OVARIAN CANCER and US

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#ovariancancers



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Friday, October 07, 2016

Ovarian Cancer and Us (blog): what you were reading this week - top 10 (+how to follow)



blog (see blog on how to follow - it can't get any easier)
Note: all spam filtered and deleted before posting, no advertising, blog has no funding = totally independent
 
 






















































































Patients Canada - Priorities for a new Health Accord (Patients Survey)



Patients Canada survey (survey monkey)

 

Have your voice heard by our ministers of health

In two weeks the Federal Minister of Health and each provincial health minister will be setting priorities for Canada’s health care for the years ahead. There will be no patients at these meetings to inform what those priorities should be.   
Patients Canada wants to make sure the health ministers understand what matters most to patients. Help us do this by responding to this short questionnaire so that we can communicate your preferences to the ministers!  Respondents will receive a summary of the survey results.

Opinion: Catholic hospitals have no right to refuse assisted dying (public hospital system - Ontario)



opinion - The Globe and Mail
 Daphne Gilbert is an associate professor of law, University of Ottawa

 All Ontario hospitals, Catholic and others, exist to deliver medically necessary services, and are funded by the province for that purpose.
 

Genomics of Ovarian Cancer Progression Reveals Diverse Metastatic Trajectories Including Intraepithelial Metastasis to the Fallopian Tube (note: sporadic/brca/non-serous..)



Blogger's Note: technical but worth reading and in the context of sporadic high-grade ovarian cancer; late metastasis

open access (pdf) 

while our study focused on sporadic HGSOC

Anti-tumour effects of resveratrol and pterostilbene on ovarian cancer (theses)



 Wiki:
Pterostilbene is a stilbenoid chemically related to resveratrol. In plants, it serves a defensive phytoalexin role.[1]
                                   ~~~~~~~~~~~~~~~~~~~
open access:
Anti-tumour effects of resveratrol and pterostilbene on ovarian cancer.

 View/Open Hosking_J_MSc_2016_thesis.pdf (1.832Mb)

 
Ovarian cancer is the most lethal gynaecologic malignancy, with a high mortality rate that is associated with the difficulty of treating the disease. This is due to the typical onset of symptoms when the disease is at a fairly advanced stage. Improved treatment strategies are required to improve longevity in patients. Recently polyphenols, secondary metabolites in plants, have aroused interest with respect to the treatment of cancer. The purpose of this study was to investigate the effect of two polyphenols, resveratrol and its derivative pterostilbene, on cell metabolism and proliferation in two ovarian cancer cell lines, OVCAR-5 and SKOV-3 that were grown in a three dimensional culture. The proteins VEGF, AKT, EGFR, HER2, cyclin D2 and PCNA were investigated to identify any possible changes to signalling pathways following exposure to the polyphenols. Both resveratrol and pterostilbene affected spheroid metabolism and proliferation in a dose- and cell line-dependant manner. Vascular endothelial growth factor and expression of the various proteins were affected following treatment. This study demonstrates that resveratrol and pterostilbene are capable of down regulating the cell metabolism and inhibiting proliferation in the ovarian cancer spheroids, potentially through several different pathways.

Reproductive/hormonal factors in relation to survival/platinum resistance among ovarian cancer cases (HRT/endometriosis...)



abstract : 
Reproductive and hormonal factors in relation to survival and platinum resistance among ovarian cancer cases : British Journal of Cancer

Background:

Ovarian cancer survival is poor, particularly for platinum-resistant cases. The previous literature on pre-diagnostic reproductive factors and ovarian cancer survival has been mixed. Therefore, we evaluated pre-diagnostic reproductive and hormonal factors with overall survival and, additionally, platinum-chemotherapy resistance.
Methods:
We followed 1649 invasive epithelial ovarian cancer cases who were enrolled between 1992 and 2008 for overall mortality within the New England Case-Control Study and abstracted chemotherapy data on a subset (n=449). We assessed pre-diagnostic reproductive and hormonal factors during in-person interviews. We calculated hazard ratios (HRs) using Cox-proportional hazards models.
Results:
We observed 911 all-cause deaths among 1649 ovarian cancer cases. Self-reported endometriosis and longer duration of hormone therapy use were associated with improved survival (HR: 0.72; 95% confidence interval (CI): 0.54–0.94 and HR, greater than or equal to5 years vs never: 0.70; 95% CI: 0.55–0.90, respectively). Older age at menopause and menarche were associated with worse survival (HR, less than or equal to50 vs >50 years: 1.23; 95% CI: 1.03–1.46 and HR, 13 vs <13 years: 1.24; 95% CI: 1.06–1.44, respectively). We observed no association between oral contraceptive use, parity and tubal ligation, and overall survival. No significant associations were observed for any of the reproductive and hormonal factors and platinum resistance.
Conclusions:
These results suggest that pre-diagnostic exposures such as endometriosis and HT use may influence overall survival among ovarian cancer patients.

Risk Prediction for Epithelial Ovarian Cancer in 11 United States–Based Case-Control Studies



abstract:
Risk Prediction for Epithelial Ovarian Cancer in 11 United States–Based Case-Control Studies: Incorporation of Epidemiologic Risk Factors and 17 Confirmed Genetic Loci
 Abbreviations: AUC, area under the curve; COGS, Collaborative Oncological Gene-Environment Study; EOC, epithelial ovarian cancer; GWAS, genome-wide association study; MCMC, Markov chain Monte Carlo; MHT, menopausal hormone therapy; OC, oral contraceptive; OCAC, Ovarian Cancer Association Consortium; ROC, receiver operating characteristics; SNP, single nucleotide polymorphism.

Previously developed models for predicting absolute risk of invasive epithelial ovarian cancer have included a limited number of risk factors and have had low discriminatory power (area under the receiver operating characteristic curve (AUC) < 0.60). Because of this, we developed and internally validated a relative risk prediction model that incorporates 17 established epidemiologic risk factors and 17 genome-wide significant single nucleotide polymorphisms (SNPs) using data from 11 case-control studies in the United States (5,793 cases; 9,512 controls) from the Ovarian Cancer Association Consortium (data accrued from 1992 to 2010). We developed a hierarchical logistic regression model for predicting case-control status that included imputation of missing data. ....... The best predictive power was obtained in the full model among women younger than 50 years of age (AUC = 0.714); however, the addition of SNPs increased the AUC the most for women older than 50 years of age (AUC = 0.638 vs. 0.616). Adapting this improved model to estimate absolute risk and evaluating it in prospective data sets is warranted.

(Lynch Syndrome/microsatellite instability eg. MSI-H) DNA repeat stretches tied to cancer progression and survival | UW HSNewsBeat



media


The team used a new technique to analyze sequences of all the genes from nearly 6,000 tumors from 18 different kinds of cancer. The researchers obtained the sequencing information from a massive genome database storehouse called The Cancer Genome Atlas. Their technique and the availabily of this atlas allowed them to examine more than 200,000 microsatellite sites in many different cancer types.
They found that most cancer types had examples of tumors with microsatellite instability. They also learned that different cancer types had distinct patterns of mutation across their microsatellites. Over half of the microsatellite instability sites they uncovered were within or near so-called “cancer genes” — genes that that are implicated in cancer development and progression. This finding suggests the microsatellite mutations may be causing these genes to malfunction.
 The researchers also observed a paradox: patients who had tumors with comparatively more unstable microsatellite sites tended to survive longer.
Salipante and his colleagues hypothesize that cancers cells with relatively high numbers of microsatellite instability events are producing more mutated proteins of all kinds, not just cancer genes.  These mutated proteins draw the attention of the immune system and trigger immune attacks that slow tumor progression.

Patient View 2016 survey results: The specific unmet needs/gaps in scientific information about cancer



SURVEY RESULTS
  (pdf download)

Dear  health campaigner,
You are receiving this email because you responded to a May 2016 survey from us on the

Use of scientific information about cancer among carers, patients and the public

[This survey was commissioned and sponsored by AstraZeneca]
We are pleased  to say that as many as 124 cancer-oriented patient/carer groups took part in the survey, and gave us their opinions on the subject.
Two of the more important findings from the survey are:
(i.) 99% of respondent patient/carer groups reported that people living with cancer (and their families/carers) want to know HOW cancer treatments work; and
(ii.) over 90% of respondent patient/carer groups stated that people living with cancer must understand scientific concepts about the disease if they are to better manage their cancer.

How breast cancer screening could be better and less painful



Science news
 The breast cancer screening tests offered to women may in many cases be unnecessarily painful. New research shows that strong compression of the breast during mammography screening does not automatically lead to a better basis for diagnosis.

Trabectedin (Yondelis) as a chemotherapy option for patients with BRCA deficiency



abstract
 

Highlights

  • We sought if BRCA deficiencies are associated with clinical responses to trabectedin.
  • BRCA genes are an important predictive indicator of sensitivity to trabectedin.
  • Improved response to trabectedin is a hallmark of BRCA1/2-mutated carriers.
  • Stratification based on BRCA mutations should become standard in upcoming trials.

Abstract

Trabectedin is a marine-derived product that was originally isolated from the Caribbean sea squirt Ecteinascidia turbinata and the first anticancer marine drug to be approved by the European Union. It is currently used as a single agent for the treatment of patients with soft tissue sarcoma after failure of anthracyclines and ifosfamide, or for those patients who are unsuited to receive these agents, and in patients with relapsed, platinum-sensitive ovarian cancer in combination with pegylated liposomal doxorubicin. Trabectedin has a unique multi-faceted mechanism of action that involves transcription regulation and DNA repair systems, including transcription-coupled nucleotide excision repair and homologous recombination repair (HRR) as the main hallmarks of its antiproliferative activity. In addition, trabectedin has shown the ability to modulate the tumor microenvironment. Indeed, the activity of trabectedin is related to altered function and expression of DNA repair genes, such as BRCA1 (BReast-CAncer susceptibility gene 1) and BRCA2. The particular sensitivity of sarcoma, ovarian and breast cancer cells deficient in HRR, previously observed in preclinical models, now has been confirmed in the clinical setting as well, suggesting that BRCA mutations are associated with improved clinical responses to trabectedin. Current efforts are focused on the evaluation of these unique features of trabectedin and on the identification of predictive factors for patients with an objective to determine whether a deficiency of HRR DNA repair pathway could impact the clinical benefit achieved from trabectedin.

The Problem With Ovarian Cancer Screening Tests (overview of recent media/screening)



Huffington Post

(blog) Nimesh P. Nagarsheth, MD
Associate Professor of Obstetrics, Gynecology, and Reproductive Science
Icahn School of Medicine at Mount Sinai
Associate Director of Gynecologic Oncology
The Mount Sinai Hospital

Universal tumor screening for Lynch syndrome: health-care providers' perspectives : Genetics in Medicine : Springer Nature



  reflex testing: automatic, routine
                  ~~~~~~~~~~~~~~~~~~~~~~~               
abstract:
Universal tumor screening for Lynch syndrome: health-care providers' perspectives

Purpose:

Population-based reflex testing of colorectal tumors can identify individuals with Lynch syndrome (LS), but there is debate regarding the type of patient discretion such a program warrants. We examined health-care providers’ views and experiences to inform the design of a reflex-testing program and their perspectives regarding an opt-out option.

Methods:

We interviewed providers managing LS or colorectal cancer patients, including surgeons, genetic counselors, oncologists, primary-care physicians, and gastroenterologists. Qualitative data were analyzed thematically using constant comparison techniques.

Results:

Providers supported a reflex-testing program because of the current lack of coordinated immunohistochemistry (IHC) testing and underascertainment of LS patients as well as the opportunity to standardize the increasing use of genomic tests in practice. Most supported an opt-out after reflex testing because they felt that IHC is akin to other pathology tests, which are not optional. Some favored an opt-out before testing because of concern for patients experiencing distress, insurance discrimination, or a diagnostic odyssey that may be inconclusive.

Conclusion:

Providers support a reflex-testing program to improve the identification and management of suspected LS patients. However, how to support meaningful information provision to enable an opt-out without jeopardizing testing uptake and the anticipated public health benefits remains a policy challenge.

Affiliations

  1. Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada

  2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

  3. Independent Qualitative Researcher, Toronto, Ontario, Canada

  4. Department of Surgery, St. Michael’s Hospital, Toronto, Ontario, Canada

  5. Department of Family and Community Medicine, Sinai Health System, Toronto, Ontario, Canada

  6. Department of Surgery, University of Toronto, Toronto, Ontario, Canada

  7. Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada

  8. Cancer Care Ontario, Toronto, Ontario, Canada

  9. Department of Medicine, University of Toronto, Toronto, Ontario, Canada

Thursday, October 06, 2016

NEJM — The Changing Face of Clinical Trials (sundry articles)



NEJM — A collection of articles that examine the current challenges in the design, performance, and interpretation of clinical trials.

Leptomeningeal metastasis from gynecologic cancers diagnosed by brain MRI



Leptomeningeal carcinomatosis (LC) is a rare complication of cancer in which the disease spreads to the membranes (meninges) surrounding the brain and spinal cord. LC occurs in approximately 5% of people with cancer and is usually terminal.
                        ~~~~~~~~~~~~~~~~~~~~~~

abstract

 Leptomeningeal metastasis (LM) is rarely observed in gynecologic cancers. As gadolinium-enhanced magnetic resonance imaging (Gd-MRI) is highly effective for diagnosing LM, the aim of this study is to describe the clinical behaviors and outcomes of LM patients who were diagnosed by Gd-MRI. After securing institutional review board approvals, we retrospectively reviewed patient records. Eight patients were found to have LM from gynecological malignancies. Primary tumors included three ovarian, one tubal, one peritoneal, two endometrial, and one cervical cancer. Gd-MRI of the brain and the spine is indicated as the high priority inspection for the diagnosis of this devastating complication.

(age range 7mo-14 yrs) Juvenile granulosa cell tumor of the ovary: a clinicopathologic study



abstract

Study Objective

To report on the clinical characteristics and outcome of pediatric patients with juvenile granulosa cell tumor (JGCT) of the ovary.

Design, Setting, and Participants

Patients with histopathologically confirmed ovarian JGCT diagnosed between 1990 and 2016 were identified. Data on the clinical presentation, surgical management, oncologic management, laboratory investigation, follow-up, and outcome were collected. Tumor was staged according to the International Federation of Gynecology and Obstetrics (FIGO) criteria.

Results

Eight patients were diagnosed with ovarian JGCT during the study period. The median age at presentation was 3 years (range 0.7 – 14 years). Precocious puberty was the presenting symptom in all five prepubertal children; abdominal distension due to mass effect was the presenting symptom in three children greater than 9 years of age. In patients who had preoperative serologic testing, estradiol (n=3) and inhibin (n=3) were elevated. Five patients had stage I disease, and three had stage III. All stage I patients underwent salpingo-oophorectomy as the only treatment. Stage III patients received adjuvant chemotherapy. After a median follow-up of 6.2 years, six patients (75%) were alive without evidence of disease. One stage I patient with germline p53 mutation and PTEN mutation, died due to subsequent liposarcoma. One patient with stage IIIB disease developed recurrence detected by elevated inhibin serum level, and died due to progressive disease despite receiving multiple chemotherapy regimens.

Conclusion

JGCT has a favorable prognosis in patients with stage I disease following surgical resection alone. Adjuvant chemotherapy may be indicated in patients with higher stage tumors.

Key Words

  • Juvenile granulosa cell tumor;
  • pathology;
  • inhibin B;
  • chemotherapy

FDA clears phase 2 trial of drug candidate for ileus, adhesions



pharma press release
 LEADING BIOSCIENCES INC.

Multi-center study of 100-120 patients, evaluating pre- and post-treatment of LB1148 administered orally for major abdominal surgeries. Enrollment expected to begin in August 2016. For ileus, the study will measure the number of hours from surgical closure to resolution of postoperative ileus via various returning gastrointestinal functions. Length of stay will also be measured. For adhesions, study will evaluate whether LB1148 reduces the number of surgical adhesions formed in certain types of abdominal surgeries where a 2nd operation is required.

clincialtrials.gov:

A Study to Evaluate LB1148 for Return of Gastrointestinal Function and Adhesions in Subjects Undergoing Bowel Resection (PROFILE)

This study is not yet open for participant recruitment. (see Contacts and Locations)
Verified August 2016 by Leading BioSciences, Inc
Sponsor:
Information provided by (Responsible Party):
Leading BioSciences, Inc
ClinicalTrials.gov Identifier:
NCT02836470
First received: July 13, 2016
Last updated: August 29, 2016
Last verified: August 2016
 
Criteria
Inclusion Criteria:
  • Scheduled to undergo an elective (non-emergent) bowel resection with or without a planned stoma via laparotomy or minimally invasive technique. This includes any subject in which a resection of the small intestine, colon, or rectum is performed for any elected indication.
Please refer to this study by its ClinicalTrials.gov identifier: NCT02836470
Contacts
Contact: Thomas M Hallam, PhD 858.704.4900 tom.hallam@leadingbiosciences.com

(plagiarism) Retraction notice to 'Does ovarian stimulation for IVF increase gynaecological cancer risk? A systematic review and meta-analysis'



Retraction notice to 'Does ovarian stimulation for IVF increase gynaecological cancer risk? A systematic review and meta-analysis'

Reprod Biomed Online. 2016 Oct;33(4):534. doi: 10.1016/j.rbmo.2016.08.001.

Retraction notice to 'Does ovarian stimulation for IVF increase gynaecological cancer risk? A systematic review and meta-analysis' [Reproductive BioMedicine Online 31 (2015) 20-29].

Abstract

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief. The authors have plagiarized part of a paper that had already appeared in Hum. Reprod. Update, Volume 19 (2013) 105-123http://dx.doi.org/10.1093/humupd/dms051. One of the conditions of submission of a paper for publication is that authors declare explicitly that their work is original and has not appeared in a publication elsewhere. Re-use of any data should be appropriately cited. As such this article represents a severe abuse of the scientific publishing system. The scientific community takes a very strong view on this matter and apologies are offered to readers of the journal that this was not detected during the submission process.

open access: Prevalence and distribution pattern of nodal metastases in advanced ovarian cancer



Blogger's Note: previously posted as abstract only

open access

Wednesday, October 05, 2016

The impact of paclitaxel and carboplatin chemotherapy on the autonomous nervous system of patients with ovarian cancer (+heart systems)




sen·so·ri·mo·tor
ˌsen(t)sərēˈmōdər/adjective
Physiology adjective: sensorimotor (of nerves or their actions) having or involving both sensory and motor functions or pathways.
                                  ~~~~~~~~~~~~~~~~~~~~~~
open access - | BMC Neurology | Full Text
October 1, 2016

Background

Paclitaxel-based regimens are frequently associated with the development of peripheral neuropathy. The autonomous nervous system (ANS) effects, however, of this chemotherapeutic agent remain unexplored.

Methods

We investigated a group of 31 female patients with ovarian cancer receiving treatment with paclitaxel and carboplatin, as well as a group of 16 healthy age- and gender-matched healthy volunteers. All study participants completed a questionnaire and were assessed neurophysiologically at three time points (baseline, 3–4 months and 6–8 months following the onset of chemotherapy). The evaluation of the ANS included assessment of the adrenergic cardiovascular function (orthostatic hypotension-OH), parasympathetic heart innervation (30/15 ratio) and sympathetic skin response (SSR).

Results

At the 3–4 months ANS assessment, 19.2 % of the patients had systolic OH and the same percentage had diastolic OH, but at the 6–8 months evaluation no patient had systolic OH and only 13.8 % had diastolic OH. The values of the 30/15 ratio were significantly reduced at both time points, whereas the SSR was not affected.

Conclusions

Combined paclitaxel and carboplatin chemotherapy is associated with significant effects on the parasympathetic heart innervation and occasionally with effects on the adrenergic cardiovascular reaction. The SSR remained unaffected. Physicians should be alert to the possibility of these treatment-emergent side effects, so as to monitor ANS parameters and introduce treatment modifications accordingly. Our findings however, should be validated in larger cohorts.

Background

Paclitaxel is commonly used as first-line chemotherapy for advanced ovarian cancer and as adjuvant treatment, in combination with cisplatin or carboplatin, for residual disease. Taxanes (paclitaxel and docetaxel) are associated with numerous side effects, particularly including neurotoxic phenomena [1] . For instance, severe peripheral neuropathy is known to occur in patients receiving cumulative doses of around 1000 mg/m2 paclitaxel and 400 mg/m2 docetaxel [2]. In recent years, research interest focused on maximizing the therapeutic efficacy of paclitaxel, while minimizing the associated side effects. Despite these efforts, primarily sensory and occasionally sensorimotor [3, 4] peripheral neuropathy occurs in 59 to 78 % of treated patients [5, 6, 7].
Generalized peripheral neuropathies are frequently accompanied by autonomous nervous system (ANS) dysfunction [8]. However, it is currently unknown whether paclitaxel or its combination with carboplatin affects the ANS and whether paclitaxel-induced neuropathy comprises autonomic phenomena, as well.
The present study was designed to address this issue and investigate the effects of the combination of paclitaxel and carboplatin chemotherapy on the ANS. From a clinical point of view, paclitaxel is occasionally associated with hypotension, bradycardia and hypertension. Accordingly, we investigated the impact of paclitaxel on the sympathetic and parasympathetic innervation of the heart....

 Conclusions
The present study highlights the fact that combined paclitaxel and carboplatin chemotherapy for ovarian cancer is associated with significant effects on the sympathetic and parasympathetic heart innervation, whereas the SSR remains relatively untouched. Physicians caring for patients with ovarian cancer should be alert to the possibility of these treatment-emergent side effects, so as to monitor ANS parameters (BP, cardiac rhythm and their alterations upon standing) and introduce treatment modifications accordingly. Our findings however, should be validated in larger cohorts.

Abbreviations

ANS: 
Autonomous nervous system
BP: 
Blood pressure
DBP: 
Diastolic blood pressure
NCVs: 
Nerve conduction velocities
OH: 
Orthostatic hypotension
OS: 
Overall survival
PFS: 
Progression-free survival
SBP: 
Systolic blood pressure
SD: 
Standard deviation
SSR: 
Sympathetic skin response

SGO collaboration (new) Genetics Toolkit (Lynch Syndrome/BRCA/variants....)



Genetics Toolkit | SGO

A collaboration of the Society of Gynecologic Oncology, the American College of Obstetricians and Gynecologists, the National Society of Genetic Counselors, Bright Pink and Facing Our Risk of Cancer Empowered (FORCE)
 

The Society of Gynecologic Oncology has partnered with medical societies and patient advocacy groups to develop a toolkit designed to provide critical, practical information to heath care provers interested in gaining a deeper understanding of the role of genetics in gynecologic cancers. While not written for a lay audience, patients and families will gain an appreciation for the complexity of genetic testing and the challenges providers face every day.

The toolkit is comprised of specific case studies telling an individual woman’s story. Key points are illuminated from each organization’s perspective. Each case history provides references, national guidelines and society statements. A “General Resources” section includes useful tools and websites of interest.

Society of Gynecologic Oncology Genetics Toolkit (Complete version)
Case 1: BRCA1- and BRCA2-related ovarian cancer
Case 2: Daughter of BRCA1 mutation carrier
Case 3: Risk-reducing salpingo-oophorectomy
Case 4: Health outcomes after risk-reducing salpingo-oophorectomy
Case 5: Impact of hereditary breast and ovarian cancer genes on male family members
Case 6: Ambiguous test results and variants
Case 7: Lynch syndrome
General Resources
Collaborating Organizations

ESMO 2016 conference (Oct 7-11) 3 presidential sessions (niraparib/ovarian)



Medscape 


Taking place from October 7 to 11 in Copenhagen, this is the largest oncology meeting in Europe, say the organizers, who are expecting more than 20,000 attendees listening to 1600 approved abstracts, of which 50 will be reporting late-breaking trials. This will form part of 21 tumor tracks covering all areas of oncology, from basic science to clinical activities and public health.
Andrés Cervantes, MD, professor of medicine at the University of Valencia, Spain, and Scientific Committee chair for ESMO 2016, explained that so many trials are being reported at the meeting that are predicted to have an impact on clinical practice that there will be not one but three presidential sessions.
The first presidential symposium takes place on Saturday, October 8, and will discuss three abstracts that feature new investigational agents. The first will discuss results from the MONALEESA-2 study, which looked at the investigational CDK4/6 inhibitor ribociclib (formerly LEE011, Novartis) used with letrozole (Femara, Novartis) in postmenopausal women with hormone receptor–positive, HER2-negative advanced breast cancer. In the same session, results will be presented from a randomized study on the use of a new PARP (poly [ADP-ribose] polymerase) inhibitor niraparib, which is under development by Tesaro, in patients with platinum-sensitive ovarian cancer.

Smart Patients and AliveAndKickn: Lynch Syndrome online community



Smart Patients
 
AliveAndKickn is a proud to partner with Smart Patients, an online community for patients and caregivers affected by Lynch Syndrome and associated cancers. The online support of the Smart Patients Lynch Syndrome Community complements the work of AliveAndKickn, whose mission is to improve the lives of individuals and families affected by Lynch Syndrome and associated cancers through research, education, and screening.
Join Smart Patients, ask a question, and support others who can learn from you.

(blog) Plaintiff Attys Seek 3rd Win Against J&J At Trial Over Talc Powder's Supposed Cancer Risk



legal blog

Canada Denies Public Access To Potentially Life-Prolonging (oral) Ovarian Cancer Treatment LYNPARZA® (olaparib)



News Press Release | PharmiWeb.com

AstraZeneca Canada
Canada NewsWire
MISSISSAUGA, ON, Oct. 5, 2016

Pan-Canadian Oncology Drug Review (pCODR) Decides not to Recommend Lynparza for Reimbursement
MISSISSAUGA, ON, Oct. 5, 2016 /CNW/ - Following its deliberations, the pan-Canadian Oncology Drug Review (pCODR) recently announced its decision not to recommend for provincial reimbursement, Lynparza (olaparib), a maintenance treatment for women with platinum-sensitive relapsed BRCA-mutated (germline or somatic) high grade serous epithelial ovarian, fallopian tube or primary peritoneal cancer. AstraZeneca Canada is extremely disappointed that pCODR has disregarded the demonstrated significant clinical benefits of Lynparza, including potentially prolonging life, creating a roadblock for Canadian women in accessing the first oral, targeted therapy for BRCA-mutated relapsed ovarian cancer
"We are surprised and deeply disappointed in pCODR's assessment of Lynparza," says Mark Findlay, Vice President, Patient Access & Established Brands, AstraZeneca Canada. "Regulatory bodies around the world, Canadian oncologists and patient organizations have all demonstrated strong support for this important advancement in ovarian cancer treatment. Additionally, women from many countries with similar reimbursement agencies as pCODR, such as the UK, France, Norway, Denmark and Sweden, already have access to this treatment option as a result of reimbursement of Lynparza; Canadian women deserve no less. We are committed to working with provincial governments to urgently address the issue of access to Lynparza for Canadian women with relapsed ovarian cancer."
In its assessment, pCODR questioned the clinical benefits of Lynparza, despite Health Canada, the U.S. Food and Drug Administration (FDA), the European Medicines Agency (EMA) and many regulatory bodies around the world having assessed and approved Lynparza based on its efficacy and safety data. Lynparza was first approved by the FDA in 2014 following an accelerated approval. Since then, more than 45 countries have approved Lynparza, several of which have also provided accelerated approval.1 The pCODR recommendation not to list means that, for many Canadian women, it will be more difficult to receive coverage for a medicine that has been reimbursed and available to patients in many countries since 2014. Canadian women with ovarian cancer are at a distinct disadvantage, as Canada is now falling behind emerging economies, including Greece, Romania, Hungary and Poland, when it comes to providing public funding for this innovative, targeted therapy.2

Effect of ARID1A/BAF250a expression on carcinogenesis and clinicopathological factors in pure-type clear cell adenocarcinoma of the ovary (Japan)



Blogger's Note: important to note that clear cell ovarian cancer is diagnosed at significantly higher rates than other countries and may represent a distinct phenotype

open access:
Effect of ARID1A/BAF250a expression on carcinogenesis and clinicopathological factors in pure-type clear cell adenocarcinoma of the ovary

Frequent mutation of the ARID1A gene has been recently identified in ovarian clear‑cell adenocarcinoma (CCA); however, the clinical significance of BAF250a expression encoded by the ARID1A gene remains to be determined. The aim of the present study was to assess whether BAF250a expression had an impact on the clinical features of CCA....Although loss of BAF250a expression was associated with early tumorigenesis in endometriosis‑related CCA, this alteration was not significantly correlated with chemosensitivity and prognoses of CCA. Further biomarker analyses, including BAF250a expression, are required to improve the prognoses of CCA.
 Patients
A total of 97 cases of CCA treated between 1984 and 2007 at the National Defense Medical College Hospital, (Tokorozawa, Japan) were enrolled in the present study. Of the 97 CCAs, a consecutive series of 38 CCAs synchronous with endometriosis (EM-related CCAs) and 21 CCAs adjacent to CCAF component (CCAF-related CCAs) were identified, according to the histopathological criteria described previously (18). Of those, 31 non-atypical endometrioses, 38 atypical endometrioses, 20 benign CCAFs and 21 borderline CCAFs were identified. A total of 18 cases with solitary endometriosis that had no CCA were used as controls.
 

Reproductive and hormonal factors in relation to survival and platinum resistance among ovarian cancer cases



Abstract:
 Reproductive and hormonal factors in relation to survival and platinum resistance among ovarian cancer cases : British Journal of Cancer
 
Background:
Ovarian cancer survival is poor, particularly for platinum-resistant cases. The previous literature on pre-diagnostic reproductive factors and ovarian cancer survival has been mixed. Therefore, we evaluated pre-diagnostic reproductive and hormonal factors with overall survival and, additionally, platinum-chemotherapy resistance.
Methods:
We followed 1649 invasive epithelial ovarian cancer cases who were enrolled between 1992 and 2008 for overall mortality within the New England Case-Control Study and abstracted chemotherapy data on a subset (n=449). We assessed pre-diagnostic reproductive and hormonal factors during in-person interviews. We calculated hazard ratios (HRs) using Cox-proportional hazards models.
Results:
We observed 911 all-cause deaths among 1649 ovarian cancer cases. Self-reported endometriosis and longer duration of hormone therapy use were associated with improved survival (HR: 0.72; 95% confidence interval (CI): 0.54–0.94 and HR, greater than or equal to5 years vs never: 0.70; 95% CI: 0.55–0.90, respectively). Older age at menopause and menarche were associated with worse survival (HR, less than or equal to50 vs >50 years: 1.23; 95% CI: 1.03–1.46 and HR, 13 vs <13 years: 1.24; 95% CI: 1.06–1.44, respectively). We observed no association between oral contraceptive use, parity and tubal ligation, and overall survival. No significant associations were observed for any of the reproductive and hormonal factors and platinum resistance.
Conclusions:
These results suggest that pre-diagnostic exposures such as endometriosis and HT use may influence overall survival among ovarian cancer patients.

The generalizability of NCI-sponsored clinical trials accrual among women with gynecologic malignancies



abstract:
The generalizability of NCI-sponsored clinical trials accrual among women with gynecologic malignancies
 

Highlights

  • The population enrolled to gynecologic cancer clinical trials differs from the US population
  • Extremes of age, racial and ethnic minorities in are under-represented in these clinical trials
  • Several factors including geography influence the diversity of clinical trials accruals

Objectives

Enrollment of a representative population to cancer clinical trials ensures scientific reliability and generalizability of results. This study evaluated the similarity of patients enrolled in NCI-supported group gynecologic cancer trials to the incident US population.

Methods

Accrual to NCI-sponsored ovarian, uterine, and cervical cancer treatment trials between 2003 and 2012 were examined. Race, ethnicity, age, and insurance status were compared to the analogous US patient population estimated using adjusted SEER incidence data.

Results

There were 18,913 accruals to 156 NCI-sponsored gynecologic cancer treatment trials, ovarian (56%), uterine (32%), and cervical cancers (12%). Ovarian cancer trials included the least racial, ethnic and age diversity. Black women were notably underrepresented in ovarian trials (4% versus 11%). Hispanic patients were underrepresented in ovarian and uterine trials (4% and 5% versus 18% and 19%, respectively), but not in cervical cancer trials (14 versus 11%). Elderly patients were underrepresented in each disease area, with the greatest underrepresentation seen in ovarian cancer patients over the age of 75 (7% versus 29%). Privately insured women were overrepresented among accrued ovarian cancer patients (87% versus 76%), and the uninsured were overrepresented among women with uterine or cervical cancers. These patterns did not change over time.

Conclusions

Several notable differences were observed between the patients accrued to NCI funded trials and the incident population. Improving representation of racial and ethnic minorities and elderly patients on cancer clinical trials continues to be a challenge and priority.

(weight loss - gyn + breast pts) Aspects of Health-Related Factors and Nutritional Care Needs by Survival Stage among Female Cancer Patients (South Korea)



open access
Aspects of Health-Related Factors and Nutritional Care Needs by Survival Stage among Female Cancer Patients in South Korea
 

Introduction

Over 2.4 million South Korean women were diagnosed with a female cancer (site of breast, cervix uteri, corpus uteri, or ovary) in 2012....
.... In addition, there are some national health/medical care systems for cancer patients in Korea with national health insurance systems as “Caner Control Act”, “Policy on Home-Based Management for Cancer” and “Policy on Hospice and Palliative Care for Terminal Cancer Patients” [2729]. However cancer patients still cannot be given better service. Those medical care systems are graded payment, and insufficient to cover the all patients and survivors. Regarding diet and nutrition managements, several hospitals are carrying out nutritional care, counselling, and education program, but it is not responsibility. Even there are no statistical figures to investigate the supports’ implementation status.....

Abstract

Purpose

This study examined diet-related problems and needs associated with nutritional care according to survival stage in Korean female cancer survivors.

Methods

186 outpatients (breast or gynecologic cancer survivors) recruited. Subjects were classified as (1) extended stage (ES, 2–5 years from diagnosis) and (2) long-term stage (LS, ≥5 years from diagnosis). Eating habits, changes in health related factors, nutritional needs, and quality of life were investigated.

Results

43% of ES survivors had diet-related problems (p = .031); ES group reported dyspepsia (indigestion) and LS group reported anorexia/nausea as the major problem. Half of ES survivors had taste change, decreasing amount of intake, and reduced quality of life (p < .05). The LS group had a greater preference for sweet tastes than the ES group. According to their diagnosis, ES survivors with breast cancer gained weight (27.1%), whereas ES survivors with gynecologic cancer lost their body weight (34.5%) significantly. LS breast cancer patients showed great food preference for vegetables, whereas those with gynecologic cancer showed an increased preference for fish, meat and grain. Approximately 90% of survivors demanded nutritional care regarding restricted foods, preventing recurrence, particularly in ES survivors (p < .01). Moreover, main factors for nutritional care needs were body weight control for breast cancer and food environment for gynecologic cancer.

Conclusion

Survivors have different aspects of diet-related problems by survival stage as dyspepsia in ES and anorexia in LS. ES stage had changes in dietary patterns and their food consumption have decreased. Most of survivors have demanded nutritional care regardless of survival stage. These features of each stage should be considered to improve their health.

Integrative Development of a TLR8 Agonist for Ovarian Cancer Chemo-immunotherapy



 Motolimod (formerly VTX-2337)

abstract

Background: Immunotherapy is an emerging paradigm for the treatment of cancer, but the potential efficacy of many drugs cannot be sufficiently tested in the mouse. We sought to develop a rational combination of motolimod-a novel Toll-like receptor 8 (TLR8) agonist that stimulates robust innate immune responses in humans but diminished responses in mice-with pegylated liposomal doxorubicin (PLD), a chemotherapeutic that induces immunogenic cell death.
Methods: We followed an integrative pharmacologic approach including healthy human volunteers, non-human primates, NSG-HIS ("humanized immune system") mice reconstituted with human CD34+ cells, and cancer patients to test the effects of motolimod and to assess the combination of motolimod with PLD for the treatment of ovarian cancer.
Results: The pharmacodynamic effects of motolimod monotherapy in NSG-HIS mice closely mimicked those in non-human primates and healthy human subjects, while the effects of the motolimod/PLD combination in tumor-bearing NSG-HIS mice closely mimicked those in patients with ovarian cancer treated in a phase 1b trial (NCT01294293). The NSG-HIS mouse helped elucidate the mechanism of action of the combination, and revealed a positive interaction between the two drugs in vivo. The combination produced no dose-limiting toxicities in ovarian cancer patients. Two subjects (15%) had complete responses and 7 subjects (53%) had disease stabilization. A phase 2 study was consequently initiated.
Conclusions: These results are the first to demonstrate the value of pharmacologic approaches integrating the NSG-HIS mouse, non-human primates, and cancer patients for the development of novel immunomodulatory anticancer agents with human specificity.

Tuesday, October 04, 2016

(popular writing) I Have Cancer and Haven't Learned Anything New About Life | Mother Jones



Blogger's Note: not about ovarian cancer but words many can relate to
Mother Jones

(Nfld, Canada) Evaluation of a Population Based Approach to Familial Colorectal Cancer



abstract

 As Newfoundland has the highest rate of familial CRC in the world, we started a population-based clinic to provide colonoscopic and Lynch syndrome (LS) screening recommendations to families of CRC patients based on family risk. Of 1091 incident patients 52% provided a family history. Seventy-two percent of families were at low or intermediate-low risk of CRC and colonoscopic screening recommendations were provided by letter. Twenty eight per cent were at high and intermediate-high risk and were referred to the genetic counsellor, but only 30% (N = 48) were interviewed by study end. Colonoscopy was recommended more frequently than every 5 years in 35% of families. Lower family risk was associated with older age of proband but the frequency of screening colonoscopy recommendations varied across all age groups, driven by variability in family history. Twenty four percent had a high MMR Predict score for a Lynch Syndrome mutation, and 23% fulfilled the Provincial Program criteria for LS screening. A population-based approach in the provision of colonoscopic screening recommendations to families at risk of CRC was limited by the relatively low response rate. A family history first approach to the identification of LS families was inefficient.

webcast Oct 26th: (Canada) CPSI and CIHI collaborate on Hospital Harm



Hospital Harm Measure

Webcast

October 26, 2016
Measuring Patient Harm in Canadian Hospitals Virtual Announcement
Join the expert panel to hear an announcement​ on Measuring Patient Harm in Canadian Hospitals and available Hospital Harm Improvement Resources to make care safer. 
Join us at 1 pm ET. 
Hospital Harm Project (anticipated release date: Fall 2016)

Hospital Harm Measure  
  • A new measure intended to monitor variations in patient safety in inpatient acute care settings at the national level.  across facilities over time.
  • It is designed to help identify patient safety improvement initiatives in hospitals and could be the basis of a future comparable indicator. 
  • The measure captures hospitalizations with at least one occurrence of unintended harm that could have potentially been prevented by implementing known evidence-informed practices.

journal (pdf) Cancer patterns and trends in Central and South America



 Blogger's Note: limited references to ovarian cancer

open access

Global Cancer Observatory: Cancer in Central and South America Project



Global Cancer Observatory

Cancer in Central and South America Project

The Cancer in Central and South America Project is a collaboration between the Section of Cancer Surveillance of the International Agency for Research on Cancer (IARC), the Red de Institutos e Instituciones Nacionales de Cáncer (RINC) and cancer registries in the Central and South American region. The project commenced in 2013, with the primary objective of collating data collected by these cancer registries; presenting the data in a standardized, comparable format; and making them available to cancer research and control communities within the region and elsewhere.

Three online resources are available from the Cancer in Central and South America Project:

Cancer in Central and South America

This supplement issue of the journal Cancer Epidemiology comprises a series of 17 peer-reviewed, open access papers describing the background, methodology and results of the project. Included in the collection are a broad overview of cancer incidence and mortality patterns within the region and 14 cancer site-specific papers looking in detail at the geographical and temporal patterns for the major cancers.
Cancer Epidemiology [Volume 44 Supplement 1] (2016)
  1. Foreword Wild CP, Delgado L.
  2. Cancer in Central and South America: Introduction Forman D.,Sierra MS.
  3. Cancer in Central and South America: Methodology Sierra MS,Forman D.
  4. Cancer patterns and trends in Central and South America Sierra MS, Soerjomataram I, Antoni S, Laversanne M, Piñeros M, de Vries E, Forman D.
  5. Head and neck cancer burden and preventive measures in Central and South America Perdomo S, Roa GM, Brennan P, Forman D, Sierra MS.
  6. The burden of oesophageal cancer in Central and South America Barrios E, Sierra MS, Musetti C, Forman D.
  7. Stomach cancer burden in Central and South America Sierra MS, Cueva P, Bravo LE, Forman D.
  8. Burden of colorectal cancer in Central and South America Sierra MS, Forman D.
  9. Burden of gallbladder cancer in Central and South America Izarzugaza MI, Fernández L, Forman D, Sierra MS.
  10. Descriptive epidemiology of lung cancer and current status of tobacco control measures in Central and South America Piñeros M, Sierra MS, Forman D.
  11. The burden of cutaneous melanoma and status of preventive measures in Central and South America de Vries E, Sierra MS, Loria D, Forman D.
  12. Female breast cancer in Central and South America Di Sibio A, Abriata G, Forman D, Sierra MS.
  13. Cervical cancer in Central and South America: Burden of disease and status of disease control Murillo R, Herrero R, Sierra MS, Forman D.
  14. Prostate cancer burden in Central and South America Sierra MS, Soerjomataram I, Forman D.
  15. Descriptive epidemiology of brain and central nervous system cancers in Central and South America Piñeros M, Sierra MS, Izarzugaza I, Forman D.
  16. Thyroid cancer burden in Central and South America Sierra MS, Soerjomataram I, Forman D.
  17. Hodgkin lymphoma burden in Central and South America Kusminsky G, Abriata G, Forman D, Sierra MS.
  18. The burden of non-Hodgkin lymphoma in Central and South America Diumenjo MC, Abriata G, Forman D, Sierra MS.
A complete list of the Cancer in Central and South America Working Group participants, including all the contributing registries is available here and the project's Editorial Board members are listed here.
Working Group members represented their respective cancer registries at the time of the call for data in 2013. Current contact information for cancer registries in the region can be found at the International Association of Cancer Registries (IACR) website.

Cancer in Central and South America - a comprehensive analysis (17 articles)



Medical News 

A series of 17 scientific articles coordinated by the International Agency for Research on Cancer (IARC), based on the most extensive collation of data on cancer incidence and mortality in Central and South America to date, will be published next week as a supplement issue of Cancer Epidemiology. The series provides a comprehensive analysis of recent cancer patterns in the region and can also be accessed on the IARC Global Cancer Observatory website, along with additional resources and statistics.