Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement - multinational/abstract/eletters/response

This version published online on June 21, 2010
Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2009-2509

Submitted on November 24, 2009
Accepted on April 21, 2010

Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement

Richard J. Santen^*, D. Craig Allred, Stacy P. Ardoin, David F. Archer, Norman Boyd, Glenn D. Braunstein, Henry G. Burger, Graham A. Colditz, Susan R. Davis, Marco Gambacciani, Barbara A. Gower, Victor W. Henderson, Wael N. Jarjour, Richard H. Karas, Michael Kleerekoper, Roger A. Lobo, JoAnn E. Manson, Jo Marsden, Kathryn A. Martin, Lisa Martin, JoAnn V. Pinkerton, David R. Rubinow, Helena Teede, Diane M. Thiboutot, and Wulf H. Utian
Division of Endocrinology and Metabolism (R.J.S.), Department of Obstetrics and Gynecology (J.V.P.), University of Virginia, Charlottesville, Virginia 22908; Tufts University School of Medicine (R.H.K.), Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts 02111; Jean Hailes Research Centre (H.T.), School of Public Health, Melbourne, Australia 3168; Prince Henry's Institute of Medical Research (H.G.B.), Monash Medical Centre, Melbourne, Australia 3168; Department of Medicine/Women's Health Program (S.R.D.), Monash University, Melbourne, Australia 3181; Departments of Health Research and Policy (Epidemiology) and of Neurology and Neurological Sciences (V.W.H.), Stanford University, Stanford, California 94305; Departments of Pathology and Immunology (D.C.A.) and Surgery (G.A.C.), Washington University School of Medicine, St. Louis, Missouri 63110; Department of Nutrition Sciences (B.A.G.), University of Alabama at Birmingham, Birmingham, Alabama 35294; St. Joseph Hospital (M.K.), Internal Medicine, Reichert Health Center, Ypsilanti, Michigan 48197; Division of Immunology and Rheumatology, Ohio State University School of Medicine (W.N.J., S.P.A.), Columbus, Ohio 43219; University of Pisa (M.G.), Department of Obstetrics and Gynecology, Pisa I-56100, Italy; University of Toronto (N.B., L.M.), Department of Nutritional Sciences, Department of Medicine, Toronto, Ontario, Canada M5G 2C1; Cedars-Sinai Medical Center (G.D.B.), Department of Medicine, Los Angeles, California 90048; Columbia University Medical Center (R.A.L.), Department of Obstetrics and Gynecology, New York, New York 10037; Eastern Virginia Medical School (D.F.A.), Clinical Research Center, Norfolk, Virginia 23507; North American Menopause Society (W.H.U.), Mayfield Heights, Ohio 44124; Massachusetts General Hospital (K.A.M.), UptoDate, Waltham, Massachusetts 02453; University of North Carolina at Chapel Hill (D.R.R.), Chapel Hill, North Carolina 27516; Section of Dermatology (D.M.T.), Hershey Medical Center, Pennsylvania State University School of Medicine, Hershey, Pennsylvania 17033; King's Breast Care (J.M.), King's College Hospital, London SE5 9RS, United Kingdom; and Harvard Medical School (J.E.M.), Brigham and Women's Hospital, Boston, Massachusetts 02215


Objective: Our objective was to provide a scholarly review of the published literature on menopausal hormonal therapy (MHT), make scientifically valid assessments of the available data, and grade the level of evidence available for each clinically important endpoint.
Participants in Development of Scientific Statement: The 12-member Scientific Statement Task Force of The Endocrine Society selected the leader of the statement development group (R.J.S.) and suggested experts with expertise in specific areas. In conjunction with the Task Force, lead authors (n = 25) and peer reviewers (n = 14) for each specific topic were selected. All discussions regarding content and grading of evidence occurred via teleconference or electronic and written correspondence. No funding was provided to any expert or peer reviewer, and all participants volunteered their time to prepare this Scientific Statement.
Evidence: Each expert conducted extensive literature searches of case control, cohort, and randomized controlled trials as well as meta-analyses, Cochrane reviews, and Position Statements from other professional societies in order to compile and evaluate available evidence. No unpublished data were used to draw conclusions from the evidence.
Consensus Process: A consensus was reached after several iterations. Each topic was considered separately, and a consensus was achieved as to content to be included and conclusions reached between the primary author and the peer reviewer specific to that topic. In a separate iteration, the quality of evidence was judged using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system in common use by The Endocrine Society for preparing clinical guidelines. The final iteration involved responses to four levels of additional review: 1) general comments offered by each of the 25 authors; 2) comments of the individual Task Force members; 3) critiques by the reviewers of the Journal of Clinical Endocrinology & Metabolism; and 4) suggestions offered by the Council and members of The Endocrine Society. The lead author compiled each individual topic into a coherent document and finalized the content for the final Statement. The writing process was analogous to preparation of a multiauthored textbook with input from individual authors and the textbook editors.
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.

eLetters:
Read all eLetters

Statistical Analysis in the Postmenopausal Hormone Therapy

Joseph W. Goldzieher

JCEM Online, 17 Aug 2010 [Full text]
"It is to be hoped that this monumental, desperately needed report will help to counter the persistent damaging effect of the 2002 WHI publication, and have an influence that ranges from generators of policy and guidelines to the most remote doctor/patient interaction...."

How to follow up advanced-stage borderline tumours? Mode of diagnosis of recurrence in a large series stage II-III serous borderline tumours of the ov

BACKGROUND: The aim of this study was to describe how recurrences were diagnosed in the largest series of patients treated for an advanced-stage serous borderline ovarian tumour.
PATIENTS AND METHODS: From 1973 to 2006, 45 patients with a serous borderline tumour and peritoneal implants relapsed among 162 patients with a follow-up exceeding 1 year. Data concerning recurrences and the mode of diagnosis were reviewed.
CONCLUSIONS: This study demonstrates that ultrasound is the most relevant follow-up procedure in this context. Nevertheless, the blood CA 125 test is of particular interest for detecting invasive recurrent disease, which is the most crucial event.

How medical specialists appraise three controversial health innovations: scientific, clinical and social arguments (abstract)

How medical specialists appraise three controversial health innovations: scientific, clinical and social arguments.

Lehoux P, Denis JL, Rock M, Hivon M, Tailliez S.

Department of Health Administration, University of Montreal, Montreal, Quebec, Canada. pascale.lehoux@umontreal.ca

Abstract

Medical specialists play a pivotal role in health innovation evaluation and policy making. Their influence derives not only from their expertise, but also from their social status and the power of their professional organisations. Little is known, however, about how medical specialists determine what makes a health innovation desirable and why. Our qualitative study investigated the views of 28 medical specialists and experts from Quebec and Ontario (Canada) ...cont'd (not specific to ovarian cancer)

Vermillion's OVA1 2010 Sales Target Is Looking Like a Moon Shot. How Will it Hit It? GenomeWeb (financial)

The test, approved last September, costs $650 and is reimbursed at $540 by Medicare, according to the company. (assuming U.S. dollars)

The American Cancer Society And LIVESTRONG(R) Launch First Global Economic Cost Of Cancer Report

How Power Affects Us - WSJ.com

Ovarian Cancer Alliance of Ohio - website and tribute page

tribute page:   http://www.ocao.org/tealtributes.aspx

tweet cloud - for fun

Arresting Development: Blood Biomarker Patterns May Aid Early Diagnosis of Ovarian Cancer: Scientific American

Note: in research

full free access: More stakeholder engagement is needed to improve quality of research, say US experts

Blogger's note: Agree  based on years of RCT reviews

"Researchers need to overcome the evidence paradox of 18 000 randomised trials being published each year but almost every review concluding that not enough hard evidence exists to actually inform decision making, experts have said."

"We can’t just keep putting band aids on this system," she said. "Either health care is going to be subject to scientific methods and actually become evidence based or we are just going to keep generating little bits of evidence here and there and valiantly try to assemble them into some kind of path forward."

Slideshow: Preparing for Surgery. Tips to get ready for surgery and your post-surgery recovery (not specific to ovarian cancer )

Note: easy to read/good tips

Identification of a Danish breast/ovarian cancer family double heterozygote for BRCA1 and BRCA2 mutations

Abstract
Mutations in the two breast cancer susceptibility genes BRCA1 and BRCA2 are associated with increased risk of breast and ovarian cancer. Patients with mutations in both genes are rarely reported and often involve Ashkenazi founder mutations. ......Since the BRCA1 Arg1699Gln mutation is also suggested to be disease-causing, we consider this family double heterozygote for BRCA1 and BRCA2 mutations.

abstract: A cross-sectional study of the psychosexual impact of cancer-related infertility in women: third-party reproductive assistance

What Happens to Liability Costs When A Hospital Admits Errors? - Health Blog - WSJ

Note: comment section is open for you to express your views, as you wish

abstract: A 67-Year-Old Woman with BRCA 1 Mutation Associated with Pancreatic Adenocarcinoma case report/discussion

Abstract

INTRODUCTION: There are approximately 40,000 new cases of pancreatic adenocarcinoma diagnosed in the USA each year. It is estimated that 5-10% of all patients with pancreatic cancer have a first-degree relative with the disease, while up to 20% of cases have a hereditary component. Individuals who carry a germline mutation in the BRCA 1 or 2 genes have an increased lifetime risk of developing pancreatic adenocarcinoma when compared with the general population.

CASE REPORT: Here, we present a case of metastatic pancreatic adenocarcinoma arising in a 67-year-old carrier of a BRCA 1 germline mutation.

DISCUSSION: In patients with known BRCA 1 or 2 mutation-associated pancreatic adenocarcinoma, the addition of a DNA cross-linking agent such as cisplatin, oxaliplatin, or mitomycin to a standard gemcitabine chemotherapy backbone should be considered. Poly ADP-ribose inhibitors are a novel class of drug, which have demonstrated promising efficacy in trials of BRCA 1 and 2 mutant breast and ovarian cancer, and are currently undergoing prospective evaluation in advanced pancreatic cancer.

second article: Biomarkers: How good a cancer test are they? Science

For Women with Ovarian Cancer: A Toll Free Educational Teleconference. Free press release - Sept 20th Monday

Monday, September 20, from 8:00 pm – 9:00 pm (EST) The program is free. Women interested in participating should call Support Connection IN ADVANCE to register and receive instructions. On the night of the teleconference, participants will call a special toll-free number and be connected with the group. To learn more or to register, call Support Connection at 914-962-6402 or 1-800-532-4290. For Women with Ovarian Cancer: A Toll Free Educational Teleconference. Free. For women with ovarian cancer: A toll-free teleconference presentation & discussion with Dr. Thomas J. Herzog of Columbia University Herbert Irving Comprehensive Cancer Center at The New York-Presbyterian Hospital. Free. Topics to be discussed include: Women facing recurrence; Highlights of some new targeted molecular therapies with a focus on a clinical trial that includes the role of Bevacizumab (Avastin) in the treatment of ovarian cancer; and the role of bio markers and molecular profiling. Participants will have the opportunity to ask questions, interact with one another and share common life experiences. A Support Connection Peer Counselor will facilitate the discussion.

Lymphedema beyond breast cancer - - Cancer (journal) abstract

BACKGROUND:
Secondary lymphedema is a debilitating, chronic, progressive condition that commonly occurs after the treatment of breast cancer. The purpose of the current study was to perform a systematic review and meta-analysis of the oncology-related literature excluding breast cancer to derive estimates of lymphedema incidence and to identify potential risk factors among various malignancies.


RESULTS:
A total of 47 studies (7779 cancer survivors) met inclusion criteria: melanoma (n = 15), gynecologic malignancies (n = 22), genitourinary cancers (n = 8), head/neck cancers (n = 1), and sarcomas (n = 1). The overall incidence of lymphedema was 15.5% and varied by malignancy (P < .001): melanoma, 16% (upper extremity, 5%; lower extremity, 28%); gynecologic, 20%; genitourinary, 10%; head/neck, 4%; and sarcoma, 30%. Increased lymphedema risk was also noted for patients undergoing pelvic dissections (22%) and radiation therapy (31%). Objective measurement methods and longer follow-up were both associated with increased lymphedema incidence.

CONCLUSIONS:
Lymphedema is a common condition affecting cancer survivors with various malignancies. The incidence of lymphedema is related to the type and extent of treatment, anatomic location, heterogeneity of assessment methods, and length of follow-up.

Review: Cochrane Collaboration - Palliative surgery versus medical management for bowel obstruction in ovarian cancer

Surgery compared to non-surgical treatment to relieve symptoms of bowel obstruction in ovarian cancer

Authors' conclusions

We found only low quality evidence comparing palliative surgery and medical management for bowel obstruction in ovarian cancer. Therefore we are unable to reach definite conclusions about the relative benefits and harms of the two forms of treatment, or to identify sub-groups of women who are likely to benefit from one treatment or the other. However, there is weak evidence in support of surgical management to prolong survival.

2010 Review: Cochrane Collaboration Topotecan for ovarian cancer

Background
Chemotherapeutic agents such as topotecan can be used to treat ovarian cancer. The effects of using topotecan as a therapeutic agent have not been previously been systematically reviewed.
Objectives
To evaluate the effectiveness and safety of topotecan for the treatment of ovarian cancer. 

Results: 

Participants were more likely to respond to topotecan on a 21-day cycle as opposed to a 42-day cycle (RR 7.23, 95% CI 0.94 to 55.36). Small tumor diameter, sensitivity to platinum-based chemotherapy was associated with better prognosis. Small sample size, methodological flaws and poor reporting of the included trials made measurement bias of the trials difficult to assess.

Plain language summary

Topotecan is an active second line chemotherapeutic drug, used to treat patients with relapsed ovarian carcinoma
It appears to have a similar level of effectiveness as paclitaxel and pegylated liposomal doxorubicin, though with different patterns of side effects. Larger, well-designed randomised controlled trials (RCTs) are required to define an optimal regime.

Abstract: Which staging system to use for gynaecological cancers: a survey with recommendations for practice in the UK

Aims
There are two commonly used staging systems for gynaecological cancers, namely Federation Internationale de Gynecologie et d'Obstetrique (FIGO) and TNM. The authors wished to ascertain which staging system is most commonly used in dealing with gynaecological cancers in the UK.
Methods
The authors undertook a survey among participants in the National Gynaecological Pathology EQA scheme to investigate whether gynaecological pathologists in the UK use FIGO or TNM staging in their routine reporting of gynaecological cancers.
Results
There were 105 respondents out of 278 participants (38%). Of the analysed results, a majority of respondents (64%) use FIGO staging, while 32% use both FIGO and TNM. 80% of respondents stated that their multidisciplinary team meeting uses FIGO staging, while 18% use both FIGO and TNM. Only an extremely small minority of pathologists and multidisciplinary team meetings use TNM alone. A survey of members of the British Gynaecological Cancer Society revealed similar findings.
Conclusions
Since FIGO and TNM are not always equivalent, and there may be confusion when more than one staging system is used, it is recommended that FIGO staging be used for gynaecological cancers. The survey revealed support for the use of TNM, as well as FIGO, only for cervical cancer, since FIGO does not take the lymph node status into account. Given the prevalent practice in the UK, the British Association of Gynaecological Pathologists, British Gynaecological Cancer Society and gynaecological clinical reference group of the National Cancer Intelligence Network recommend that FIGO staging be used for gynaecological cancers with recording of the lymph node status for cervical cancer. This may be done by providing a TNM stage for this cancer type only or by recording the lymph-node status at the multidisciplinary team meeting.

Cancer Patients' Roles in Treatment Decisions: Do Characteristics of the Decision Influence Roles? JCO

Purpose
Patients with more active roles in decisions are more satisfied and may have better health outcomes. Younger and better educated patients have more active roles in decisions, but whether patients' roles in decisions differ by characteristics of the decision itself is unknown.

Conclusion
 Patients making decisions about treatments for which no evidence supports benefit and decisions about noncurative treatments reported more physician control, which suggests that patients may not want the responsibility of deciding on treatments that will not cure them. Better strategies for shared decision making may be needed when there is no evidence to support benefit of a treatment or when patients have terminal illnesses that cannot be cured.

Patient groups must reveal corporate sponsorship, urges campaign group - BMJ

Care for Caregivers: Groups Offer a Unique Support for Caregivers - Cancerwise | Cancer blog from MD Anderson Cancer Center

While friends and family may try to offer assistance and support, a feeling of "you don't know what it's like for me" is both common and reasonable.

Research uncovers possible new targets for attacking ovarian cancer - Cancerwise | Cancer blog from MD Anderson Cancer Center

Note: in research

Two studies led by scientists at MD Anderson open new areas of research that could potentially improve ovarian cancer treatment.

The discoveries published today in the journal Cancer Cell are preclinical - they employ laboratory experiments to better understand the molecular processes that drive formation and growth of cancer. Both studies found previously unknown roles for two proteins, singling them out for further research and possible drug development. ...cont'd

Understanding Patient Perspectives on Communication About the Cost of Cancer Care: A Review of the Literature — JOP

Conclusion: To my knowledge, patient preferences surrounding discussion of cost of cancer care have gone largely unstudied and are thus unknown. If the goal is to provide high-quality care while controlling rising health care costs, more research is needed to better understand patient perspectives on communication surrounding the cost of oncologic care, particularly given the significant impact such discussions may have on cancer outcomes, cost, and overall patient satisfaction.

full free access: Practice and Productivity of Physician Assistants and Nurse Practitioners in Outpatient Oncology Clinics at National Comprehensive Cancer Network Institutions — JOP

short video (45 seconds): Health 2.0 Washington DC Conference: Interview with Gilles Frydman

Interview with Gilles Frydman, Founder and President of ACOR

Are Some Hospitals Afraid of “Powerful Patients”?--Editorial - EmpowHER.com

E-Health Insider :: Government to scrap Audit Commission UK

"It is less clear where its medication and patient safety work will go, since the government has already announced that it will be scrapping the National Patient Safety Agency as part of its bid to reduce the number of arms length bodies in the health service."

Survivors display artwork-Ovarian Cancer Awareness and Treatment in Saskatchewan group (OCATS)

It's Our Time - American Association for Cancer Research (AACR)

A phase II study of sunitinib in patients with recurrent epithelial ovarian and primary peritoneal carcinoma: an NCIC Clinical Trials Group Study

Results: Of 30 eligible patients, most had serous histology (67%), were platinum sensitive (73%) and had two prior chemotherapies (60%). One partial response (3.3%) and three CA125 responses (10%) were observed, all in platinum-sensitive patients using intermittent dosing. Sixteen (53%) had stable disease. Five had >30% decrease in measurable disease. Overall median progression-free survival was 4.1 months. Common adverse events included fatigue, gastrointestinal symptoms, hand–foot syndrome and hypertension. No gastrointestinal perforation occurred.

Conclusions: Single-agent sunitinib has modest activity in recurrent platinum-sensitive ovarian cancer, but only at the 50 mg intermittent dose schedule, suggesting that dose and schedule may be vital considerations in further evaluation of sunitinib in this cancer setting.

Cancer epigenomics: Implications of DNA methylation in personalized cancer therapy - Cancer Science

Note: in research; see Table 1 for references to ovarian cancer/cisplatin

"Methylation of FANCF has been found in 20% of primary ovarian cancers not previously exposed to cisplatin, but the correlation between chemosensitivity and FANCF methylation in primary tumors remains to be determined."

Review Symptom research in gynecologic oncology: A review of available measurement tools (abstract)

 define: heterogeneity - diverse and not comparable

 Results

Nine studies examined symptom assessment, quality-of-life assessment, or symptom indexes for various gynecologic cancers. Studies varied in design, patient profiles, symptoms assessed, and outcomes measured. Meta-analysis was not performed due to heterogeneity in the studies.

Conclusion

Although pain is well-studied and well-characterized, other disease-specific and general systemic symptoms of gynecologic cancers need better understanding and assessment. Accordingly, assessment of symptoms throughout the course of disease is crucial for treatment decisions and outcomes monitoring for patients with gynecologic cancer. This is especially true for survivors of gynecologic cancer, for patients whose treatment was unsuccessful, or for choosing between treatments with comparable survival outcomes. However, measurement and assessment of cancer-related symptoms is challenging because of the complex interaction between disease progression, multi-modality treatments, and symptoms. In this review, we evaluate the currently available symptom assessment tools for gynecologic cancers, along with quality-of-life assessment tools that include symptom items, and we give recommendations for further research.

Informa Healthcare - Summary: Standardized FDG uptake as a prognostic variable and as a predictor of incomplete cytoreduction in primary advanced ovar

Discussion
FDG uptake in the primary tumor of patients with advanced ovarian cancer was not a prognostic variable and the FDG uptake did not predict complete cytoreduction after primary surgery. Future prospective clinical trials will need to clarify if other PET tracers can serve as prognostic variables in ovarian cancer.

Chemotherapy Options in the Management of Platinum-Sensitive Recurrent Ovarian Cancer

Note: registration required to view (free) SPECIAL EDITION / EDUCATIONAL REVIEWS

ISSUE: AUGUST, 2010 | VOLUME: 05:08 Chemotherapy Options in the Management of Platinum-Sensitive Recurrent Ovarian Cancer

abstract: Expert Opinion on Drug Metabolism & Toxicology - Effects of herbal products on the metabolism and transport of anticancer agents

What the reader will gain: Potential interactions of herbal medicines with anticancer agents have become a safety concern in cancer chemotherapy.

Take home message: Further studies are warranted to investigate the efficacy and safety profiles of herbal medicines commonly used by cancer patients.

full free access: A KRAS-Variant in Ovarian Cancer Acts as a Genetic Marker of Cancer Risk — Cancer Res

Note: in research; discusses HBOC (BRCA/mutation not found); KRAS has been studied extensively in colorectal cancer but not mentioned in this research eg. Lynch Syndrome

FDA considers revoking approval of Avastin for advanced breast cancer

Medicine, Health Care and Philosophy A European Journal Editorial: The language of medicine and bioethics

"...The contributions in this section clearly show the new stage in the development of global bioethics, with an increasing body of documents, guidelines, publications at the level of international law. The language of human rights is becoming the new language of bioethics."

eMJA: The Medical Journal of Australia : Conflict between doctors and politicians

How do you rank and use medical evidence? short discussion on clinical trials

Randomized clinical trials are the gold standard ; Mixed bag of evidence to determine drug safety

The Cancer Biomarker Conundrum: Too Many False Discoveries

The Cancer Biomarker Conundrum: Too Many False Discoveries
14 Aug 2010

"The boom in cancer biomarker investments over the past 25 years has not translated into major clinical success. The reasons for biomarker failures include problems with study design and interpretation, as well as statistical deficiencies, according to an article published online August 12 in The Journal of the National Cancer Institute...".cont'd including several references to ovarian cancer

Expert Opinion on Medical Diagnostics - KRAS mutations - Summary

What the reader will gain: KRAS mutations in mCRC and NSCLC primary tumors predict resistance to EGFR-targeted therapy. In pancreatic cancer, KRAS may prove useful as a diagnostic biomarker to screen for early neoplasia. Furthermore, quantitative KRAS mutation analysis could have the potential to distinguish pancreatic cancer from other conditions such as chronic pancreatitis.

With respect to ovarian and endometrial cancer, further studies should focus on determining reliable biomarkers for predicting response to EGFR-targeted therapy. Besides EGFR inhibition, KRAS may also serve as a diagnostic and predictive biomarker for evolving therapies directed against mutant RAS proteins.

Take home message: KRAS has been recognized as an outstanding predictive biomarker to select mCRC and NSCLC patients for EGFR-targeted therapies; however, multi-determinant approaches including other molecular markers should facilitate the identification of patients likely to respond to such therapies.

See also blog post:

Wednesday, July 21, 2010

A KRAS-Variant in Ovarian Cancer Acts as a Genetic Marker of Cancer Risk (full access)

REPOST: updated to include commentaries - Missing an Ovarian Cancer Diagnosis Should Be Criminal

Note:
The reposted blog includes commentaries from a number of well known ovarian cancer advocates/survivors/family and is open for comment

Protocol: Cochrane Collaboration - Vitamin D supplementation for prevention of cancer in adults

Objectives

To assess the beneficial and harmful effects of vitamin D supplementation for prevention of cancer in adults.

Abstract

This is the protocol for a review and there is no abstract. The objectives are as follows:

To assess the beneficial and harmful effects of vitamin D supplementation for prevention of cancer in adults.
Why it is important to do this review

The available evidence on vitamin D and cancer incidence is intriguing but inconclusive. Results of recently completed randomised clinical trials testing the influence of vitamin D supplementation for cancer prevention are inconsistent. Lappe et al found that vitamin D supplementation is associated with significantly decreased cancer incidence (Lappe 2007). On the contrary, another large randomised clinical trial found no effect of vitamin D and calcium supplementation on cancer incidence (Wactawski-Wende 2006). A recent meta-analysis by Autier and Gandini of 18 randomised clinical trials found significantly lower mortality in vitamin D supplemented participants (Autier 2007). We have been unable to identify any systematic reviews of randomised trials on vitamin D supplementation for cancer prevention.

Ontario cancels vitamin D testing for all - media article

blog - Women of Teal: "Get Back Up Again" (blogger Dee/ovarian cancer survivor)

full access: Ovarian Cancer Metastatic to the Breast Presenting as Inflammatory Breast Cancer: A Case Report and Literature Review - Journal of Cancer

Conclusion. Although ovarian metastasis to the breast presenting as inflammatory breast cancer is rare, it should be included in the differential diagnosis for any patient with a personal history of ovarian cancer. Accurate differentiation is necessary because treatment differs significantly for patients with ovarian metastasis to the breast, as compared with patients with primary inflammatory breast cancer. Ovarian metastasis to the breast confers a poor prognosis...cont'd

(full access) Review: Vitamin D in combination cancer treatment - Journal of Cancer

Technique to Preserve Fertility in Young Women May Be Unsafe for Patients With Leukemia (AML/CML)-- press release

Note: study of 18 patients (AML/CML)

WASHINGTON, Aug. 13 /PRNewswire-USNewswire/ --

Although the use of ovarian tissue cryopreservation and transplantation has lead to 13 live births in women with lymphoma or solid tumors, this method of fertility preservation may be unsafe for patients with leukemia, according to a recent study published online in article: Blood, the journal of the American Society of Hematology "Reimplantation of cryopreserved ovarian tissue from patients with acute lymphoblastic leukemia is potentially unsafe". The method involves removing and freezing ovarian tissue before the patient undergoes aggressive chemotherapy and radiotherapy, and then reimplanting the tissue once the cancer has been brought under control. One major concern with leukemia patients is the risk that their frozen-thawed ovarian tissue might harbor malignant cells that could induce a recurrence of the disease after reimplantation.

"Our study provides clear evidence that cancer cells in women with acute and chronic leukemias can contaminate the ovaries," said Marie-Madeleine Dolmans, MD, professor at the Universite Catholique de Louvain in Brussels and lead author of the study. "If this tissue is reimplanted in these women when they're ready to have children, there's a good possibility that the cancer will come back." ...cont'd

"Moreover, chemotherapy before ovarian cryopreservation does not exclude malignant contamination. Finally, reimplantation of cryopreserved ovarian tissue from ALL and CML patients puts them at risk of disease recurrence."

Expert Opinion on Investigational Drugs - Summary: Histone deacetylase (HDAC) inhibitors

Take home message: There are extensive preclinical studies with transformed cells in culture and tumor-bearing animal models, as well as limited clinical studies reported to date, which indicate that HDAC inhibitors will be most useful when used in combination with cytotoxic or other targeted anticancer agents.

Don Berwick to Head Medicare - Great Choice by President Obama - blogger's notes

Note: having been involved in WHO's (World Health Organization) Patients for Patient Safety I had the ocassion several times to hear Don Berwick speak. Here are some notes from Trisha's blog:

Patient Empowerment Blog

By Trisha Torrey, Patient Empowerment Guide

Here's an example of Dr. Berwick's point of view. From the IHI website, this is the No Needless List:
No needless deaths
No needless pain or suffering
No helplessness in those served or serving
No unwanted waiting
No waste
No one left out

(U.S.) Community Oncology Alliance - audio interview (10 min) Ted Okon

August 12, 2010: COA Executive Director Ted Okon Talks Cancer Crisis

Assessing Women at High Risk of Breast Cancer: A Review of Risk Assessment Models: Abstract and Introduction

".......In addition to increasing the risks of breast and ovarian cancers, germline mutations in BRCA1 and BRCA2 are associated with an increased risk of prostate cancer and BRCA2 mutations are associated with increased risks of pancreatic and gastric cancers and melanoma.^[12] BRCA mutations tend to cluster within certain ethnic groups, such as Ashkenazi Jews,^[13–15] and in some populations, such as those in the Netherlands,^[16] Iceland,^[17,18] and Sweden.^[19] Germline mutations that are associated with familial breast cancer have been identified in other genes, including TP53, PTEN, ATM, CHEK2, NBS1, RAD50, BRIP, and PALB2, and others are suspected.^[20,21]"


Women who are at high risk of breast cancer can be offered more intensive surveillance or prophylactic measures, such as surgery or chemoprevention. Central to decisions regarding the level of prevention is accurate and individualized risk assessment. This review aims to distill the diverse literature and provide practicing clinicians with an overview of the available risk assessment methods. Risk assessments fall into two groups: the risk of carrying a mutation in a high-risk gene such as BRCA1 or BRCA2 and the risk of developing breast cancer with or without such a mutation. Knowledge of breast cancer risks, taken together with the risks and benefits of the intervention, is needed to choose an appropriate disease management strategy. A number of models have been developed for assessing these risks, but independent validation of such models has produced variable results. Some models are able to predict both mutation carriage risks and breast cancer risk; however, to date, all are limited by only moderate discriminatory accuracy. Further improvements in the knowledge of how to best integrate both new risk factors and newly discovered genetic variants into these models will allow clinicians to more accurately determine which women are most likely to develop breast cancer. These steady and incremental improvements in models will need to undergo revalidation....cont'd

Caveats and Concerns With New Study on Hormone Therapy and Breast Cancer

Note: references studies - WHI (Women's Health Initiative) and California Teachers Study

Clinicians vary in their approaches to HT, said Dr. Ursin. "Certain gynecologists are very careful with finding the right dose for each woman, and some even prescribe [estrogen] alone for women who have a uterus, but then monitor the uterus carefully. Please keep in mind that the risk of breast cancer associated with EPT is relatively moderate. The risk of endometrial cancer with [estrogen] alone is much higher — a more than 4-fold increase in risk in this same population of California teachers," she said.

Future Medicine - Full Text Cancer pharmacogenomics: do cancer cell lines have the right stuff?

Note: cell 'lines' (test tube) vs  patient tumors

"....But with all the effort and money being put into pharmacogenomics research using cancer cell lines, it is appropriate to ask: how faithfully do cancer cell lines represent the tumors that they are being used to model?"

"Next, do cancer cell lines behave similarly to the tumors they are intended to model to be useful for pharmacogenomics research? First, cancer cell lines are more appropriate for assessing the response to cytotoxic anticancer drugs, rather than the response to newer biologic agents which exert their anti-tumor effects via mechanisms other than eliciting cell death. Second, an important consideration to keep in mind when using cancer cell lines for pharmacogenomics research is that cell lines are generally more sensitive to cytotoxic agents than solid tumors.

"Another important question is: how well does testing in cancer cell lines predict responses in clinical trials with real world patients? When assessing whether there is a correlation between drug activity in Phase II clinical trials and preclinical activity in cancer cell line models, one study found that preclinical activity did not correlate with Phase II response, with the exception of non-small-cell lung cancer [5].

However, ..........It is becoming more and more apparent that the process of culturing cells in vitro alters the genetic make-up of the cancer cell lines."

BioMed Central Blog : Correspondence: Sequencing of a tumor and its metastases

Note: Correspondence (in full), still early days in research but progress noted 

"In an article just published in Genome Biology, Steven Jones and colleagues at the British Columbia Cancer Agency have used next generation sequencing to monitor the development of a tumor as it metastasized and used the genomic information to inform treatment.

Cancers are known to accumulate mutations as they progress, and there are several mutations characteristic of metastases. However, even the most well-characterised of tumor types show genetic heterogeneity, and there are few data available for rare tumor types. The recent advent of next generation sequencing technology, allowing rapid and inexpensive genome sequencing, has made it possible to explore the genomic landscape of tumors in more detail.

In this study, a man presented with an unusual cancer of the tongue. He received surgery and radiotherapy, but was subsequently found to have metastases in the lungs. The patient was initially treated with the EGFR inhibitor erlotinib, but the lung metastases continued to grow. Sequencing of the metastases uncovered amplification of the RET oncogene, which explained the resistance to erlotinib, and also suggested the use of the RET inhibitor sunitinib. This drug reduced the size of the lung lesions for a few months, before they started to grow again. A skin metastasis was also detected, and sequencing uncovered seven new mutations that were present in neither the lung metastases nor the original tongue tumor. It appeared that the tumor had upregulated the AKT signalling pathway to compensate for the inhibition of the RET pathway.

This eloquent study demonstrates nicely both how tumors respond to treatment with compensatory changes and also how genomics can be used to guide medical treatment.

Doctor and Patient - How Good Are Foreign-Trained Doctors? - NYTimes.com

Medical News: Cancer Biomarkers Missing in Action - Ovarian Cancer - Medscape

With a handful of possible exceptions, Diamandis wrote, "very few, if any, molecules have been identified that are expressed only by a cancer tissue but not by the corresponding normal tissue."
Cancer biomarkers are missing in action despite the availability of "highly sophisticated and powerful technologies" to discover them, as well as large investments, Diamandis wrote, adding that the last biomarker approved by the FDA -- in 2009 -- was HE4 protein, indicated for monitoring recurrence but not early detection of ovarian cancer."

Action Points  

---

• Note that this commentary documents the hazards of reports on promising biomarkers for cancer screening.



• The author points out that one of the major problems is finding biomarkers released in significant amounts from asymptomatic (usually small) tumors, but not from normal tissues.

Expert Analysis: Clinical Care Options Oncology - Ovarian Cancer

INDEPENDENT CONFERENCE COVERAGE 2010 American Society of Clinical Oncology Annual Meeting* *CCO is an independent medical education company that provides state-of-the-art medical information to healthcare professionals through conference coverage and other educational programs.
	To: CCO member From: Thomas J. Herzog, MD Columbia University College of Physicians and Surgeons New York, New York Subject: CME/CE-Certified Expert Analysis From Chicago Click to Access: Ovarian Cancer
	While attending the clinical oncology meeting in Chicago, Illinois, I met with Bradley J. Monk, MD, to review the clinical implications of recent studies in ovarian cancer. Our discussion is available on the Clinical Care Options Web site as a CME/CE-certified Expert Analysis. Select topics include: Bevacizumab-Based First-line Regimen and Maintenance Therapy for Advanced Ovarian Cancer First-line Gemcitabine/Carboplatin vs Paclitaxel/Carboplatin, Followed by Paclitaxel Maintenance for Advanced Epithelial Ovarian Cancer Frontline PLD/Carboplatin vs Paclitaxel/Carboplatin for Advanced Ovarian Cancer Exploration of PARP Inhibitors in Ovarian Cancer With and Without BRCA Mutations New Antiangiogenesis Inhibitor for the Treatment of Recurrent Ovarian Cancer: AMG 386 Novel Monoclonal Antibody for the Treatment of Platinum-Sensitive Epithelial Ovarian Cancer: Farletuzumab Novel Vincristine-Based Agent for the Treatment of Platinum-Resistant Advanced Ovarian Cancer: EC125 Nab-Paclitaxel Plus Bevacizumab in Platinum-Resistant Primary Epithelial Ovarian Cancer or Primary Peritoneal Cancer Novel Irinotecan-Based Agent for the Treatment of Platinum-Resistant/Refractory Ovarian Cancer: NKTR-102 Platinum-Free Interval Extension With Trabectedin/PLD in Partially Platinum-Sensitive Recurrent Ovarian Cancer 2-Step Screening Strategy for Ovarian Cancer Using Annual CA-125 Measurement and Possible Transvaginal Ultrasound To review this CME/CE-certified Expert Analysis, click here. This Expert Analysis is located online at: http://clinicaloptions.com/Oncology/Conference%20Coverage/Clin%20Onc%20June%202010.aspx

Institutional financial conflicts of interest policies at Canadian academic health science centres: a national survey - full free access

Facebook loophole reveals names, pictures with sign-on errors | Security - CNET News

Facebook loophole reveals names, pictures with sign-on errors | Security - CNET News

Expert Opinion: full free access for the next 7 days

Note: so far I have scanned the article as below which includes references to ovarian cancer;
Tip:  click on the titles below and then go to link clicking on the website which will bring you to the document :

• Treatment of thromboembolism in cancer patients
  Marina Panova-Noeva, Anna Falanga

index




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Preclinical > Phase I > Phase II > Phase III > Launch" src="http://marketing.informahealthcare.com/client_work/7876_eo_html_template_1/header_top.gif" border="0" height="104" width="555">

A week's free online access to this month's most read Expert Opinion articles

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This month's Editors' Picks: A safety assessment of tumor necrosis factor antagonists during pregnancy Vanessa C Osting, John D Carter Treatment of thromboembolism in cancer patients Marina Panova-Noeva, Anna Falanga Computational systems approach for drug target discovery Nagasuma Chandra Re-overcoming barriers in translating biomarkers to clinical practice Andrea Staratschek-Jox, Joachim L Schultze Molecular switching of osteoblastogenesis versus adipogenesis: implications for targeted therapies Ichiro Takada, Alexander P Kouzmenko, Shigeaki Kato Biosimilars: current status and future directions Simon D Roger Advances in PEGylation of important biotech molecules: delivery aspects Sinéad M Ryan, Giuseppe Mantovani, Xuexuan Wang, et al.

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Disadvantaged face the hardest fight against cancer

Note: to cancer patients and their families this is not a surprise, I would suspect via media reports, past and present, that the public is wiser as well (aka: "the Wisdom of Crowds")

"To many Canadians this finding might come as a surprise."

Read more: http://www.vancouversun.com/health/Disadvantaged+face+hardest+fight+against+cancer/3384687/story.html#ixzz0wMeKYWYt

Index of articles: Future Medicine - Biomarkers in Medicine - Vol. 4

Note: this journal requires subscription ($$$), abstracts available free

(full free access) Foreword: Today’s discoveries to tomorrow’s care: cancer biomarkers revisited

1) link:  Themed content: Using biomarkers to individualize and monitor cancer therapy - Foreword

2) link: Epigenomics and ovarian carcinoma

Leonel Maldonado, Mohammad Obaidul Hoque

Biomarkers in Medicine, August 2010, Vol. 4, No. 4, Pages 543-570.

(Summary)

 

.

(U.S.) SRA Wins $100 Million Contract with Department of Defense - MarketWatch

FAIRFAX, Va., Aug 10, 2010 (BUSINESS WIRE) -- SRA International, Inc. , a leading provider of technology and strategic consulting services and solutions to government organizations and commercial clients, today announced that the Department of Defense (DoD) awarded the company a re-compete contract to support the receipt and scientific review of research grant applications for DoD's Congressionally Directed Medical Research Programs (CDMRP). The contract has a potential total dollar value of $100 million over five years, if all options are exercised.
SRA has provided a vast range of services supporting scientific and technical merit review of the thousands of research grant applications received by the U.S. Army Medical Research and Materiel Command's (USAMRMC) CDMRP. Research initiatives supported by SRA have included breast, prostate and ovarian cancers; chronic myelogenous leukemia; osteoporosis; neurofibromatosis; tuberous sclerosis complex; autism spectrum disorder, amyotrophic lateral sclerosis, post traumatic stress disorder, traumatic brain injury, prion diseases; and initiatives related to the health and readiness of military personnel...cont'd

Filly fulfills a special role - Times Union (nice if not sad story - ovarian cancer/horse lovers)

"Half a million when you're broke?" Snyder said at Saratoga, where he's sleeping in a tack room in the barn near his horse. "That's a lot of money. But she's not for sale -- at any price. This is a personal thing for me."

CHOP iPhone App Records Side Effects in Clinical Trials | The Children's Hospital of Philadelphia

example as per website

AACR Hosts Cancer Disparities Conference in Miami, Fla. abstract online Sept

This year, the American Association for Cancer Research will host its third conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved at the Loews Miami Beach Hotel in Miami, Fla.

Findings presented at this year’s meeting will include:

• proven communication methods for reaching minority populations;
• strategies to increase enrollment in clinical trials;
• prognosis in lung cancer affected by race;
• breast cancer trends in Arab and Israeli Jewish women;
• the importance of social support and physical activity in survivors; and,
• socioeconomics and access to health care.
To help you plan your coverage of the conference, the program schedule is available online at
http://www.aacr.org/disparities2010

abstracts will be available on Sept. 22, 2010

Free App Helps Caregivers Record, Grade Side Effects in Clinical Trials

"...A physician or nurse making rounds can locate and page through a 200-page reference book that lists the possible adverse events that may occur to patients in a clinical trial, or can instead keep all the same information in their pocket, in a 4-ounce iPhone. For many in healthcare, that’s an easy choice.The classifications of adverse events originated in the National Cancer Institute as a way to help standardize record-keeping of side effects occurring in patients enrolled in clinical trials. Printed out, the Institute’s Common Terminology Criteria for Adverse Events (CTCAE) is a 200-page handbook in its most recent edition, version 4.0..cont'd

media article: Initial Trials on New Ovarian Cancer Tests (blood) Exhibit Extremely High Accuracy

Blogger's Note:
media reporting issues = watch the word 'extremely' (94 patients in study); comment on symptoms/early stage;

also note the research comment regarding lack of access to ovarian cancer patients/study ?? (needs 500 pts)

 ..........................................................................................................................
“The caveat is we don’t currently have 500 patients with the same type of ovarian cancer, so we’re going to look at other types of ovarian cancer,” said Fernandez. “It’s possible that there are also signatures for other cancers, not just ovarian, so we’re also going to be using the same approach to look at other types of cancers. We’ll be working with collaborators in Atlanta and elsewhere.”

comments in the media item:
In addition to having a relatively low prevalence ovarian cancer is also asymptomatic in the early stages. Therefore, if further testing confirms the ability to accurately detect ovarian cancer by analyzing metabolites in the serum of women, doctors will be able detect the disease early and save many lives.

media article: New Findings Further Clarify Breast Cancer Risk With Hormone Therapy

“This is evidence that the story is complicated,” said Tanmai Saxena, an M.D./Ph.D. student at the Keck School of Medicine at the University of Southern California. “The benefits of hormone therapy for relief of postmenopausal symptoms among women are clear, but the risks are more complicated than we had previously thought.”

phase 11 - RO4929097 in Treating Patients With Recurrent and/or Metastatic Epithelial Ovarian Cancer, Fallopian Tube Cancer, or Primary Peritoneal Cancer - Full Text View - ClinicalTrials.gov (location: PMH Toronto)

This study is not yet open for participant recruitment.

Verified by National Cancer Institute (NCI), August 2010

Purpose

RATIONALE: RO4929097 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.

PURPOSE: This phase II trial is studying the side effects and how well RO4929097 works in treating patients with recurrent and/or metastatic epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer.

(U.S.) Carolyn Benivegna - (ongoing petition) Ovarian Cancer Awareness USPS Postage Stamp

Carolyn's Ovarian Cancer Awareness Stamp petition

In memory of Carolyn Benivegna, survivors, family and friends of those touched by ovarian cancer, please click on the updated link and help us send our message through the U. S. Postal Service. http://www.ipetitions.com/petition/ovcastamp

Together we can make an OvCa stamp a reality. Since 2001, Carolyn Benivegna had led the national effort to petition for the creation of an Ovarian Cancer Awareness Postage Stamp. The hope is that a postage stamp will increase awareness of the disease to improve the chances of early detection. If you would like to support our goals, please sign (or re-sign) our online petition; we will continue each year to submit a request to the U.S. Postal Service along with the signatures that share in our quest to make this a reality.

Don't forget to send this link to your family and friends, too!

Thank you.
Kim
Ovacome
www.ovacome.us
ovcasurvivor@verizon.net
http://www.ipetitions.com/petition/ovcastamp/

NCCS Self-Advocacy: Putting Your Skills into Action

Communicating	Solving Problems
Finding Information	Negotiating
Making Decisions	Standing Up for Your Rights

Making comparative effectiveness work in cancer care - Cancer Network

Note: discusses cost eg. BRCA's - surgery vs surveillance

JCO (Special Issue) Overview: Host Factors and Cancer Outcome

"A solitary focus on tumor-related factors may explain some of the
failures of clinical translations of preclinical discoveries, which often
take place in systems (eg, the cell culture) that do not involve host
influences. There is growing evidence that it is necessary to go beyond
the cell into the whole organism to fully understand the biology of
cancer and its treatment. In the clinic, we are constantly reminded that
the cancer cell does not exist in isolation in the controlled environment
that is possible in the laboratory—it exists within a complex host
that interacts with both the cancer cell and the treatments that are used
to target that cancer cell. It is our hope that this special issue of Journal
of Clinical Oncology will stimulate future basic and translational research
that will facilitate the incorporation of these complex tumor,
treatment, and host factor interactions to optimize the care provided
to our patients."

Continental Divide? The Attitudes of US and Canadian Oncologists on the Costs, Cost-Effectiveness, and Health Policies Associated With New Cancer Drugs

Health Services and Outcomes

Continental Divide? The Attitudes of US and Canadian Oncologists on the Costs, Cost-Effectiveness, and Health Policies Associated With New Cancer Drugs

From the Sunnybrook Odette Cancer Center; University of Toronto; Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Clinical Evaluative Sciences, Toronto; McMaster University; Juravinski Cancer Center at Hamilton Health Sciences, Hamilton; Peel Regional Cancer Center, Mississauga, Ontario, Canada; University of Michigan School of Medicine, Ann Arbor, MI; Charles Sammons Cancer Center, Baylor University Medical Center, Dallas, TX; and the Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA.


ABSTRACT

Purpose Oncologists in the United States and Canada work in different health care systems, but physicians in both countries face challenges posed by the rising costs of cancer drugs. We compared their attitudes regarding the costs and cost-effectiveness of medications and related health policy.

Methods Survey responses of a random sample of 1,355 United States and 238 Canadian medical oncologists (all outside of Québec) were compared.

Results Response rate was 59%. More US oncologists (67% v 52%; P < .001) favor access to effective treatments regardless of cost, while more Canadians favor access to effective treatments only if they are cost-effective (75% v 58%; P < .001). Most (84% US, 80% Canadian) oncologists state that patient out-of-pocket costs influence their treatment recommendations, but less than half the respondents always or frequently discuss the costs of treatments with their patients. The majority of oncologists favor more use of cost-effectiveness data in coverage decisions (80% US, 69% Canadian; P = .004), but fewer than half the oncologists in both countries feel well equipped to use cost-effectiveness information. Majorities of oncologists favor government price controls (57% US, 68% Canadian; P = .01), but less than half favor more cost-sharing by patients (29% US, 41% Canadian; P = .004). Oncologists in both countries prefer to have physicians and nonprofit agencies determine whether drugs provide good value. 

(blogger's usual take (based on abstract): and patients in the determination process ??)

 






Conclusion Oncologists in the United States and Canada generally have similar attitudes regarding cancer drug costs, cost-effectiveness, and associated policies, despite practicing in different health care systems. The results support providing education to help oncologists in both countries use cost-effectiveness information and discuss drug costs with their patients.

Role of Vitamin and Mineral Supplementation and Aspirin Use in Cancer Survivors (abstract)

Note: abstract does not reference ovarian cancer "The potential beneficial or adverse effects of dietary supplements and aspirin in survivors of cancer warrant further study."

Review: Practical Considerations in Ovarian Cancer Chemotherapy (Medscape)

From Therapeutic Advances in Medical Oncology

Posted: 08/09/2010; Ther Adv Med Oncol. 2010;2(3):175-187. © 2010 Sage

• Abstract and Introduction
• Overview of Ovarian Cancer
• History of the Modern Treatment of Ovarian Cancer
• IP Chemotherapy
• Managing a Patient on IP Chemotherapy: A Nursing Perspective
• New Directions in Ovarian Cancer Treatment
• Conclusions

• References

e-ESO Online educational resource video (free) "The challenge of ovarian cancer in relapse" video/ESO

Note: requires registration (free)

e-grandround:

The challenge of ovarian cancer in relapse ^{CME accredited}

GR109 - 05 August 2010 - 18:15-19:00 CET
Expert: Eric Pujade-Lauraine, Hospital Hotel-Dieu, Paris, France
Discussant: Fedro A. Peccatori, European Institute of Oncology, Milano, Italy

Abstract: Cervical manifestation of a borderline type ovarian cancer with pseudomyxoma peritonei - a case report

Note: mucinous cell type is a cell type found in numerous organs including colon/rectum Abstract: Borderline tumours of the ovary (BOTs) are rare tumour entities that do not show any destructive or invasive growth in the majority of cases, even though they can display characteristics of malignant tumours The mucinous subtype can also originate from the appendix, and ovarian metastases can mimic primary ovarian BOTs, often accompanied by peritoneal manifestation in terms of pseudomyxoma peritonei. In cases where a concomitant appendiceal tumour is present, it may prove difficult to determine the primary tumour. This report describes a special case of BOT with a specific example of the complexity of the differential diagnosis of pseudomyxoma peritonei. Especially the case was simultaneously linked to appendiceal and ovarian cancer. Moreover, this case was exceptional for its unusual manifestation of BOT in the cervix.

Recurrent Ovarian Cancer: Use of Contrast-enhanced CT and PET/CT to Accurately Localize Tumor Recurrence and to Predict Patients’ Survival1 — Radiology

Abstract

Purpose: To compare accuracy and interobserver variability in the detection and localization of recurrent ovarian cancer with contrast material–enhanced (CE) computed tomography (CT) and positron emission tomography (PET)/CT and determine whether imaging findings can be used to predict survival.

Conclusion: Preliminary data suggest that CE CT and PET/CT may have similar accuracy in detection of recurrent ovarian cancer. Tumor size, number, and SUVmax may have potential as prognostic biomarkers for patients with recurrent ovarian cancer.

Casting light on 25-hydroxyvitamin D deficiency in ovarian cancer: A study from the NHANES (National Health and Nutrition Examination Surveys)

Abstract

Objectives

Ecological studies have long described a higher incidence of ovarian cancer in more extreme latitudes, where sun exposure, and presumably vitamin D exposure, is lower. Basic science studies have also noted polymorphisms of the vitamin D receptor in ovarian cancers. The aim of this study is to examine the relationship of serum vitamin D to ovarian cancer.

Conclusions

Prevalent ovarian cancer cases have lower serum 25-hydroxyvitamin D (25[OH]D) than the general population. Deficiency in vitamin D may provide an etiologic link between the long-known ecologic findings regarding latitude and the basic science noting polymorphisms in the vitamin D receptor.

SGO White Paper Ovarian Education Campaign [INTRODUCTORY PARAGRAPH-Herzog/Coleman] Project I-Background, Screening & Surveillance

Note: this journal requires subscription ($$$)

 Abstract

Ovarian cancer is a heterogeneous, rapidly progressive, highly lethal disease of low prevalence. The etiology remains poorly understood. Numerous risk factors have been identified, the most prominent involving an inherited predisposition in 10% of cases. Women with germline mutations associated with Hereditary Breast/Ovarian Cancer and Lynch syndromes have dramatically elevated risks (up to 46% and 12%, respectively). Risk-reducing salpingo-oophorectomy is the best method to prevent ovarian cancer in these high-risk women. Significant risk reduction is also seen in the general population who use oral contraceptives. Since up to 89% patients with early-stage disease have symptoms prior to diagnosis, increased awareness of the medical community may facilitate further workup in patients who otherwise would have had a delay. Despite enormous effort, there is no proof that routine screening for ovarian cancer in either the high-risk or general populations with serum markers, sonograms, or pelvic examinations decreases mortality. Further evaluation is needed to determine whether any novel biomarkers, or panels of markers, have clinical utility in early detection. Prospective clinical trials have to be designed and completed prior to offering of any of these new diagnostic tests. CA125 is currently the only biomarker recommended for monitoring of therapy as well as detection of recurrence. This commentary provides an overview on the background, screening and surveillance of ovarian cancer.

Objective To identify risk factors for the presence of a non-invasive lesion of the fallopian tube in women with a BRCA1 or BRCA2 mutation (abstract)

Objective

To identify risk factors for the presence of a non-invasive lesion of the fallopian tube in women with a BRCA1 or BRCA2 mutation.

Conclusion

The prevalence of tubal p53 signature and TIC (tubal intra-epithelial carcinoma)  increases with age at salpingectomy and with BMI. Oral contraceptive use is associated with a decrease in the prevalence of TICs.

Partners of long-term gynaecologic cancer survivors: Psychiatric morbidity, psychosexual outcomes and supportive care needs (abstract)

Objective

To describe long-term psychological morbidity, unmet supportive care needs, positive changes, sexual outcomes and relationship satisfaction in partners of gynaecologic cancer survivors, as compared with respective survivors.

Method

Self-report measures were administered to a cross-sectional sample of 68 partners recruited via patient survivors.

Conclusion

The majority of partners reported excellent sexual outcomes and little perceived change since the survivors' diagnosis. The association between unmet needs and psychological morbidity suggests a useful target for further intervention. Despite methodological limitations, these data are novel and present a starting point for further investigation to improve outcomes for survivors and partners.

The National Cancer Database report on advanced-stage epithelial ovarian cancer: Impact of hospital surgical case volume on overall survival and surgical treatment paradigm (abstract)

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.

Hospice enrollment for terminally ill patients with gynecologic malignancies: Impact on outcomes and interventions (abstract)

Objective 

To determine survival and interventions for patients with non-curative gynecologic malignancies based on supportive care enrollment.

  
Conclusions
While retrospective reviews evaluating hospice are challenging, our data suggest no detrimental impact on survival for hospice patients. Continued evaluation for patients at the end-of-life is necessary in order to optimize resource utilization.

pilot program - Drug mishap reporting system created for consumers - Canadian Medical Association Journal

Note: the article does not mention until the final statements that this is a pilot project NOR does the website



The new national medication incident reporting system is the first of its kind to directly engage Canadian consumers

http://safemedicationuse.ca/report/index.html

"Health care practitioners and hospitals have been reporting medication incidents using similar tools for years, but there’s never been a formal mechanism to collect incident reports from consumers," says Bonnie Salsman, project lead for the website, which was developed with support from Health Canada.


In the past, if a consumer wanted to report a medication mistake, they had to use a tool designed for health care workers, or else ask a medical practitioner to report the incident on their behalf.


"It wasn’t a consumer-friendly process. It was really difficult for people to get their concerns heard without doing a considerable amount of footwork first," says Salsman. "That there were still patients who took the initiative to report incidents using the practitioner reporting system showed us how helpful a consumer tool would be."


The website offers Canadians a simplified form to report any medication incident involving the use of prescription and nonprescription drugs, natural health products, imported products, or devices used to administer medicine. Consumers can report incidents that occur at any stage in the prescribing, dispensing, administration, or monitoring of a medication. They can also offer their own suggestions on how to avoid similar mishaps in future....cont'd

According to the 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults, 1 in 10 Canadians with health problems have reported receiving the wrong medication or doses when filling a prescription or when hospitalized in the last two years, while nearly 1 in 7 said they had experienced a medication error in the past two years.
The Institute for Safe Medication Practices Canada will continue to monitor the success of the website’s pilot phase in the coming months, and expects to report preliminary results to Health Canada this fall.

ISMP Canada will:

• review your report
• look for system problems that could cause errors to happen
• prepare recommendations that are designed to prevent mistakes with medication
• send recommendations about medication safety to health professionals and consumers
• provide consumer-focused information and tips about medication safety on the SafeMedicationUse.ca website

ISMP Canada will not:

• investigate a complaint on your behalf with an organization or health professional that is responsible for an error in care
• investigate the actions of individual practitioners
• report (for disciplinary purposes) the incident to professional authorities responsible for regulating the practice of health professionals
• release or publish any information that could identify the reporter of an incident, a patient, a health professional or an organization involved in an incident

Ovatax

New Data Demonstrates Effectiveness of Clarient’s Ovatax™ Test for Ovarian Cancer.

See study, titled “Expression of TLE3 Predicts Response to Taxane Therapy in Ovarian Carcinoma,” included 293 carcinoma samples mostly collected at UAB

New Zealand - "Opening Doors" first ever Hereditary Breast and Ovarian Cancer (BRCA's) conference - professionals and public October 1st

Overview

On Friday 1st October and Saturday 2nd October, at the Latimer Conference Centre, Christchurch will be hosting people from all over New Zealand who are impacted by Hereditary Breast and Ovarian Cancer, specifically the BRCA mutation. Medical practitioners and the public will be coming together to share experiences, increase their understanding, learn about advancements in this field, have questions answered and meet others in similar situations.

Medscape article: Simple Cysts and Ovarian Cancer Risk

Curis announces preliminary results of GDC-0449 Phase II clinical trial in advanced ovarian cancer - press release

".... Accordingly, Roche and Genentech have indicated that they plan to further analyze the data, including subset analyses in the coming months. Following these analyses, they expect to make a portfolio decision regarding whether, or to what extent, they will continue development of GDC-0449 in advanced ovarian cancer.

“While we await the final analysis of the data from this advanced ovarian cancer study, we remain optimistic about the continued evaluation of GDC-0449 in tumors such as basal cell carcinoma”

No obvious new safety signals were observed in patients treated with GDC-0449. It is expected that data from this Phase II study will be submitted for presentation at an upcoming medical meeting....cont'd

No Gene For That? | The Daily Scan | GenomeWeb (personality)

UK media article: Patient safety at risk from eurosceptics (re: hours of work)

blogger's note: while the patient safety communities typically reflect on airline safety/rules, it is always interesting to observe that no, if any,  references are made to the transportation industry (as a whole) and in particular the fatigue issues. Many studies have been done on fatigue/commercial vehicle safety hours of work issues. In addition, studies have been done not only on fatigue but also on the effects of alcholism (impairment/performance).

Who owns pink ideas or cure slogans? Welcome to the Charity Brawl - Gary Schwitzer's HealthNewsReview Blog

 blogger's note:  patients are not typically aware of  'turf' wars in charities, irrespective of 'color'. Turf wars are typically thought of as issues between governments, professions etc but not usually associated with charities. Thus the importance of not only expert patients but an informed public.

1) article: Gary Schwitzer's HealthNewsReview Blog

2) Wall Street Journal reports on an ugly dispute
 Charity Brawl: Nonprofits Aren't So Generous When a Name's at Stake

abstract: Imaging of the gastrointestinal complications of systemic chemotherapy

Abstract:

Gastrointestinal complications of chemotherapy may be serious and potentially life-threatening. Familiarity with and awareness of the potential complications associated with various chemotherapeutic agents/regimens is paramount to enable accurate and timely diagnosis. In this article we review the radiological manifestations of the most notable gastrointestinal complications associated with chemotherapeutic administration.

Article Outline (requires subscription/$$$)

Introduction

Neutropenic enterocolitis

Pseudomembranous colitis

Ulceration

Perforation

GI haemorrhage

Ileus

Obstruction

Mesenteric infarction

Conclusion

Figure 1. A 70-year-old woman on day 10 of idorubicin and cytosine arabinoside chemotherapy for acute myeloid leukaemia developed vomiting, abdominal pain, loose bloody stool, and was profoundly neutropenic. Intravenous contrast-enhanced CT demonstrates diffuse colonic mural thickening (black arrow), with surrounding mesenteric stranding (white curved arrow) and ascites (black curved arrow). The distribution is pan-colonic. This constellation of clinical and radiological findings is highly suggestive of neutropenic enterocolitis.

View Within Article

Discriminative MRI features of fallopian tube masses (abstract)