesday, May 14, 2013
A patient's perspective on ovarian cancer as a chronic disease—Devaluing a survivor's challenge - Cary Vera-Garcia (2004 - in memory of)
Discussion
A patient's perspective on ovarian cancer as a chronic disease—Devaluing a survivor's challenge
Purchase $39.95
Correspondence: Clinical Trials of Palliative Chemotherapy in Platinum-Resistant or Refractory Ovarian Cancer: Time to Think Differently?
Blogger's Note: worth reading; the language and clinical issue of the term 'chronic' as it applies to ovarian cancer has long been debated between ovarian cancer survivors/advocates and professionals, therefore, this noteworthy comment as highlighted (read the paper for full context); more importantly, Cary Vera-Garcia wrote an excellent article which was published in the Journal of Gynecologic Oncology addressing 'chronic' (as an ovarian cancer survivor) with a subsequent professional rebuttal published thereafter (Cary is no longer with us); Cary's publication was one of the first to be published on ovarian cancer as a chronic disease in ovarian cancer (to my knowledge)
~~~~~~~~~~~~~~~~~
JCO
"Platinum-resistant or -refractory ovarian cancer can hardly be
called a chronic cancer......"
TO THE EDITOR:
Wewere interested to read the recent editorial by
Spriggs entitled, “Drug Development for Chronic Cancers: Time to
Think Differently,”1 which accompanied the report by Colombo et al2
of a randomized phase III trial that compared patupilone to liposomal
doxorubicin (PLD) in 829 patients with platinum-resistant
or -refractory ovarian cancer. The primary end point of the study was
overall survival (OS). There was no difference in patient outcomes
between the two treatments. The median progression-free survival
(PFS) was 3.7 months in both arms, and theOSwas 13.2 months in the
patupilone arm and 12.7 months in the PLD arm. Twenty percent of
patients in the experimental arm discontinued treatment because of
toxicity..........
89 charged in Medicare fraud busts | Modern Healthcare
media
"Nearly 100 people, including 14 doctors and nurses, were charged for their roles in separate Medicare scams that collectively billed the taxpayer-funded program for roughly $223 million in bogus charges in a massive bust spanning eight cities, federal authorities said Tuesday.....
Crack-Prone Scissors May Burn Patients, Da Vinci Maker Says
Medscape
Intuitive Surgical, the embattled manufacturer of the da Vinci robotic surgical system, warned customers last week that certain versions of its cautery scissors may develop microcracks that could leak electrical energy and inadvertently burn tissue.
The instrument in question, EndoWrist Hot Shears Monopolar Curved Scissors, is used to cut and coagulate tissue in a wide variety of procedures, including hysterectomy, prostatectomy, and gastric bypass. The scissors and other EndoWrist instruments are made exclusively for use with the da Vinci Surgical System, consisting of a console from which a surgeon manipulates instruments attached to robotic arms while viewing the procedure in 3 dimensions. Some 2000 systems are installed at US hospitals......
Patient Safety in Surgery: Surgical checklists: the human factor
open access
Background
Surgical checklists has been shown to improve patient safety and teamwork in the operating
theatre. However, despite the known benefits of the use of checklists in surgery,
in some cases the practical implementation has been found to be less than universal.
A questionnaire methodology was used to quantitatively evaluate the attitudes of theatre
staff towards a modified version of the World Health Organisation (WHO) surgical checklist
with relation to: beliefs about levels of compliance and support, impact on patient
safety and teamwork, and barriers to the use of the checklist.
Inclusion of minorities and women in cancer clinical trials, a decade later: Have we improved?
Abstract
BACKGROUND
Inclusion
of diverse groups of participants in cancer clinical trials is an
important methodological and clinical issue. The quality of the science
and generalizability of results depends on the inclusion of study
participants who represent all populations among whom these treatment
and prevention approaches will be used.
METHODS
We
conducted a systematic review using OVID as the primary source of
reports included. Based on 304 peer-reviewed publications, diversity in
the inclusion and reporting of study participants during a decade of
cancer treatment and prevention trials (2001-2010) is summarized.
Recommendations are made for improvements in the science and reporting
of cancer clinical trials.
RESULTS
Of
the 277 treatment trials and 27 prevention trials included in this
report, more than 80% of participants were white and 59.8% were male. In
the recent decade, race and sex are rarely used as selection criteria
unless the trial is focused on a sex-specific cancer.
CONCLUSIONS
Women
and racial/ethnic minorities remain severely underrepresented in cancer
clinical trials, thus limiting the generalizability of cancer clinical
research.
Hysterectomy Does Not Raise Heart Risk (except and maybe....)
Medpage
....."Thus, we conclude that hysterectomy with or without bilateral oophorectomy does not introduce a substantial increase in cardiovascular risk factors among mid-life women," they wrote.
They acknowledged several potential limitations of the analysis, including the possibility that the participants were not young enough to evaluate the effect of hysterectomy on cardiovascular disease risk because "bilateral oophorectomy may have a greater impact on ... risk if the surgery [is] performed at younger ages, when the decline in ovarian hormones would [be] more pronounced."
In addition, there was a low number of cases of hysterectomy with bilateral oophorectomy, and follow-up ended before the women reached the high-risk period after age 65, precluding an assessment of differences in clinical events between the groups.
The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institute on Aging, the National Institute of Nursing Research, and the National Institutes of Health Office of Research on Women's Health."
Vaginal Vault Dehiscence After Robotic Hysterectomy for Gynecologic Cancers: Search for Risk Factors and Literature Review
Abstract
Introduction: Vaginal vault dehiscence following
robotic-assisted hysterectomy for gynecologic cancer may be attributed
to surgical techniques and postoperative therapeutic interventions. We
searched for risk factors in patients with gynecologic cancers and
complemented this with a literature review.
Methods: Evaluation of prospectively gathered information
on all consecutive robotic surgeries for gynecologic cancers was
performed in a tertiary academic cancer center between December 2007 and
March 2012. The literature was reviewed for articles relevant to
"gynecologic oncology" and "robotics" with "vaginal cuff dehiscence" in
the English and French languages. Respective authors were contacted to
complete relevant information.
Results: Seven dehiscences were identified of 441 cases
with established gynecologic cancers. The closures in these 7 were
performed using interrupted 1-Vicryl (Ethicon Inc) (3/167; 1.8%),
combination of interrupted 1-Vicryl and 1-Biosyn (Covidien Inc) (3/156,
1.9%), and V-Loc (Covidien Inc) (1/118, 0.8%) sutures. Associated risk
factors included adjuvant chemotherapy and/or brachytherapy, early
resumption of sexual activity, and low body mass index (mean, 23 +/-
3.23 kg/m2). Dehiscences occurred regardless of suturing by staff or
trainees. Review of operative videos did not reveal a detectable
etiologic factor, such as excessive cautery damage to the vaginal cuff
or shallow tissue sutured. All 7 colporrhexis repairs were performed
through a vaginal approach without the need of laparoscopy or
laparotomy.
Conclusions: Postoperative chemotherapy, brachytherapy,
and early resumption of sexual activities are risk factors for vaginal
vault dehiscence. Surgical technique, particularly the use of delayed
absorbable sutures, deserves further evaluation
CA-125 Level as a Prognostic Indicator in Type I and Type II Epithelial Ovarian Cancer
Abstract
Objective: Most patients with epithelial ovarian cancer
achieve a complete clinical remission (CCR) with normal CA-125 but will
still relapse and die from their disease. The present study was designed
to determine whether CA-125 levels before, during, and after primary
treatment provide prognostic information for both type I and type II
ovarian cancer.
Methods: In this retrospective study, we identified 410
patients with epithelial ovarian cancer who had achieved a CCR between
1984 and 2011. A Cox proportional hazards model and log-rank test were
used to assess associations between the nadir CA-125, histotype, and
prognosis.
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