OVARIAN CANCER and US

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Wednesday, October 30, 2013

The roles of ARID1A in gynecologic cancer



 open access




 Received Aug 6, 2013, Accepted Aug 7, 2013
This article was solicited and has not been peer reviewed


CONCLUSION
Disorganized chromatin structure is known to be associated
with the appearance of various abnormal phenotypes,
including cancer [53,54]. ARID1A , a gene participated in
chromatin remodeling, is an emerging tumor suppressor
gene. Accumulating evidence has reported somatic inactivating
mutations of ARID1A and loss of its expression in many
types of human cancers, especially in endometrium-derived
tumors, including ovarian clear cell carcinomas, ovarian endometrioid
carcinomas
and uterine endometrioid carcinomas.
The high prevalence of somatic mutations in those ovarian
and endometrial cancers indicates a pivotal role of ARID1A in
their development. Understanding the roles of ARID1A in the
pathogenesis of endometrium-derived tumors is fundamental
for future translational studies aimed at designing new
diagnostic tests for early detection and identifying critical
molecular targets for new therapeutic interventions.

Parameters that Define A Successful Colonoscopy



open access (see tables 1 & 2)

Dose-dense effect: other contributors – Author's reply : The Lancet Oncology



abstract

"Kesikli and colleagues argued that results shown by the JGOG 3016 study for dense-dense paclitaxel in ovarian cancer 1 were caused by a higher cumulative dose received by the dose-dense group and by antiangiogensis effects of paclitaxel rather than by the dose-dense administration of the drug. However, increased dose of paclitaxel in ovarian cancer has shown no survival benefit in previous studies. Bolis and colleagues 2 compared standard-dose paclitaxel 175 mg/m 2 plus carboplatin with increased dose ... (to read further requires $$$)


 

Untangling BRCA mutations, sex hormones, and cancer risk : The Lancet Oncology



open access

Understanding basic disease mechanisms might allow development of novel strategies for the primary prevention of breast and ovarian cancer. For carriers of BRCA1/2 mutations, options for primary prevention are limited to bilateral salpingo-oophorectomy and prophylactic mastectomy. In The Lancet Oncology, Martin Widschwendter and colleagues1 compare ovarian and endometrial function in carriers of the BRCA1/2 mutation with high-risk, mutation negative women in the UK Familial Ovarian Cancer Screening Study. BRCA1/2 mutations are thought to cause cancer via a defect in DNA damage response or in the DNA repair pathway, but this does not explain organ-specific cancer penetrance. These novel data suggest that end-organ response might have a role..... 

The CONSORT Patient-Reported Outcome (PRO) extension: implications for clinical trials and practice



open access

Health and Quality of Life Outcomes (multi-national)

To inform clinical guidelines and patient care we need high quality evidence on the relative benefits and harms of intervention. Patient reported outcome (PRO) data from clinical trials can "empower patients to make decisions based on their values" and "level the playing field between physician and patient". While clinicians have a good understanding of the concept of health-related quality of life and other PROs, evidence suggests that many do not feel comfortable in using the data from trials to inform discussions with patients and clinical practice. This may in part reflect concerns over the integrity of the data and difficulties in interpreting the results arising from poor reporting.The new CONSORT PRO extension aims to improve the reporting of PROs in trials to facilitate the use of results to inform clinical practice and health policy. While the CONSORT PRO extension is an important first step in the process, we need broader engagement with the guidance to facilitate optimal reporting and maximize use of PRO data in a clinical setting. Endorsement by journal editors, authors and peer reviewers are crucial steps. Improved design, implementation and transparent reporting of PROs in clinical trials are necessary to provide high quality evidence to inform evidence synthesis and clinical practice guidelines. 

Background
Randomized controlled clinical trials (RCTs) can provide high-quality data regarding the impact of study interventions on patient outcomes, and remain the ‘gold standard’ of evidence regarding both the benefits and harms associated with an intervention. Over the last twenty years, the number of clinical trials that assess patient reported outcomes (PROs) has
substantially increased [1]. PROs can be defined as a “measurement of any aspect of a patient’s health status that comes directly from the patient (i.e. without the interpretation of the patient’s responses by a physician or anyone else” [2] and include health-related quality
of life (HRQL), symptoms, satisfaction and adherence to medication. These subjective measures of outcome help evaluate the burden of disease and treatment from the patients’ perspective. In the conceptual framework developed by Till and colleagues adapted in (Figure 1) [3], PRO data from clinical trials may directly inform patients and practitioners, or may indirectly inform clinical practice through evidence synthesis into clinical practice guidelines.....

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

 

Choosing Wisely Campaign: American Society of Clinical Oncology 2013 Top Five List in Oncology



ASCO - open access

Medical News |
October 30, 2013

5 Cancer Tests and Treatments with Little or No Value

By Joe Elia
The American Society of Clinical Oncology has identified a second group of commonly used tests and treatments in cancer medicine that have little or no benefit. The list, part of the American Board of Internal Medicine's "Choosing Wisely" initiative, appears in the Journal of Clinical Oncology.
Briefly, here are this year's "top five" items:
  • Don't give antiemetics to patients starting chemotherapies that have low-to-moderate potential for causing symptoms.
  • In treating metastatic breast cancer, avoid combination chemotherapy unless the patient's cancer burden needs to be reduced quickly.
  • Avoid PET scanning in routine follow-up unless there's "high-level" evidence that the imaging will improve outcomes.
  • Don't do PSA testing in asymptomatic men when life expectancy is under 10 years.
  • Don't use therapy targeted against a specific genetic aberration unless the patient has specific biomarkers that predict effective response.
- See more at: http://www.jwatch.org//fw108085/2013/10/30/5-cancer-tests-and-treatments-with-little-or-no-value#sthash.E2u68UGy.dpuf
Medical News |
October 30, 2013

5 Cancer Tests and Treatments with Little or No Value

By Joe Elia
The American Society of Clinical Oncology has identified a second group of commonly used tests and treatments in cancer medicine that have little or no benefit. The list, part of the American Board of Internal Medicine's "Choosing Wisely" initiative, appears in the Journal of Clinical Oncology.
Briefly, here are this year's "top five" items:
  • Don't give antiemetics to patients starting chemotherapies that have low-to-moderate potential for causing symptoms.
  • In treating metastatic breast cancer, avoid combination chemotherapy unless the patient's cancer burden needs to be reduced quickly.
  • Avoid PET scanning in routine follow-up unless there's "high-level" evidence that the imaging will improve outcomes.
  • Don't do PSA testing in asymptomatic men when life expectancy is under 10 years.
  • Don't use therapy targeted against a specific genetic aberration unless the patient has specific biomarkers that predict effective response.
- See more at: http://www.jwatch.org//fw108085/2013/10/30/5-cancer-tests-and-treatments-with-little-or-no-value#sthash.E2u68UGy.dpuf
Medical News |
October 30, 2013

5 Cancer Tests and Treatments with Little or No Value

By Joe Elia
The American Society of Clinical Oncology has identified a second group of commonly used tests and treatments in cancer medicine that have little or no benefit. The list, part of the American Board of Internal Medicine's "Choosing Wisely" initiative, appears in the Journal of Clinical Oncology.
Briefly, here are this year's "top five" items:
  • Don't give antiemetics to patients starting chemotherapies that have low-to-moderate potential for causing symptoms.
  • In treating metastatic breast cancer, avoid combination chemotherapy unless the patient's cancer burden needs to be reduced quickly.
  • Avoid PET scanning in routine follow-up unless there's "high-level" evidence that the imaging will improve outcomes.
  • Don't do PSA testing in asymptomatic men when life expectancy is under 10 years.
  • Don't use therapy targeted against a specific genetic aberration unless the patient has specific biomarkers that predict effective response.
- See more at: http://www.jwatch.org//fw108085/2013/10/30/5-cancer-tests-and-treatments-with-little-or-no-value#sthash.E2u68UGy.dpuf

Fruit and vegetable consumption associated with reduced risk of epithelial ovarian cancer in southern Chinese women



abstract


Highlights

First report on fruit and vegetable intake and ovarian cancer in southern China.
High fruit and vegetable consumption appears protective against ovarian cancer.
Intakes of nutrients derived from fruits and vegetables are inversely associated with the ovarian cancer risk.

Objective

To investigate the association between fruit and vegetable consumption and the risk of epithelial ovarian cancer in southern Chinese women.

Methods

A case-control study was undertaken in Guangzhou, Guangdong Province, between 2006 and 2008. Participants were 500 incident ovarian cancer patients and 500 hospital-based controls. Information on habitual fruit and vegetable consumption was obtained by face-to-face interview using a validated and reliable food frequency questionnaire. Unconditional logistic regression analyses were performed to assess the association between fruit and vegetable intakes and the ovarian cancer risk.

Results

The mean fruit and vegetable daily intakes of ovarian cancer patients (324.2 g (SD 161.9) and 582.7 g (SD 250.2)) were significantly lower (p < 0.001) than those of controls (477.3 g (SD 362.1) and 983.3 g (SD 739.9)). The adjusted odds ratios were 0.30 (95% confidence interval (CI) 0.21 to 0.44) and 0.07 (95% CI 0.04 to 0.12) for more than 490 g of fruits and 970 g of vegetables per day, relative to at most 320 g and 690 g per day, respectively. With the exception of lycopene, substantial risk reductions were evident for a variety of nutrients derived from fruits and vegetables.

Conclusion

Consumption of fruits and vegetables was inversely associated with the incidence of epithelial ovarian cancer in southern Chinese women.
 

Tuesday, October 29, 2013

Pelvic MRI as the “gold standard” in the subsequent evaluation of ultrasound-indeterminate adnexal lesions: A systematic review



abstract

Review

Highlights

The preponderant contribution of MRI in adnexal mass evaluation is its specificity.
Pelvic MRI provides confident diagnosis of a plethora of benign adnexal lesions.
Contrast-MRI provides the highest post-test probability of ovarian cancer detection.

Objective

Incidentally discovered adnexal masses are common, posing a challenging diagnostic problem due to overlapping imaging features of benign and malignant. Thus, once an adnexal lesion has been detected, the primary goal of further imaging is accurate tissue characterization resulting in surgery only for lesions that are indeterminate or frankly malignant. This study aims to conduct a systematic review, following the PRISMA guidelines, and critically appraise pelvic MR Imaging as the preferred advanced second imaging test, as regards detection of ovarian cancer and assessment of indeterminate adnexal masses, with respect to pre-operatively improving the assignment of these patients to the appropriate level of care.

Methods

A comprehensive computerized systematic literature search of English language studies was performed (from 2002 to 2012) of PubMed, EMBASE, Scopus, Evidence Based Medicine Reviews (Cochrane Database and Cochrane Central Register of Controlled Trials), and Google Scholar. Relevant article reference lists were hand searched.

Results

Computerized database search revealed 37 citations of relevance, 10 of which fulfilled the inclusion/exclusion criteria. From the aforementioned, 8 articles were acquired (2 authors were contacted but did not respond) as well as assessed with AHRQ, QUADAS, and STARD evaluation tools. Finally, 6 papers (5 prospective and 1 retrospective) were included in the systematic review.

Conclusions

MRI with intravenous (IV) contrast administration provides the highest post-test probability of ovarian cancer detection. However, the preponderant contribution of MRI in adnexal mass evaluation is its specificity because it provides confident diagnosis of many benign adnexal lesions.
 

The Role and Timing of Palliative Medicine Consultation for Women with Gynecologic Malignancies: Association with End of Life Interventions and Direct Hospital Costs (NY)



abstract


"Palliative care is often confused with hospice care."


Highlights

Timely palliative medicine consultation is associated with improved quality of end of life care.
Decreased direct hospital costs are associated with timely palliative medicine consultation.

Objective

Aggressive care interventions at the end of life (ACE) are reported metrics of sub-optimal quality of end of life care that are modifiable by palliative medicine consultation. Our objective was to evaluate the association of inpatient palliative medicine consultation with ACE scores and direct inpatient hospital costs of patients with gynecologic malignancies.

Methods

A retrospective review of medical records of the past 100 consecutive patients who died from their primary gynecologic malignancies at a single institution was performed. Timely palliative medicine consultation was defined as exposure to inpatient consultation ≥ 30 days before death. Metrics utilized to tabulate ACE scores were ICU admission, hospital admission, emergency room visit, death in an acute care setting, chemotherapy at the end of life, and hospice admission < 3 days. Inpatient direct hospital costs were calculated for the last 30 days of life from accounting records. Data were analyzed using Fisher’s Exact, Mann–Whitney U, Kaplan-Meier, and Students T testing.

Results

49% of patients had a palliative medicine consultation, 18% had timely consultation. Median ACE score for patients with timely palliative medicine consultation was 0 (range 0–3) versus 2 (range 0–6) p = 0.025 for patients with untimely/ no consultation. Median inpatient direct costs for the last 30 days of life were lower for patients with timely consultation, $0 (range 0–28,019) versus untimely, $7729 (0–52,720), p = 0.01.

Conclusions

Timely palliative medicine consultation was associated with lower ACE scores and direct hospital costs. Prospective evaluation is needed to validate the impact of palliative medicine consultation on quality of life and healthcare costs.

Platelet-derived Growth Factor Receptor Alpha (PDGFRα) Targeting and Relevant Biomarkers in Ovarian Carcinoma (IMC-3G3)



abstract


Highlights

Targeting PDGFRα with monoclonal antibody (IMC-3G3) significantly enhanced the efficacy of chemotherapy in ovarian cancer cells both in-vitro and in-vivo.
Ovarian cancer cells with high-PDGFRα expression showed significant antitumor effects with IMC-3G3 monotherapy, whereas those expressing low-PDGFRα did not.
MAPK and CCNB1 were associated with response to IMC-3G3 in high-PDGFRα cells that showed antitumor effects with IMC-3G3 monotherapy.

Objective

Platelet-derived growth factor receptor alpha (PDGFRα) is believed to be associated with cell survival. We examined (i) whether PDGFRα blockade enhances the antitumor activity of taxanes in ovarian carcinoma and (ii) potential biomarkers of response to anti-PDGFRα therapy.

Methods

PDGFRα expression in 176 ovarian carcinomas was evaluated with tissue microarray and correlated to survival outcome. Human-specific monoclonal antibody to PDGFRα (IMC-3G3) was used for in vitro and in vivo experiments with or without docetaxel. Gene microarrays and reverse-phase protein arrays with pathway analyses were performed to identify potential predictive biomarkers.

Results

When compared to low or no PDGFRα expression, increased PDGFRα expression was associated with significantly poorer overall survival of patients with ovarian cancer (P = 0.014). Although treatment with IMC-3G3 alone did not affect cell viability or increase apoptosis, concurrent use of IMC-3G3 with docetaxel significantly enhanced sensitization to docetaxel and apoptosis. In an orthotopic mouse model, IMC-3G3 monotherapy had no significant antitumor effects in SKOV3-ip1 (low PDGFRα expression), but showed significant antitumor effects in HeyA8-MDR (high PDGFRα expression). Concurrent use of IMC-3G3 with docetaxel, compared with use of docetaxel alone, significantly reduced tumor weight in all tested cell lines. In protein ontology, the EGFR and AKT pathways were downregulated by IMC-3G3 therapy. MAPK and CCNB1 were downregulated only in the HeyA8-MDR model.

Conclusion

These data identify IMC-3G3 as an attractive therapeutic strategy and identify potential predictive markers for further development.
 

Health spending in Canada 2013 | CIHI (+comparisons to other countries/individual provinces)



 http://www.cihi.ca/CIHI-ext-portal/jpg/internet/INTER_IMG_LOGO_EN

infograph

  More information
To download the annual report,
presentation, methodological
notes or up-to-date data tables,
visit our website at www.cihi.ca/nhex.

Table of Contents — November 2013 Hereditary breast and ovarian cancers: lessening the burden



Table of Contents 

  • Hereditary breast and ovarian cancers: lessening the burden
Volume 24 suppl 8 November 2013

introduction

Malignant Transformation from Endometriosis to Atypical Endometriosis and Finally to Endometrioid Adenocarcinoma within 10 Years



abstract

Atypical endometriosis is reported to possess a precancerous potential attributed to premalignant changes characterized by cytological atypia and architecture proliferation. Moreover, the coexistence of atypical endometriosis and neoplasms had been reported. However, cases of atypical endometriosis transformation to carcinoma are rarely reported.

We describe the case of a 33-year-old woman who had a long therapeutic history of endometriosis. Three laparoscopic surgeries were performed to treat endometriosis. After the third surgery, she was diagnosed as having grade 1 endometrioid adenocarcinoma. The histological review of the previous surgery confirmed the diagnosis of atypical endometriosis based on the second specimen. The patient's disease progressed from a benign endometriotic cyst to atypical endometriosis and finally to endometrioid adenocarcinoma within 10 years. When we encounter cases of atypical endometriosis, it is necessary to consider the possibility of ovarian cancer and carefully follow the patients for long periods.
 

It's the "Good" Cancer, So Who Cares? Perceived Lack of Support Among Young (Thyroid) Cancer Survivors



Blogger's Opinion: it is seriously pathetic, young or old, irregardless of type of cancer/prognosis that this mentality still exists and even though this study was few in numbers, larger social/human lessons have not been learned in many cancers

abstract
 
Purpose/Objectives: 

To describe the survivorship experience of young adult patients with thyroid cancer.

Research Approach:

A qualitative, descriptive study.

Setting:

Four Canadian provinces, with most participants from Ontario.

Participants:

12 young adult thyroid cancer survivors who participated in a larger study on follow-up care needs consisting of 55 young adult cancer survivors.

Methodologic Approach:

Telephone interviews were conducted with cancer survivors who were diagnosed from age 18-39 years and were 1-5 years post-treatment.

Findings:

All 12 thyroid cancer survivors discussed the feeling that their cancer experiences often were downplayed because thyroid cancer is labeled as the "good" cancer. Many said that they were not considered real patients with cancer by healthcare providers and other patients with cancer, and they were unable or unwilling to access support programs or assistance from healthcare providers.

Conclusions:  

Cancer can have an impact on a person's life regardless of the prognosis. Being diagnosed with thyroid cancer at a young age can pose additional challenges because of the lack of available support to address needs specific to young adults.

Interpretation: 

Healthcare providers must recognize the needs of thyroid cancer survivors and encourage them to access supportive services.

Knowledge Translation:

Patients with thyroid cancer believe that their needs often are overlooked because of high survival rates, and they have difficulty accessing support resources and finding help. Young adults with cancer often have unique support needs. Support needs may not be the same for all young adult patients with cancer, and those needs should be recognized and addressed.
 

Excess of extracolonic non-endometrial multiple primary cancers in MSH2 germline mutation carriers over MLH1



abstract

BACKGROUND:

The lynch syndrome (LS) tumor spectrum involves colorectal cancer (CRC), endometrial cancer (EC), and less frequently various extracolonic non-endometrial cancers (non-EC). The organ-specific survival rates of these patients are well defined, however, the collective survival of all-cancers combined (CRC + EC + non-EC) are unclear.

METHODS:

Fifty-two MSH2 patients and 68 MLH1 patients were followed for a median of 6.3 years after diagnosis of first cancer, regardless of type. The proportions of CRC only, EC, non-EC, and multiple primary cancers were compared between the two genotypes. Kaplan-Meier curves were developed for survival comparisons.

RESULTS:

MSH2 patients present less frequently with only CRC (37% MSH2, 62% MLH1, P = 0.0096), manifest more multiple primary cancers (38% MSH2, 18% MLH1, P = 0.013), develop more extracolonic cancers (62% MSH2, 38% MLH1, P = 0.003), non-EC only cancers (46% MSH2, 24% MLH1, P = 0.028) and carry a greater risk for urinary tract cancer (UTC) (13.4% MSH2, 1.5% MLH1, P = 0.024). There was no difference in 10-year survival between the two groups (P = 0.4).

CONCLUSION:

The additional propensity for UTC in MSH2 carriers argues in favor of UTC screening in MSH2 individuals. Other types of cancer screening should be tailored to the expression history of the specific LS mutation.

 

protocol: Exercise for cancer cachexia in adults | Cochrane Summaries



Cochrane

Exercise for cancer cachexia in adults New

Grande A, Silva V, Maddocks M, Riera R, Medeiros A, Vitoriano SG P, Peccin MS
Published Online: 
October 27, 2013
This Cochrane Review is at the protocol stage and there is no abstract or plain language summary. The objectives for the review are as follows:
The primary objective is to determine the effectiveness of exercise, compared to usual care or no treatment, on biomarkers and outcomes of cachexia in adults with cancer. Secondary objectives, subject to the availability of data, are to examine the acceptability and safety of exercise in this setting and to compare effectiveness according to the characteristics of the exercise intervention or patient population.
- See more at: http://summaries.cochrane.org/CD010804/exercise-for-cancer-cachexia-in-adults#sthash.3AdXH4Ei.dpuf
 

Exercise for cancer cachexia in adults New

Grande A, Silva V, Maddocks M, Riera R, Medeiros A, Vitoriano SG P, Peccin MS
Published Online: 
October 27, 2013
This Cochrane Review is at the protocol stage and there is no abstract or plain language summary. The objectives for the review are as follows:
The primary objective is to determine the effectiveness of exercise, compared to usual care or no treatment, on biomarkers and outcomes of cachexia in adults with cancer. Secondary objectives, subject to the availability of data, are to examine the acceptability and safety of exercise in this setting and to compare effectiveness according to the characteristics of the exercise intervention or patient population.
- See more at: http://summaries.cochrane.org/CD010804/exercise-for-cancer-cachexia-in-adults#sthash.3AdXH4Ei.dpuf

Brazil: Hereditary cancer risk assessment: essential tools for a better approach



open access

Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da
Universidade de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo,
Brazil

High levels of omega-3 fatty acid consumption may lead to unintended health consequences



medical news

More Guidance For Hormone Replacement Therapy - National Institutes of Health (NIH)



 Blogger's Note: the often quoted research from the WHI's initial study did not reflect some of the benefits as well as some of the discrepancies such as described in this post-WHI article including the significance of age (as one example)

(NIH)

"Women who took estrogen alone had overall rates of illness and death similar to those for women who took placebo pills. The results, however, differed by age. Women who took estrogen in their 50s had a 16% reduced risk of overall illness and death. In absolute terms, there were 19 fewer major illnesses or deaths per year for every 10,000 women in this age group compared to the same number taking a placebo..... 

e-eso: Thrombosis and cancer



Thrombosis and cancer
  CME accredited
e-grandround GR269 - 07 November 2013 - 18:15-19:00 CET



The live session starts in about 9 days

Access to the live session is open 15 minutes before the start of the session
Submit your question in advance  

the Art of Oncology series: On Denying Denial (Terror management theory (TMT))



open access

"...“What exactly do you mean by ‘she is obviously
in denial?’” I asked somewhat pointedly....

Monday, October 28, 2013

World Journal of Stem Cells - Aiming to immune elimination of ovarian cancer stem cells



open access

Ovarian cancer accounts for only 3% of all cancers in women, but it causes more deaths than any other gynecologic cancer. Treatment with chemotherapy and cytoreductive surgery shows a good response to the therapy. However, in a large proportion of the patients the tumor grows back within a few years. Cancer stem cells, that are less responsive to these treatments, are blamed for this recurrence of disease. Immune therapy either cellular or humoral is a novel concept to treat cancer. It is based on the notice that immune cells invade the tumor. However, the tumor invest heavily to escape from immune elimination by recruiting several immune suppressive mechanisms. These processes are normally in place to limit excessive immune activation and prevent autoimmune phenomena. Here, we discuss current knowledge about the immune (suppressive) status in ovarian cancer. Moreover, we discuss the immunological targets of ovarian cancer stem cells.....
 
 
Core tip: Ovarian cancer harbors, at a low frequency, cancer stem cells. Those cancer stem cells express stem cell specific antigens. Natural immunity against those antigens exists but is hampered by the suppressive microenvironment that the tumor creates. Erasing this suppressive microenvironment will make immunological elimination of those cancer stem cells is an attractive treatment option.

 

Ready for Direct-to-Consumer Genetic & Genomic Testing?



medscape


 

Author Insights: Rapid Drug Approvals Leave Many Safety Questions Unanswered



 news@JAMA

"The US Food and Drug Administration (FDA) has created fast-track approval processes to speed certain drugs to market, but an analysis of these expedited approvals finds they often leave important safety questions unanswered. The analysis was published today in JAMA Internal Medicine.
To help expedite approval of drugs, the FDA has created processes that waive some of the requirements that are part of a standard drug approval. These expedited reviews, popular with industry and patient groups, are used for drugs that the FDA determines represent “a significant therapeutic advance” or that fill unmet needs. The Obama administration has also proposed additional ways to speed the pace of drug approval.
But an analysis of the differences between standard and fast-track reviews by Thomas J. Moore, AB, a senior scientist at the Institute for Safe Medication Practices (ISMP) in Alexandria, Virginia, and Curt Furberg, MD, PhD, of the Wake Forest School of Medicine in Winston-Salem, North Carolina, found that although fast-track approvals may shave about 2½ years off approval time, they also provide less information about the safety and efficacy of the drugs.....


 analysis

Original Investigation |

"Development Times, Clinical Testing, Postmarket Follow-up, and Safety Risks for the New Drugs Approved by the US Food and Drug Administration"

 Conclusions and Relevance  For new drugs approved by the FDA in 2008, those that received expedited review were approved more rapidly than those that received standard review. However, considerably fewer patients were studied prior to approval, and many safety questions remained unanswered. By 2013, many postmarketing studies had not been completed.

 

death rates - United States Cancer Statistics (USCS) Data - 2010 Top Ten Cancers



death rates graph

http://apps.nccd.cdc.gov/uscs/Graphs/Graph_TopTenCancers.aspx?tabletype=Mortality&title=Top+10+Cancer+Sites%3a+2010%2c+Female%2c+United+States%e2%80%94All+Races&table=&year=2010&group=3f&SiteCol=value0&ValueCol=value1&CI=True&state=United%20States&race=All%20Races&gender=Female&surveyinstanceid=1&mainvaluetype=Mortality

 

US Cancer Statistics: An Interactive Atlas



Interactive

graph - United States Cancer Statistics (USCS) Data - 2010 Top Ten Cancers



 2010 Top Ten Cancers


View tabular data for Top 10 Cancer Sites: 2010, Female, United States 

Cancer - NPCR - USCS - United States Cancer Statistics (USCS)



Cancer - NPCR - USCS - View Data Online

View Data Online

1999–2010 Cancer Incidence and Mortality Data
This Web-based report includes the official federal statistics on cancer incidence from registries that have high-quality data and cancer mortality statistics for each year and 2006–2010 combined. It is produced by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), in collaboration with the North American Association of Central Cancer Registries (NAACCR).
   ----------------------------
 
----------------------------


Image of Maps Maps


The Interactive Cancer Atlas (InCA) shows USCS data from 1999–2010 in a dynamic format.

Interactive Cancer Atlas (InCA)

Image of Magnifying Chart Cancer Data by State

Use the dropdown menu to view cancer information for a selected state. (see website)

 

National Guideline Clearinghouse | Guidelines on urothelial carcinomas of the upper urinary tract.



 Blogger's Note: of interest to Lynch Syndrome patients; this guideline published by the NGC was previously published in full early 2013, however, this format is simpler to read

National Guideline Clearinghouse | Guidelines on urothelial carcinomas of the upper urinary tract.

EvidenceUpdates/Professional commentaries: Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis



EvidenceUpdates

INTERPRETATION: Continuing widespread use of vitamin D for osteoporosis prevention in community-dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate. 

Sunday, October 27, 2013

Pancreatic Atrophy — A New Late Toxic Effect of Sorafenib



 NEJM

" We report reproducible evidence of irreversible pancreatic atrophy in two patients after long-term treatment with sorafenib." 

Placebo and Nocebo Effects in Randomized Controlled Trials: The Implications for Research and Practice



abstract


Placebo and nocebo effects are known to contribute significantly to the response to symptom control, including analgesia. Clinical trial methodologies using placebo controls are designed to identify the magnitude of these effects in the research context. An adequately powered, randomized, double-blind, placebo-controlled trial of ketamine in cancer pain has recently been reported, which demonstrated no net clinical benefit for ketamine over and above that of placebo. Rates of placebo and nocebo responses were high. The setting of a clinical trial provides an opportunity to quantify the nonpharmacologic aspects of patient responses to analgesia, raising important clinical and ethical issues for practice. The findings of the ketamine study are analyzed in the context of a methodological discussion of placebo and nocebo effects, what is known about the biological and psychological bases for each of these, and their implications for a clinical trial design in the palliative care setting. Along with reviewing the use of ketamine after this negative trial, clinicians need to remain aware of the strength and significance of both placebo and nocebo responses in their own practices and the biopsychosocial complexity of why and how patients actually respond to pain management strategies. The results of this study strongly reinforce the importance of the therapeutic relationship and the context of care.
 

New Approaches to Understand Cognitive Changes Associated With Chemotherapy for Non-Central Nervous System Tumors



abstract


Context

Researchers have described a constellation of cognitive deficits (e.g., impairments in executive functions, working memory, attention, and information-processing speed) associated with cancer treatment, and specifically chemotherapy, for non-central nervous system tumors. However, findings have been inconsistent, largely because of measurement and study design issues.

Objectives

To propose ways for researchers to more clearly delineate and characterize the mild cognitive deficits and related outcomes that appear to affect a subset of cancer patients and suggest methods to make more effective use of the existing data to understand risk factors for impaired neuropsychological functioning.

Methods

We examined the literature on the relationship between chemotherapy and cognitive impairment, as well as related literature on neuropsychological measurement, structural and functional neuroimaging, alternative measures of health outcomes, and integrative data analysis.

Results

A more comprehensive picture of cognitive functioning might be obtained by incorporating nontraditional ecological measures, self-reports, computational modeling, new neuroimaging methods, and markers of occupational functioning. Case-control and integrative data analytic techniques potentially could leverage existing data to identify risk factors for cognitive dysfunction and test hypotheses about the etiology of these effects.

Conclusion

There is a need to apply new research approaches to understand the real-world functional implications of the cognitive side effects of chemotherapy to develop and implement strategies to minimize and remediate these effects before, during, and after cancer treatment.
 

Changes in Symptom Intensity Among Cancer Patients Receiving Outpatient Palliative Care



abstract


Context

Symptom changes are usually reported using summary statistics such as mean and/or median, which may obscure the treatment effect.

Objectives

The main objective of this retrospective study was to determine the magnitude of symptom changes as assessed by the Edmonton Symptom Assessment System (ESAS) also after outpatient palliative care at the first follow-up visit.

Methods

We reviewed 1612 consecutive patients with cancer who were referred to the outpatient Supportive Care Center and who completed the ESAS at the initial and first follow-up visits between January 2003 and December 2010. All patients received interdisciplinary care led by the palliative care specialists following an institutional protocol.

Results

The distribution of the magnitude of symptom changes was stratified by baseline intensities. Patterns were similar for different ESAS items. At the follow-up visit (median: 15 days later), 52–74% of patients showed a decrease of one or more points in the ESAS score. However, 48–80% of patients with moderate/severe intensity at baseline complained of symptoms with an ESAS score of four or more after outpatient palliative care. Symptoms with absent/mild intensity worsened, ranging from a mean of −3.04 to 0.12 at the first follow-up visit, whereas symptoms with moderate/severe intensity improved from −0.2 to 3.86 (P < 0.001).

Conclusion

A considerable proportion of patients with moderate or severe intensity at baseline still had symptoms with an ESAS score of four or more. Patients with absent/mild intensities at baseline complained of symptom exacerbation at the first follow-up visit. Various strategies are needed to optimize symptom control in advanced cancer.
 

selected open access publications: search terms - 'ovarian cancer' '2013'



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Search Results [1–10 of 26 articles]

    Ovarian and Breast Cancer Spheres Are Similar in Transcriptomic Features and Sensitive to Fenretinide, Haiwei Wang, Yuxing Zhang, and Yanzhi Du
    BioMed Research International
    Volume 2013 (2013), Article ID 510905, 11 pages
    New Hypothesis on Pathogenesis of Ovarian Cancer Lead to Future Tailored Approaches, P. Rescigno, I. Cerillo, R. Ruocco, C. Condello, S. De Placido, and M. Pensabene
    BioMed Research International
    Volume 2013 (2013), Article ID 852839, 13 pages
    Clinicopathological Impact of ABCC1/MRP1 and ABCC4/MRP4 in Epithelial Ovarian Carcinoma, Marina Bagnoli, Giovanni L. Beretta, Laura Gatti, Silvana Pilotti, Paola Alberti, Eva Tarantino, Mattia Barbareschi, Silvana Canevari, Delia Mezzanzanica, and Paola Perego
    BioMed Research International
    Volume 2013 (2013), Article ID 143202, 7 pages
    Detection of MUC1-Expressing Ovarian Cancer by C595 Monoclonal Antibody-Conjugated SPIONs Using MR Imaging, Daryoush Shahbazi-Gahrouei and Mohammad Abdolahi
    The Scientific World Journal
    Volume 2013 (2013), Article ID 609151, 7 pages
    Meta-Analysis of Microarray Data Identifies GAS6 Expression as an Independent Predictor of Poor Survival in Ovarian Cancer, Michelle Buehler, Brian Tse, Alix Leboucq, Francis Jacob, Rosmarie Caduff, Daniel Fink, Darlene R. Goldstein, and Viola Heinzelmann-Schwarz
    BioMed Research International
    Volume 2013 (2013), Article ID 238284, 9 pages
    Molecular Profiling Predicts the Existence of Two Functionally Distinct Classes of Ovarian Cancer Stroma, Loukia N. Lili, Lilya V. Matyunina, L. DeEtte Walker, Benedict B. Benigno, and John F. McDonald
    BioMed Research International
    Volume 2013 (2013), Article ID 846387, 9 pages
    Ovarian Cancer Stem Cells: A New Target for Cancer Therapy, Qinglei Zhan, Chunmei Wang, and Saiming Ngai
    BioMed Research International
    Volume 2013 (2013), Article ID 916819, 10 pages
    Microvesicles as Potential Ovarian Cancer Biomarkers, Ilaria Giusti, Sandra D’Ascenzo, and Vincenza Dolo
    BioMed Research International
    Volume 2013 (2013), Article ID 703048, 12 pages
    Serum Anti-Müllerian Hormone Levels in Patients with Epithelial Ovarian Cancer, Pawel Walentowicz, Pawel Sadlecki, Magdalena Krintus, Grazyna Sypniewska, Aneta Mankowska-Cyl, Marek Grabiec, and Malgorzata Walentowicz-Sadlecka
    International Journal of Endocrinology
    Volume 2013 (2013), Article ID 517239, 6 pages
    MDR Gene Expression Analysis of Six Drug-Resistant Ovarian Cancer Cell Lines, Radosław Januchowski, Karolina Wojtowicz, Patrycja Sujka-Kordowska, Małgorzata Andrzejewska, and Maciej Zabel
    BioMed Research International
    Volume 2013 (2013), Article ID 241763, 10 pages

Search Results [11–20 of 26 articles]

Cumulative Genetic Risk Predicts Platinum/Taxane-Induced Neurotoxicity (ovarian cancer patients)



abstract


Purpose: The combination of a platinum and taxane are standard of care for many cancers, but the utility is often limited due to debilitating neurotoxicity. We examined whether single-nucleotide polymorphisms (SNP) from annotated candidate genes will identify genetic risk for chemotherapy-induced neurotoxicity

Patients and Methods: A candidate–gene association study was conducted to validate the relevance of 1,261 SNPs within 60 candidate genes in 404 ovarian cancer patients receiving platinum/taxane chemotherapy on the SCOTROC1 trial. Statistically significant variants were then assessed for replication in a separate 404 patient replication cohort from SCOTROC1. 

Results: Significant associations with chemotherapy-induced neurotoxicity were identified and replicated for four SNPs in SOX10, BCL2, OPRM1, and TRPV1. The population attributable risk for each of the four SNPs ranged from 5% to 35%, with a cumulative risk of 62%. According to the multiplicative model, the odds of developing neurotoxicity increase by a factor of 1.64 for every risk genotype. Patients possessing three risk variants have an estimated OR of 4.49 (2.36–8.54) compared to individuals with 0 risk variants. Neither the four SNPs nor the risk score were associated with progression-free survival or overall survival.
 
Conclusions: This study shows that SNPs in four genes have a significant cumulative association with increased risk for the development of chemotherapy-induced neurotoxicity, independent of patient survival.  

Ovarian Sertoli--Leydig cell tumors: MRI findings and pathological correlation



open access

Background

To investigate the magnetic resonance imaging (MRI) characteristics of ovarian Sertoli-Leydig cell tumors (SLCT).

Methods

The clinical, MRI and pathological findings of five cases of SLCT were reviewed retrospectively. MRI appearances of tumors including laterality, shape and size, architecture, wall, septa and vegetation, signal intensity and contrast-enhancement pattern were evaluated and correlated with pathological findings.

Results

Two tumors were solid which appeared as low signal intensity on T1-weighted imaging (T1WI) and moderate on T2-weighted imaging (T2WI) with multiple small cysts in one of them. The remaining three SLCT were multilocular cystic with the irregularly thickened wall and septa, and with solid area and mural nodules in one of them. The cystic components had the same signal intensity as urine. All the solid components were intensely enhanced after administration of contrast medium. All five tumors were pathologically intermediate differentiation and at FIGO stage I.

Conclusions

SLCT demonstrate variable MRI morphological appearances. However, the irregularly thickened wall and septa, the moderate T2WI signal intensity and obvious enhancement in the solid components are three MRI features.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production. 

 Background

Sertoli-Leydig cell tumors (SLCT) of ovary are a rare type but well defined clinicopathologic entity of sex cord-stromal tumors, accounting for less than 0.5% of ovarian neoplasms [1]. These tumors are histopathologically characterized by the presence of variable proportions of Sertoli and Leydig cells. Most SLCT occur in young women and are at stage I (International Federation of Gynecology and Obstetrics, FIGO) [2]. Conservative surgery is acceptable for young patients who wish to preserve fertility without compromising 5-year disease-specific
survival [3]. Some clinicopathological studies of SLCT have been reported. To our knowledge, however, only three imaging case reports have been published [4-6]. The present study described the magnetic resonance imaging (MRI) appearances of five patients with SLCT by correlated with pathological findings, with the aim to be familiar with the imaging
appearances of this entity and improve the accuracy of preoperative diagnosis.....