Tuesday, March 13, 2012
JCO - open access: Editorial - Financial Hardship: A Consequence of Survivorship?
Financial Hardship: A Consequence of Survivorship?
"Despite this success on the treatment front, we have done
little in a concerted and well-planned fashion to investigate
and address the problems of survivors. It is as if we have
invented sophisticated techniques to save people from
drowning, but once they have been pulled from the water,
we leave them on the dock to cough and splutter on their
own in the belief that we have done all that we can."
—Fitzhugh Mullan, MD, physician, survivor of cancer, and
founding president of the National Coalition for Cancer
Survivorship
Monday, March 12, 2012
open access: Performance of a multianalyte test as an aid for the diagnosis of ovarian cancer in symptomatic women (comparison to CA-125)
Performance of a multianalyte test as an aid for the diagnosis of ovarian cancer
Performance of a multianalyte test as an aid for the diagnosis of ovarian cancer in symptomatic women
Journal of Translational Medicine 2012, 10:45 doi:10.1186/1479-5876-10-45
Publication date 12 March 2012
Article URL http://www.translational-medicine.com/content/10/1/45
"The study population comprised 244 apparently healthy normal women, 223 patients with benign gynecological conditions, 53 patients with borderline ovarian tumours and 222 patients with malignant ovarian tumours (serous, mucinous, endometrioid, clear cell, other) (Table 1)."
"The malignant ovarian cancer cohort comprised 130 (58.5%) serous, 19 (8.6%)endometrioid, 16 (7.2%) mucinous, 16 (7.2%) clear cell and 41 (18.5%) of other types that included predominantly mixed forms and adenocarcinomas with no specific histotype recorded (Table 1). A total of 33 (14.9%) of malignant ovarian cancer samples had no staging data reported, 42 (18.9%) were diagnosed with Stage I disease, 27 (12.2%) with Stage II, 106 (47.7%) Stage III and 14 (6.3%) with Stage IV disease (Table 1)."
"Of the ovarian malignancies, 88.5% of all serous tumours, 57.9% of all endometrioid tumours, 62.5% of all mucinous tumours, 81.2% of all clear cell tumours and 85.4% of other epithelial ovarian cancer plasma samples were correctly identified (Table 5). The IVDMIA correctly predicted 91.7% of the late stage (Stages III-IV) samples, and 69.6% of the early stage (Stages I-II) malignant ovarian cancer samples (Table 5).
Conclusions
This study confirms in an independent sample set that a blood-based multianalyte assay has significant advantages over CA125 for distinguishing symptomatic women with borderline and malignant ovarian cancer from controls or those with benign disease.
Competing interests
This study was funded as part of the research and development activities of Healthlinx Ltd. DJA, LR, KK and KB are employees of Healthlinx Ltd and GER is non-executive chairman of Healthlinx Ltd. DJA is an inventor on patent applications that are related to the current
study.
Keywords
Ovarian cancer, Tumour markers, Multianalyte, Diagnostic
Background
phase 11/111 - Comparing Three Combination Chemotherapy Regimens in Treating Patients With Stage IIB, Stage IIC, Stage III, or Stage IV Ovarian Epithelial Cancer, Primary Peritoneal Cancer, or Fallopian Tube Cancer - Full Text View - ClinicalTrials.gov
Comparing Three Combination Chemotherapy Regimens in Treating Patients With Stage IIB, Stage IIC, Stage III, or Stage IV Ovarian Epithelial Cancer, Primary Peritoneal Cancer, or Fallopian Tube Cancer - Full Text View - ClinicalTrials.gov
Comparing Three Combination Chemotherapy Regimens in Treating Patients With Stage IIB, Stage IIC, Stage III, or Stage IV Ovarian Epithelial Cancer, Primary Peritoneal Cancer, or Fallopian Tube Cancer
This study is currently recruiting participants.
Verified March 2012 by NCIC Clinical Trials Group
First Received on October 9, 2009.
Last Updated on March 9, 2012
History of Changes
| Sponsor: | NCIC Clinical Trials Group |
|---|---|
| Collaborators: | National Cancer Institute (NCI) Grupo Español de Investigación en Cáncer de Ovario Cancer Research UK Southwestern Oncology Group (SWOG) |
| Information provided by (Responsible Party): | NCIC Clinical Trials Group |
| ClinicalTrials.gov Identifier: | NCT00993655 |
Purpose
RATIONALE:
Drugs used in chemotherapy, such as paclitaxel, carboplatin, and
cisplatin, work in different ways to stop the growth of tumor
cells, either by killing the cells or by stopping them from dividing.
Giving more than one drug (combination chemotherapy) and giving them in
different ways may kill more tumor cells. It is not yet known which combination chemotherapy regimen is more effective in treating patients with ovarian epithelial cancer, primary peritoneal cancer, and fallopian tube cancer.
PURPOSE: This randomized
phase II/III trial is comparing the side effects of three combination
chemotherapy regimens and to see how well they work in treating patients
with stage IIB, stage IIC, stage III, or stage IV ovarian epithelial cancer, primary peritoneal cancer, or fallopian tube cancer.
| Condition | Intervention | Phase |
|---|---|---|
| Fallopian Tube Cancer Metastatic Cancer Ovarian Cancer Peritoneal Cavity Cancer |
Drug: carboplatin Drug: cisplatin Drug: paclitaxel Procedure: quality-of-life assessment |
Phase II Phase III |
Phase 1 - TKM 080301 for Primary or Secondary Liver Cancer - Full Text View - ClinicalTrials.gov (ovariancolorectal/pancreas/gastric (stomach)/breast)
TKM 080301 for Primary or Secondary Liver Cancer - Full Text View - ClinicalTrials.gov
Colorectal Cancer With Hepatic Metastases
Pancreas Cancer With Hepatic Metastase
Gastric Cancer With Hepatic Metastase
Breast Cancer With Hepatic Metastase
Ovarian Cancer With Hepatic Metastase
TKM 080301 for Primary or Secondary Liver Cancer
This study is currently recruiting participants.
Verified February 2012 by National Institutes of Health Clinical Center (CC)
First Received on September 16, 2011.
Last Updated on March 9, 2012
History of Changes
| Sponsor: | National Cancer Institute (NCI) |
|---|---|
| Information provided by: | National Institutes of Health Clinical Center (CC) |
| ClinicalTrials.gov Identifier: | NCT01437007 |
Purpose
Background:
Cancer in the liver can start in the liver (e.g., primary liver cancer or hepatocellular cancer) or spread to the liver from cancers in other parts of the body (e.g. colon, pancreas, gastric, breast, ovarian, esophageal cancers, cancer with metastases to the liver.) People who have tumors that can be removed by surgery live longer than those whose cancer cannot be removed. Chemotherapy can shrink some tumors in the liver, which also helps people to live longer, and sometimes chemotherapy can shrink tumors enough that they can be removed by surgery. However, most chemotherapy drugs do not work well on tumors in the liver. In this study we are testing a new drug, TKM-080301, given directly into the cancer blood supply in the liver circulation, to see if it will cause tumors to shrink.
Objectives:
- To test the safety and effectiveness of TKM-080301 for cancer in the liver that has not responded to standard treatments.
Beta-Blocker / Ovarian - Full Text View - ClinicalTrials.gov
Beta-Blocker / Ovarian - Full Text View - ClinicalTrials.gov
Beta-Blocker / Ovarian
This study is currently recruiting participants.
Verified March 2012 by M.D. Anderson Cancer Center
First Received on January 3, 2012.
Last Updated on March 9, 2012
History of Changes
| Sponsor: | M.D. Anderson Cancer Center |
|---|---|
| Information provided by (Responsible Party): | M.D. Anderson Cancer Center ( M.D. Anderson Cancer Center ) |
| ClinicalTrials.gov Identifier: | NCT01504126 |
Purpose
The
goal of this clinical research study is to learn if it is feasible to
give a beta-blocker such as Inderal (propranolol hydrochloride) with
standard chemotherapy (paclitaxel and carboplatin or possibly docetaxel)
to treat ovarian cancer. The safety of propranolol hydrochloride will also be studied.
Propranolol hydrochloride
is designed to block certain chemicals that affect the heart.
Researchers want to learn if this might also boost the immune system,
allowing the chemotherapy to be more effective.
Paclitaxel is designed to block cancer cells from dividing, which may cause them to die.
Carboplatin is designed to interfere with the growth of cancer cells by stopping cell division, which may cause the cells to die.
Lymphedema: Separating Fact From Fiction - Cancer Network
Lymphedema: Separating Fact From Fiction - Cancer Network
"..... Recently, Cormier et al found only 47 studies between 1972 and 2008 with more than 10 patients that prospectively evaluated lymphedema as a primary or secondary outcome after treatment for melanoma, bladder, sarcoma, penile, prostate, vulvar, cervical, endometrial, or head and neck cancers.[2] The authors’ analysis of these studies demonstrated the overall incidence of lymphedema to be 16.3% after melanoma, 10.1% after genitourinary cancers, and 19.6% after gynecologic malignancies, and notes that lymphedema rates are higher when the lower rather than upper extremity is affected. Given the abundance of breast cancer data, this review will focus on breast cancer–related lymphedema. However, the principles and controversies discussed are relevant regardless of the type of malignancy to which the lymphedema is attributed....."
Association of Patient-Centered Outcomes With Patient-Reported and ICD-9–Based Morbidity Measures
Association of Patient-Centered Outcomes With Patient-Reported and ICD-9–Based Morbidity Measures
CONCLUSIONS
"A comprehensive assessment of morbidity requires both subjective and objective measurement of disease burden as well as an assessment of emotional symptoms. Such multidimensional morbidity measurement is particularly relevant for research or quality assessments involving the delivery of patient-centered care to complex patient populations."
open access: (Canada) How the Medical Culture Contributes to Coworker-Perpetrated Harassment and Abuse of Family Physicians (includes patients, families, education system, co-workers)
How the Medical Culture Contributes to Coworker-Perpetrated Harassment and Abuse of Family Physicians
"At present, little is being undertaken to address the issue of abuse in the workplace of family physicians. The most worrisome finding from our study is that these kinds of practices are a part of the medical culture starting in medical school and carried out throughout medical training and into the work environment. This culture is supported by power imbalances, power structures, and such systemic issues as physician shortages. The criminological broken window theory is helpful to explain why abuse may be perpetuated in the medical system, and it also provides a context for an approach to address the issue."
Elderly Frequently 'Undertriaged' in Emergency Departments
Elderly Frequently 'Undertriaged' in Emergency Departments
"Finally, the authors investigated reasons for inadequate triage. The most common reason for undertriage was neglect of high-risk situations, sometimes in combination with abnormal vital signs or in combination with severe pain or distress.
The second most important reason for undertriage was inappropriate interpretation of vital signs, sometimes in combination with severe pain or distress, high-risk situations, or an altered mental status.
"[I]nadequate triage appears to be due to a lack of adherence to the Emergency Severity Index algorithm rather than to an inherent deficit of the algorithm itself," the researchers conclude."
Ann Emerg Med. Published online March 9, 2012. Abstract
Conclusion
"In our study, older patients were at risk for undertriage. However, our results suggest that the Emergency Severity Index is reliable and valid for triage of older patients."
MD News - HIPEC: Furthering Survivorship for GYN Cancer Patients
MD News - HIPEC: Furthering Survivorship for GYN Cancer Patients
Monday, March 12, 2012
A team of cancer specialists at the Seidman Cancer Center at University Hospitals (UH) Case Medical Center is among the first in the nation to launch a dedicated gynecologic program using Hyperthermic Intraperitoneal Chemotherapy (HIPEC) to treat ovarian, endometrial and select other malignancies.
Q: What is HIPEC, and how is it delivered?
Q: What are the advantages of HIPEC over traditional IV chemotherapy?
Q: I understand UH is planning several research studies on HIPEC. What will they involve?
Q: What do you want physicians to know about HIPEC?
Blogger: “And you’re ugly too” | genomeboy (genetic testing/patents, brca....)
“And you’re ugly too” | genomeboy
"All of this, of course, was precipitated by AMP v. USPTO (“The Myriad Case”), in which patients with family histories of breast cancer asserted that they have not been able to get confirmatory or “second opinion” testing because there is but a single, exclusive licensee of the patents on the most clinically important genes that predispose to hereditary breast and ovarian cancer, BRCA1 and BRCA2.
I attended the public hearing at the USPTO in Alexandria, VA on 16 February 2012. I was so appalled by what I heard that I attended the second one in San Diego on 9 March 2012 and testified. I am still adding links to my testimony in order to submit it before public comment closes on 26 March 2012. Here is a brief excerpt on Myriad’s unwillingness to share its mutation data:................"
open access: March 12th - Daily aspirin reduces colorectal cancer incidence in patients with Lynch syndrome - Barton - 2012 - CA: A Cancer Journal for Clinicians - Wiley Online Library
Daily aspirin reduces colorectal cancer incidence in patients with Lynch syndrome - Barton - 2012 - CA: A Cancer Journal for Clinicians
"According to the investigators, this study, along with earlier data, supports the use of aspirin in the chemoprevention treatment of patients with Lynch syndrome, although the dose and timing of use have not been established. A CAPP3 study is planned that will investigate optimizing the dose and duration. (More information can be found at www.CAPP3.org.)"
AACR Announces Annual Meeting 2012 Press Conference Schedule
AACR Announces Annual Meeting 2012 Press Conference Schedule:
|
Press conferences will be held at the Hyatt McCormick Conference Center, which is adjacent to the McCormick Place Conference Center. Attendance is limited to registered members of the media and pre-approved guests.
CMAJ: Who should hold the keys to your DNA?
Editor’s note: Third of a multipart series on genetic testing.
Part 1: Separating hype from reality in the era of the affordable genome (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4143).
Part 2: Popping the genetics bubble (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4142).
Next: Race and genetics in the doctor’s office
CMAJ: Who should hold the keys to your DNA?
"Opinion is divided over whether doctors or patients should be receiving the results of direct-to-consumer genetic tests........."
"“I think there is a need to think this through and to have some balance. On the one hand, we should respect consumers’ preferences and freedom to choose,” says Peter Neumann, director of the Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston, Massachusetts and lead author on the paper. “We should also inform them about the risks and benefits.”
In some countries, governments have stepped in to ensure that doctors are the ones who must inform consumers about risks and benefits. Laws in France, Germany, Portugal and Switzerland stipulate that genetic tests only be administered by physicians. There are no regulations in Canada and few in the United States, though the US Food and Drug Administration has indicated that it will be stepping up efforts in the area...."
Women of Teal: upcoming talk: speaker - Dee Sparacio (and blogger) Survivor to Survivor: Understanding Cancer Research
Monday, March 12, 2012
Survivor to Survivor: Understanding Cancer Research
| Survivor to Survivor: Understanding Cancer Research | |
Thursday, March 15 • 6:30–7:30 pm
Guest Speaker: Dee Sparacio, CSC Participant, Ovarian Cancer Survivor and Research Advocate
Cure
for Cancer Found–News at 11! What do the cancer research sound bites on
the evening news mean for you? Learn how to read and interpret cancer
research results from posters to journal articles. Find out which Web
sites are reputable sources of cancer research information.
|
Please call 908-658-5400 to register.
Sunday, March 11, 2012
Seth's Blog: "It's not business, it's personal"
Seth's Blog:
"It's not business, it's personal"
It's too easy to blame the organization and the system and the
bottom line for decisions that a person would never be willing to take
responsibility for.
Whenever you can, work with people who take it personally.
Whenever you can, work with people who take it personally.
abstract: Evaluation of ovarian cancer remission markers HE4, MMP7 and Mesothelin by comparison to the established marker CA125 (includes graphic/study of 23 patients)
Highlights
(in study of 23 patients)
► Three new markers were compared to CA125 for lead time to ovarian cancer recurrence.
► HE4 elevates at recurrence when CA125 does not.
► Mesothelin has less marker potential, MMP7 shows promise and requires confirmation.
Evaluation of ovarian cancer remission markers HE4, MMP7 and Mesothelin by comparison to the established marker CA125: Publication year: 2012
Objective
Evaluate and compare the effectiveness of CA125, HE4, Mesothelin and MMP7 marker levels to monitor ovarian cancer patients after surgery and chemotherapy. Evaluate the lead time of a rise of marker levels before recurrence.
Methods
The study consists of 23 patients with advanced stage ovarian/fallopian tube cancer. Blood was drawn after front line surgery and chemotherapy treatment and at 3 month intervals thereafter. One patient had chemoresistant disease, two patients remained in remission and 20 patients had recurring disease and were used for marker evaluation.
Results
In five patients HE4 was the only marker to elevate before recurrence with a lead time of up to 4½ months including one patient who did not have a CA125 response at all. In a further two patients, HE4 increased before CA125 did. In four of these seven patients, HE4 levels were consistently at or above threshold during remission when both CA125 and imaging results were negative. MMP7 elevated before recurrence in one patient who was negative for the other markers. Mesothelin elevated in two patients who were also positive for CA125 and HE4.
Conclusions
HE4 can predict ovarian cancer recurrence earlier than CA125 and it can be elevated in patients that do not express CA125 at sufficient levels to make a clinical decision. MMP7 and Mesothelin have lower potential as markers for ovarian cancer recurrence to complement CA125. A failure of HE4 levels to normalize at completion of standard therapy may indicate a poor prognosis.
Graphical Abstract
Highlights
► Three new markers were compared to CA125 for lead time to ovarian cancer recurrence.► HE4 elevates at recurrence when CA125 does not.
► Mesothelin has less marker potential, MMP7 shows promise and requires confirmation.
A phase I study with an expanded cohort to assess the feasibility of intravenous paclitaxel, intraperitoneal carboplatin and intraperitoneal paclitaxel in patients with untreated ovarian, fallopian tube or primary peritoneal carcinoma: A Gynecologic Oncology Group study
A phase I study with an expanded cohort to assess the feasibility of intravenous paclitaxel, intraperitoneal carboplatin and intraperitoneal paclitaxel in patients with untreated ovarian, fallopian tube or primary peritoneal carcinoma: A Gynecologic Oncology Group study
Objective
To define the maximum tolerated dose (MTD) and assess the feasibility of intravenous (IV) paclitaxel, intraperitoneal (IP) carboplatin, and IP paclitaxel in women with newly diagnosed Stages II–IV ovarian, fallopian tube, or primary peritoneal carcinoma.
Methods
Patients received escalating doses of paclitaxel IV and carboplatin IP on day 1 and paclitaxel IP 60mg/m2 on day 8. A standard 3+3 design was used in the escalation phase. A two-stage group sequential design with 20 patients at the MTD was used in the feasibility phase. Patient-reported neurotoxicity was assessed pre and post treatment.
Results
Patients were treated with paclitaxel 175mg/m2 IV and carboplatin IP from AUC 5–7 on day 1 and paclitaxel 60mg/m2 IP on day 8. The MTD was estimated at carboplatin AUC 6 IP and 25 patients enrolled at this dose level. Within the first 4cycles, seven (35%) of twenty evaluable patients had dose-limiting toxicities (DLTs) including grade 4 thrombocytopenia (1), grade 3 neutropenic fever (3), >2week delay due to ANC recovery (1), grade 3 LFT (1), and grade 3 infection (1). De-escalation to paclitaxel 135mg/m2 IV was given to improve the safety. After six evaluable patients completed 4 cycles without a DLT, bevacizumab was added and six evaluable patients completed 4cycles with one DLT (grade 3 hyponatremia).
Conclusions
Paclitaxel at 175mg/m2 IV, carboplatin AUC 6 IP day 1 and paclitaxel 60mg/m2 IP day 8 yield 18–56% patients with DLTs. The tolerability of the regimen in combination with bevacizumab was indicated in a small cohort.
abstract: Lymphatic ascites following pelvic and paraaortic lymphadenectomy procedures for gynecologic malignancies
Blogger's Note: the abstract does not differentiate types of gyn cancers, journal is subscriber based ($$$)
Lymphatic ascites following pelvic and paraaortic lymphadenectomy procedures for gynecologic malignancies
Objective
Lymphatic ascites is an unusual complication in patients with cancer. In the gynecologic oncology patient population, the most common etiology is operative lymph node dissection. The purpose of this study was to explore the incidence, presenting symptoms, methods of diagnosis and treatment modalities utilized for lymphatic ascites in patients undergoing lymph node dissection for gynecologic cancers.
Methods
This observational study retrospectively reviewed the charts of patients who underwent lymphadenectomy as part of the surgical management for a gynecologic cancer. Patients that developed postoperative lymphatic ascites between January 2000 and December 2010 were included for analysis. Data extracted from the medical records included tumor pathology, number of harvested lymph nodes, postoperative course, method of diagnosis and treatment.
Results
From a total of 300 surgical staging procedures, 12 patients with lymphatic ascites were identified (4%). The most common reported symptom was leakage of clear fluid per vagina (7, 58%), followed by abdominal distension (4, 33%). The median interval from surgery to development of symptoms was 12.5 days (range 0–22days). 5 patients had complete resolution of symptoms with dietary modifications alone while 7 patients required paracentesis. The median time from surgery to resolution of symptoms was 44days (range 9–99).
Conclusion
Lymphatic ascites is an under recognized and infrequently reported postoperative complication. Although it usually resolves spontaneously or with conservative management without sequelae, this condition can significantly prolong postoperative recovery and cause patient discomfort. To our knowledge this is the largest group of patients undergoing gynecologic surgical staging procedures to be reviewed for the occurrence of lymphatic ascites.
A phase II study of aflibercept in patients with advanced epithelial ovarian cancer and symptomatic malignant ascites
A phase II study of aflibercept in patients with advanced epithelial ovarian cancer and symptomatic malignant ascites
Objective
The recombinant fusion protein, aflibercept binds and neutralizes vascular endothelial growth factor (VEGF) A, B and placental growth factor (PlGF). Aflibercept inhibits ascites formation and reduces tumor burden in an ovarian cancer model. This open-label, single-arm, multicenter phase II study assessed the efficacy and safety of aflibercept in patients with advanced chemo-resistant epithelial ovarian cancer and symptomatic malignant ascites.
Methods
Patients who required ≥3 previous paracenteses at 1-4 paracenteses per month received intravenous aflibercept 4mg/kg every 2weeks. The primary endpoint was repeat paracentesis response rate (RPRR), with response defined as at least a two-fold increase in time to repeat paracentesis compared with the baseline interval.
Results
Ten out of 16 enrolled patients achieved a response; the RPRR was 62.5% (95% CI 35.4%–84.8%). Aflibercept was considered effective based on a hypothesis that the RPRR was ≥60%. Median time to repeat paracentesis was 76.0 (95% CI 64.0–178.0) days, which was 4.5 times longer than the baseline interval (16.8days). Median progression-free survival was 59.5 (95% CI 41.0–83.0) days. Twelve patients experienced adverse events considered related to aflibercept treatment including hypertension (7 patients), headache, anorexia, and dysphonia (3 patients each). Two patients experienced Grade 3/4 treatment-related adverse events (Grade 3 hypertension and weight loss in one patient, Grade 3 intestinal perforation in one patient).
Conclusion
Aflibercept 4mg/kg every 2weeks was effective at controlling malignant ascites, reducing the interval between repeat paracenteses. The safety profile was consistent with that reported for anti-VEGF agents.
Outcomes of surgical management of bowel obstruction in relapsed epithelial ovarian cancer (EOC)
Outcomes of surgical management of bowel obstruction in relapsed epithelial ovarian cancer (EOC):
Objective
To describe the outcomes of surgical management of bowel obstruction in relapsed epithelial ovarian cancer (EOC) so as to define the criteria for patient selection for palliative surgery. Methods 90 women with relapsed EOC underwent palliative surgery for bowel obstruction between 1992 and 2008.
Conclusion
Surgery for bowel obstruction in relapsed EOC is associated with a high morbidity and mortality rate especially in emergency cases when compared to other gynaecological oncological procedures. Palliation can be achieved in almost two thirds of cases, is equally likely in elective and emergency cases but is less likely in those with ascites.
abstract: Have racial disparities in ovarian cancer increased over time? An analysis of SEER data
Have racial disparities in ovarian cancer increased over time? An analysis of SEER data:
Objective
Race has been postulated to be a prognostic factor in women with ovarian cancer. The reasons for racial disparities are multifactorial. Recent literature suggests that racial disparities in ovarian cancer survival emerged in the 1980s, when modern treatments such as aggressive surgical debulking and platinum-based chemotherapy first gained widespread use. We suspect that as improvements in treatment have evolved, the effects of access to treatment have amplified racial disparities in survival from ovarian cancer. Methods SEER 9 data were analyzed, including African American and white patients diagnosed with ovarian cancer from 1973 to 2007, with 2008 as the cutoff for follow-up. Using the Kaplan–Meier method, we evaluated racial differences in survival, to determine whether this difference has increased over time.
Results
There were 44,562 white and 3190 African American women available for analysis. Overall African Americans had 1.10 times the crude hazard (95% CI 1.06–1.15) of all-cause mortality compared to whites, with a widening trend over time (p<0.01). Adjusted for SEER registry, age, tumor stage, marital status and time of diagnosis, the hazard ratio (HR) for all-cause mortality comparing African Americans to whites was 1.31 (95% CI 1.26–1.37). When the receipt of surgery was added to the model, the HR for all-cause mortality remained higher for African American women at 1.27 (95% CI 1.21–1.34).
Conclusions
African Americans diagnosed with ovarian cancer have worse survival than whites, and this disparity has increased over time. Measured differences in treatment, such as receipt of surgery, account for part of the disparity.
Disparities in hospice care among older women (over 65 yrs) dying with ovarian cancer
Disparities in hospice care among older women dying with ovarian cancer:
Background
Timely hospice referral is an essential component of quality end-of-life care, although a growing body of research suggests that for patients with various types of cancer, hospice referrals often occur very late in the course of care, and are marked by sociodemographic disparities. However, little is known about the ovarian cancer patient population specifically. We examined the extent and timing of hospice referrals in ovarian cancer patients over age 65, and the factors associated with these outcomes.
Methods
We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify 8211 women aged 66+ with ovarian cancer who were diagnosed between 2001 and 2005 and died by December 31, 2007. We excluded women who were not eligible for Medicare A continuously during the 6 months prior to death. Outcomes studied included overall hospice use in the last 6months of life and late hospice enrollment, defined as within 3 days of death. We examined variations in these two measures based on year of diagnosis and sociodemographic characteristics (age, race, marital status, rural residence, income, education) and type of Medicare received (fee-for-service vs. managed care).
Results
Among 8211 women in the cohort who died from ovarian cancer, 39.7% never received hospice care (3257/8211). Overall hospice care increased over the period of observation, from 49.7% in 2001 to 74.9% in 2005, but the proportion of women receiving hospice care within 3days of death did not improve. Among those who received hospice care, 11.2% (556/4954) and 26.2% (1299/4954) received such care within 3 and 7 days of death, respectively. A higher proportion of black women (46.5% vs. 38.4% among whites), women in the lowest income group (42.8% vs. 37.0% in the highest income group), and those receiving fee-for-service Medicare (41.3% vs.33.5% for women in managed care) never received hospice care. In multivariable models, factors associated with lack of hospice care included age younger than 80 years (OR 1.27, 95% CI 1.15–1.40), non-white race (OR 1.44, 95% CI 1.26–1.65), low income (OR 1.17, 95% CI 1.04–1.32) and enrollment in fee-for-service Medicare compared with managed care (OR 1.39, 95% CI 1.24–1.56).
Conclusion
More older women with ovarian cancer are receiving hospice care over time, however, a substantial proportion receive such care very near death, and sociodemographic disparities in hospice care exist. Our data also support the need to target lower-income and minority women in efforts to increase optimally timed hospice referrals in this population. Our finding that ovarian cancer patients enrolled in managed care plans were more likely to receive hospice care suggests the importance of health care system factors in the utilization of hospice services.
abstract: Combined treatment of L1CAM antibodies and cytostatic drugs improve the therapeutic response of pancreatic and ovarian carcinoma 10.1016/j.canlet.2011.12.035 : Cancer Letters | ScienceDirect.com
Combined treatment of L1CAM antibodies and cytostatic drugs improve the therapeutic response of pancreatic and ovarian carcinoma 10.1016/j.canlet.2011.12.035 : Cancer Letters | ScienceDirect.com
Abstract
The
adhesion molecule L1CAM (CD171) accounts for enhanced motility,
invasiveness and chemoresistance of tumor cells and represents a novel
marker for various tumor entities including pancreatic and ovarian
carcinoma. Recently, we showed that L1CAM inhibition increases the
apoptotic response of tumor cells towards cytostatic drugs pointing to
the potential of L1CAM to serve as a chemosensitizer in anti-cancer
therapy. Thus, the present study evaluated the therapeutic potential of
combined treatment with L1CAM antibodies and chemotherapeutic drugs in
pancreatic and ovarian carcinoma model systems in vivo.
Saturday, March 10, 2012
open access: Adequacy of family history taking in ovarian cancer patients: a population-based study.
Blogger's Note: repost/open access
Adequacy of family history taking in ovarian cancer patients: a population-based study
Abstract:
The aim of this study was to evaluate the adequacy of family history taking in epithelial ovarian cancer (EOC) patients and to identify factors that determine adequacy. Furthermore, the validity of family history taking was assessed by comparison with self-administered questionnaires. Medical records of all 1,112 EOC patients registered by the nation-wide cancer registry and diagnosed in eleven Dutch hospitals between 1996 and 2006 were reviewed. Adequate family history taking was defined as a written notification of the presence or absence of relatives with breast or ovarian cancer. Factors that were correlated with family history taking were identified using univariable and multivariable logistic regression. 147 patients filled in a postal questionnaire. An adequate family history was taken in 41% of all cases. Younger age, an academic hospital and having undergone surgery and/or chemotherapy were associated with adequate family history taking. The comparison with self-administered questionnaires showed a disagreement in 64% mainly due to missing data in medical records. Documentation on family history is either absent or inadequate in the medical records in the majority of EOC patients. These data urge for better uptake of hereditary cancer risk assessment. Different strategies for this assessment like improved family history taking and genetic testing in EOC patients should be explored.
Recurrent germline mutations in BRCA... [Breast Cancer Res Treat. 2012] - PubMed - NCBI
Recurrent germline mutations in BRCA... [Breast Cancer Res Treat. 2012] - PubMed - NCBI
Recurrent germline mutations in BRCA1 and BRCA2 genes in high risk families in Israel.
Abstract
The spectrum of germline mutations among Jewish non Ashkenazi high risk breast/ovarian cancer families includes a few predominant mutations in BRCA1 (185delAG and Tyr978X) and BRCA2 (8765delAG). A few additional recurring mutations [A1708E, 981delAT, C61G (BRCA1) R2336P, and IVS2 + 1G > A (BRCA2)] have been reported in Jewish non Ashkenazi families. The 4153delA*BRCA1 C61G*BRCA1 and the 4075delGT*BRCA2 has been reported to recur in Russian/Polish non Jews and Ashkenazim, respectively. The rate of these recurring mutations has not been reported in Israeli high risk families. Genotyping for these recurring mutations by restriction enzyme digest and sequencing method was applied to high risk, predominantly cancer affected, unrelated Israeli individuals of Ashkenazi (n = 827), non Ashkenazi (n = 2,777), non Jewish Caucasians (n = 193), and 395 of mixed ethnicity. Jewish participants included 827 Ashkenazi, 804 Balkans, 847 North Africans, 234 Yemenites, and 892 Asians (Iraq and Iran). Age at diagnosis of breast cancer (median ± SD) (n = 2,484) was 47.2 ± 9.6 for all women participants. Males (n = 236) were also included, of whom 24 had breast cancer and 35 had pancreatic cancer. Overall, 8/282 (2.8%) of the Balkan cases carried the BRCA1*A1708E mutation, 4/180 (2.2%) the R2336P mutation, and 0/270 the IVS2 + 1G > A BRCA2 mutations, respectively. Of North Africans, 7/264 (2.65%) carried the BRCA1*981delAT mutation. The BRCA1*C61G mutation was detected in 3/269 Ashkenazi, non Ashkenazi, and non Jewish Russians; the BRCA1*Tyr978X mutation was detected in 23/3220 individuals of non Ashkenazi origin, exclusively of Asian ethnicity (23/892, 2.6% of the Asians tested). The BRCA1*4153delA mutation was noted in 2/285 non Jewish Caucasians, and none of the Ashkenazim (n = 500) carried the BRCA2*4075delGT mutation. Jewish high risk families of North African, Asian, and Balkan descent should be screened for the 981delAT, Tyr978X, A1708E BRCA1, and the R2336P BRCA2 mutations, respectively.abstract JCO: Opioid Prescription After Pain Assessment: A Population-Based Cohort of Elderly Patients With Cancer - Sunnybrooke Health Sciences Centre, Toronto, Canada
Opioid Prescription After Pain Assessment: A Population-Based Cohort of Elderly Patients With Cancer
Abstract
Purpose The purpose of this study was to measure opioid prescription (OP) rates in elderly cancer outpatients around the time of
assessment for pain and to evaluate factors associated with receiving OPs for those with severe pain.
Patients and Methods
The cross-sectional cohort includes all patients with cancer in Ontario
older than age 65 years who completed a pain assessment
as part of a provincial initiative of systematic
symptom screening. Patients were assigned to mutually exclusive
categories
by pain score severity: 0, 1 to 3 (mild), 4 to 6
(moderate), and 7 to 10 (severe). We linked multiple provincial health
databases
to examine the proportion of patients with an OP
within 7 days after or 30 days before the assessment date. We examined
factors
associated with OPs for patients with pain
scores of 7 to 10.
Results The proportion
of patients with an OP increased as pain score severity increased: 10%
of those with no pain, 24% of those
with mild pain, 45% of those with moderate pain,
and 67% of those with severe pain. More specifically, for those with
severe
pain, 41% filled an OP within 7 days of
assessment for pain, and 26% had an OP from the 30 days before
assessment for pain,
leaving 33% without an OP. In multivariable
analysis, factors associated with OPs are younger age, male sex,
comorbid illness,
cancer type, and assessment at home.
Conclusion Despite a
generous time window for capturing OPs, the proportion of patients
without an OP seems high. Further knowledge
translation is required to maximize the impact
of the symptom screening initiative in Ontario and to optimize
management of
cancer-related pain.
open access: The use of telephone in genetic counseling versus in-person counseling: a randomized study on counselees’ outcome
"In total only 15% of the referred participants declined
participation in the questionnaire study, indicating a highly
motivated population. Non-participants were equally distributed
between telephone and in-person OGNC, speaking
in favor of an unbiased cohort."
"Given the results of our study, the option of a pre-counseling
telephone model could be an equal or even better
alternative to in-person counseling and could very well be a
standard mode in the future. The results show that a considerable
number of participants experienced difficulties
with the process of creating a pedigree and dissatisfaction
with information on recommended surveillance and prevention.
These items should be areas of improvement."
Friday, March 09, 2012
abstract: Time-varying incidence of cancer after the onset of type 2 diabetes: evidence of potential detection bias British Columbia, Canada
Time-varying incidence of cancer after the onset of type 2 diabetes: evidence of potential detection bias.:
Diabetologia. 2011 Sep;54(9):2263-71
Abstract
AIMS/HYPOTHESIS:
Despite the vast body of epidemiological literature on the risk of cancer in people with diabetes, few studies have examined the pattern of cancer risk during different time windows following diabetes onset. The objective of the study was to examine the risks of site-specific cancer in people with incident type 2 diabetes during different time windows following diabetes onset.
METHODS:
This was a population-based retrospective cohort study. The study period was 1 April 1994 to 31 March 2006; censoring occurred at 31 March 2006, at death or on departure from British Columbia, Canada. Using linked health databases, we identified incident cohorts with and without diabetes, who were matched by age, sex and index year. Following a minimum 2-year cancer washout period, first site-specific cancers were identified prospectively in both cohorts.
RESULTS:
Within 3 months following diabetes onset, participants with diabetes had significantly increased risks of colorectal, lung, liver, cervical, endometrial, ovarian, pancreatic and prostate cancers. After the initial 3-month period, the risks for colorectal (HR 1.15, 95% CI 1.05, 1.25), liver (HR 2.53, 95% CI 1.93, 3.31) and endometrial (HR 1.58, 95% CI 1.28, 1.94) cancers remained significantly elevated compared with those without diabetes.
The diabetes cohort remained at increased risk of pancreatic cancer in later years, but followed a different pattern: HR 3.71 at 3 months-1 year, 2.94 at 1-2 years, 1.78 at 2-3 years and 1.65 at 3-10 years (p value for all <0.01). After an initial period of elevated risk, men with type 2 diabetes subsequently had a decreased risk of prostate cancer (HR 0.82, 95% CI 0.76, 0.88).
CONCLUSIONS/INTERPRETATION:
People with type 2 diabetes are at increased risk of select cancers; this risk is particularly elevated at the time of diabetes onset, which is likely to be due to increased ascertainment.
open access: Medscape - How Would Physicians Die?
How Would Physicians Die?
"How do doctors prefer to die? This question was addressed in a recent article on the Website zocalopublicsquare.org. The article suggests that physicians eschew extraordinary measures to extend life; instead they put a priority on reducing the pain and maximizing the quality of any limited time remaining. In a discussion on Medscape Physician Connect, an all-physician discussion group, doctors evaluated the accuracy of this portrait.
Overwhelmingly, the respondents agreed with sentiments expressed in the article. They sought to avoid the agony of a lingering final illness for themselves and for those they love. The results of an accompanying poll were unanimous. When completing the thought, "If I or my family were faced with a terminal illness with great potential for a terrible course and reasonable options have failed," all 27 respondents chose, "I'd want the focus to be on quality of life and comfort, no CPR." Not one expressed a preference for life-extending measures. Several physicians shared wrenching stories from personal experience...........cont'd
open access: CA-125: To Monitor or Not to Monitor?: Evidence Against Monitoring CA-125 For Ovarian Cancer Patients in Remission (Dr's Rustin, Karlan, Markman)
CA-125: To Monitor or Not to Monitor?: Evidence Against Monitoring CA-125
For Ovarian Cancer Patients in Remission
Posted: 03/08/2012
CA-125 is the most useful tumor marker in ovarian cancer. Since 1981, measurement of the serum level of the CA-125 antigen has become a standard component of routine management of women with advanced ovarian cancer.[1,2] CA-125 concentrations are used to monitor response to chemotherapy, relapse, and disease progression in ovarian cancer patients. However, the question remains as to whether routine monitoring of CA-125 in women with advanced ovarian cancer in complete remission is advantageous. Recently, Drs. Gordon Rustin and Beth Karlan -- experts in the treatment of ovarian cancer -- participated in a Medscape Virtual Debate via email addressing the question, "Should patients with advanced ovarian cancer in complete remission undergo routine CA-125 monitoring?" Dr. Maurie Markman served as moderator. What follows is their conversation..........cont'd
open access: Expert Reviews - Current developments in ovarian cancer screening (March 2012)
Expert Reviews - Expert Review of Obstetrics & Gynecology - 7(2):131 - Full Text
| ABSTRACT |  |
|---|
Over 150 delegates from the UK, USA and Europe with a core interest in risk prediction and screening for ovarian cancer attended the International Conference on Ovarian Cancer
Screening held on 29–30 November 2011 in London, UK. The scientific
program was driven by two experts in the field – Usha Menon and Ian
Jacobs – with assistance from the scientific committee, which included
Steve Skates, Jatinderpal Kalsi, Anna Lokshin, Uzi Beller, Tim Mould and
Ranjit Manchanda. Over the 2 days, key opinion leaders and researchers
reported on the latest developments, and debated the future of risk
prediction and screening for ovarian cancer.
~~~~~~~~~~~~~
The
conference started with a welcome from Ian Jacobs (University of
Manchester, Manchester, UK), followed by an overview of the current
management of ovarian cancer
(OC) by Tim Mould (University College Hospitals NHS Trust, London, UK).
Stuart Campbell (Create Health Ltd, London, UK), a stalwart in the
field of pelvic ultrasonography, chaired the first session on
differential diagnosis in symptomatic patients. Robert Bast (University
of Texas MD Anderson Cancer
Center, TX, USA), who in the early 1980s discovered CA125, discussed
recent biomarker panels and algorithms (Risk of Malignancy Index [RMI],
Risk of Ovarian
Malignancy Algorithm [ROMA] and OVA1) for OC diagnosis. His view was
that the current challenge, especially in the USA, was implementation so
that OC patients could be operated on by trained gynecological
oncologists. Of the many OC markers, CA125 and HE4 provided the greatest
discrimination between malignant and benign adnexal masses, with the
latter particularly useful in premenopausal women..........cont'd
open access: Expert Reviews - Outlining novel scenarios for improved therapeutic cancer vaccines: the PANVAC paradigm (ovarian/breast)
Expert Reviews - Expert Review of Vaccines - 11(3):275 - Full Text
Outlining novel scenarios for improved therapeutic cancer vaccines: the PANVAC paradigm
Key issues
• Heterologous
prime—boost regimen with antigenically diverse recombinant poxviruses
encoding for tumor-associated antigens and B7.1/ICAM-1/LFA3 cassette
represents a most promising vaccination schedule inducing clinical and
immunological responses.
| |||||||||
• PANVAC shows clinical efficacy in patients with metastatic breast and ovarian cancers.
| |||||||||
• Patients with limited tumor burden and minimal prior chemotherapy had a benefit from PANVAC vaccination.
| |||||||||
• PANVAC was demonstrated to be immunologically active in some of the patients who developed clinical responses.
| |||||||||
• Overall
survival, rather than progression-free survival, may be more relevant
for addressing the effects of therapeutic cancer vaccines.
| |||||||||
• PANVAC,
as also other cancer vaccines, elicits a dynamic process of immune
responses, which may be exploited in subsequent therapies.
| |||||||||
• Vaccines
used in the adjuvant setting (i.e., in patients with low tumor burden
following conventional treatment) may be more efficacious than in
patients with more advanced disease having increased tumor load.
| |||||||||
• Immunological end points as intermediate markers are needed for assessing clinical efficacy shortly after vaccination.
Financial & competing interests disclosure
The
author has no relevant affiliations or financial involvement with any
organization or entity with a financial interest in or financial
conflict with the subject matter discussed in the article. This includes
employment, consultancies, stock ownership or options, grants or
patents received or pending, or royalties.
No writing assistance was utilized in the production of this article.
| |||||||||
abstract: Clinical Outcome Prediction by MicroRNAs in Human Cancer: A Systematic Review
Clinical Outcome Prediction by MicroRNAs in Human Cancer: A Systematic Review
Background
MicroRNA (miR) expression may have prognostic value for many types of cancers. However, the miR literature comprises many small studies. We systematically reviewed and synthesized the evidence.
. ........The median hazard ratio for poor outcome in externally validated studies was 2.52 (IQR = 2.26–5.40). For all classifier miRs in studies that evaluated overall survival across diverse malignancies, the miRs most frequently associated with poor outcome after accounting for differences in miR assessment due to platform type were let-7 (decreased expression in patients with cancer) and miR 21 (increased expression).
Conclusions MiR
classifiers show promising prognostic associations with major cancer
outcomes and specific miRs are consistently identified
across diverse studies and platforms. These
types of classifiers require careful external validation in large groups
of cancer
patients that have adequate protection from
bias.
pdf: Summaries for Patients - Surrogate Decision Makers’ Interpretation of Prognostic Information
Surrogate Decision Makers’ Interpretation of Prognostic Information
What are the implications of the study?
Inaccurate interpretations of doctors’ prognostications arise partly from optimistic biases rather than simply from misunderstandings. Helping surrogates attain realistic expectations about patients’ likely outcomes is more complex than just giving clear information.
Weighing the Chances at Life's End - NYTimes.com
Weighing the Chances at Life's End - NYTimes.com
"........But the grimmer the prognosis, the more inaccurate and more optimistic the surrogates’ responses became. Only 22 percent correctly interpreted a statement about what a “5 percent chance of surviving” meant, while 65 percent answered with greater optimism.
“They clearly grasped the meaning of these statements,” Dr. White said. “They were not misunderstanding the numbers. They weren’t misunderstanding the language.” If that had been the case, you’d expect them to have been inaccurate about good news, too.
Instead, relatives hearing doctors deliver dire prognoses just didn’t accept or believe them. They displayed, in medspeak, “a systematic optimism bias.”
Such bias has shown up many times before in the medical literature. Cancer patients enrolled in early phases of clinical trials, for instance,....."
Limited significance of family history for presence of BRCA1 gene mutation in Polish breast and ovarian cancer cases. (300T>G mutation)
Limited significance of family history for presence of BRCA1 gene mutation in Polish breast and ovarian cancer cases.:
Fam Cancer. 2012 Mar 1;
Abstract
It is estimated that about 5-10% of ovarian and 2-5% of all breast cancer patients are carriers of a germline BRCA1 or BRCA2 gene mutation. Most families with detected BRCA1 or BRCA2 gene mutation are qualified for molecular testing on the basis of family history of breast or ovarian cancers. The purpose of our study was to establish the frequency of positive family history of cancer in a series of Polish consecutive breast and ovarian cancer patients in two groups, with and without the BRCA1 gene mutations. We analysed the prevalence of four of the most common BRCA1 mutations: 5382insC (c.5266dupC), 300T>G (p.181T>G), 185delAG (c.68_69delAG) and 3819del5 (c.3700_3704del5). The patient group consisted of 1,845 consecutive female breast and 363 ovarian cancer cases. 19 out of 37 (51%) of BRCA1-positive ovarian cancer patients and 21 out of 55 (39%) BRCA1-positive breast cancer had negative family history of breast and/or ovarian cancer among first- and second-degree relatives.
In ovarian cancer patients, negative family history was more frequent in those with 300T>G BRCA1 gene mutation than in 5382insC carriers. This finding indicates the necessity of searching for 300T>G mutation in families with a single diagnosis of ovarian cancer in family. The high frequency of mutations detected in breast cancer patients lacking obvious family history shows that breast cancer patients should be qualified for genetic testing on the basis of wide clinical and pathological criteria.
Impact of using multiple causes of death codes to compute site-specific, death certificate-based cancer mortality statistics in the United States
Impact of using multiple causes of death codes to compute site-specific, death certificate-based cancer mortality statistics in the United States: Publication year: 2012
Source:Cancer Epidemiology, Volume 36, Issue 1
Background:
Cancer mortality statistics, an important indicator for monitoring cancer burden, are traditionally restricted to instances when cancer is determined to be the underlying cause of death (UCD) based on information recorded on standard certificates of death. This study's objective was to determine the impact of using multiple causes of death codes to compute site-specific cancer mortality statistics.
Methods:
The state cancer registries of California, Colorado and Idaho provided linked cancer registry and death certificate data for individuals who died between 2002 and 2004, had at least one cancer listed on their death certificate and were diagnosed with cancer between 1993 and 2004. These linked data were used to calculate the site-specific proportion of cancers not selected as the UCD (non-UCD) among all cancer-related deaths (any mention on the death certificate). In addition, the retrospective concordance between the death certificate and the population-based cancer registry, measured as confirmations rates, was calculated for deaths with cancer as the UCD, as a non-UCD, and for any mention.
Results:
Overall, non-UCD deaths comprised 9.5 percent of total deaths; 11 of the 79 cancer sites had proportions greater than 3 standard deviations from 9.5 percent. The confirmation rates for UCD and for any mention did not differ significantly for any of the cancer sites.
Conclusion and impact:
The site-specific variation in proportions and rates suggests that for a few cancer sites, death rates might be computed for both UCD and any mention of the cancer site on the death certificate. Nevertheless, this study provides evidence that, in general, restricting to UCD deaths will not under report cancer mortality statistics.
(re: statistics) Comparison of methods for calculating relative survival in population-based studies
Comparison of methods for calculating relative survival in population-based studies: Publication year: 2012
Source:Cancer Epidemiology, Volume 36, Issue 1
Background:
It is vital that unbiased estimates of relative survival are estimated and reported by cancer registries. A single figure of relative survival is often required to make reporting simpler. This can be obtained by pooling all ages or, more commonly, by using age-standardisation. The various methods for providing a single figure estimate of relative survival can give very different estimates.
Methods:
The problem is illustrated through an example using Finnish thyroid cancer data. The differences are further explored through a simulation study that investigates the effect of age on the estimates of relative survival.
Results:
The example highlights that in practice the all-age estimates from the various methods can be substantially different (up to 6 percentage units at 15 years of follow-up). The simulation study confirms the finding that differing estimates for the all-age estimates of relative survival are obtained. Performing age-standardisation makes the methods more comparable and results in better estimation of the true net survival.
Conclusions:
The all-age estimates of relative survival rarely give an appropriate estimate of net survival. We feel that modelling or stratifying by age when calculating relative survival is vitally important as the lack of homogeneity in the cohort of patients leads to potentially biased estimates. We feel that the methods using modelling provide a greater flexibility than life-table based approaches. The flexible parametric approach does not require an arbitrary splitting of the time-scale, which makes it more computationally efficient. It also has the advantage of easily being extended to incorporate time-dependent effects.
Postmenopausal hormone therapy and ductal carcinoma in situ: A population-based case–control study
Postmenopausal hormone therapy and ductal carcinoma in situ: A population-based case–control study: Publication year: 2012
Source:Cancer Epidemiology
Background and aim:
The relationship between hormone therapy (HT) and invasive breast cancer has been extensively investigated, but the relationship between HT and in situ breast cancer has received relatively little attention. We examined the relationship between HT and ductal carcinoma in situ (DCIS) among postmenopausal women who participated in a population-based case–control study in Connecticut, USA.
Methods:
This analysis included 1179 post-menopausal women (603 controls and 576 cases), who comprised a subset of a population-based case–control study that included all incident cases of breast carcinoma in situ (BCIS) in Connecticut and frequency-matched controls by 5-year age intervals.
Results:
We found no association between DCIS and ever use of any HT (adjusted odds ratio (OR)=0.85, 95% confidence interval (CI): 0.65–1.11); of estrogen alone (adjusted OR=0.93; 95% CI: 0.68–1.29) or of estrogen and progesterone (adjusted OR=0.75; 95% CI: 0.52–1.08). There was also no association between DCIS and current use of these hormones. In addition, estimated risk of DCIS did not increase with duration of use of these preparations. Conclusions: These results add to a small literature that remains inconclusive. To determine whether HT poses risk of in situ breast cancer, larger studies with greater power and precise control of important covariates (e.g., mammography screening) are needed, as are meta-analyses of available data.
Cetuximab inhibits the growth of mucinous ovarian carcinoma tumor cells lacking... - Abstract - UK PubMed Central
The purpose of this study was to explore the possibility of targeted molecular therapy with anti-epidermal growth factor receptor (anti-EGFR) antibody (cetuximab) for the treatment of mucinous ovarian carcinoma. ...............These results suggest the possibility of targeted molecular therapy with cetuximab for mucinous ovarian carcinoma cells lacking a KRAS gene mutation.
Activity and resistance of trastuzumab according to different clinical settings
Activity and resistance of trastuzumab according to different clinical settings: Publication year: 2012
Trastuzumab, a humanized monoclonal antibody directed against HER2, has shown efficacy in breast cancers; however many patients do not respond to this reagent. Here, we discuss the potential mechanisms of trastuzumab efficacy and resistance in different clinical settings as a step toward optimizing the appropriate application of this antibody. The three major antitumor mechanisms of trastuzumab, i.e., inhibition of proliferation, antibody-dependent cell cytotoxicity (ADCC) and inhibition of DNA repair, appear to be differentially operative in different clinical settings. ADCC appears to be the prevalent mechanism in trastuzumab neoadjuvant monotherapy, whereas in neoadjuvant, adjuvant or metastatic settings in which trastuzumab is combined with chemotherapy, the relative role of ADCC is probably small, considering the compromising effects of chemotherapy on the immune cells that mediate this mechanism. In neoadjuvant and adjuvant settings involving concomitant use of trastuzumab and chemotherapy, the primary mechanism at play is presumably inhibition of DNA repair by the antibody, while in sequential protocols, the antibody acts mostly by exerting cytostatic activity through inhibition of HER2-mediated tumor cell proliferation. According to the ability of the antibody to induce cytotoxic or cytostatic antitumor effects depending on the clinical setting, different criteria, i.e., RECIST for cytotoxic effect, OS, and DFS for cytostatic, must be considered in accurately estimating antibody efficacy. Moreover, since trastuzumab resistance likely depends directly on the mechanisms responsible for its antitumor activity, resistance mechanisms must also be considered with respect to the different clinical settings.
Importance of monitoring renal function in patients with cancer
Importance of monitoring renal function in patients with cancer: Publication year: 2012
Monitoring renal function in patients with solid tumors and hematologic malignancies is vital to the safe administration of therapeutic agents. Renal impairment is frequent in elderly patients (i.e., age⩾65) with cancer, despite normal serum creatinine levels in most patients. Because serum creatinine levels do not accurately reflect clearance rates, renal function should be estimated by calculation (either Cockcroft-Gault or abbreviated Modification of Diet in Renal Disease [aMDRD] equations) or by measuring creatinine clearance using a 24-h urine collection. Additionally, patients with cancer often have preexisting comorbidities or other risk factors that increase the probability of renal impairment before receiving potentially nephrotoxic therapies. Patient age, preexisting renal dysfunction, and chronic comorbidities (e.g., diabetes, kidney disease, hypertension, and cardiac insufficiency) all contribute to the risk of renal impairment. Furthermore, both cancer and its therapies may lead to renal impairment. A number of cancer therapy agents are nephrotoxic, including chemotherapy agents, molecular targeted agents, pain management agents, radiopharmaceuticals, contrast agents used in radiology, and antiresorptive agents, and contrast agents used in radiology are nephrotoxic as well. Undetected decreases in clearance rates by the kidneys can greatly increase exposure to treatment agents, possibly decreasing the safety of treatment and exacerbating renal impairment.
In conclusion, all cancer patients, not only those receiving potentially nephrotoxic agents, require renal monitoring.
Reliability, validity and feasibility of quality of life instruments for adult patients with cancer undergoing chemotherapy: result from a systematic review - 2012 - International Journal of Evidence-Based Healthcare
Abstract
Aim
The aim of this review was to analyse the literature critically and
present the best available evidence related to quality of life (QoL)
instruments that consists of all four subscales of physical,
psychological, social and spiritual, which can be used in the clinical
setting to assess adult patients with cancer on chemotherapy.
Inclusion criteria
This review included randomised control trials and observational
studies without control group related to QoL instruments used for cancer
chemotherapy. The types of participants for this review included all
adults with cancer over the age of 18 years who have undergone
chemotherapy. The QoL instruments for this review included instruments
that consist of all subscales of physical, psychological, social and
spiritual. In order to retrieve QoL instruments that were current and
not outdated, this review included studies reported in the recent 10
years.
Results A total of
3149 references was retrieved during the initial search. Only 13
articles with validation of the QoL instruments that contained all the
four subscales of physical, psychological, social and spiritual were
included in this review. Four QoL instruments were identified. These
include the City of Hope QOL – Ovarian Cancer Tool (QOL-OVCA),
QOL-Breast cancer version (QOL-BC) ........
Conclusion
In this review, there was one article on development of new QoL
instrument, the New India QoL tool, which has comprehensive validity
examinations – the least number of items that may be useful in the
clinical setting but need further psychometric testing in different
settings or languages. The QLI-CV instrument has had comprehensive
intra- and inter-method validation on different languages, different
cultural settings and various types of cancer. However, the instrument
may not be feasible because the method to calculate the QoL score is not
straightforward.
Thursday, March 08, 2012
March 7th /text and/or podcast: PARP Inhibitors and the Challenges of Developing Ovarian Cancer Therapeutics - Cancer Network Dr's Ledermann/Birrer
Blogger's Note: podcast and/or text available, registration required (free)
~~~~~~~~~~~~~~~~~~
PARP Inhibitors and the Challenges of Developing Ovarian Cancer Therapeutics - Cancer Network
Jonathan Ledermann, Cancer UK, London; Michael Birrer, Harvard Medical School, Dana-Farber Institute
AUDIO:
Right-click to download MP3
Right-click to download MP3
PODCAST
PARP Inhibitors and the Challenges of Developing Ovarian Cancer Therapeutics
Interviewed by Anna Azvolinsky, PhD |
March 7, 2012
Ovarian cancer is notoriously difficult to treat because it is usually diagnosed at an advanced stage, and because of the high variance in the types of mutations that are found in individual tumors. This creates hurdles for the development of efficacious treatments.
CancerNetwork presents an interview with two prominent ovarian cancer researchers from both sides of the Atlantic. Dr. Jonathan Ledermann is professor of medical oncology at the UCL Cancer Institute in London, England. He treats gynecological cancers and is heavily involved in ovarian cancer clinical trials. Dr. Michael Birrer is a professor of medicine at the Harvard Medical School and is part of the Dana-Farber/Harvard Cancer Center where he also treats gynecological cancers and leads an effort to molecularly characterize gynecological cancers.......
~~~~~~~~~~~~~~~~~~~~~
"CancerNetwork: Despite promising results at ASCO last year, with one of the PARP inhibitors, olaparib, showing positive progression-free survival (PFS) benefit, the phase II trial was stopped in mid December because this PFS benefit was not likely to translate to an overall survival benefit. I would like to get both of your perspectives on this and then what the future holds for other PARP inhibitors in development.
Dr. Ledermann: Mike Birrer will want to comment on this, but can I just correct you on a point of fact. The phase II trial was not stopped. In fact it is still going. There are still patients on treatment, and it has not been unblinded. What the company that manufactures olaparib, which is one of the PARP inhibitors, said in their press release was they were not going to continue development of olaparib in high-grade serous ovarian cancer because, as you said, the interim analysis of survival didn’t show the benefit they wanted to see in relation to the benefit in PFS that I reported at the ASCO conference. But the trial is still continuing and a final analysis will be done probably toward the end of this year."
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