Monday, September 24, 2012

Screening for Ovarian Cancer

You Are Here: U.S. Preventive Services Task Force > Topic Index > Screening for Ovarian Cancer

Screening for Ovarian Cancer

This topic page summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on screening for ovarian cancer.

Current Recommendation

Release Date: September 2012

The USPSTF recommends against screening for ovarian cancer in women.
Grade: D Recommendation.

Supporting Documents

Supporting Document	Related Items
Reaffirmation Recommendation Statement	Clinical Summary (PDF File, 58 KB; PDF Help)
	Consumer Fact Sheet (PDF File, 118 KB; PDF Help)
	2004 Recommendation Statement (PDF File, 188 KB; PDF Help)
Reaffirmation Evidence Report (PDF File, 84 KB;PDF Help)	2012 Addendum (PDF File, 112 KB; PDF Help)
Reaffirmation Evidence Report (PDF File, 84 KB;PDF Help)	2004 Evidence Report (PDF File, 182 KB; PDF Help)

Current as of September 2012

Internet Citation:

Screening for Ovarian Cancer, Topic Page. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsovar.htm

Accessibility

Freedom of Information Act

Web Site Disclaimers

USPSTF Program Office 540 Gaither Road, Rockville, MD 20850

http://www.uspreventiveservicestaskforce.org/uspstf/uspsovar.htm

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National Guideline Clearinghouse | Complications of colonoscopy.

http://guideline.gov/content.aspx?f=rss&id=37852

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CME -- Variability of sorafenib toxicity and exposure over time: a pharmacokinetic/pharmacodynamic analysis

Variability of sorafenib toxicity and exposure over time: a pharmacokinetic/pharmacodynamic analysis

http://cme.alphamedpress.org/cgi/hierarchy/ampcme_course;ONC-17-9-1204

CME -- Lymphocele and Ovarian Cancer: Risk Factors and Impact on Survival

Lymphocele and Ovarian Cancer: Risk Factors and Impact on Survival

About this course

Released: September 24, 2012
Expires: September 24, 2014
Time to Complete: 1.00 hour(s)
Medium: Internet Online

http://cme.alphamedpress.org/cgi/hierarchy/ampcme_course;ONC-17-9-1198

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WEBINAR: Infection Control and Prevention in Outpatient Oncology Clinics | CDC Foundation

Monday, September 24th

1:00–2:00 p.m. EDT

Register at no cost

http://www.cdcfoundation.org/preventcancerinfections/webinar

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Nanoparticles: the future for platinum drugs or a research red herring?, Nanomedicine, Future Medicine

ReachMD - Program - Vitamins, Herbs, and Supplements: The "Real Scoop" on Evidence

Program Details

Vitamins, Herbs, and Supplements: The "Real Scoop" on Evidence

Program Description

This discussion focuses on the current state of evidence behind vitamins, herbs, and supplements in popular demand. What does the latest research recommend for use, and what should we be avoiding? Featured is Dr. Mark Moyad, the Jenkins/Pokempner Director of Preventive & Complementary Medicine at the University of Michigan Medical Center. Dr, Brian McDonough hosts.

Series

Clinician's Roundtable

New Chemotherapy Strategy Emerges in Ovarian Cancer

New Chemotherapy Strategy Emerges in Ovarian Cancer

"...The noteworthy results stem from Japanese Gynecologic Oncology Group (JGOG) trial 3016, which established a significant survival benefit for patients who received dose-dense weekly paclitaxel plus carboplatin versus the conventional dosing schedule for those two drugs.^1..."

Four Patient Safety Questions to Ask When Using Patient-Controlled Analgesia (PCA) Pumps - PR Newswire - The Sacramento Bee

http://www.sacbee.com/2012/09/20/4838030/four-patient-safety-questions.html

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Sunday, September 23, 2012

Optimal first-line treatment in ovarian cancer

OhioLINK ETD: Integration of family health history in clinical guidelines for breast, ovarian, and colorectal cancer

OhioLINK ETD:

New insights into ovarian cancer pathology

Navigate This Article

Table of Contents — Educational Book of the 37th ESMO Congress Vienna, Austria 28 September – 2 October 2012

Table of Contents — September 2012, 23 (suppl 10)

Educational Book of the 37th ESMO Congress Vienna, Austria 28 September – 2 October 2012

Volume 23 suppl 10 September 2012

Table of Contents — Educational Book of the 37th ESMO Congress Vienna, Austria 28 September – 2 October 2012

Table of Contents — September 2012, 23 (suppl 10)

Educational Book of the 37th ESMO Congress Vienna, Austria 28 September – 2 October 2012

Volume 23 suppl 10 September 2012

migrated to youtube: Survivors' Debate: The Past Decade in Ovarian Cancer Novi/Toronto - excerpts

Survivors' Debate: The Past Decade in Ovarian Cancer Novi/Toronto - excerpts

YouTube - Survivors' Debate: The Past Decade in Ovarian Cancer

YouTube

Survivors' Debate: The Past Decade in Ovarian Cancer

One debate - two conferences: Novi, MI & Toronto, Canada:
Survivors' Debate: The Past Decade in Ovarian Cancer Distributed by Tubemogul.

Why Do Academic Medical Centers Do Poorly on Quality Report Cards?

"...Academic medical center hospitals often save the lives of patients with complicated conditions who benefit from cutting edge treatments supported by basic science research. However, it is revealing that the community Holy Cross Hospital in Silver Spring, Maryland made the Joint Commission’s list of “top performers” and the famed Johns Hopkins did not do as well on the quality scoring report card.
The Holy Cross vice president of quality and care management cites three factors for the hospital’s excellent quality results: intensive review of patients’ charts, the electronic medical record system, and the leadership focus on quality.
When it comes to choosing a hospital, patients should take into account quality report cards as well as reputation."

Why Do Academic Medical Centers Do Poorly on Quality Report Cards?:

By KENT BOTTLES, MD

In September 2012, the Joint Commission recognized 620 hospitals (about 18% of the total number of accredited American hospitals) as “top performers,” but many were surprised when some of the biggest names in academic medical centers failed to make the cut. Johns Hopkins, Massachusetts General Hospital, and the Cleveland Clinic (perennial winners in the US News & World Report best hospital competition) did not qualify when the Joint Commission based their ranking not on reputation but on specific actions that “add up to millions of opportunities ‘to provide the right care to the patients at American hospitals.’”

Can the Source of Funding for Medical Research Affect the Results?

Can the Source of Funding for Medical Research Affect the Results?:

Many clinical research studies are funded by pharmaceutical companies and there is a general perception that such industry-based funding could potentially skew the results in favor of a new medication or device. The rationale underlying this perception regarding the influence of industry funding is fairly straightforward. Pharmaceutical companies or device manufacturers need to increase the sales of newly developed drugs or devices in order to generate adequate profits. It would be in their best interest to support research that favors their corporate goals. Even though this rationale makes intuitive sense, it does not necessarily prove that industry-funding does influence the results of trials. However, there is also data to support the fact that the funding source does seem to correlate with the outcomes of clinical trials.
One such study was conducted by Paul Ridker and Jose Torres and published in 2006 in JAMA ( Journal of the American Medical Association ). Ridker and Torres analyzed randomized cardiovascular trials published in leading, peer-reviewed medical journals ( JAMA, The Lancet, and the New England Journal of Medicine ) during the five year period of 2000-2005 in which one treatment strategy was directly compared to a competing treatment. They found that 67.2% of studies funded exclusively by for-profit organizations favored the newer treatment, whereas only 49.0% of studies funded by non-profit organizations (such as non-profit foundations and state or federal government agencies) showed results in favor of the newer treatment. This contrast was even more pronounced for pharmaceutical drugs, where 65.5% of the industry sponsored studies showed benefits of the newer treatment, while only 39.5% of non-profit funded studies favored the new treatment.
[More]

Some deadly breast cancers share genetic features with ovarian tumors | Newsroom | Washington University in St. Louis

Some deadly breast cancers share genetic features with ovarian tumors | Newsroom | Washington University in St. Louis

"The most comprehensive analysis yet of breast cancer shows that one of the most deadly subtypes is genetically more similar to ovarian tumors than to other breast cancers.......

repost - open access link: Rethinking Ovarian Cancer: Recommendations for Improving Outcomes (multinational authors)

Rethinking Ovarian Cancer: Recommendations for Improving Outcomes

Saturday, September 22, 2012

(provisional) programme: FIGO 2012 Oct 7-12th

programme.pdf (application/pdf Object)

Select a test or treatment - imaging (eg. CT, Biopsy....)

Select a test or treatment

Test/Treatment

Select a test or treatment from the following list:
Angiography
Arterial and Venous Interventions
Biliary Interventions
Biopsy
Chest Interventions
Computed Tomography (CT or CAT Scan)
Dialysis Fistula/Graft Declotting Interventions
Embolization
Magnetic Resonance Imaging (MRI)
Mammography (Breast Imaging)
Nuclear Medicine
Percutaneous Abscess Drainage
Peritoneal Ports
Radiation Therapy (Oncology)
Radiofrequency Ablation
Spinal Interventions
Ultrasound (Sonography)
Urinary Interventions
X-ray (Radiography)

Radiology information - Abdomen (CT......)

Abdomen
Abdomen (colon, intestines, kidneys, liver, pancreas, pelvis, stomach)

Select from the following list:

Diagnostic Radiology

Computed Tomography (CT)

Computed Tomography (CT) - Abdomen and Pelvis

Computed Tomography (CT) - Body

CT Colonography

CT Enterography

Urography

Magnetic Resonance Imaging (MRI)

Magnetic Resonance Cholangiopancreatography (MRCP)

Magnetic Resonance Imaging (MRI) - Body

MR Enterography

Urography

Ultrasound

Ultrasound - Abdomen

Ultrasound - General

Ultrasound - Pelvis

X-ray (Radiography)

Catheter Angiography

Intravenous Pyelogram (IVP)

Therapeutic Enema for Intussusception

Video Fluoroscopic Swallowing Exam (VFSE)

X-ray (Radiography), Lower GI Tract

X-ray (Radiography), Upper GI Tract

Interventional Radiology (IR)

Biliary Interventions

Biopsies - Overview

Catheter Angiography

Catheter Embolization

Chemoembolization

Dialysis and Fistula/Graft Declotting and Interventions

Foreign Body Retrieval

Inferior Vena Cava Filter Placement and Removal

Percutaneous Abscess Drainage

Peritoneal Ports

Radioembolization (Y90)

Radiofrequency Ablation of Kidney Tumors

Radiofrequency Ablation of Liver Tumors

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Ureteral Stenting and Nephrostomy

Nuclear Medicine

General Nuclear Medicine

Nuclear Medicine, Hepatobiliary

Renal Scintigraphy

Radiation Therapy

Brachytherapy

Colorectal Cancer Treatment

External Beam Therapy

Intensity-Modulated Radiation Therapy

Prostate Cancer Treatment

Proton Therapy

Radioembolization (Y90)

Stereotactic Radiosurgery

There Is More to Life Than Death — NEJM

There Is More to Life Than Death — NEJM

"....Basing decisions on the outcome of death ignores vital dimensions of life that are not easily quantified. There are real complexities and uncertainties that we all, patients and physicians alike, confront in weighing risk and benefit. Wrestling with these uncertainties requires nuanced and individualized judgment. It is neither ignorant nor irrational to question the wisdom of expert recommendations that are sweeping and generic. There is more to life than death."

Seth's Blog: Curiosity was framed

Curiosity was framed:

Avoid it at your peril. The cat's not even sick. (HT to C. J. Cherryh)
If you don't know how it works, find out.
If you're not sure if it will work, try it. If it doesn't make sense, play with it until it does.
If it's not broken, break it.
If it might not be true, find out.
And most of all, if someone says it is none of your business, prove them wrong.

Noninvasive micropapillary urothelial carcinoma: a clinicopathologic study of 18 cases.

Noninvasive micropapillary urothelial carcinoma: a clinicopathologic study of 18 cases.:

Hum Pathol. 2012 Aug 30;

Abstract
Noninvasive micropapillary urothelial carcinoma consists of slender tufts of urothelial carcinoma lacking fibrovascular cores analogous to ovarian papillary serous tumors of borderline malignancy. Eighteen noninvasive micropapillary urothelial carcinoma cases were identified from the Pathology Department of The Johns Hopkins Hospital (2000-2011). Patients lacked history of invasive urothelial carcinoma. Two patterns of noninvasive micropapillary urothelial carcinoma were identified: (1) as a variant of noninvasive high-grade papillary urothelial carcinoma (high-grade papillary urothelial carcinoma/micropapillary urothelial carcinoma) (n = 13 cases) and (2) as a variant of urothelial carcinoma in situ (carcinoma in situ/micropapillary urothelial carcinoma) (n = 5 cases with 2 of these patients also having high-grade papillary urothelial carcinoma/micropapillary urothelial carcinoma). Of 18 patients, 16 (88%) were male with a mean age of 71.8 years (range, 54-87 years). Of the 12 patients initially treated with surveillance, Bacillus-Calmette Guérin, or intravesical chemotherapy, 4 did not recur and were without evidence of disease at 6, 21, 24, and 39 months. Four patients experienced recurrences with 3 of them without evidence of disease at 36, 52, and 72 months and with the fourth whose last follow-up was at 84 months when recurrence occurred. One patient is alive at 11 months with disease, and 1 died of other causes at 1 month. Two patients progressed to pT2 and pT3 disease at 5 and 21 months, respectively. It is critical to differentiate and clearly specify in pathology reports whether micropapillary urothelial carcinoma is invasive or noninvasive because invasive micropapillary urothelial carcinoma is an aggressive disease with a high degree of understaging, whereas some cases of noninvasive micropapillary urothelial carcinoma are not necessarily associated with an adverse outcome.

PMID: 22939957 [PubMed - as supplied by publisher]

New insights into the pathogenesis of ovarian carcinoma: time to rethink ovarian cancer screening.

New insights into the pathogenesis of ovarian carcinoma: time to rethink ovarian cancer screening.:

Abstract
Recent discoveries about the pathogenesis of ovarian cancer have suggested that it can no longer be thought of as a single entity, but that the histologically defined ovarian cancer subtypes are different diseases, with different precursor lesions and distinct biomarker expression profiles. Most serous carcinomas probably arise from the fallopian tube. Clear cell and endometrioid carcinomas are associated with endometriosis and likely originate from ectopic endometrium. The focus of large ovarian cancer screening trials has been detection of macroscopic ovarian abnormalities by ultrasonography and detection of serum biomarkers associated with the most common (serous) subtype of ovarian cancer. The only completed and phase three randomized controlled trial failed to achieve the objective of reducing ovarian cancer mortality and was not able to demonstrate a stage migration effect of the screening. Future screening strategies have to incorporate our growing understanding of each subtype of pelvic (ovarian or fallopian tube) cancer, its organ of origin, and disease-specific biomarkers. We review how our current understanding of pathogenesis should prompt a reexamination of data from ovarian cancer screening studies and discuss potential designs for future screening strategies.

PMID: 22996112 [PubMed - in process]

Clonal evolution of high-grade serous ovarian carcinoma from primary to recurrent disease.

Clonal evolution of high-grade serous ovarian carcinoma from primary to recurrent disease.:

J Pathol. 2012 Sep 21;

Abstract
High-grade serous carcinoma (HGSC) is the most common and fatal form of ovarian cancer. While most tumors are highly sensitive to cytoreductive surgery and platinum- and taxane-based chemotherapy, the majority of patients experience recurrence of treatment-resistant tumors. The clonal origin and mutational adaptations associated with recurrent disease are poorly understood. We performed whole exome sequencing on tumor cells harvested from ascites at three time points (primary, first recurrence and second recurrence) for three HGSC patients receiving standard treatment. Somatic point mutations and small insertions and deletions were identified by comparison to constitutional DNA. The clonal structure and evolution of tumors were inferred from patterns of mutant allele frequencies. TP53 mutations were predominant in all patients at all time points, consistent with the known founder role of this gene. Tumors from all three patients also harbored mutations associated with cell cycle checkpoint function and Golgi vesicle trafficking. There was convergence of germline and somatic variants within the DNA repair, ECM, cell cycle control and Golgi vesicle pathways. The vast majority of somatic variants found in recurrent tumors were present in primary tumors. Our findings highlight both known and novel pathways that are commonly mutated in HGSC. Moreover, they provide the first evidence at single nucleotide resolution that recurrent HGSC arises from multiple clones present in the primary tumor with negligible accumulation of new mutations during standard treatment.
PMID: 22996961 [PubMed - as supplied by publisher]

Effect of radical cytoreductive surgery on omission and delay of chemotherapy for advanced-stage ovarian cancer.

Effect of radical cytoreductive surgery on omission and delay of chemotherapy for advanced-stage ovarian cancer.:

Obstet Gynecol. 2012 Oct;120(4):871-81

Abstract
OBJECTIVE: : Cytoreductive surgery is associated with extensive morbidity and may delay chemotherapy. We examined the associations among cytoreduction, perioperative complications, and delay or omission of chemotherapy.
METHODS: : Women aged 65 years or older with stage III-IV ovarian cancer who were treated with surgery from 1991-2005 and recorded in the Surveillance, Epidemiology, and End Results-Medicare database were examined. We estimated the influence of extended cytoreduction as well as the occurrence of major perioperative complications on receipt and timing of chemotherapy and survival.
RESULTS: : Among 3,991 patients, 479 (12%) failed to receive chemotherapy. Of those treated with chemotherapy, 2,527 (72%) initiated treatment within 6 weeks of surgery, 838 (24%) within 6-12 weeks, and 147 (4%) more than 12 weeks after surgery. In a multivariable model, older patients, those with comorbidities, mucinous tumors, and stage IV neoplasms were more likely not to receive chemotherapy (P<.05). Extended cytoreduction and the occurrence of postoperative complications were not associated with omission of chemotherapy but were associated with chemotherapy delay. For every 14 patients who underwent one extended procedure and for every 13 who had two extended procedures, one patient had a delay in receipt of chemotherapy. For every 14 patients who had one complication and for every four who had two complications, one patient had a delay in receipt of chemotherapy. The occurrence of more than two perioperative complications (hazard ratio 1.31, 95% confidence interval [CI] 1.15-1.49) and initiation of chemotherapy more than 12 weeks after surgery (hazard ratio 1.32, 95% CI 1.07-1.64) were associated with decreased survival.

CONCLUSION: : Extended cytoreductive surgery and perioperative complications significantly delay initiation but do not increase the chance of omission of chemotherapy for women with ovarian cancer.
LEVEL OF EVIDENCE: : II.

PMID: 22996105 [PubMed - in process]

Friday, September 21, 2012

Monoclonal antibody drugs for cancer treatment: How they work - MayoClinic.com

Clinical Oncology News - MRI Breast Surveillance Stands Up to Expectations

Doubt About Ovarian Cancer Screening - NYTimes.com (letters)

http://www.nytimes.com/2012/09/21/opinion/doubt-about-ovarian-cancer-screening.html?_r=1&emc=tnt&tntemail1=y

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Thursday, September 20, 2012

When Cancer Treatment Causes Menopause: Tips for Preparing and Coping

http://www.onclive.com/publications/contemporary-oncology/2012/Spring-2012/When-Cancer-Treatment-Causes-Menopause-Tips-for-Preparing-and-Coping

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Wednesday, September 19, 2012

Molecular abnormalities in ovarian carcinoma: clinical, morphological and therapeutic correlates

Abstract

The histopathological classification of ovarian surface epithelial carcinomas (referred to hereafter as "ovarian carcinoma") has shifted over the past 10 years to better reflect our understanding of molecular events during carcinogenesis. Ovarian carcinoma is no longer viewed as a singular entity but as multiple disease processes, with each having different molecular pathways altered during oncogenesis, resulting in differences in clinical and pathological features, such as biomarker expression, pattern of spread, and response to chemotherapy. There are five subtypes of ovarian carcinoma that are sufficiently distinct and well characterized that they should be considered to be different diseases i.e. high-grade serous, clear cell, endometrioid, mucinous and low-grade serous, from most to least common, respectively. This review summarizes the molecular abnormalities of these five ovarian carcinoma subtypes, relating them to clinical and pathological features.

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Serial measurements of serum PDGF-AA, PDGF-BB, FGF2, and VEGF in multiresistant ovarian cancer patients treated with bevacizumab

IntroductionAnti-VEGF treatment has proven effective in recurrent ovarian cancer. However, the identification of the patients most likely to respond is still pending. It is well known that the angiogenesis is regulated by several other pro-angiogenic proteins, e.g. the platelet - derived growth factor (PDGF) system and the fibroblast growth factor (FGF) system. These other signaling pathways may remain active or become upregulated during anti-VEGF treatment.The aim of the present study was to investigate if potential changes of PDGF-BB, PDGF-AA, and FGF2 before and during bevacizumab treatment had predictive value for early progression or survival. Furthermore, we wanted to investigate the importance of serum VEGF in the same cohort.
Methods:
This study included 106 patients with chemotherapy-resistant epithelial ovarian cancer who were treated with single agent bevacizumab as part of a biomarker protocol. Patients were evaluated for response by the Response Evaluation Criteria In Solid Tumors (RECIST) and/ or Gynecologic Cancer Intergroup (GCIG) CA125 criteria. Serum samples were collected at baseline and prior to each treatment. FGF2, PDGF-BB, PDGF-AA were quantified simultaneously using the Luminex system, and VEGF-A was measured by ELISA. Eighty-eight baseline samples were avaliable for FGF2, PDGF-BB, PDGF-AA analysis, and 93 baseline samples for VEGF
Results:
High baseline serum VEGF was related to poor overall survival. Furthermore, high serum PDGF-BB and FGF2 was of prognostic significance. None of the markers showed predictive value, neither at baseline level nor during the treatment.

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HE4 and ROMA Index in Czech Postmenopausal Women

Aim: The first aim of the project was to evaluate the benefits of the determination of human epididymis protein 4 (HE4) and the risk of ovarian malignancy algorithm (ROMA) index for primary detection of ovarian cancer in a population of Czech women. The second aim was to study the advantages HE4, cancer antigen 125 (CA125) and ROMA index for distinguishing between benign and malignant tumors. Aware of the age distribution of ovarian cancer, we focused on postmenopausal patients. Patients and Methods: Our group of patients consisted of 256 females, 21 with ovarian cancer and 235 with benign ovarian tumors. All diagnoses were histologically verified. We determined the serum levels of HE4 and CA125 and calculated the ROMA2 index for postmenopausal women. Serum levels of the analytes were measured using an Architect 1000i instrument. Serum samples were collected prior to surgery or any other form of treatment and the results of the two groups of patients were compared (malignant vs. benign). Results: There was a significant difference in the serum levels for all parameters studied between the groups of patients with malignant and those with benign diagnoses (Wilcoxon test, p<0.0001). When all parameters were evaluated at 95% specificity, the HE4 cut-off was 112 pmol/l at a sensitivity of 71.42%, a positive predictive value (PPV) of 55.56%, a negative predictive value (NPV) of 97.14% and an area under the curve (AUC) of 0.9152. The CA125 cut-off was 81 IU/l at a sensitivity of 80.95%, a PPV of 58.62%, a NPV of 98.23% and an AUC of 0.9731. ROMA2 index had a cut-off 37.70% at a sensitivity of 85.71%, a PPV of 62.06%, a NPV of 98.65% and an AUC of 0.9803. The highest diagnostic efficiency was achieved by the ROMA2 index. Conclusion: Determination of HE4 along with CA125 and ROMA2 index calculation is a suitable method for the improvement of the primary detection of ovarian cancer. This approach also improves the differential diagnostic possibilities for distinguishing between malignant and benign tumors.

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Health-related Quality of Life During Sequential Chemotherapy with Carboplatin Followed by Weekly Paclitaxel in Advanced Ovarian Cancer: A Multicenter Phase II Study of the North Eastern German Society of Gynecological Oncology

Aim: We describe the impact of a sequential dose-dense schedule of carboplatin and paclitaxel on the quality of life (QoL) of patients with ovarian cancer. Patients and Methods: In this multicenter phase II trial, four cycles of carboplatin followed by 12 cycles of weekly paclitaxel were applied after cytoreductive surgery. QoL was assessed using the QoL questionnaires EORTC QLQ-C30 and QLQ-OV28 before chemotherapy (baseline), after four cycles of carboplatin, at the end of treatment (EOT), and after 6, 12, and 24 months. Results: Out of 104 eligible patients 87 (84%) participated in at least one QoL assessment. At baseline, all QLQ-C30 scales and symptoms were significantly worse than age-adjusted values for the general population. Subsequently QoL improved in general. During chemotherapy with paclitaxel, most functioning scales and symptoms worsened slightly (not significantly). However, peripheral neuropathy and chemotherapy-related side-effects increased to clinically important levels. At the end of treatment, most QoL scores were similar to those of the general population, but physical functioning and fatigue were worse. Sexual functioning and peripheral neuropathy remained problematic. Conclusion: QoL was affected mainly by the weekly paclitaxel schedule, but effects were in most cases only temporary. A dose-dense regimen using a sequential protocol may be favourable in terms of QoL.

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Salvage Chemotherapy Using Gemcitabine for Taxane/Platinum-resistant Recurrent Ovarian Cancer: A Single Institutional Experience

Background: The purpose of this study was to report on the safety and efficacy of gemcitabine used as salvage chemotherapy for ovarian cancer. Patients and Methods: From January 2002 to October 2011, 27 patients were treated with gemcitabine for platinum-resistant recurrent ovarian cancer. Gemcitabine (800 mg/m²) was given on days 1, 8, and 15 of every 28 days. The patients' medical records were retrospectively reviewed. Results: All 27 patients had previously received paclitaxel/carboplatin doublet and their disease had become platinum-resistant. The median number of previous chemotherapy regimens was 2 (range 1-7). A total of 114 cycles of single-agent gemcitabine were administered, with a median of 3 (range 1-10). No complete responses were observed. Partial response (PR) was observed in five patients (18.5%). Eight patients demonstrated stable disease (SD). The median duration of response for 5 responders was 4 months (range 2-6 months). The median survival time was 15 months. Patients with PR or SD (n=13) had significantly better survival compared with the group with progressive disease (n=14) (p=0.03, by univariate analysis). In addition, multivariate Cox proportional hazards analysis revealed that responses to gemcitabine were a significant factor for survival (hazard ratio=0.08, 95% confidence interval=0.0138 to 0.5614, p=0.01). Cases with hematological toxicity included 10 patients (37.0%) with grade 3/4 neutropenia, 3 patients (11.1%) with grade 3 thrombocytopenia, and 3 patients (11.1%) with grade 3 anemia. Non-hematological toxicity was well-tolerated. Conclusion: Gemcitabine (800 mg/m²) used for recurrent ovarian cancer possesses a modest activity and a well-tolerated toxicity.

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Treatment Decision-making Processes in the Systemic Treatment of Ovarian Cancer: Review of the Scientific Evidence

Background: The systemic treatment of epithelial ovarian cancer (OC) is one of the cornerstones in the multimodal management of advanced OC in both primary and recurrent stages of this disease. In most situations various treatment options are available but only few data exists about the treatment decision-making process. Therefore, we conducted a review of the current literature regarding the decision-making process concerning the systemic therapy in patients with advanced ovarian cancer. Materials and Methods: The electronic database MEDLINE (PubMed) was systematically reviewed for studies that evaluate the treatment decision-making processes in patients with advanced OC. Results: The PubMed database was searched in detail for all titles and abstracts of potentially relevant studies published between 1995 and 2011. An initial search identified 15 potentially relevant studies, but only seven met all inclusion criteria. Factors that influence treatment decisions in patients with OC include not only rational arguments and medical reasons, but also individual attitudes, fears, existential questions, various projections resulting from the physician patient relationship and the social environment. The physician's personal experience with OC treatment seems to be an important factor, followed by previous personal experience with medical issues, and the fear of side-effects and future metastases. Family and self-support organisations also seem to play a significant role in the treatment decision-making process. Conclusion: This review underlines the need for more research activities to explore the treatment decision-making process to enable the best individual support for patients in treatment decision-making. It is a challenge for clinicians to determine the individual information needs of women with OC and to involve them during the decision-making process to the extent they wish.

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Gemcitabine-induced Pulmonary Toxicity

Background: Gemcitabine is the only approved cytotoxic agent for the treatment of pancreatic cancer by the Food and Drug Administration. In addition, gemcitabine is also commonly used for the management of breast, ovarian, and non-small cell lung cancer. Myelosuppression is the most common toxicity of gemcitabine therapy. Pulmonary toxicities due to gemcitabine have, however, been reported. Dyspnea occurs in approximately 25% of patients treated with gemcitabine, whereas serious pulmonary toxicities are much less common, approximately 0.3%. Here, we present a case of gemcitabine-induced pneumonitis, encountered during treatment of pancreatic cancer, and review the literature of this rare, but dangerous complication. Case Report: A 56-year old male being treated for stage IV pancreatic cancer developed progressive dyspnea on exertion, chest tightness, and palpitations. Oxygen saturation was 82-84%. Computerized-tomography (CT) angiography of the chest demonstrated new diffuse groundglass opacities in the bilateral lower lobes when compared to the CT of the chest without intravenous contrast, 5 weeks prior. Mild to moderate emphysema was also seen, but no pulmonary emboli were detected. Myocardial infraction was ruled-out by normal electrocardiogram and normal cardiac biomarkers. Conclusion: We report another case of gemcitabine-induced pneumonitis. Physicians seeing such patients should be aware of this rare but real pulmonary toxicity. A delay in diagnosis and treatment can lead to potentially fatal outcomes.

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Loss of function germline mutations in RAD51D in women with ovarian carcinoma.

Loss of function germline mutations in RAD51D in women with ovarian carcinoma.

Gynecol Oncol. 2012 Sep 14;

Authors: Wickramanyake A, Bernier G, Pennil C, Casadei S, Agnew KJ, Stray SM, Mandell J, Garcia RL, Walsh T, King MC, Swisher EM

Abstract

OBJECTIVE: RAD51D, a gene in the Fanconi Anemia-BRCA homologous recombination pathway, has recently been shown to harbor germline mutations responsible for ovarian carcinoma in multiply affected families. We aimed to extend these results to ovarian carcinoma in the general population. METHODS: We sequenced RAD51D in germline DNA from 360 individuals with primary ovarian, peritoneal or fallopian tube carcinoma who were not selected for age of cancer onset or family history. We also sequenced RAD51D in 459 probands from 226 high risk breast cancer families who were wild type for 21 breast and ovarian cancer genes. RESULTS: Of 360 cases, three (0.8%) carried loss-of-function mutations in RAD51D. All three subjects had ovarian carcinoma; one was also diagnosed with a synchronous endometrial carcinoma. Only one of the three subjects had a family history of breast or ovarian cancer. Combined with previous data for this series, 23.9% of women with unselected ovarian, fallopian tube, or peritoneal carcinoma carried a germline loss-of-function mutation in any of 13 tumor suppressor genes. Among the 449 women and 10 men with familial breast cancer, none carried a loss of function mutation in RAD51D. CONCLUSIONS: These data support the previous observation that loss-of-function mutations in RAD51D predispose to ovarian carcinoma but not to breast carcinoma. We conclude that inherited ovarian cancer is highly heterogeneous genetically, and that approximately one in four ovarian carcinoma patients carry a germline mutation in a known tumor suppressor gene that confers high risk.

PMID: 22986143 [PubMed - as supplied by publisher]

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Tuesday, September 18, 2012

Table of Contents — Abstract Book of the 37th ESMO Congress Vienna, Austria, 28 September – 2 October 2012

Table of Contents — September 2012, 23 (suppl 9)

Abstract Book of the 37th ESMO Congress Vienna, Austria, 28 September – 2 October 2012

Volume 23 suppl 9 September 2012

RCT: L-carnitine supplementation shows no benefit for fatigue in cancer patients - NeLM

RCT: L-carnitine supplementation shows no benefit for fatigue in cancer patients

Reference: J Clin Oncol published early online on 17 September 2012

Source: J Clin Oncol

Date published: 18/09/2012 17:15

Summary

by: Hina Radia

According to research published early online in the Journal of Clinical Oncology, four weeks of L-carnitine supplementation did not improve fatigue in patients with invasive malignancies and good performance status.

A double-blind, placebo-controlled study was conducted to evaluate L-carnitine, a popular complementary medicine often used by cancer patients for the treatment of fatigue.

The study involved 376 patients randomised to receive treatment with either 2g per day of L-carnitine supplementation or placebo. The primary end point was the change in average daily fatigue from baseline to week 4 using the Brief Fatigue Inventory (BFI). The following results were reported:

• The primary outcome, fatigue, measured using the BFI, improved in both arms compared with baseline (L-carnitine: −0.96, 95% CI, −1.32 to −0.60; placebo: −1.11, 95% CI −1.44 to −0.78, p=0.57 – not statistically significant).

• Secondary outcomes, including fatigue measured by the Functional Assessment of Chronic Illness Therapy–Fatigue instrument, depression, and pain, did not show significant difference between arms.

• There were no statistically significant differences in incidence of adverse events reported across the two groups.

The researchers concluded that despite some of the limitations of the study, it appears that 2-g of L-carnitine supplementation per day does not improve symptoms of fatigue in cancer patients.

RCT: Patupilone vs. pegylated liposomal doxorubicin in patients with epithelial ovarian, primary fallopian tube, or primary peritoneal cancer - NeLM

RCT: Patupilone vs. pegylated liposomal doxorubicin in patients with epithelial ovarian, primary fallopian tube, or primary peritoneal cancer

Reference: J Clin Oncol published early online on 17 September 2012

Source: J Clin Oncol

Date published: 18/09/2012 17:17

Summary

by: Hina Radia

The Journal of Clinical Oncology has featured a phase III study evaluating the safety and efficacy of patupilone vs. pegylated liposomal doxorubicin (PLD) in patients with platinum-refractory or -resistant epithelial ovarian, primary fallopian tube, or primary peritoneal cancer.

The study involved a total of 829 patients who had received three or fewer prior regimens and who had received first-line taxane/platinum-based combination chemotherapy and were platinum refractory or resistant. Patients were randomised to receive either patupilone 10 mg/m2 intravenously every 3 weeks (n=412) or PLD 50 mg/m2 intravenously every 4 weeks (n=417). The primary endpoint was overall survival, and secondary endpoints were progression-free survival (PFS) and overall response rate (ORR). The following results were reported:

• The median overall survival rates were 13.2 months for patupilone and 12.7 months for PLD (Hazard ratio 0.93; 95% CI 0.79 to 1.09; p=0.195)

• The overall response rate (all partial responses) was higher in the patupilone arm than in the PLD arm (15.5% v s. 7.9%; odds ratio, 2.11; 95% CI, 1.36 to 3.29)

• Frequently observed adverse events of any grade included diarrhea (85.3%) and peripheral neuropathy (39.3%) in the patupilone arm and mucositis/stomatitis (43%) and hand-foot syndrome (41.8%) in the PLD arm.

The researchers concluded that patupilone did not demonstrate a statistically significant improvement compared to PLD in patients with platinum-refractory or -resistant epithelial ovarian, primary fallopian tube, or primary peritoneal cancer.

Background on the Oncotype DX Colon Cancer Assay: QUASAR and C-07 video

http://www.oncologytube.com/index.php?page=videos§ion=view&vid_id=103062&utm_medium=email&utm_campaign=Video%3A+EMILIA+Trial+Results&utm_source=YMLP&utm_term=Background+on+the+Oncotype+DX+...

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Personalised medicine: a note of caution

Tailoring a patient's treatment to the particular biology of their cancer holds out the enticing prospect of avoiding over-treatment and reducing unnecessary toxicity – patients and cash-strapped health systems both stand to benefit. But delivering the right option for the right patient at the right time takes more than having the right biomarkers. And success in developing predictive biomarkers and targeted drugs has so far been modest when compared to the time, money and effort invested.

All of which gives cause for concern that so many people are jumping on the 'personalised medicines' bandwagon and are pushing national and European policy makers to make this a priority.

The problem lies not with personalised medicine per se. Medicine has always been about tailoring treatment and care to a patient's particular disease, age, comorbidities and preferences. The problem is that when the term 'personalised medicine' is used today, the focus is on one aspect of tailored cancer treatment – the use of targeted drugs and predictive biomarkers.

We know that translating scientific know how into clinical reality is a highly uncertain business. History is littered with scientific failures that once appeared highly promising but ended up on the scrap heap. So far only a minority of cancer patients have derived significant benefit from targeted drugs, and that is not likely to change much in the immediate future. Arguing in favour of putting all our eggs in the 'personalised medicine' basket is therefore a flawed strategy that risks creating unrealistic public expectations.

It also takes the focus away from addressing obstacles to delivering personalised care that we do know how to overcome. Much more public funding is needed to conduct the optimisation studies that can show how best to use the the therapies we already have. Then there is the question of delivering personalised cancer care in everyday practice. Urgent action is required to improve cancer services, so every patient receives the attention of the right mix of specialists, to plan and deliver care tailored to their needs.

And finally, while we certainly need to vigorously pursue the potential for developing therapies designed using our knowledge of cancer genetics, the current heavy focus on drugs is too narrow. What about the potential for more precise tailoring of surgical and radiotherapy strategies, which currently account for only a tiny fraction of research into personalised therapies?

We need to be careful about the messages we send out. The biggest potential for improving cancer outcomes over the coming years lies in redesigning health systems to give all patients, regardless of cancer type, access to high-quality treatment and care from a multidisciplinary team of specialists. If we call for policymakers to focus instead on a scientific potential that might never reach the mainstream, we risk giving them a green light to shirk their duty to do what they must do to improve th...

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HE4 protein and SMRP: Potential novel biomarkers in ovarian cancer detection.

HE4 protein and SMRP: Potential novel biomarkers in ovarian cancer detection.

Oncol Lett. 2012 Sep;4(3):385-389

Abstract

Epithelial ovarian cancer has the highest mortality of all gynecological cancers, and its progression is often without symptoms. Clinical outcome and survival may be improved if the disease is identified in the early stages. The objective of the study was to evaluate the utility of the serum biomarkers human epididymis protein 4 (HE4), soluble mesothelin-related protein (SMRP) and CA125 in the detection of ovarian cancer. In this retrospective study, the serum concentrations of CA125, HE4 protein and SMRP were measured in a cohort of 70 patients with epithelial ovarian cancer (EOC) compared with 78 healthy controls. Median serum levels of CA125 for ovarian cancer cases were 503.55±560.7 U/ml vs. 9.28±14.47 U/ml in the control group (p<0.001); for SMRP 5.13±7.64 nM vs. 1.02±0.89 nM (p<0.01); and for HE4 597.95±934.59 pM vs. 56.75±43.79 pM (p<0.001), respectively. Positive correlations between the clinical stage of EOC and CA125, HE4 and SMRP serum concentrations were found [(R=0.83; p<0.001); (R=0.64; p<0.001); (R=0.45; p<0.001), respectively]. Data analysis for the whole study group also revealed a significant correlation between plasma concentrations of CA125 and HE4 (R=0.45; p<0.001), between CA125 and SMRP (R=0.38; p<0.001) as well as HE4 and SMRP (R=0.51; p<0.001). Similar significant correlations between serum biomarker concentrations were also found in the ovarian cancer group [CA125 and HE4 (R=0.31; p<0.01); CA125 and SMRP (R=0.25; p<0.05); HE4 and SMRP (R=0.44, p<0.001), respectively]. A significant correlation was observed between the serous histological type of EOC and serum concentration of HE4 in the study group compared with other non-serous types of ovarian cancer (p<0.01). In conclusion, measuring CA125 in combination with new biomarkers such as SMRP and HE4 may improve the accuracy of ovarian cancer diagnosis, particularly in early detection of the disease.

PMID: 22984370 [PubMed - as supplied by publisher]

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Being Young, Female, and BRCA Positive. - PubMed

http://www.ncbi.nlm.nih.gov/m/pubmed/22982855/

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Hormone replacement therapy (transdermal patch..)

http://informahealthcare.com/stoken/default+domain/news1708/abs/10.3109/13697137.2012.669332#/doi/full/10.3109/13697137.2012.669332

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Monday, September 17, 2012

Sept 24th Webinar for Outpatient Oncology Providers + information on preventing infections in cancer patients

Webinar for Outpatient Oncology Providers

Centers for Disease Control and Prevention (CDC) sent this bulletin at 09/17/2012 01:05 PM EDT Doctors and nurses who care for cancer patients can take steps to help prevent infections. Join us for a free webinar featuring experts from CDC and other organizations. This webinar is a must-attend for every doctor, nurse, and health care provider who works with cancer patients. The webinar will—

Help doctors make sure their clinic is following recommended infection control standards to reduce their patients' risk of getting infections.
Feature new information and tools that providers can use to help prevent infections.

Webinar: Infection Control and Prevention in Outpatient Oncology Clinics
Monday, September 24, 2012, 1:00–2:00 p.m. EDT

More Information about Preventing Infections in Cancer Patients

Design and implementation of a pharmacist-directed preventive care program - NeLM

Patient understanding of emergency department discharge instructions: where are knowledge deficits greatest? - NeLM

Canadian survey of critical care pharmacists' views and involvement in clinical research - NeLM

Patients' perceptions of subcutaneous delivery of darbepoetin alfa by autoinjector prefilled pen versus prefilled syringe: a randomized, crossover study - NeLM

If I Paint a Rosy Picture, Will You Promise Not to Cry? The Art of Oncology series

If I Paint a Rosy Picture, Will You Promise Not to Cry?

“Am I going to be OK, doc?”

“Yes. Yes, you are.”

“How do you know?”

“Because I'm a doctor.”

These are powerful words, and it is impressive how very much we want to say them. The patient is in distress. The physician's voice is calm, reassuring.

“You're going to be OK. I'm a doctor. I know.”....

A Phase I Trial of Trastuzumab and Alvespimycin

A Phase I Trial of Trastuzumab and Alvespimycin:

Purpose: We conducted a phase I dose-escalation study to define the maximum tolerated dose (MTD), pharmacokinetics (PK), and pharmacodynamics of alvespimycin (17-DMAG), a heat shock protein 90 (Hsp90) inhibitor, given in combination with trastuzumab.
Experimental Design: Patients were treated with trastuzumab followed by intravenous alvespimycin on a weekly schedule. Hsp90 client proteins were measured at baseline and serially in peripheral blood lymphocytes (PBL) during cycle 1. Patients with advanced solid tumors progressing on standard therapy were eligible.
Results: Twenty-eight patients (25, breast; 3, ovarian) were enrolled onto three dose cohorts: 60 (n = 9), 80 (n = 13), and 100 mg/m² (n = 6). Dose-limiting toxicities (DLT) were: grade III left ventricular systolic dysfunction presenting as congestive heart failure in 1 patient (100 mg/m²), and reversible grade III keratitis in two patients (80 mg/m²). Drug-related grade III toxicity included one episode each of fatigue, diarrhea, myalgia, and back pain. Common mild to moderate toxicities included diarrhea, fatigue, myalgia, arthralgia, nausea, blurry vision, headache, back pain, and dry eyes. There was one partial response and seven cases of stable disease (range, 4–10 months), all in HER2+ MBC. In addition, an ovarian cancer patient had complete resolution of ascites and pleural effusion that lasted 24.8 months. There was no change in PK upon weekly dosing. Hsp70 effect continued to increase across four weeks and was most pronounced at 80 and 100 mg/m².
Conclusion: The combination of alvespimycin and trastuzumab is safe and tolerable at MTD. Antitumor activity was seen in patients with refractory HER2+ MBC and ovarian cancer. The recommended dose of alvespimycin for further study in this combination is 80 mg/m² weekly. Clin Cancer Res; 18(18); 5090–8. ©2012 AACR.

message from Genetic Alliance: Genetic Alliance wants to hear from you about your experience with biobanks and registries‏

16/09/2012

Genetic Alliance is conducting a short, anonymous survey about biobanks. (We are defining biobank as a collection of human biological samples, such as blood or tissue samples and the information associated with these samples, such as health information, that are stored for future use and managed according to professional standards.) We are asking current biobank participants and those who may be interested in participating in biobanking in the future. This survey has been approved by the Genetic Alliance Institutional Review Board #IORG0003358.

Take the survey

Help us recruit additional participants for our survey! The more people that respond, the more accurately we can take the pulse of the community on biobanking. Please consider sending this to your clients/members (below)/network. We want to be sure ordinary people are well represented!

Dear Member/client/friend…,

An umbrella group (or network – your choice) called Genetic Alliance to which we belong, is asking people who have banked biological samples anywhere (in a hospital surgery, in a biobank, in a research project or clinical trial) or donated health information, to reply to a short survey. They are working to understand what people who bank these samples and health information are concerned about.to make sure policies to protect participants are in place, and also to understand what people who bank these samples are concerned about. The survey has been approved by the Genetic Alliance Institutional Review Board. Please respond ASAP: Take the survey

Best,

You

As always, we will share the results with you!

Thanks very much!

Sharon

Best,

Sharon

===========================

Sharon F. Terry | President and CEO

sterry@geneticalliance.org | http://www.geneticalliance.org