http://jco.ascopubs.org/cgi/content/full/28/19/e321?cmpid=jco_etoc_1July2010
"...Overall, I think that there will be no need for institutionalreview boards of community-based centers or universities totake up a formal position in this context. Indeed, I think thatthe more and more diffuse use in the clinical practice of PLD40 mg/m2 will be, in and by itself, stronger than any regulatoryrules, and that the lower and safer PLD dose level will tacitlyreplace the US Food and Drug Administration–approved dosagein clinical trials.
"...It is essential that those reading this letter do not misinterpret its meaning. There is absolutely no intent in this discussion to vilify any individual, organization, or company involved in the oncology drug development paradigm. It is unquestionably the case that all working in this arena have as their major goal the advancement of antineoplastic strategies that are effective, relatively safe, and that improve the survival and quality of life of patients with cancer.
Found 8 studies with search of: ovarian cancer | Open Studies | received from 06/01/2010 to 06/27/2010
1 Not yet recruiting Incidence of Cancer in Women at Increased Genetic Risk of Ovarian Cancer
Conditions: Breast Cancer; Fallopian Tube Cancer; Ovarian Cancer; Peritoneal Cavity Cancer
Interventions: Other: questionnaire administration; Procedure: evaluation of cancer risk factors; Procedure: quality-of-life assessment; Procedure: study of high risk factors
2 Recruiting N-acetylcysteine Given IV With Cisplatin and Paclitaxel in Patients With Ovarian Cancer
Conditions: Ovarian Carcinoma, Stage 3 or 4; Epithelial Ovarian Carcinoma; Primary Peritoneal Carcinoma
Interventions: Drug: Paclitaxel; Drug: N-acetylcysteine; Drug: Cisplatin
3 Not yet recruiting Study of JI-101 in Patients With Advanced Head and Neck Cancers, Ovarian Cancers or K-RAS Mutant Colon Cancers
Conditions: Cancer; Head & Neck Cancer; Ovarian Cancer; Colon Cancer
Interventions: Drug: JI-101; Drug: Everolimus
4 Not yet recruiting Veliparib and Liposomal Doxorubicin Hydrochloride in Treating Patients With Recurrent Ovarian Cancer, Fallopian Tube Cancer, or Primary Peritoneal Cancer or Metastatic Breast Cancer
Conditions: Breast Cancer; Fallopian Tube Cancer; Ovarian Cancer; Peritoneal Cavity Cancer
Interventions: Drug: pegylated liposomal doxorubicin hydrochloride; Drug: veliparib; Other: laboratory biomarker analysis; Other: pharmacological study
5 Not yet recruiting Safety Study of MGAH22 in HER2-positive Carcinomas
Conditions: Breast Cancer; Gastric Cancer; Bladder Cancer; Ovarian Cancer; Non-small Cell Lung Cancer
Intervention: Biological: MGAH22
6 Recruiting Assessing Fertility Potential in Female Cancer Survivors
Condition: History of Cancer
Intervention:
7 Recruiting Intraperitoneal Ropivacaine Nebulization for Pain Control After Gynecologic Laparoscopic Surgery
Condition: Ovarian Cysts
Interventions: Drug: Ropivacaine nebulization; Drug: Ropivacaine instillation
8 Recruiting Effects of Exercise for Overweight Women With Polycystic Ovary Syndrome
Conditions: Polycystic Ovary Syndrome; Obesity
Interventions: Other: 16-week exercise training program; Other: Control Group without PCOS
Note: detailed article on PARP's/BRCA
"....Interest in PARP inhibition was perhaps best reflected by the question an attendee at the packed session put to Dr. Gelmon.
"My problem is, as a practicing oncologist, I see these great, wonderful results, in a very difficult population of patients with ovarian cancer," he said. "I want to know when I can get my hands on some. There are patients dying today because of this lack of access.""
".....Already, in its pilot phase, this NIH-supported project has produced comprehensive molecular classification systems for ovarian cancer and glioblastoma, which is the most common form of brain cancer. This information may help doctors do a better job of matching individual patients with the therapies that are most likely to work well for them. What's more, the findings may lead to new therapies directed at the molecular changes underlying various subtypes of cancer.
"This month, PLoS Genetics is publishing an article from the company 23andMe reporting the first genome-wide association studies (GWAS) on multiple traits ascertained by self-reported information provided through the Internet from over 10,000 participants who pay the company for providing whole genome genotypes [1]. The paper passed through scientific review by a panel of three experts relatively quickly and is sure to attract the attention of anyone with freckles, curly hair, or an aversion to asparagus. Novel associations are described for four intrinsically interesting traits (out of 22 considered), while known associations with hair and eye color are replicated in a dynamic data-gathering context. Additionally, intriguing observations on the interaction between genetic self-knowledge and self-report of phenotypes are described. The implications of the successful application of this Internet-enabled approach to GWAS research were considered to be more than sufficient to warrant publication in the journal.
However, publication was delayed for six months while the editors sought a variety of opinions on three issues: ethical review, consent, and data access...."
Note: see prior blog posting "BSB4uD" (Be Smart Before You Donate) - +$1million dollars in salaries and rising
Job Categories: Program / Project Evaluation & Development
Position Type: Part Time
Job Region: QC - Quebec City
Location(s): 4950 chemin Queen Mary
Career Level: Experienced (Non-manager)
Ad Online Since: 06/22/2010
Application Deadline: 07/06/2010
abstract:
Women diagnosed with ovarian cancer may experience many shortterm and long-term effects from cancer and its treatment. Cancer has more than a physical impact, yet there is a lack of information about the types of needs these women have and whether they want help in meeting their needs. The main purpose of this cross-sectional, descriptive study was to identify the supportive care needs (physical, emotional, social, informational, spiritual, psychological and practical) of women with ovarian cancer who attended a comprehensive, outpatient cancer centre. A further purpose was to determine if women wanted assistance in meeting those needs. A total of 50 women diagnosed with ovarian cancer participated in this study by completing a self-report questionnaire (The Supportive Care Needs Survey). The data indicated that a range of supportive care needs remained unmet for this patient group. Eight of the top 10 most frequently reported needs were psychosocial, such as fears about the cancer returning or spreading. The women also expressed a range of difficulty in managing their needs. However, despite this reality, significant numbers of women indicated they did not wish to have assistance from the clinic staff with some needs. Suggestions for practice and future research are offered to assist oncology nurses in providing care to these women.
OBJECTIVE: To examine the
effect of hospital procedure volume and other prognostic variables on
overall survival outcome and likelihood of receiving standard
recommended care among patients with advanced-stage epithelial ovarian
cancer. CONCLUSIONS: Hospital ovarian cancer surgical volume >/=21 cases/year
is associated with a higher likelihood of patients with Stage IIIC/IV
epithelial ovarian cancer receiving standard treatment (surgery followed
by adjuvant chemotherapy). Even after adjusting for treatment paradigm
and other factors, hospital volume >/=21 cases/year was significantly
predictive of improved overall survival outcome.
CONCLUSIONS:
Both integrated FDG-PET/CT and contrast-enhanced multidetector CT are sensitive surveillance modalities for the detection of recurrent ovarian cancer; the use of both modalities aids decisions on treatment plans and may ultimately have a favorable impact on prognosis. However, contrast-enhanced multidetector CT is recommended for the regular follow-up for ovarian cancer patients after initial treatment.
Conclusions. Advanced age can deter oncologists from choosing intensive cancertherapy, even if patients are
highly functional and lack comorbidities.Education on
tailoring cancer treatment and a greater use ofcomprehensive
geriatric assessment may reduce cancer undertreatmentin the
geriatric population.
"This study explored the impact of gender on cancer patients' needs and preferences, and found that, of all the patient- and disease-related factors, gender was the most important independent predictor of patient preferences."
Note:very complicated condition/conditions/subsets of conditions and requires specialist consultation/s.
"When patients with cancer develop neurologic symptoms, common causes include metastasis, infections, coagulopathy, metabolic or nutritional disturbances, and neurotoxicity from treatments. A thorough clinical history, temporal association with cancer therapies, and results of ancillary tests usually reveal one of these mechanisms as the etiology. When no etiology is identified, the diagnosis considered is often that of a paraneoplastic neurologic disorder (PND). With the recognition that PNDs are more frequent than previously thought, the availability of diagnostic tests, and the fact that, for some PNDs, treatment helps, PNDs should no longer be considered diagnostic zebras, and when appropriate should be included in the differential diagnosis early in the evaluation."
"The study used a convenience sample of patients undergoing surveillance following curative treatment for localized cancer who completed a paper survey to estimate the maximum copayment patients are willing to pay for better treatment outcomes. Results suggest that patients may be less willing to pay high copayments for treatments with modest benefit. In addition, sociodemographic factors such as education and employment status were associated with willingness to pay."
"In conclusion, this study demonstrates that it is feasible to measure cancer patients' WTP (willingness to pay) for treatments in both the adjuvant and palliative settings. In addition, our results support the hypothesis that cancer patients' WTP for treatment may be influenced by both sociodemographic factors and their assessment of the treatment's value. If confirmed in a larger, more heterogeneous population, these findings suggest that insurance benefit designs based on treatment value may be feasible for cancer treatment. However, they also highlight the risk that higher out-of-pocket expenses may contribute to socioeconomic disparities in cancer care."
"In a phase I trial, a generally well-tolerated dose was identified at which the majority of patients achieved pazopanib plasma concentrations above the concentration required for maximal in vivo inhibition of VEGFR-2 phosphorylation in preclinical models.
Administered as monotherapy, evidence of antitumor activity was observed in phase II studies in several tumor types, including soft tissue sarcoma, renal cell cancer (RCC), ovarian cancer, and non-small cell lung cancer.
Recently, the U.S. Food and Drug Administration granted approval for treatment with pazopanib in patients with RCC based on the longer progression-free survival time observed with this agent in a placebo-controlled, randomized trial.
------------------------------------------------------------
"Furthermore, preliminary data from a small phase II study inwomen
with progressive, platinum-pretreated ovarian cancer showeda
cancer antigen 125 response (defined as a confirmed decrease50% from baseline) in 11 (31%) patients, with a median
durationof response of 113 days.*>"
(*Annals of Oncology 19 (Supplement 8): viii211–viii216, 2008
doi:10.1093/annonc/mdn512:
PAZOPANIB (GW786034) IS ACTIVE IN WOMEN WITH
ADVANCED EPITHELIAL OVARIAN, FALLOPIAN TUBE AND
PERITONEAL CANCERS: RESULTS OF A PHASE II STUDY
M. Friedlander1, K.C. Hancock2, B. Benigno3, D. Rischin4, M. Messing5,
C.A. Stringer6, J.P. Hodge7, B. Ma7, G. Matthys7, J.J. Lager7
1Oncology Day Center, Prince of Wales Hospital, Randwick, Sydney/
AUSTRALIA, 2Oncology, Texas Oncology, Fort Worth/UNITED STATES OF
AMERICA, 3Oncology, SE Gynecologic Oncology, Atlanta/UNITED STATES OF
AMERICA, 4Oncology, Mercy Hospital for Women, Melbourne/AUSTRALIA,
5Oncology, Texas Oncology, Bedford/UNITED STATES OF AMERICA,
6Oncology, Texas Oncology, Dallas/UNITED STATES OF AMERICA, 7Scientific
Communications, GlaxoSmithKline, Research Triangle Park/UNITED STATES
OF AMERICA )
" Putting pazopanib into perspective and comparing it with otherVEGFR
TKIs that have been approved for a longer time are difficultand
have to be done on the basis of indirect comparisons, giventhe
lack of data from comparative trials among the several treatmentoptions."
"MuGard is indicated in Europe for the prevention and management of oral mucositis, and has been used by over 2,000 cancer patients globally. A total of 185 documented patients from various studies utilized MuGard in both prophylactic and curative settings"
OBJECTIVES: The purpose of this study is to determine the prevalence of BRCA1 and BRCA2 mutations among a large series of women with carcinoma of the fallopian tube.
METHODS: Two series of women diagnosed with carcinoma of the fallopian tube were studied. Women identified from the Ontario Cancer Registry who were diagnosed with fallopian tube cancer between 1990 and 1998 and between 2002 and 2004. A second, hospital-based series was identified at Cedars Sinai Medical Centre, Los Angeles, California. These women were diagnosed between 1991 and 2007. Each subject was approached to provide her family history and ethnic background and to provide a blood sample for genetic testing for mutations in the BRCA1 and BRCA2 genes.
RESULTS: In total, 108 patients with fallopian tube cancer were recruited (70 from Ontario and 38 from Los Angeles). Thirty-three patients (30.6%) were found to have a deleterious mutation; 23 in BRCA1 (21.3%) and 10 in BRCA2 (9.3%). The prevalence of mutations was 55.6% in Jewish women and was 26.4% in non-Jewish women. A family history of ovarian or breast cancer was positive for 24 women (23.3%); of these, 14 had a mutation (58.3%). Fourteen (14.4%) of the patients had a previous history of breast cancer; of these, 10 (71.4%) had a mutation. 40.3% of the women who were diagnosed with fallopian tube cancer before age 60 had a mutation, compared with 17.4% of the women diagnosed at age 60 and above.
CONCLUSIONS: Approximately 30% of women with fallopian tube cancer have a mutation in BRCA1 or BRCA2. The highest frequencies of BRCA mutations were seen in women with fallopian tube cancer diagnosed under age 60, in Jewish women, in women with a family history of breast or ovarian cancer, and in women with a personal history of breast cancer. All patients diagnosed with invasive fallopian tube cancer should be considered candidates for genetic testing.
A few years ago, I was asked to write a paper on ovarian cancer specific to the Survivors' Debate. Carolyn and Tracy were enlisted to co-author the article - a team approach for those who know best. This was the final version which went unpublished. It went unpublished mainly because editorial requests virtually 'sanitized' the article to the point where our message became close to irrelevant. At that point, I declined our involvement. On behalf of my - our friends, Carolyn and Tracy, and with the beneficial advances brought on through social media, here is the final and unedited version.
Authors:
Carolyn Benivegna*, Tracy Gorden*, Sandi Pniauskas (*with us in spirit)
During her research for a presentation
concerning cancer patients’ voices in healthcare, SandiPniauskas
took special notice of a paper published by an expert panel that included the following
statement: "Patients or their representatives should not attend the Multidisciplinary
Cancer Conference to ensure unbiased case review" (Report
dated June 2006, www.cancercare.on.ca/pdf/pebcmccf.pdf).
While it would be imprudent to take this
singular and remarkable quote as the “rule du jour,” this philosophy, and
others similar to it, are prevalent in both private perception and in published
literature on cancer survival.
We can be thankful for more enlightened
views, such as this example from the Journal of Health and Social Policy
that, instead, celebrates the voices and contributions of (non-medical) health
educators and activists:
The activists'
efforts wrested control of “authoritative knowledge” that had once
been the sole domain
of the “experts” with advanced medical training. They used
this knowledge to
empower “average” people with medical information…to
promote self help and
engage in civil disobedience, which led to changes in
healthcare delivery (2006;21(3):55-69).
As ovarian cancer survivors
we have learned much over the years.
Average, everyday citizens are taking active roles in their treatments
and educating themselves about this deadly disease. Yet in our view, and through the course of
shedding light on this disease and the experiences of those living with it, it
has become obvious that there is no such thing as an “average” survivor.
Ovarian cancer is not
a new disease; in fact, it has been traced back as far as Egyptian times. Advancements in research, education,
awareness and access to care have gained some momentum, but they have also hit
many roadblocks. As ovarian cancer
survivors with international grassroots connections
to, and support from, other survivors we
regularly discuss where this disease has been, and where it is going. We now feel it is time to move these
behind-the-scenes discussions to open forums.
By being informed and proactive
women with ovarian cancer, we have recognized the value and importance of
conducting our own critical analysis. Most
importantly, we have learned to shift the focus onto the human elements and
burdens of suffering that we experience each day in our communities.
Creating
a public forum for ovarian cancer survivors
As those living with this disease, we dream
of what the future holds in terms of early detection, education, research,
treatment and a cure. This dream has evolved in the form of organizing two
ovarian cancer conferences for October 2007 -- one to be held in Novi, Michigan
(US) and another in Toronto, Ontario (Canada) -- both entitled, “Survivors’ Debate: The Past Decade
in Ovarian Cancer.”
These public meetings are the result of a
collaborative effort by proactive and knowledgeable ovarian cancer survivors
with supporting oncology nurses. They will take place with the understanding
that they will be fully inclusive – everyone is welcome -- but that the focus
will remain on the experiences, needs and concerns of cancer patients and
survivors, their families and friends.
The conferences will take place in two
locations in two countries because our issues are the same: access to care,
awareness, early detection, survival rates and genetics. The directive and
focus of both conferences is to offer a place to exchange ideas honestly and
openly without judgment or bias.
Patients need an environment where they
feel encouraged to discuss the many difficulties they face. Sometimes it is very difficult to find that space
-- a place without fear of retribution, criticism or dismissive attitudes. Patient-to-patient
discussion and counseling offers this environment. It allows for in-depth
dialogue on a variety of topics that detail what strategies work for survivors
and their families and what is not effective. Healthcare settings just do not
currently lend themselves to foster the dialogue that is needed for survivors
that this new forum provides.
However, the conferences will also focus on
creating a public force to expedite change, which can only start with
communication. Born from need – an arena
for discussion for ovarian cancer survivors by survivors -- the “Survivors’
Debate” has taken form.
But while the conferences are about patients
speaking for themselves they are not speaking by themselves. With this
new forum for dialogue, debate and discussion, we can highlight the detailed
knowledge and expertise of our international ovarian cancer community with
almost a decade of experience behind us, and explain why, as a community, we
work. But we will also be able to explore the variety of reasons why what is
needed by survivors and their friends and families is not currently being translated
into caregiving.
Our ovarian cancer survivor connections and
bonds have formed through the years by enduring extreme challenges and personal
losses. The only bias we have as survivors is the bias to endure and to survive
to the best of our abilities, not only as individuals but, importantly, as a
community. To be very blunt, previously this has included much silent
suffering.
It is long past due that we take our real
issues into a public forum and encourage everyone to participate. We plan to
make some long overdue noise at these debates about ovarian cancer, and we
envision that these two scheduled events are only the beginning of a completely
new trend in ovarian cancer activism.
Ovarian cancer is a serious and under-recognized threat to women's
health which kills more women than all of the gynaecologic cancers
combined. The lifetime risk of contracting
ovarian cancer is one in seventy. Ovarian cancer is very treatable when caught early, but the
vast majority of cases are not diagnosed until too late, which means that while
it is not as common as some other cancers, it remains a woman’s cancer with a
poor survival rate.
Unfortunately, an early detection test still remains elusive and
contrary to public perception, the PAP test is not a screening test for ovarian
cancer. Efforts to diagnose ovarian cancer is through a combination of: tumor
marker test (called the CA125), a bimanual pelvic/rectal exam and transvaginal
ultrasound. Actual confirmation of the diagnosis of ovarian cancer is confirmed
with surgery and pathology reports (eg. Laboratory tests on tissues specimens).
When ovarian cancer is caught before it has spread beyond the ovaries 80-90% of
women will survive five years. When diagnosed after the disease has spread, the
chance of five-year survival drops to approximately 20-30% or less.
Signs and symptoms
Symptoms of ovarian cancer are nonspecific
and mimic those of many other more common conditions. However, as a result of the original work in
1999 of Cindy Melancon
, RN
(who died of ovarian cancer in 2003) and DrBarbaraGoff, it has now been established that
both early and advanced stage ovarian cancer do have recognizable symptoms.
A consensus expert panel convened earlier
this year concluded that the following four symptoms are much more likely to
occur in women with ovarian cancer than women in the general population:
* Bloating;
* Pelvic or abdominal pain;
* Difficulty eating or feeling full quickly;
* Urinary symptoms (urgency or frequency).
Several other symptoms have been commonly
reported by women with ovarian cancer, as well; these symptoms include fatigue,
indigestion, back pain, pain with intercourse, constipation and menstrual
irregularities. A woman should consult with
a health care professional if any of these symptoms persist or feel abnormal.
What you can do
* Understand your family history (e.g., ovarian, breast, colorectal
cancer,endometrial cancers);
*
Educate yourself and understand ovarian cancer as it relates to your
specific diagnosis;
*
Communicate your concerns with your healthcare professional;
*
Recognize and support other ovarian cancer women/families in your
community;
*
Join an online support or face-to-face support group;
*
Join a cancer organization or a program in your community and/or
hospital.
Ovarian cancer
is not a silent disease – speak up and speak out
Have a look:
ACOR – Ovarian Cancer Mailing List
(ASSOCIATION OF CANCER ONLINE RESOURCES
An adverse event is any undesirable experience associated with the use of a medical product in a patient. The event is serious and should be reported when the patient outcome is:
Death
Report if the patient's death is suspected as being a direct outcome of the adverse event. Life-Threatening
Report if the patient was at substantial risk of dying at the time of the adverse event or it is suspected that the use or continued use of the product would result in the patient's death.
Examples: Pacemaker failure; gastrointestinal hemorrhage; bone marrow suppression; infusion pump failure which permits uncontrolled free flow resulting in excessive drug dosing. Hospitalization (initial or prolonged)
Report if admission to the hospital or prolongation of a hospital stay results because of the adverse event.
Examples: Anaphylaxis; pseudomembranous colitis; or bleeding causing or prolonging hospitalization.
Disability
Report if the adverse event resulted in a significant, persistent, or permanent change, impairment, damage or disruption in the patient's body function/structure, physical activities or quality of life.
Examples: Cerebrovascular accident due to drug-induced hypercoagulability; toxicity; peripheral neuropathy.
Congenital Anomaly
Report if there are suspicions that exposure to a medical product prior to conception or during pregnancy resulted in an adverse outcome in the child.
Examples: Vaginal cancer in female offspring from diethylstilbestrol during pregnancy; malformation in the offspring caused by thalidomide. Requires Intervention to Prevent Permanent Impairment or Damage
Report if you suspect that the use of a medical product may result in a condition which required medical or surgical intervention to preclude permanent impairment or damage to a patient.
Examples: Acetaminophen overdose-induced hepatotoxicity requiring treatment with acetylcysteine to prevent permanent damage; burns from radiation equipment requiring drug therapy; breakage of a screw requiring replacement of hardware to prevent malunion of a fractured long bone.
FDA to Communicate Safety Monitoring Activities to Consumers and Health Care Professionals New website will contain safety reports on recently approved drugs, biologics
prIME Oncology invites you to view important Clinical SpotlightsSM on new ovarian cancer data just released from the 2010 Oncology Annual Meeting in Chicago.
View an expert analysis with Gini Fleming, MD, and Bradley Monk, MD, and a supplemental perspective and discussion with Bradley Monk, MD, and Michael Birrer, MD, PhD,
regarding newly released data concerning targeting angiogenesis in the
treatment of ovarian cancer as reported in the GOG-0218 trial.
An eNewsflash and downloadable slide deck highlighting these new data accompany these interviews.
"Immunohistochemistry helps in the distinction between SCTs of the ovary and other primary or metastatic ovarian neoplasms with eosinophilic and clear-cell histology. In addition, immunohistochemistry can confirm the presence of recurrent SCT, if no sufficient clinical history is provided. As some SCTs can be positive for epithelial markers and histologically similar epithelial tumors can be positive for sex cord stromal markers, the use of multiple immunohistochemical stains is recommended."
"...Did that create a chain reaction! Fox
Run’s Paul Benivegna, a Korean War veteran who chairs the
community’s hobby shop, got to work designing a veterans-themed float..." cont'd
1) study period - "We calculated age-cancer-specific screening rates for ages 40-60 using the Canadian Community Health Survey (2003 and 2005), a cross-sectional, nationally representative survey of health status, health care utilization and health determinants in the Canadian population."
2) includes: breast, mammography, PSA
Note: abstract onlyOR = overall risk; 1.0+ denotes an increased risk; in this study, mucinous cell type was the key finding Methods:Associations were evaluated in the Ovarian Cancer Association Consortium, including 16 studies of 5,593 epithelial ovarian carcinoma cases and 9,962 controls of white non-Hispanic origin.
Results: The five polymorphisms were not associated with ovarian carcinoma overall ; however, associations for the minor allele at TYMS rs495139 were observed for carcinomas of mucinous type (OR, 1.19; 95% CI, 1.03-1.39; P = 0.02), clear cell type (OR, 0.86; 95% CI, 0.75-0.99; P = 0.04), and endometrioid type (OR, 0.90; 95% CI, 0.81-0.99; P = 0.04; Pheterogeneity = 0.001). Restriction to low-grade mucinous carcinomas further strengthened the association for the mucinous type (OR, 1.32; 95% CI, 1.07-1.62; P = 0.01). TYMS rs495139 was not associated with serous type (OR, 1.06; 95% CI, 1.00-1.13; P = 0.05).
Conclusions:TYMS rs495139 may be associated with a differential risk of ovarian carcinoma types, indicating the importance of accurate histopathologic classification.
Impact: Biomarkers that distinguish ovarian carcinoma types are few, and TYMS rs495139 may provide a novel clue to type etiology.
"....governed by the duty to put patients first..." Note: background on Steven Lewis:
Bio:
Steven Lewis is a health policy and research consultant based in Saskatoon, and Adjunct Professor of Health Policy at the University of Calgary and Simon Fraser University (where he was Visiting Scholar from January to April 2007). Prior to resuming a full-time consulting practice he headed a health research granting agency and spent 7 years as CEO of the Health Services Utilization and Research Commission in Saskatchewan. He has served on various boards and committees, including the Governing Council of the Canadian Institutes of Health Research, the Saskatchewan Health Quality Council, the Health Council of Canada, and the editorial boards of several journals, including the newly launched Open Medicine. His published work covers topics such as reforming and strengthening medicare, improving health care quality, primary health care, regionalization, and the management of wait times.
Conclusions
Combination therapy is administered more often than carboplatin; especially in those with younger age, better PS and nonmucinous histology. Recurrence and death rates were similar with both treatments. Well-designed trials are needed to identify the optimum chemotherapy regimen in this group.
Conclusions:
The major conclusions related to the overall benefits and risks of MHT expressed as the number of women per 1000 taking MHT for 5 yr who would experience benefit or harm. Primary areas of benefit included relief of hot flashes and symptoms of urogenital atrophy and prevention of fractures and diabetes. Risks included venothrombotic episodes, stroke, and cholecystitis. In the subgroup of women starting MHT between ages 50 and 59 or less than 10 yr after onset of menopause, congruent trends suggested additional benefit including reduction of overall mortality and coronary artery disease. In this subgroup, estrogen plus some progestogens increased the risk of breast cancer, whereas estrogen alone did not. Beneficial effects on colorectal and endometrial cancer and harmful effects on ovarian cancer occurred but affected only a small number of women. Data from the various Women's Health Initiative studies, which involved women of average age 63, cannot be appropriately applied to calculate risks and benefits of MHT in women starting shortly after menopause.
At the present time, assessments of benefit and risk in these younger women are based on lower levels of evidence.
Introduction Inhibition of Angiogenesis for Anticancer Purposes Process of Carcinogenesis and Subsequent Tumor
Angiogenesis Angiopoietins and TIE Receptors Delta/Jagged-Notch Signaling HIF Antiangiogenesis Compounds Inhibitors of Growth Factors, RTKs, and Signaling
Pathways Monoclonal Antibodies Directed at EGFRPI3K/AKT/mTOR Pathway Inhibitors MAPK-Farnesyltransferase Rho and Ras InhibitorsHIF Pathways and Binding... Known and Potential Side Effects From the Inhibition of
AngiogenesisConclusions References
Conclusions:
The complex molecular pathways that govern tumor angiogenesis are logical targets for pharmacological manipulation given the important role they play in the growth and development of cancers.
The quality of oncologic pathology testing currently is focused on the evaluation of testing steps involved in the ordering, procuring, processing, interpreting, reporting, and decision making based on pathology test results. Most errors in cancer diagnosis are related to several factors and not simply a pathologist's interpretation. Clinical practitioners may improve the safety of oncologic pathology testing services by facilitating communication between clinical services and pathology laboratories at all levels of testing.
We have shown an association between tamoxifen and its metabolites and estrogen serum levels. An impact of CYP2C19 predicted activity on tamoxifen, as well as estrogen kinetics may partly explain the observed association between tamoxifen and its metabolites and estrogen serum levels. Since the role of estrogen levels during tamoxifen therapy is still a matter of debate further prospective studies to examine the effect of tamoxifen and estrogen kinetics on treatment outcome are warranted."
"SGO Practice Survey Task Force Chairman James Orr, MD, said in a news release, “The information in this report is a useful tool not only to current, practicing gynecologic oncologists with regard to how their practice composition relates to their peers, but also has important implications for individuals considering a career in this subspecialty, medical schools interested in creating a specialty program, and hospitals and health systems investigating the addition of specialized cancer care to their women's health care programs.”"
Breast Cancer; Fallopian Tube Cancer; Ovarian Cancer; Peritoneal Cavity Cancer
Interventions:
Other: questionnaire administration; Procedure: evaluation of cancer risk factors; Procedure: quality-of-life assessment; Procedure: study of high risk factors
CANCER OF THE OVARY (25) (reviews in process/completed)
Prevention (0)
Screening (0)
Initial management and follow-up (12)
Immunotherapy (0)
Surgery (2)
Laparoscopy versus laparotomy for FIGO Stage I ovarian cancer
Ultraradical surgery for the primary debulking of epithelial ovarian cancer (protocol stage)
Radiotherapy (1)
Chemotherapy and/or radiotherapy after surgery for ovarian carcinosarcoma (protocol stage)
Chemotherapy (5)
Adjuvant (post-surgery) chemotherapy for early stage epithelial ovarian cancer
Chemotherapy and/or radiotherapy after surgery for ovarian carcinosarcoma (protocol stage)
Intraperitoneal chemotherapy for the initial management of primary epithelial ovarian cancer
Maintenance chemotherapy for ovarian cancer (protocol stage)
Topotecan for ovarian cancer
Hormonal therapy (1)
Antigen-specific active immunotherapy for ovarian cancer
Combined modality therapy (2)
Effectiveness of different treatment modalities for the management of adult onset granulosa cell tumours of the ovary (primary and recurrent) (protocol stage)
Interventions for the treatment of borderline ovarian tumours (protocol stage)
Follow-up (1)
Evaluation of follow-up strategies for patients with epithelial ovarian cancer following completion of primary treatment (protocol stage)
Management of advanced disease (13)
Source: Research Update on PARP Inhibition: Emerging Data in Breast, Ovarian, and Other Cancers
William J. Gradishar, MD, FACP,
reviews the mechanism of PARP inhibition and its rationale as a
therapeutic pathway and describes recent data using novel PARP
inhibitors.
To download for use as a self-study resource or in your own noncommercial talks.
Download slides on recent data in PARP inhibitors in breast, ovarian, and other solid tumors.
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"The only association observed in this set of 6 analyses was a troubling one: that risk of pancreatic cancer was doubled for those in the highest quintile of circulating vitamin D levels. This observation is disconcerting both because pancreatic cancer is now the fourth leading cause of cancer death in the United States and because the proponents of the vitamin D hypothesis are now arguing that substantially elevating circulating blood concentrations into that range should be a nutritional policy objective for the general population (15, 16). As pointed out by Dr. Helzlsouer (20) in this issue of the Journal, many ongoing randomized controlled trials are now using quite high doses of vitamin D. As we await clearer evidence of benefits from those trials, we will also need to be prepared to be vigilant about their individual and collective power to assess any potential harms (21, 22).
It is timely for us to now reflect on the history of the past 25 years of our alphabetical approach to studying single vitamin deficiency states as causal factors for cancer. We have learned some hard lessons along the alphabetical way. We now know that supernutritional levels of vitamins taken as supplements do not emulate the apparent benefits of diets high in foods that contain those vitamins (13), and we now know that taking vitamins in supernutritional doses can cause serious harm. In short, we have found that the reality of human biology is far more complex than is suggested by our simple ideas."
Secondary surgical efforts to remove recurrent ovarian cancer in women who are no longer in remission
Ovarian cancer is the sixth most common cancer among women. Epithelial ovarian cancer is a disease in which malignant cells form in the tissue covering the ovary. It accounts for about 90% of ovarian cancers., the remaining 10% arise from germ cells and the sex cord and stroma of the ovary. Women with epithelial ovarian cancer that has returned after primary surgery (recurrent disease) may need secondary surgery to remove all or part of the cancer. The option of surgery (debulking or cytoreductive surgery) is currently offered to a select group of women with recurrent ovarian cancer. It is important to ascertain whether this surgery helps women with recurrent disease to survive for longer than if they only got chemotherapy.
We searched for studies that compared secondary cytoreductive surgery and chemotherapy with chemotherapy alone in women with recurrent epithelial ovarian cancer. Although we checked 1431 possible articles, we found no relevant studies.Therefore there is currently no evidence to determine if secondary cytoreductive surgery is better or worse than chemotherapy alone in terms of prolonging life.
The review highlights the need for good quality studies comparing secondary cytoreductive surgery to chemotherapy.
CONCLUSIONS: Septated cystic ovarian tumors without solid areas or papillary projections have a low risk of malignancy and can be followed sonographically without surgery
Are DNA repair inhibitors as effective and
harmless compared to conventional chemotherapy in the treatment of
ovarian cancer?
Ovarian cancer is the sixth commonest cancer
in women world-wide and remains a leading cause of death, with an annual
incidence
of 6.6 cases per 100,000 women and an annual mortality rate of
4.0 deaths per 100,000 women. Most ovarian cancers (90%) are
epithelial ovarian cancer and arise from the surface of the
ovary. Epithelial ovarian cancer typically occurs in post-menopausal
women, with a peak incidence around the age of 60, although it
does occur in younger women, often associated with genetic
predispositions. The onset of this disease is insidious and 75%
of women present with advanced stage disease (stage III or
IV) when the 5 year survival is around 30%. Treatment consists
of debulking surgery and platinum-based chemotherapy, with
or without taxanes. Although initial response to chemotherapy
is good, most women will relapse, requiring further chemotherapy
treatment and develop cancer that is resistant to chemotherapy.
Conventinal
chemotherapy acts on all rapidly dividing cells by damaging DNA. Cancer
cells divide very rapidly, which is why
chemotherapy works better on cancer cells than normal cells.
However, there is no inherent selectivity for normal calls and
so rapidly dividing cells, such as gut lining, hair follicles
and bone marrow, are also affected, leading to diarrhoea, mouth
ulcers, hair loss, anaemia and susceptibility to infections.
All
cells are equipped with a number of systems or pathways that repair DNA
damage. If cells are unable to repair their DNA,
the cell undergoes programmed cell death (apoptosis) in order
to prevent an abnormal cell from dividing. Because being able
to repair DNA is vital to cell survival, normal cells have more
than one DNA-repair pathway, so that if one is lost cells
can still repair themselves. Cancer cells often develop defects
in these pathways, due to mutations, which may promote development
of cancer (e.g. BRCA mutations). However, these same mutations
mean that these cancer cells are more susceptible to DNA damage,
such as that caused by chemotherapy, than normal cells. Novel
therapeutical agents have been developed to inhibit DNA-repair
pathways, which makes cells that already have faults in another
DNA repair pathway due to a mutation, exquisitely sensitive
to DNA damaging chemotherapy agents. The most common target for
this type of novel anti-cancer agent are the DNA-repair enzymes
called poly (ADP-ribose) polymerases (PARPs). PARPs are a
family of related enzymes, which are involved in regulating various
cellular processes, including DNA repair, cell death, and
inflammation. PARP inhibitors therefore have a potentially wide
range of applications.
Our objective was to compare
effectiveness and side effects of PARP inhibitors compared to
conventional chemotherapy in women
with ovarian cancer. The identification of a safe dose of
AZD2281 (a PARP inhibitor) has been found by small non randomised
trials, with encouraging results. For ovarian cancer, there are
currently two ongoing RCTs, but outcome data are not yet available.
Results of these trials are awaited to determine if DNA repair
inhibitors have a role in addition to conventional chemotherapy
in the treatment of ovarian cancer.
August 14 & 15, 2010 – International Gathering of Ovarian Cancer Women Supporting Each Other (ACOR), Regina, SK, Canada. This event will include a free BBQ Dinner for patients and their partners on the 14th – to register for this contact Darlene at 306-775-1848 or info@ocats.ca
A luncheon for women only on the 15th out at Homestead Hall - a Prairie Girl Experience!
Golfing on the 15th for the guys at the awesome Deer Valley Golf Resort A Block of Rooms have been set aside at the "Regina Inn, for more info or to register under “OCATS Aug 2010”
For more info call Darlene at 306-775-1848 or info@ocats.ca
Altered androgen hormone homeostasis and androgen receptor (AR)
activity have been implicated in ovarian carcinogenesis but the
relationship between AR expression in ovarian cancer and clinical
outcome remains unclear.
Conclusions
AR expression is considerably reduced in EOC as compared to fallopian
tubes, and in EOC of the serous subtype, high AR expression is a
favourable prognostic factor. These results indicate that assessment of
AR expression might be of value for treatment stratification of EOC
patients with serous ovarian carcinoma.
"While several immunohistochemistry (IHC)-based studies have confirmed widespread AR (androgen receptor)expression in EOC, data describing it as a prognostic biomarker are relatively sparse. One study describing a large series of tumors (n=322), found no association between AR protein expression and clinical outcome, however individual histological subtypes were not examined. Increased levels of AR mRNA have been described in cells from normal ovarian surface epithelium as compared to ovarian cancer cells, the majority of which were derived from serous tumors. We are, however, unaware of any studies describing AR expression in fallopian tubes, from which a substantial but not yet not fully appreciated proportion of serous ovarian carcinomas are thought to arise.."
"A new centre which is set to become one of the UK’s leading research facilities on ovarian, bowel and breast cancer opens in Edinburgh today.
The Edinburgh Cancer Research UK Centre is part of a country-wide network of centres that are run under the auspices of Cancer Research UK.
Their aim is to prevent duplication of research and bring together world class laboratory researchers with doctors to provide the best possible results for cancer patients in the future.
Edinburgh is known for its globally renowned research on genetics and the biology of cancer. The centre aims to become a world centre for developing treatments tailor-made for individual patients.
Researchers will also look at the problem of cancer cells spreading, and developing drug resistance.
David Cameron, professor of oncology and head of NHS Lothian Cancer Services, is the clinical director of the new centre. He said: “This is a very exciting development for cancer patients and for research in Scotland......"
18th June 2010 - The health regulator, "The National Institute for Health and Clinical Excellence (NICE), says a new treatment for ovarian cancer is not recommended for the NHS because the manufacturer did not submit sufficient evidence that the medication benefits patients more than the most widely-used treatments.
NICE is appraising trabectedin (Yondelis) in combination with pegylated liposomal doxorubicin (PLDH) for the treatment of relapsed ovarian cancer that is sensitive to platinum-based therapies.
Its independent advisory found that the evidence submitted by the manufacturer was not robust because it did not compare trabectedin against a current ‘gold-standard’ treatment for relapsed ovarian cancer: paclitaxel in combination with platinum-based chemotherapy. This meant NICE couldn’t confirm whether or not the treatment extends patients’ lives for longer than one of the more effective and commonly-used treatments...."
Note: discussion with particular reference to SARS (2003).
blog author's opinion: the most interesting/important comment in the article might be the following, as below. The larger question is the resulting action.
"Provide guidance and education on the important differences between public health research and practice to foster consistency in application of the differences and on how to recognize when projects proposed during emergencies cross the line from practice to research."
Note: I believe that registration (free) is required to view this article
Lynch syndrome
prevalence and penetrance of mismatch-repair gene mutations
Lynch syndrome is the most common hereditary colorectal cancer (CRC) syndrome and it accounts for ∼1%–3% of all CRC burden. The syndrome is transmitted with an autosomal dominant pattern and it is associated with mutations in the mismatch repair (MMR) genes, MLH1, MSH2, MSH6 and PMS2. These alterations lead to tumour DNA instability at microsatellites (MSI) and foster inactivating mutations in tumour suppressors containing microsatellites (i.e. TGF-βRII and BAX). Mutations in the MMR genes may lead to loss of expression of the corresponding protein and be detected by immunohistochemistry (IHC) techniques.
Overall, mutation carriers mainly have an increased risk of CRC (lifetime 30%–70%) and endometrial cancer (lifetime 30%–60%). Other extracolonic tumours observed at increased risk (lifetime 5%–15%) are urinary tract, small intestine, ovary, gastric, pancreas, biliary tract, brain and sebaceous gland tumours. A genotype–phenotype correlation has been observed in which MLH1 mutation carriers are at higher risk of young onset CRC cancer, MSH2 at higher risk of extracolonic cancers, MSH6 at increased risk of endometrial cancer and PMS2 carriers show a lower lifetime absolute risk of CRC and endometrial cancer (15%–20%) compared with other mutation carriers.
The name Turcot syndrome refers to patients with MMR gene mutations and
brain tumours, and the name Muir–Torre syndrome to
patients with cutaneous gland tumours
(keratoacanthomas, sebaceous adenomas or adenocarcinomas)......cont'd
From
2002 to 2003, the breast cancer incidence in the United States, as
reported by the National Cancer Institute's Surveillance Epidemiology
and End Results (SEER 9) database, appeared to decrease by 6.7%. This
phenomenon has been attributed to a reduction in the use of menopausal
hormone therapies after the initial publication of the Women's Health
Initiative (WHI) study results in July of 2002.
However, attempts to
draw a causal association between the use of menopausal hormone
therapies and the incidence of breast cancer have not accounted for the
facts that prescriptions of estrogen-plus-progestin menopausal
therapies, which are associated with increased rates of breast cancer,
fell by 53% from 2002 to 2003, while prescriptions of estrogen-only
therapies fell by only 27%. To address this issue,...
Of the 250 articles identified by our search strategy, none provided evidence (direct or indirect) regarding the safety of IUD use among women with ovarian cancer.
Conclusions
No evidence on the safety of IUD use among women with ovarian cancer was identified. While there are some theoretical concerns that IUD use might affect monitoring of disease progression of sex cord-stromal (non-epithelial ovarian) tumors, or increase risk of pelvic infection or vaginal bleeding among women undergoing chemotherapy, we did not find any data to suggest that IUD use would lead to worsening of primary ovarian cancer.
Abstract
Treatment with the angiogenesis inhibitors bevacizumab, sunitinib, and sorafenib as single agents or in combination with conventional chemotherapy is becoming a cornerstone of modern anticancer therapy. However, the potential toxicity of these drugs, mainly to the cardiovascular system, is still being investigated. Patient assessment at baseline, of crucial importance in candidates for treatment, involves the evaluation of risk factors and screening for past or present cardiovascular disease. Strict monitoring of treatment-related adverse effects must be conducted in order to allow the early detection of cardiovascular toxicities and their prompt medication. In the present paper, the most frequent cardiovascular toxicities and their underlying mechanisms are investigated, with a view to providing indications for effective patient management.
The descriptive nature of the studies
included in this review makes it very difficult to calculate the exact
difference between
preferred and actual roles in decision making;
hence, the authors report a summary range. Nevertheless, despite the use
of
a summary range, it is still quite clear that there
is a limited concordance between preferred and actual roles in decision
making. This limited concordance between patients’
preferred and actual roles assumed during decision making has indicated
that clinicians need to raise their sensitivity
regarding patient's participation in health care decisions. Given the
variability
and dynamic nature of patients’ role preferences,
an individual assessment should be carried out during the entire course
of treatment planning, particularly each time a
critical treatment decision is about to be made. There is a need for
clinicians
to improve their communication skills to promote a
patient's willingness to share his/her needs and desires. Innovative
intervention
studies that can improve matching of patient's
preferred and actual roles during decision making are warranted as are
studies
that examine clinicians’ views on patient
participation in decision making. Research on how patient- and
clinician-related
characteristics affect treatment decisions (e.g.
age, gender, race/ethnicity, education) is also needed to determine
those
factors that affect the actualization of patients’
preferred role.
Note: the papers from ESMO (ovarian cancer) requires registration/access is free
1) Classification of germ cell ovarian tumors
2) Classification of sex cord stromal ovarian tumors
"This set of recommendations applies to invasive epithelial ovarian carcinoma; the management of tumors of low malignant potential (‘borderline’) is not covered here."
Approved by the ESMO Guidelines Working Group: April 2002, last update
October 2008. This publication supercedes the previously
published version—Ann Oncol 2008; 19 (Suppl
2): ii14–ii16.
"Because specific antihyperglycemic medications are associated with cancer risk factors, confounding by unmeasured or incompletely measured risk factors may explain at least in part the previously reported associations between medications and cancer. To our knowledge, few studies to date have examined the risk associated with the dose, duration, or recency of medication use, which might inform the biologic plausibility of observed associations. Many agents that affect carcinogenesis have long latencies or require a minimum exposure level, and the risk associated with some agents may return to baseline after the exposure has been terminated for a period of time. Some diabetes medications have only recently come on the market (eg, TZDs, insulin analogs, and incretin-based therapies), and therefore, studies of these agents will only assess the cancer risk associated with relatively short-term use.
It is unlikely that the effect of diabetes therapies on cancer risk and progression, particularly at specific cancer sites, will be fully addressed with randomized controlled clinical trials, due to both cost and follow-up time limitations.
"Is there a shortage of gynecologists on the North Fork?
I am the only gynecologist who has an office [full time] on the North
Fork. And I'm the only gynecologist who has had a permanent office on
the North Fork in 25 years. I'm not talking specialty. I'm talking
general gyn. Riverhead is the town where the North and South forks
separate. There are two ob-gyn practices in Riverhead. And there are
several on the South Fork of Long Island, East Hampton, Southampton and
Hampton Bays. The only [full-time] gyn practice on the North Fork
driving east is mine."
Note: "some gynecologic cancers"/talks briefly about "changes in neuropathy"/treatments etc
" Research Gaps Remain
The panel found that there is consistent evidence that exercise training can lead to improvements in aerobic fitness, muscular strength, quality of life, and fatigue in breast, prostate, and hematologic cancer patients and survivors, but that the data for colon and gynecologic cancers are still too limited to lead to conclusions.
Multiple research gaps remain in this field, the panel notes. These include a need for greater specificity with regard to the dose-response effects of specific modes of exercise training on specific end points and within a broader range of populations, such as survivors of colon and gynecologic cancers.
They also urge fitness trainers who work with cancer survivors to learn as much as possible about the specifics of the cancer diagnosis and treatment to make informed safe choices with regard to exercise testing and prescription.
Cancer diagnosis and treatment effects numerous body systems that are required for and affected by exercise training, they conclude, and "because cancer treatments are increasingly customized according to specific tumor characteristics, fitness professionals may benefit from contacting the medical treatment team for more precise information regarding the treatments received.""
50% from baseline) in 11 (31%) patients, with a median
duration of response of 113 days.*>"
Click here to view the interviews, eNewsflash, and downloadable slide deck
from this data release.
