Racial Disparities and Mortality Rates for Ovarian Cancer in Texas, 1999-2009

abstract

 Conclusion: Racial disparities and geographical factors can play an important role in predicting the disease outcome.

Volatile anaesthetics enhance the metastasis related cellular signalling including CXCR2 of ovarian cancer cells

open access

 Volatile anaesthetics at clinically relevant concentrations have strong effects on cancer cell biology which in turn could enhance ovarian cancer metastatic potential. This work raises the urgency for further in vivo studies and clinical trials before any conclusions can be made in term of the alteration of clinical practice.

INTRODUCTION

The death rate from ovarian cancer in the United States is more than double that of any other gynaecological malignancy [1, 2]. The poor prognosis is not only due to the aggressive nature of this disease but also because metastases are often present at the time of diagnosis or surgery [3]. It is thought that perioperative factors may contribute to cancer recurrence [4]. Surgical procedures such as biopsy and resection have been reported to disseminate cancer cells into the circulation and surrounding tissues [5] and many studies have reported that general anaesthesia dampens immune function, which is required to eliminate cancer cells [3, 6, 7].

The effect of general anaesthetics on healthy cells or tissues in the micro-environment have been investigated for many years and both volatile and intravenous agents have been shown to alter miRNA, mRNA and protein expressions [7, 8]. A variety of anaesthetics are used for cancer resection without their direct cellular effects on cancer cells being known. Recent clinical evidence has indicated that the choice of anaesthesia and application technique could potentially change the long-term prognosis of cancer patients. It has been shown that, compared to general anaesthesia, epidural anaesthesia for surgery to resect colonic cancer is associated with improved survival [9]. The latest study indicated an association between certain inhalational anesthetics and ovarian cancer outcomes [10] .....

open access — NEJM

Perspective

Aiming High — Changing the Trajectory for Cancer

Douglas R. Lowy, M.D., and Francis S. Collins, M.D., Ph.D.

April 4, 2016DOI: 10.1056/NEJMp1600894

Blue Ribbon Panel Announced to Help Guide Vice President Biden’s National Cancer Moonshot Initiative

National Institutes of Health (NIH)

Senate Private Bill - Bill S-201 - First Reading (42-1)

Senate Private Bill - Bill S-201 - First Reading (42-1) (December 2015)

Cover

Summary

Bill S-201

SHORT TITLE

INTERPRETATION

PROHIBITIONS

OFFENCES AND PUNISHMENT

CANADA LABOUR CODE

Division XV.3

Genetic Testing

CANADIAN HUMAN RIGHTS ACT

PRIVACY ACT

PERSONAL INFORMATION PROTECTION AND ELECTRONIC DOCUMENTS ACT

Définitions et Interprétation

Bill S-201 | openparliament.ca Genetic Non-Discrimination Act - Canada

Bill S-201 | openparliament.ca

 Bill S-201

Genetic Non-Discrimination Act

An Act to prohibit and prevent genetic discrimination

This bill was previously introduced in the 41st Parliament, 2nd Session.

Status

Considering committee report (Senate), as of March 22, 2016
Subscribe to a feed of speeches and votes in the House related to Bill S-201.

Summary

This is from the published bill. The Library of Parliament often publishes better independent summaries.

This enactment prohibits any person from requiring an individual to undergo a genetic test or disclose the results of a genetic test as a condition of providing goods or services to, entering into or continuing a contract or agreement with, or offering specific conditions in a contract or agreement with, the individual. Exceptions are provided for health care practitioners and researchers. The… read more

How genetic testing can be used against you - and how Bill S-201 could change that (Canada)

media + public comments

 Canada is the only country in the G7 that does not have a law in place to protect people from discrimination based on their genetics.

Inaccurate Life Expectancy in CA Not Usually From Medical Source

medicalnews

 FRIDAY, April 1, 2016 (HealthDay News) -- Most patients with advanced cancer are inaccurate in their life expectancy estimates (LEEs), and the source of that information typically is not a medical provider, according to a study published online March 29 in Cancer.....

Acupuncture for breast cancer story left out past study findings

Healthnewsreview

 Our Review Summary
The story focuses on a recent study published in the Journal of Clinical Oncology that finds female breast cancer patients who use acupuncture therapy in conjunction with “enhanced self-care” had fewer problems with hot flashes than patients who used only enhanced self-care.
The story does a good job of explaining the study’s design, and includes an independent source. However, it fell short when quantifying the benefits, and it did not discuss potential harms or the already existing body of work related to acupuncture’s use to ameliorate hot flashes in breast cancer patients.

(how to) Search ClinVar with Ease - YouTube (clinical variants)

YouTube

Outcomes of fertility-sparing surgery among young women with FIGO stage I clear cell carcinoma of the ovary

abstract
 

OBJECTIVES:

To evaluate the outcome of fertility-sparing surgery among young women with early-stage clear cell carcinoma of the ovary.

METHODS:

In a retrospective study, data were reviewed for patients aged 45years or younger who had FIGO stage I clear cell carcinoma of the ovary and had attended one institution in South Korea between December 1999 and December 2009. Outcomes were compared between women undergoing fertility-sparing surgery, defined as preservation of the uterus and at least one adnexa, and those undergoing radical surgery.

RESULTS:

Overall, 47 patients were included (22 underwent fertility-sparing surgery, 25 radical surgery). After a median follow-up of 72months (range 8-175), 5 (23%) patients who underwent fertility-sparing surgery and 5 (20%) in the radical surgery group had recurrent disease (P=0.820). The mean time to recurrence was 19months after fertility-sparing surgery versus 20months after radical surgery (P=0.935). The anatomical location of recurrence did not differ. There was no difference in 5-year disease-free survival (77% vs 84%; P=0.849) or 5-year overall survival (91% vs 88%; P=0.480).

CONCLUSION:

Fertility-sparing surgery was found to be a safe alternative for young women with FIGO stage I clear cell carcinoma of the ovary who wish to preserve fertility.

The incidence and mortality of ovarian cancer and their relationship with the Human Development Index in Asia

open access

 Table 1. Number, crude and standardised incidence rates, and mortality from ovarian cancer in Asian countries in 2012 (sorted by age-standardised rate from the highest to lowest).

Limitations

This was an ecological study. Result of this type of study should be interpreted at the population level, and ecological fallacy will occur if results are inferred and concluded at the individual level. Some other factors such as the number of reproductive and contraceptive factors that suppress ovulation, including gravidity, breast feeding, and oral contraception, reduce the risk of ovarian cancer, and gynaecologic surgeries including hysterectomy and tubal ligation were protective. Some of the environmental factors and medical conditions that increased risk of disease included talc use, endometriosis, ovarian cysts, and hyperthyroidism. However, in this study we do not have access to enough information on these factors to consider their role in the incidence and mortality of ovarian cancer in Asian countries. Therefore, it is suggested that in addition to ecological studies, in each of these countries, studies in the form of case-control or cohort studies should be done to determine the role of factors related to the incidence and mortality from this disease on an individual level.

Genetic anticipation in BRCA1/BRCA2 families after controlling for ascertainment bias and cohort effect

 Blogger's Note: breast cancer only is included in this summary, so ovarian cancer is ??

abstract

BACKGROUND

Genetic anticipation, the earlier onset of disease in successive generations, has been reported in hereditary breast and ovarian cancer syndrome (HBOC), but little is known about its underlying mechanisms. Ascertainment bias has been suggested as a reason in previous studies. Likewise, cohort effect, which may be caused by environmental factors, can be misinterpreted as genetic anticipation.

METHODS

The authors reviewed the pedigrees of 176 kindreds, segregating those with deleterious mutations in breast cancer genes 1 and 2 (BRCA1/BRCA2) who had at least 2 consecutive generations of the same cancer (breast or ovarian). By using mutation probabilities as analytical weights in weighted random-effect models, generational differences in the age at onset of breast/ovarian cancer were calculated. The analyses were further controlled for ascertainment bias by excluding probands and adjusting for birth-cohort effect in the anticipation models.

RESULTS

The mean age at the onset of breast cancer for the probands' generation was 41.9 years, which was 6.8 years and 9.8 years earlier than the parents' and grandparents' generations, respectively. The anticipation effect for breast cancer remained significant after excluding the probands. There was a birth-cohort effect: patients who were born in 1930s and 1940s had breast cancer 5.0 years and 7.6 years earlier than patients who were born before 1920. The difference in breast cancer age of onset across generations was no longer significant after adjusting for birth-cohort effect.

CONCLUSIONS

The observed anticipation effect was driven mainly by a decrease in age of onset across birth cohorts, underscoring the need for risk-reducing interventions that target changing environmental/lifestyle factors in BRCA1/BRCA2 carriers.

Contract research organizations in oncology clinical research: Challenges and opportunities

abstract

 Contract research organizations (CROs) represent a multibillion dollar industry that is firmly embedded in the contemporary clinical trial process. Over the past 30 years, and especially within the last decade, the reach of CROs has extended to service all phases of drug trials in an increasingly global research environment. The presence of CROs is particularly noticeable in medical oncology because of the large number of investigational compounds developed to treat cancer that are currently undergoing testing in human subjects. Although limited data are available with which to objectively define the effects that CROs have had on the clinical trial process, with the expansion of these organizations, several reports have called into question whether ethical and professional standards in research conduct are at times secondary to economic considerations. CROs can add considerable value to the clinical trial process, but difficulty communicating with CRO representatives and time spent answering trivial data queries generated by CROs are current obstacles for study site personnel interacting with CROs. Further study of the effect of the CRO industry on the clinical trial process is needed to ensure efficient data collection and patient safety while collaboratively developing novel therapies in an expedited fashion.

Accuracy of advanced cancer patients' life expectancy estimates: The role of race and source of life expectancy information

Blogger's Note: ovarian cancer patients not included in this study (lung, pancreatic, colon, brain, stomach, esophageal) but included various religions

open access

INTRODUCTION

Many advanced cancer patients lack an accurate understanding of their illness and prognosis.[1, 2] Advanced cancer patients tend to underestimate the severity of their diagnosis,[3, 4] view their prognosis in overly positive and unrealistic terms,[5-7] and inaccurately believe that the goal of treatment is to cure their cancer.[4, 8] In recent studies of advanced cancer patients, fewer than 20% had an accurate understanding of their prognosis.[7, 9, 10].....

MATERIALS AND METHODS

Participants and Procedures

Coping With Cancer is a National Cancer Institute– and National Institute of Mental Health–funded prospective, longitudinal, multisite study of terminally ill cancer patients and their informal caregivers. Patients were recruited from September 1, 2002 to February 28, 2008. Patients in the current sample were recruited from outpatient clinics at the Yale Cancer Center (New Haven, Conn), the Veterans Affairs Connecticut Healthcare System Comprehensive Cancer Clinics (West Haven, Conn), the Simmons Comprehensive Cancer Center (Dallas, Texas), the Parkland Hospital Palliative Care Service (Dallas, Texas), the Dana-Farber Cancer Institute (Boston, Mass), Massachusetts General Hospital (Boston, Mass), and New Hampshire Oncology-Hematology (NHOH). Approval was obtained from the human subjects committees of all participating centers; all enrolled patients provided written consent and received $25 for their participation......

Unraveling How Obesity Fuels Cancer (maybe)

extract

FDA Investigates Counterfeit Materials in Surgical Mesh

medscape
April 1, 2016 

 In the meantime, the FDA wants healthcare professionals and their patients to be aware of this investigation and the FDA's plan to review additional data from Boston Scientific so that they can make the most informed decisions about their healthcare.

 The FDA will continue to update its webpage as additional information becomes available.

Healthcare professionals and patients should report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:
Complete form online at www.fda.gov/MedWatch/report or call 1-800-332-1088 to request a reporting form, which can then be completed and faxed to 1-800-FDA-0178 or returned by mail.

The MedWatch safety alert, including a link to the FDA's Urogynecologic Surgical Mesh Implants page, is available here.

HRT Clot Risk Lower for Vaginal Creams and Skin Patches

medscape
 April 01, 2016

(Reuters Health) - Women who take hormone replacement therapy (HRT) to ease menopause symptoms may have a lower risk of blood clots if they use estrogens applied vaginally or via skin patches, a Swedish study suggests.

Many women have been reluctant to use HRT to ease menopause symptoms since 2002, when the federally funded Women's Health Initiative (WHI) study linked the treatments containing man-made versions of the female hormones estrogen and progesterone to an increased risk of breast cancer, heart attack and stroke.

For the current study, researchers found that overall, estrogen-only therapy carries a lower risk of blood clots than treatment with a combination of estrogen and progestin, the synthetic version of progesterone......

 The study is observational, and can't prove vaginal estrogen or skin patches cause fewer blood clots than alternative treatments, the authors note. Researchers also lacked data to verify the exact timing of menopause, which can influence the blood clot risk associated with HRT.

Endocrine Society (and others) Advises Against Compounded Hormone Use

medscape

.....during a press briefing here at ENDO 2016, the annual meeting of the Endocrine Society. The statement was published online April 1, 2016 in the Journal of Clinical Endocrinology and Metabolism.
The statement is the latest in a series from medical societies, including the American College of Obstetricians and Gynecologists and the North American Menopause Society, cautioning against the use of custom-compounded, so-called "bioidentical" hormones. Nonetheless, many physicians are still prescribing them....

Custom-compounded products are potentially dangerous, she said, because added excipients can affect absorption, and those or other added ingredients could be contaminated or adulterated. Moreover, she noted, FDA-approved hormone products have well-characterized pharmacokinetics and efficacy and safety profiles. In contrast, "There's no such thing in the world of custom-compounded bioidentical hormones."
Endocrinologist Mark Sklar, MD, told Medscape Medical News that he agrees with the Endocrine Society's new statement and stance. "I think that there's no real reason to compound, especially gonadal hormones like estrogen or testosterone, because there are very good commercially available hormones now. They're well-made and well-tested, and there's consistency. With compounding there's not consistency in dosage." Continue Reading....

Some Supplements Can Interfere With Prescription Medicine, Study Finds

media - video

Characterization of ALDH 1 high ovarian cancer cells: Towards targeted stem cell therapy

abstract

OBJECTIVE:

The cancer stem cell (CSC) paradigm hypothesizes that successful clinical eradication of CSCs may lead to durable remission for patients with ovarian cancer. Despite mounting evidence in support of ovarian CSCs, their phenotype and clinical relevance remain unclear. We and others have found high aldehyde dehydrogenase 1 (ALDH^high) expression in a variety of normal and malignant stem cells, and sought to better characterize ALDH^high cells in ovarian cancer.

METHODS:

We compared ALDH^high to ALDH^low cells in two ovarian cancer models representing distinct subtypes: FNAR-C1 cells, derived from a spontaneous rat endometrioid carcinoma, and the human SKOV3 cell line (described as both serous and clear cell subtypes). We assessed these populations for stem cell features then analyzed expression by microarray and qPCR.

RESULTS:

.....However, the following druggable targets were consistently expressed in the ALDH^high cells from both models: mTOR signaling, her-2/neu, CD47 and FGF18/FGFR3.

CONCLUSIONS:

Based on functional characterization, ALDH^high ovarian cancer cells represent an ovarian CSC population. Differential gene expression identified druggable targets that have the potential for therapeutic efficacy against ovarian CSCs from multiple subtypes.

A Case of Carcinoma of the Uterine Body, Right Ovary, and Duodenum in a Patient with FAP

Abstract
 

[Article in Japanese]

We report a case of 4 carcinomas of the uterine body, right ovary, and duodenum (small intestine) in a patient with familial adenomatous polyposis (FAP). Her mother's family line carries FAP. She underwent proctocolectomy with ileoanal anastomosis for FAP when she was 20 years old. She was diagnosed with carcinoma of the uterine body and right ovary, and underwent abdominal total hysterectomy, bilateral salpingo-oophorectomy, and omentectomy at 48 years of age. The pathological examination revealed endometrioid adenocarcinoma of the uterine body (Stage ⅠB) and endometrioid adenocarcinoma of the right ovary (Stage ⅠA). Her diagnosis was Stage Ⅳ according to the Spigelman classification of duodenal polyposis, and she underwent pancreas-preserving total duodenectomy at 50 years of age. The pathological examination was conclusive for 2 carcinomas in the adenoma, which were 20 mm and 25 mm in diameter, respectively. She has been well without any evidence of cancer recurrence 20 months after the pancreas-preserving total duodenectomy.

Diagnostic error: what Muir-Torre syndrome has taught us (Lynch Syndrome)

abstract

Summary

A low-grade sebaceous carcinoma was excised from a 55-year-old woman's neck. At follow-up, 11 months later, a recent diagnosis of mucinous adenocarcinoma of the colon and history of clear cell endometrial carcinoma were identified. A strong family history of bowel cancer suggested Muir-Torre syndrome. Unexpectedly, hereditary non-polyposis colorectal cancer had previously been genetically confirmed; the results were found loosely filed in the paper chart. The patient had not informed us about her diagnosis; having discussed the case with other physicians she felt the diagnosis would be common knowledge. In 1999, US National Institute of Medicine estimated that preventable medical error resulted in the deaths of 44–98 000 people yearly in US hospitals. Four categories of medical error, including diagnosis, treatment, preventive and ‘other’ were described, while the reasoning processes that result in these errors are outlined by Reason et al. We utilise this rare case to illustrate these important concepts

Abdominal wall metastasis following open nephroureterectomy for UTUC Lynch syndrome (MSH6)

case report: (abstract) 
Abdominal wall metastasis following open nephroureterectomy for upper tract urothelial carcinoma in a patient with Lynch syndrome 
 

Summary

A 74-year-old man developed the rare complication of an abdominal wall metastasis following open nephroureterectomy for upper tract urothelial carcinoma (UTUC). This occurred in the setting of synchronous contralateral ureteric and metachronous colorectal carcinomas. Immunohistochemistry demonstrated loss of the mutS homolog 6 (MSH6) mismatch repair (MMR) protein in the metastatic abdominal wall and colonic lesions, which in conjunction with meeting the Amsterdam II criteria, is strongly suggestive of Lynch syndrome (LS). Surgical resection of the recurrence was performed with clear margins and neither recurrence nor spread during short-term follow-up.

Gynecologic Oncology (journal) - Precision Medicine Special Section (20 abstracts)

Gynecologic Oncology (not open access)

Volume 141, Issue 1, Pages 1-188 (April 2016)

Guest Editors: Robert L. Coleman and Ursula A. Matulonis

Editorial

2. • Precision medicine

   • Page 1
   • Robert L. Coleman, Ursula A. Matulonis
   • •  Purchase PDF - $39.95
   •  Not entitled to full text

Use of Precision Medicine in the Management of Gynecologic Cancers

3. • Use of comprehensive genomic profiling to direct point-of-care management of patients with gynecologic cancers

     Original Research Article
   • Pages 2-9
   • • Abstract
     • Close research highlights
     •  Purchase PDF - $39.95
     • Supplementary content

4. • The genetic prediction of risk for gynecologic cancers

     Original Research Article
   • Pages 10-16
   • • Abstract
     • Close research highlights
     •  Purchase PDF - $39.95

5. • Use of “big data” in drug discovery and clinical trials

     Original Research Article
   • Pages 17-23
   • • Abstract
     • Close research highlights
     •  Purchase PDF - $39.95
6. • Initiation of a formalized precision medicine program in gynecologic oncology

     Original Research Article
   • Pages 24-28
   • • Abstract
     • Close research highlights
     •  Purchase PDF - $39.95
7. • Personalised management of women with cervical abnormalities using a clinical decision support scoring system

     Original Research Article
   • Pages 29-35
   • • Abstract
     • Close research highlights
     •  Purchase PDF - $39.95
8. • New pattern-based personalized risk stratification system for endocervical adenocarcinoma with important clinical implications and surgical outcome

     Original Research Article
   • Pages 36-42
   • 
     
   • • Abstract
     • Close research highlights
     •  Purchase PDF - $39.95
9. • Tumor mutational analysis of GOG248, a phase II study of temsirolimus or temsirolimus and alternating megestrol acetate and tamoxifen for advanced endometrial cancer (EC): An NRG Oncology/Gynecologic Oncology Group study

     Original Research Article
   • Pages 43-48
   • • Abstract
     • Close research highlights
     •  Purchase PDF - $39.95
     • Supplementary content

10. • Prediction of taxane and platinum sensitivity in ovarian cancer based on gene expression profiles

      Original Research Article
    • Pages 49-56
    • • Abstract
      • Close research highlights
      •  Purchase PDF - $39.95

Prescription of extended-duration thromboprophylaxis after high-risk, abdominopelvic cancer surgery

abstract

OBJECTIVE:

Extended-duration thromboprophylaxis for 4 weeks after discharge has been demonstrated to reduce venous thromboembolic events (VTE) in cancer patients undergoing abdominopelvic surgery and is recommended in national guidelines. We examined the utilization and effectiveness of extended-duration low molecular weight heparin prophylaxis in high-risk cancer patients.

METHODS:

We analyzed patients with colon, ovarian, and uterine cancer who underwent surgery from 2009 to 2013 and who were recorded in the MarketScan database. Multivariable models and propensity score analysis with inverse probability of treatment weight were developed to examine uptake and predictors of use of post-discharge low molecular weight heparin (LMWH), as well as associated adverse events (transfusion, and hemorrhage).

RESULTS:

A total of 63,280 patients were identified. Use of extended-duration prophylaxis increased from 2009 to 2013 from 1.4% to 1.7% (P=0.67) for colectomy, 5.9% to 18.3% for ovarian cancer surgery (P<0.001), and 6.3% to 12.2% (P<0.001) for hysterectomy for endometrial cancer. There was no association between use of extended-duration prophylaxis and reductions in VTE for any of the procedures: colectomy (2.4% with extended-duration prophylaxis vs. 2.9% without prophylaxis, OR=0.84; 95% CI, 0.54-1.31), ovarian cancer-directed surgery (3.7% vs. 3.6%, OR=1.01; 95% CI, 0.76-1.33), hysterectomy (2.1% vs. 2.1%; OR=0.96; 95% CI, 0.67-1.38). Extended-duration prophylaxis was associated with an increased risk of adverse postoperative events: 2.20 (95% CI, 1.51-3.19) after colectomy, 1.24 (95% CI, 0.92-1.68) following ovarian cancer-directed surgery and 0.99 (95% CI, 0.66-1.48) for hysterectomy for endometrial cancer.

CONCLUSION:

Use of extended-duration thromboprophylaxis is low among high-risk cancer patients undergoing surgery.

Precision Medicine and the Future of Cancer Treatment – video 9:24 min

Insight

Two Sham Cancer Charities Closed, $75 Million Owed

medscape
 March 31, 2016

Two purported cancer charities are to be dissolved, and their leadership is responsible for repaying $75 million in public donations, federal and state officials announced yesterday.
Cancer Fund of America Inc., Cancer Support Services Inc., and their leader, James Reynolds Sr, agreed to settle charges that the two organizations claimed to help cancer patients, but instead were actually "sham charities" that spent the "overwhelming majority" of donations on personal expenses and fundraising.
Donors were told that their contributions, which amounted to $75.8 million from 2008 to 2012, would support cancer patients by providing drugs, groceries, transportation for chemotherapy, counseling, hospice care, and cash, according to the Federal Trade Commission (FTC).
But instead of medical treatment or money, patients received boxes of sample-sized soap, seasonal greeting cards, and Little Debbie Snack Cakes from the Cancer Fund of America, which is located in Tennessee, according to a report published last year in the Tampa Bay Times.....

Health-related QOL in Women With Recurrent Ovarian Cancer Receiving Paclitaxel Plus Trebananib or Placebo (TRINOVA-1)

abstract

Background To evaluate the influence of treatment on health-related quality of life (HRQoL) in 919 women with recurrent ovarian cancer enrolled in the TRINOVA-1 study, a randomized, placebo-controlled phase 3 study that demonstrated that trebananib 15 mg/kg QW plus weekly paclitaxel significantly improved PFS compared with placebo plus weekly paclitaxel (7.2 versus 5.4 months; hazard ratio, 0.66; 95% CI, 0.57–0.77; P<0.001).

Patients and Methods HRQoL was assessed with the Functional Assessment of Cancer Therapy–Ovary (FACT-O; comprising FACT-G and the ovarian cancer–specific subscale [OCS]) and EuroQOL EQ-5D instruments before treatment on day 1 of weeks 1, 5, 9, 13, 17, and every 8 weeks thereafter and at the safety follow-up visit. A pattern-mixture model was used to evaluate influence of patient dropout on FACT-O and OCS scores over time.

Results 834 of 919 randomized patients (91%) had a baseline and ≥1 post-baseline HRQoL assessment. At baseline, scores for all instruments were similar for both arms. At 25 weeks mean±SD changes from baseline were negligible, with mean±SD changes typically <1 unit from baseline: −2.4±16.6 in the trebananib arm and −1.6±15.2 in the placebo arm for FACT-O, −0.71±5.5 in the trebananib arm and −0.86±4.9 in the placebo arm for OCS, and −0.02±0.22 in the trebananib arm and 0.02±0.19 in the placebo arm for EQ-5D. Distribution of scores was similar between treatment arms at baseline and over the course of the study. In pattern-mixture models, there was no evidence that patient dropout affected differences in mean FACT-O or OCS scores. Edema had limited effect on either FACT-O or OCS scores in patients with grade ≥2 edema or those with grade 1 or no edema. 

Conclusions Our results demonstrate that the improvement in PFS among patients in the trebananib arm in the TRINOVA-1 study was achieved without compromising HRQoL.

Differences in risk for type 1 and type 2 ovarian cancer in a large cancer screening trial

abstract

OBJECTIVE:

To investigate the role of previous gynecologic surgery, hormone use, and use of non-steroidal anti-inflammatory drugs on the risk of type 1 and type 2 ovarian cancer.

METHODS:

We utilized data collected for the Prostate, Lung, Colorectal, and Ovarian cancer screening trial. All diagnosed ovarian cancers were divided into three groups: type 1, endometrioid, clear cell, mucinous, low grade serous, and low grade adenocarcinoma/not otherwise specified (NOS); type 2, high grade serous, undifferentiated, carcinosarcoma, and high grade adenocarcinoma/NOS; and other: adenocarcinoma with grade or histology not specified, borderline tumors, granulosa cell tumors. The odds ratios for type 1, type 2, and other ovarian cancers were assessed with regard to historical information for specific risk factors.

RESULTS:

Ibuprofen use was associated with a decrease in risk for type 1 ovarian cancer. Tubal ligation and oral contraceptive use were associated with a decrease in risk for type 2 ovarian cancer. A history of ectopic pregnancy was associated with a decreased risk for all ovarian cancers by almost 70%.

CONCLUSION:

These findings support the hypothesis that carcinogenic pathways for type 1 and type 2 ovarian cancer are different and distinct. The marked reduction in all ovarian cancer risk noted with a history of ectopic pregnancy and salpingectomy implies that the fallopian tube plays a key role in carcinogenesis for both type 1 and type 2 ovarian cancer.

Clear cell carcinoma of the ovary: molecular insights and future therapeutic perspectives

abstract

 Clear cell carcinoma (CCC) of the ovary is known to show poorer sensitivity to chemotherapeutic agents and to be associated with a worse prognosis than the more common serous adenocarcinoma or endometrioid adenocarcinoma. To improve the survival of patients with ovarian CCC, the deeper understanding of the mechanism of CCC carcinogenesis as well as the efforts to develop novel treatment strategies in the setting of both front-line treatment and salvage treatment for recurrent disease are needed. In this presentation, we first summarize the mechanism responsible for carcinogenesis. Then, we highlight the promising therapeutic targets in ovarian CCC and provide information on the novel agents which inhibit these molecular targets. Moreover, we discuss on the cytotoxic anti-cancer agents that can be best combined with targeted agents in the treatment of ovarian CCC.

Loss of skeletal muscle during neoadjuvant chemotherapy is related to decreased survival in ovarian cancer patients

abstract

BACKGROUND:

Malnutrition, weight loss, and muscle wasting (sarcopenia) are common among women with advanced ovarian cancer and have been associated with adverse clinical outcomes and survival. Our objective is to investigate overall survival (OS) related to changes in skeletal muscle (SM) for patients with advanced ovarian cancer treated with neoadjuvant chemotherapy and interval debulking.

METHODS:

Ovarian cancer patients (n  = 123) treated with neoadjuvant chemotherapy and interval debulking in the area of Maastricht (the Netherlands) between 2000 and 2014 were included retrospectively. Surface areas of SM and adipose tissue were defined on computed tomography at the level of the third lumbar vertebra. Low SM at baseline and SM changes during chemotherapy were compared with Kaplan Meier curves, and Cox-regression models were applied to test predictors of OS.

Long-Lasting Stent Placement in an Elderly Advanced Ovarian Cancer Patient

abstract
 

BACKGROUND:

Ovarian cancer is usually diagnosed at an advanced stage, most often co-occurring with malignant bowel obstruction. Affected patients are generally in poor physical condition, and it is important to manage the bowel obstruction to improve quality of life.

CASE REPORT:

We present the case of a 75-year-old woman who underwent a left hemicolectomy for an ovarian carcinoma with bowel obstruction. 3 years after hemicolectomy, the patient presented with an extrinsic anastomotic substenosis. A self-expanding metal stent was placed which remained in place for 7 years, rendering other invasive surgical treatments unnecessary.

CONCLUSION:

The placement of a long-lasting stent is an important option in patients with bowel obstruction subsequent to recurrent ovarian cancer, since this provides a viable alternative to surgery and increases patients' quality of life.

( SGO ) A phase III trial of bevacizumab with IV versus IP chemotherapy for ovarian, fallopian tube, and peritoneal carcinoma: An NRG Oncology Study

SGO conference
 Monday, March 21, 2016 03:13 PM - 03:20 PM

  Conclusions
•All arms have excessive toxicity
•Neurotoxicity is similarly high in all arms
•Reserve changes in treatment recommendations until survival data available for no residual disease high grade serous Stage III participants.
•IP Cisplatin increases bevacizumab associated HTN (hypertension)

 

 

 Discussion
•Survival for optimal and no residual disease participants will not be available for a few years.
•Dose reductions of paclitaxel and cisplatin as well as cross-over may have compromised efficacy.
•Dose dense paclitaxel may have improved efficacy to allow us to abandon IP chemo-must we wait-combine both?
•Bevacizumab interactions could have clouded analysis

 

Objectives:  To determine if one or both intraperitoneal chemotherapy (IP) regimens improves the progression-free survival (PFS) compared to intravenous (IV) chemotherapy for first-line treatment of patients diagnosed with optimally surgically resected stage II and III ovarian, peritoneal, or fallopian tube cancer. Methods: Eligible patients had stage II-IV epithelial ovarian, peritoneal, or fallopian tube carcinoma. They were treated with bevacizumab 15mg/kg IV on cycles 2-22, and randomized to receive six cycles of: Arm 1) IV carboplatin AUC 6/ IV weekly paclitaxel 80 mg/m2 (IV arm) or Arm 2) IP carboplatin AUC 6/ IV weekly paclitaxel 80 mg/m2/ (IP-carbo arm) or Arm 3) IV paclitaxel 135 mg/m2 day 1/IP cisplatin 75 mg/m2 day 2/IP paclitaxel 60 mg/m2 day 8 (IP-cis arm).
Results: Among, 1,560 trial participants, the median age was 58 years. 84% had Stage III disease, 72% had high grade serous histology, 57% had no visible residual disease following optimal cytoreduction. Completion rates of platinum, taxane, or bevacizumab appear in the Table. Cross-over to the IV only therapy occurred in 16% randomized to IP carbo arm and 28% randomized to IP cis arm.
 

Treatment Arm	At least 6 cycles of Platinum	At least 6 cycles of Taxane	Median # bev cycles
IV only	90%	87%	20
IP carbo	91%	88%	18
IP cis	84%	87%	17

15 deaths possibly due to toxicity were relatively evenly distributed among treatment arms. Similarly, GI perforations/fistula/leak occurred in all three arms (range, 3.7% - 5.3%). While nearly 30% of patients in each arm reported grade 2+ peripheral neuropathy, treatment-induced HTN (20.5%) and grade 3/4 nausea and vomiting (11.2%) were observed more often in the IP cis arm. IP therapy did not confer a significant PFS advantage over IV only, with the median PFS by intent-to-treat being 24.9 (IV), 27.3 (IP carbo), and 26.0 mos (IP cis). Median PFS for  Stage II/III patients with 1 cm or less visible tumor was 26.8 (IV), 28.7 (IP carbo), and 27.8 mos (IP cis). Median PFS for stage III patients with no visible residual disease was 31.3, 31.8, and 33.8 months respectively.  No statistically significant PFS benefit for IP was identified.
Conclusions: The progression free survival was not improved with IP chemotherapy. IV and IP carbo arms using weekly dose-dense paclitaxel were better tolerated than the IP cis arm.  Neurotoxicity is a major problem on all arms. The reduced dose IP cisplatin regimen does not appear to be as effective as previously reported high dose cisplatin regimens.  Survival data is not yet mature.

• Powerpoint Upload - SGO GOG 252 3-7-2016JM.ppt
• PDF Upload - Walker A PHASE III CLINICAL TRIAL OF BEVACIZUMAB.pdf

New ovarian cancer treatment fails big test - "you could have heard a pin drop" (SGO meeting)

News 
 April 1, 2016

Gynecological oncologists across the nation had been anxiously awaiting results from a major study of a grueling — but promising — method of delivering chemotherapy to ovarian cancer patients. The results were grim.
The study showed that intraperitoneal, or IP, chemotherapy was no more effective than traditional treatments.
“You could have heard a pin drop,”......

Effectiveness of prophylactic surgeries in BRCA1 or BRCA2 mutation carriers: a meta-analysis and systematic review

open access
  

Conclusions

In conclusion, options to reduce the high BC incidence and mortality risk include PBSO and PM (BPM and CPM). The summary risk reduction estimates presented in our meta-analysis confirm that BRCA1/2 mutation carriers who have been treated with prophylactic surgery have a substantially reduced risk of BC and mortality. This meta-analysis and systematic review could serve as a helpful guide for clinicians during the discussion with their patients before the final prophylactic surgical decision is made. However, further prospective studies with larger sample size and longer follow-up periods are still required to get a more precise estimation of the benefits and potential harms of prophylactic surgeries among BRCA1 or BRCA2

mutation carriers.

TAKE-HOME MESSAGE

• This was meta-analysis of 15 studies looked at clinical outcomes related to prophylactic mastectomy (PM) and bilateral salpingo-oophorectomy (PBSO) in women with BRCA1 and BRCA2 mutations. Bilateral PM significantly decreased breast cancer risk in both BRCA1 and BRCA2 mutation carriers (RR, 0.55 and 0.11, respectively), as did contralateral PM (RR, 0.072). PBSO and contralateral PM also reduced all-cause mortality in BRCA1/2 mutation carriers (HR, 0.35 and 0.51, respectively), while bilateral PM did not.
  
• The analysis found that prophylactic surgeries reduce incidence and mortality related to breast cancer.
  

Eliminating the Term Primary Care “Provider”: Consequences of Language for the Future of Primary Care

open access
  Published online March 31, 2016. doi:10.1001/jama.2016.2329

 The term “provider” first appeared in the modern health care lexicon as a shorthand referring to delivery entities such as group practices, hospitals, and networks. More recently, its use has expanded to encompass physicians, nurse practitioners (NPs), physician assistants (PAs), and perhaps others, especially those engaged in delivery of primary care.¹ On one level, this expansion is both logical and convenient, as it reflects the importance of a multidisciplinary approach to modern primary care delivery, extending beyond the traditional dyad of patient and physician.^2- 4 Being designated as a “primary care provider” also denotes qualifying for payment of services rendered,¹ a designation long sought and highly valued by advanced-practice nurses and PAs.³ Although useful in these contexts, the term “provider” has the potential for adverse consequences for primary care, calling into question the wisdom of its expanded use.

From the patient’s perspective, getting to the right primary care team member becomes problematic if all practitioners are indistinguishably designated as “providers,” which implies they are interchangeable. The term obscures their differences in depth and breadth of training, knowledge, and clinical experience as well as the particular and often unique contributions they make to a team-based effort. In well-structured, high-performance primary care practices such as the patient-centered medical home,⁴ care is taken to define and communicate the roles and responsibilities of team members according to their specific competencies.....

auto updates (pubmed) see blog: Ovarian Cancer and Us

The next 5 years in gynaecologic malignancies treatment #SGOmtg 0.27 sec

video

Recommendations to physicians who’s patients are concerned about their risk of ovarian cancer #SGOmtg 1.13 min

video

High number of uterine and BRCA mutations from study focusing on endometrial cancer patients 0.29 sec

video

SGO 2016 highlights and trends #SGOmtg. video 0.42 sec

video

Gynecologic cancer treatment trends for 2016 #SGOmtg short video 0.57 sec

video

(Understanding) Sepsis (Septicemia) Symptoms and Treatment

rxlist
 

• Sepsis (blood poisoning) facts
• What is blood poisoning?
• What is sepsis?
• Why are there so many diseases with "sepsis," "septic," "septicemia," or "blood poisoning" in their name?
• What causes sepsis?
• What are the risk factors for sepsis?
• What are the signs or symptoms of sepsis (blood poisoning)?
• How is sepsis diagnosed?
• What is the treatment for sepsis?
• What is the prognosis (outcome) with sepsis?
• What are the complications of sepsis?
• How can sepsis (blood poisoning) be prevented?
• What are some additional sources for information on sepsis (blood poisoning)?

US legislation for direct-to-consumer advertising: paternalism or common sense?

Editorial: The Lancet Oncology

DNA Repair Therapies for Ovarian Cancer (48 slides)/U of Wash/Dana Farber

LinkedIn

Can Detoxing Regimens and ‘Cleanses’ Fight Cancer?

Insight

(International) Doctor's Day (have you thanked your doctor today?)

twitter page

 
The Dedicated Doctor [Infographic] (U.S. media)

SGO: Reduced Opioid Use With Liposomal Bupivacaine in Surgery

Medpage Today

Action Points

• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• Note that this observational study using historical controls suggested that liposomal bupivacaine may decrease subsequent opioid use among women undergoing surgery for gynecologic malignancy.

SGO: Ovarian Cancer Survival Benefit With Statins

Medpage Today

Action Points

• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• Note that this observational study of women with surgically-resected ovarian cancer found that the use of statins was associated with a significant survival advantage.
• Be aware that the benefit seemed to be restricted to lipophilic statins.