abstract: Cochrane review - Optimal primary surgical treatment for advanced epithelial ovarian cancer

Abstract

BACKGROUND:

Ovarian cancer is the sixth most common cancer among women. In addition to diagnosis and staging, primary surgery is performed to achieve optimal cytoreduction (surgical efforts aimed at removing the bulk of the tumour) as the amount of residual tumour is one of the most important prognostic factors for survival of women with epithelial ovarian cancer. An optimal outcome of cytoreductive surgery remains a subject of controversy to many practising gynae-oncologists. The Gynaecologic Oncology group (GOG) currently defines 'optimal' as having residual tumour nodules each measuring 1 cm or less in maximum diameter, with complete cytoreduction (microscopic disease) being the ideal surgical outcome. Although the size of residual tumour masses after surgery has been shown to be an important prognostic factor for advanced ovarian cancer, it is unclear whether it is the surgical procedure that is directly responsible for the superior outcome that is associated with less residual disease.

OBJECTIVES:

To evaluate the effectiveness and safety of optimal primary cytoreductive surgery for women with surgically staged advanced epithelial ovarian cancer (stages III and IV).To assess the impact of various residual tumour sizes, over a range between zero and 2 cm, on overall survival.

MAIN RESULTS:

There were no RCTs or prospective non-RCTs identified that were designed to evaluate the effectiveness of surgery when performed as a primary procedure in advanced stage ovarian cancer.We found 11 retrospective studies that included a multivariate analysis that met our inclusion criteria. Analyses showed the prognostic importance of complete cytoreduction, where the residual disease was microscopic that is no visible disease, as overall (OS) and progression-free survival (PFS) were significantly prolonged in these groups of women. PFS was not reported in all of the studies but was sufficiently documented to allow firm conclusions to be drawn.When we compared suboptimal (> 1 cm) versus optimal (< 1 cm) cytoreduction the survival estimates were attenuated but remained statistically significant in favour of the lower volume disease group There was no significant difference in OS and only a borderline difference in PFS when residual disease of > 2 cm and < 2 cm were compared (hazard ratio (HR) 1.65, 95% CI 0.82 to 3.31; and HR 1.27, 95% CI 1.00 to 1.61, P = 0.05 for OS and PFS respectively).There was a high risk of bias due to the retrospective nature of these studies where, despite statistical adjustment for important prognostic factors, selection bias was still likely to be of particular concern. Adverse events, quality of life (QoL) and cost-effectiveness were not reported by treatment arm or to a satisfactory level in any of the studies.

AUTHORS' CONCLUSIONS:

During primary surgery for advanced stage epithelial ovarian cancer all attempts should be made to achieve complete cytoreduction. When this is not achievable, the surgical goal should be optimal (< 1 cm) residual disease. Due to the high risk of bias in the current evidence, randomised controlled trials should be performed to determine whether it is the surgical intervention or patient-related and disease-related factors that are associated with the improved survival in these groups of women. The findings of this review that women with residual disease < 1 cm still do better than women with residual disease > 1 cm should prompt the surgical community to retain this category and consider re-defining it as 'near optimal' cytoreduction, reserving the term 'suboptimal' cytoreduction to cases where the residual disease is > 1 cm (optimal/near optimal/suboptimal instead of complete/optimal/suboptima

Missing link: inflammation and ovarian cancer : The Lancet Oncology (commentary) - note photo in article

Note: view excellent photo (in blue/not teal) at the end of the article

LIFE Before Death : The Lancet Oncology - documentary/commentary

Genesis of the LIFE Before Death project lay in remarks from WHO. “The project co-producer Mike Hill and I read a 2009 WHO statement saying that 600 million people worldwide were going to suffer in their lifetime from untreated pain due to a lack of access to medicinal opiates”, explains Australian documentary maker Sue Collins. “We found that a very alarming statistic”, she added. Here are three more alarming statistics: more than 5 billion people worldwide have no access to essential pain medicines; this year 3·6 million people will die with untreated severe pain from cancer and AIDS; and 99·9% of these deaths will be in low-income and middle-income countries.

US physician whistleblowers face intimidation and retaliation : The Lancet Oncology

Note: partial summary/pay-per-view article "Reporting of billing fraud or drug company kickbacks is safe, and sometimes even lucrative, for US clinicians. But according to clinicians and advocates, physicians who voice concern about patient care routinely face institutional retaliation. “Blacklisting is more aggressive in the medical profession than any other industry”, says Tom Devine (Government Accountability Project, Washington, DC, USA). Although the Whistleblower Protection Act should protect federal physicians and other government ...

The predicted truncation from a (ovarian) cancer-associated variant of the MSH2 initiation codon alters activity of the MSH2-MSH6 mismatch repair complex

Abstract

Lynch syndrome (LS) is caused by germline mutations in DNA mismatch repair (MMR) genes. MMR recognizes and repairs DNA mismatches and small insertion/deletion loops. Carriers of MMR gene variants have a high risk of developing colorectal, endometrial, ovarian, and other extracolonic carcinomas. We report on an ovarian cancer patient who carries a germline MSH2 c.1A>C variant which alters the translation initiation codon. Mutations affecting the MSH2 start codon have been described previously for LS-related malignancies. However, the patients often lack a clear family history indicative of LS and their tumors often fail to display microsatellite instability, a hallmark feature of LS...."(technical)

Editorial: Slow Progress in Cancer Care Disparities: HIPAA, PPACA, and CHEWBACCA… But We're Still not There! - the Oncologist

Note: full access may require registration/fee

Several factors (Table 1) appear to contribute to these differences in cancer outcomes, and these must become part of our medical consciousness as deficits that require urgent attention and/or resolution.

View this table:

• In this window
• In a new window

Table 1.

Factors associated with disparities of cancer care

What is very clear is that this problem is not unique to the United States

Prognostic Role of Vitamin D Status and Efficacy of Vitamin D Supplementation in Cancer Patients: A Systematic Review - the Oncologist

Abstract  

Background. Whether or not hypovitaminosis D can influence the prognosis of cancer patients and whether or not vitamin D (vitD) supplementation improves outcome remain controversial.


Conclusion. Hypovitaminosis D seems to be associated with a worse prognosis in some cancers, but vitD supplementation failed to demonstrate a benefit in prostate cancer patients. The currently available evidence is insufficient to recommend vitD supplementation in cancer patients in clinical practice.

Note: per reference, one study included -  ovarian cancer

(Tamez S, Norizoe C, Ochiai K et al. Vitamin D receptor polymorphisms and prognosis of patients with epithelial ovarian cancer. Br J Cancer 2009; 101:1957–1960.)

(Canadian Medical Assoc) CMA got flood of feedback during its dialogue with Canadians

"The CMA's 2011 campaign to gather Canadians' input on their health care system was a marriage of old and new methods - town hall meetings, the Internet and social media - and it produced an unprecedented amount of feedback.
That becomes clear quickly in Voices into Action, a report that provides a synopsis of the information gathered by the CMA since the launch of its National Dialogue on Health Care Transformation last year......"

‘Fractured’ health-care system failing patients, doctors say - The Globe and Mail + public commentaries

Doctor and Patient: Making Tough Medical Choices - NYTimes.com

Clinical Oncology News - Earlier Dx of Ovarian Ca Not Associated With Improved Survival + Commentary (Markman)

Editorial: Redirecting T Cells — NEJM

Note: while not related to ovarian cancer, this 3-patient (leukemia/T-cell) study has received widespread publicity;
very early stage research; safety concerns

webinar notice: Best Practices for Decreasing Surgical Site Infections to be Discussed in Upcoming Patient Safety Webinar - Press Release - Digital Journal

Cancers | Free Full-Text | The Clinical Significance of Unknown Sequence Variants in BRCA Genes

Clinical Oncology News - Mixed News on PARP Inhibitors Presented at ASCO Meeting

EvidenceUpdates - Strategies to identify the lynch syndrome among patients with colorectal cancer: a cost-effectiveness analysis. (focus on women/risk reduction strategies) - abstract

"..... At current rates of germline testing, screening, and prophylactic surgery, the strategies reduced deaths from colorectal cancer by 7% to 42% and deaths from endometrial and ovarian cancer by 1% to 6%....."  

CONCLUSION: Widespread colorectal tumor testing to identify families with the Lynch syndrome could yield substantial benefits at acceptable costs, particularly for women with a mutation associated with the Lynch syndrome who begin regular screening and have risk-reducing surgery. The cost-effectiveness of such testing depends on the participation rate among relatives at risk for the Lynch syndrome.

Ratings (on article/professionals) pending – login (free) to http://plus.mcmaster.ca/evidenceupdates in a few days if interested.

Dresser appointed to NIH (U.S.) advisory committee | Newsroom | Washington University in St. Louis

"...Dresser, an expert in biomedical ethics, holds a joint appointment at the law school and at Washington University School of Medicine in St. Louis, teaching law and medical students about legal and ethical issues in end-of-life care, biomedical research, genetics, assisted reproduction and related topics......She has written extensively in her field and is the co-author of a casebook on bioethics and law and a book on the ethical treatment of animals. She also is the author of a book on patient advocacy and research ethics......Dresser also is a prolific speaker and panelist at national and international symposia, conferences and workshops on such topics as bioethics and cancer; advance treatment directives; stem cell research; biomedical research policy; and human cloning."

abstract: Comparing diagnostic delay in cancer: a cross-sectional study in three European countries with primary care-led health care systems (UK, Netherlands, Sweden)

Conclusions. A large-scale study comparing cancer delays in European countries and based on primary care-held records is feasible but would require supplementary sources of data in order to maximize information on demographic variables, the cancer stage at diagnosis and treatment details. Such a large-scale study is timely and desirable since our findings suggest systematic differences in the way cancer is managed in the three countries.

abstract: Attitudes to reproductive genetic testing in women who had a positive BRCA test before having children: a qualitative analysis

"Awareness of reproductive testing options was very variable among the cohort. The findings highlight the complexities of reproductive decision making for young women who knowingly carry a BRCA mutation, and the dilemmas inherent to reproductive genetic testing when the condition being tested for also affects a prospective parent."

full free access: Evidence for the Complexity of MicroRNA-Mediated Regulation in Ovarian Cancer: A Systems Approach (technical/in research)

"Our findings underscore the complexities of miRNA-mediated regulation in vivo and the necessity of understanding the basis of these complexities in cancer cells before the therapeutic potential of miRNAs can be fully realized."

full free access: Survival of patients with ovarian cancer in central and northern Denmark, 1998–2009

Objective

To examine time trends of survival and mortality of ovarian cancer in the central and northern Denmark regions during the period 1998–2009.

Conclusion

The survival of ovarian cancer patients did not improve during the study period. This lack of improvement contrasts with the national cancer strategies implemented during this last decade, focusing on improving the survival of ovarian cancer patients.

full free access: Hormonal Contraception—What Kind, When, and for Whom?

Continuing Medical Education

Abstract

Method

Selective review of the literature.

Results

COCs suppress gonadotropin secretion and thereby inhibit follicular maturation and ovulation. Their correct use is associated with 0.3 pregnancies per 100 women per year, their typical use, with 1 pregnancy per 100 women per year (Pearl index). COCs have effects on the cardiovascular and hemostatic systems as well as on lipid and carbohydrate metabolism. When given in the presence of specific risk factors, they significantly increase the likelihood of cardiovascular disease and thromboembolism. Women with persistent human papilloma virus (HPV) infection who take COCs are at increased risk of developing invasive cervical cancer. On the other hand, COCs lower the cumulative incidence of endometrial and ovarian cancer by 30% to 50%, and that of colorectal cancer by 20% to 30%. Other malignancies seem to be unaffected by COC use.

Conclusion

As long as personal and familial risk factors are carefully considered, COCs constitute a safe, reversible, and well-tolerated method of contraception.

MicroRNA Processing and Binding Site Polymorphisms Are Not Replicated in the Ovarian Cancer Association Consortium

Background: Single nucleotide polymorphisms (SNP) in microRNA-related genes have been associated with epithelial ovarian cancer (EOC) risk in two reports, yet associated alleles may be inconsistent across studies.

Results: After adjustment for European ancestry, no overall association was observed between any of the analyzed SNPs and EOC risk.

Conclusions: Common variants in these evaluated genes do not seem to be strongly associated with EOC risk.

Impact: This analysis suggests earlier associations between EOC risk and SNPs in these genes may have been chance findings, possibly confounded by population admixture. To more adequately evaluate the relationship between genetic variants and cancer risk, large sample sizes are needed, adjustment for population stratification should be carried out, and use of imputed SNP data should be considered

Combination of two drugs (carboplatin/decitabine) 'can treat ovarian cancer' | International Federation of Gynecology and Obstetrics

Decitabine (duh-sye-tuh-bean)

Trade/other name(s): Dacogen


"...Experts from Indiana University (IU) noted that carboplatin and decitabine, when combined, has a positive effect on the majority of late-stage ovarian cancer patients, even if they had previously developed a resistance to carbolplatin....Further studies will now be conducted to determine whether the drug combination can be rolled out on a wide scale."

Landmark ovarian cancer discovery as scientists unveil high risk gene (RAD51D) : Cancer Research UK

Sunday 7 August 2011

Cancer Research UK Press Release

Cancer Research UK-funded scientists have discovered that women who carry a faulty copy of a gene called RAD51D have almost a one in 11 chance of developing ovarian cancer, the most significant ovarian cancer gene discovery for more than a decade, reveals a study in Nature Genetics1 today (Sunday).

A weekly topotecan and biweekly bevacizumab combination demonstrates acceptable toxicity and encouraging efficacy in patients with platinum-resistant

Note: pay particular attention to the side effects/adverse events

RANZCOG College Statement on prophylactic oophorectomy in older women undergoing hysterectomy for benign disease: Is the evidence sufficient to change practice?

Conclusion:  A survey of gynaecologists revealed that few currently appear to adhere to the College Statement regarding prophylactic oophorectomy at the time of hysterectomy for benign disease. High quality evidence regarding either harm or benefit following retention of ovaries after menopause is lacking. Nevertheless, dialogue between clinicians and patients on this topic is important.

Cancers | Free Full-Text | Immune Modulation by Chemotherapy or Immunotherapy to Enhance Cancer Vaccines (including ovarian cancer)

Download PDF Full-Text [270 KB, uploaded 5 August 2011 17:58 CET]

Preliminary Schedule of Events | ICHG 2011 Montreal

Advocates Partnership Program Opportunities | Genetic Alliance - deadline to apply Aug 26th - Montreal conference

Advocates Partnership Program
at the International Congress of Human Genetics
October 11-15, 2011 ● Montreal, Canada
www.ichg2011.org
Deadline to Apply: August 26, 2011

Apply Now!

conference notice: Welcome to the 12th International Congress of Human Genetics annual meeting (Montreal)

On behalf of The American Society of Human Genetics (ASHG) and the International Federation of Human Genetics Societies (IFHGS), it gives us great pleasure to invite human geneticists from all around the world to attend and participate in the 12th International Congress of Human Genetics (ICHG) and the 61st ASHG Annual Meeting. The Congress will be held at the Le Palais des Congrès (Convention Center) in Montreal (Quebec), Canada from Tuesday, October 11th through Saturday, October 15th 2011, coinciding with the ASHG meeting.

The ICHG is the foremost meeting of the world human genetics community and is held every five years. The first Congress was held in 1956 in Copenhagen and subsequent venues have included Berlin, Washington, DC, Rio de Janeiro, Vienna and most recently Brisbane. The anticipated attendance is 7,000 delegates from over 60 countries around the world.

National Patient Safety Foundation: ASPPS - info/membership (fee based membership)

Membership in the American Society of Professionals in Patient Safety is open to professionals whose primary responsibility is patient safety, as well as to individuals across other healthcare disciplines, medical students, providers, risk managment and quality leaders, patient safety advocates and all those committed to safe patient care. Individual membership is the newest addition to NPSF’s portfolio, which includes continuing education credits through the Professional Learning Series, the NPSF Annual Patient Safety Congress, and other high-value programs. S

Secrets To Longevity: It's Not All About Broccoli : NPR (genes vs lifestyle)

Cancer Genome Atlas (press release July 2011) TCGA Completes Ovarian Cancer (serous) Analysis - TCGA plus link to video discussion

To view a video of Dr. Spellman discussing TCGA and the ovarian cancer findings, please go to http://www.youtube.com/watch?v=TK_CIGEUHxU

Bionomics - News - new trials phase 1/11 announced - BNC105 (combo)

Ovarian cancer trial planned:

• Randomised Phase I/II trial of BNC105 in combination with carboplatin and gemcitabine
• Preclinical data support use of BNC105 in combination with platinum (cisplatin; carboplatin) based therapeutic regimens

Quantitative and Functional Alterations of Plasmacytoid Dendritic Cells Contribute to Immune Tolerance in Ovarian Cancer

Note: in research/technical

Abstract

"In ovarian cancer, the immune system fails to eradicate established tumors partly due to the induction of immune tolerance within tumor microenvironment.....cont'd

Modification of BRCA1-Associated Breast and Ovarian Cancer Risk by BRCA1 Interacting Genes

"Overall, the data suggest that genomic variation at multiple loci that encode proteins that interact biologically with BRCA1 are associated with modified breast cancer and ovarian cancer risk in women who carry BRCA1 mutations."

Tea Consumption and Epithelial Ovarian Cancer Risk: A Systematic Review of Observational Studies

Use of SAND Balloon Catheter for Laparoscopic Management of Extremely Large Ovarian Cysts (intraperitoneal spillage)

"With proper patient selection, the SAND balloon catheter can be extremely useful in laparoscopic removal of very large adnexal masses, without intraperitoneal spillage."

Use of metformin and the risk of ovarian cancer: A case-control analysis

OBJECTIVE:

To explore the association between use of metformin or other antidiabetic drugs and the risk of ovarian cancer.

CONCLUSION:

In this large epidemiological study long-term use of metformin, but not of sulfonylureas, was associated with a tendency towards a decreased risk of ovarian cancer. Long-term use of insulin was associated with an increased risk of ovarian cancer.

Laparoscopic Intraperitoneal Port Placement for Optimally Cytoreduced Advanced Ovarian Cancer

p53 Signature and Serous Tubal In-situ Carcinoma in Cases of Primary Tubal and Peritoneal Carcinomas and Serous Borderline Tumors of the Ovary

Clear Cell Adenocarcinoma With a Component of Poorly Differentiated Histology: A Poor Prognostic Subgroup of Ovarian Clear Cell Adenocarcinoma

Ovarian Yolk Sac Tumors in Older Women Arising From Epithelial Ovarian Tumors or With No Detectable Epithelial Component

Luteinized Adult Granulosa Cell Tumor-A Series of 9 Cases: Revisiting a Rare Variant of Adult Granulosa Cell Tumor

Neoadjuvant chemotherapy for advanced ovarian cancer: overview of outcomes and unanswered questions.

An Observational Study of (Avastin) Bevacizumab-Induced Hypertension as a Clinical Biomarker of Antitumor Activity

Anti-Müllerian hormone inhibits growth of AMH type II receptor-positive human ovarian granulosa cell tumor cells by activating apoptosis

Preneoplasias of ovarian carcinoma : Biological and clinical aspects of different pathways of tumorigenesis

Canadians prefer treatment at trauma centres: poll

Canadians prefer treatment at trauma centres: poll

Private companies own your DNA – again - Steven Salzberg - Fighting Pseudoscience - Forbes

http://blogs.forbes.com/stevensalzberg/2011/07/31/private-companies-own-your-dna-again/

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(recap-dated July 29, 2011) Gynecologic Cancers Update from the 2011 Annual Oncology Meeting « OncoFacts

Gynecologic Cancers Update from the 2011 Annual Oncology Meeting

Reviewed by Bradley Monk, MD, FACS, FACOG

abstract - European Journal of Obstetrics & Gynecology and Reproductive Biology : Ovarian cancer risk assessment: a tool for preoperative assessment

Highlights

► Correct pre-operative diagnosis of ovarian cancer is key to referral.
► Surgery by gynecologic oncologist helps survival.
► Combination of age, prealbumin, CA 125 helps proper referral.

TEDMED - video Greg Lucier - genomic sequencing/medical decision making...

Greg Lucier talks about how far we have come in genomic sequencing and using that sequencing to make better medical decisions.

DIA Patient Organization/ Advocate Track - Drug Information Association - conference notice Rare Diseases/Orphan Products Oct 11-13th Washington, Dc

Patient Organization/ Advocate Track
Patient organizations/patients are invited to attend the US Conference on Rare Diseases and Orphan Products at a reduced registration fee of $400. Please submit a registration form to +1-215-442-6199 or Carrie.Dunn@diahome.org.

ELC : Interactive Case: Ovarian Cancer: Symptomatic Stage IV Disease Dr Thomas Herzo

Note: requires registration (free)

Interactive Case: Ovarian Cancer: Symptomatic Stage IV Disease Dr Thomas Herzog presents a provocative discussion focusing on options for treatment of a patient presenting with stage IV disease. His discussion incorporates the contemporary option of neo-adjuvant chemotherapy as well as the addition of an anti-angiogenic agent into the initial treatment regimen.

FDA Warns of Serious Drug Interactions in Patients Taking Psychiatric Drugs « news@JAMA (Linezolid/Zyvox/Methylene blue)

"Patients taking certain psychiatric drugs may experience serious neurological problems if they are given the antibacterial medication linezolid (sold under the brand name Zyvox) or methylene blue, a drug that is also used as a dye in some diagnostic procedures and for certain other uses, such as treating cyanide poisoning, according to a pair of warnings issued yesterday by the US Food and Drug Administration (FDA)."

Wiki Methylene blue resource:
http://en.wikipedia.org/wiki/Methylene_blue

Canadians prefer treatment at trauma centres: poll

Canadians prefer treatment at trauma centres: poll

Vitamin D Supplementation: An Update: Medscape

Note: Medscape requires registration (free)

Most women carrying cancer genes (BRCA 1/2) take action: study | Reuters

Gene Patent (Myriad) in Cancer Test Upheld by Appeals Panel - NYTimes.com (BRCA 1/2)

CAHG Study Highlights Personalized Medicine Gap - PRNewswire

MolMed starts a randomised Phase II trial of NGR-hTNF in ovarian cancer (financial news) - + prior trial results

Breast density 'linked to specific types of breast cancer' | International Federation of Gynecology and Obstetrics

"Given that the magnitude of the association with breast density is strong across all breast cancer subtypes and particularly for [oestrogen receptor]-negative disease, breast density should be included in risk prediction models across tumour subtypes," the researchers said.

Study Calls Approval Process for Medical Devices Flawed - NYTimes.com

Frequency of Rearrangements in Lynch Syndrome

http://www.ncbi.nlm.nih.gov/m/pubmed/21791569/?i=1&from=lynch%20syndrome

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Cancer Causes and Control - Dietary calcium and magnesium intake in relation to cancer incidence and mortality in a German prospective cohort

"This prospective cohort study provides no strong evidence to support that high dietary calcium and magnesium intake in the intake range observed in a German population may reduce cancer incidence or mortality."

Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial : The Lancet Oncology

Background
Dignity therapy is a unique, individualised, short-term psychotherapy that was developed for patients (and their families) living with life-threatening or life-limiting illness. We investigated whether dignity therapy could mitigate distress or bolster the experience in patients nearing the end of their lives.

abstract: Vitamin/mineral supplementation and cancer, cardiovascular, and all-cause mortality in a German prospective cohort (EPIC-Heidelberg)

abstract: Quantity, Design, and Scope of the Palliative Oncology Literature

"...Comparing 2004 with 2009, we found an increase in the proportion of original studies among all palliative oncology publications but no significant difference in study design or research topic. We identified significant deficiencies in the quantity, design, and scope of the palliative oncology literature...."

abstract: Pegylated liposomal doxorubicin: appraisal of its current role in the management of epithelial ovarian cancer.

Markman M.

Source

Cancer Treatment Centers of America, Eastern Regional Medical Center, Philadelphia, PA, USA.

Abstract

Pegylated liposomal doxorubicin (PLD) has become a major component in the routine management of epithelial ovarian cancer. The drug is frequently employed as a single agent in the platinum-resistant setting, and recently reported data reveal the superiority of the combination of PLD plus carboplatin, compared with the platinum drug plus paclitaxel, in delaying the time to disease progression in women with recurrent (potentially platinum-sensitive) disease. Current research efforts involving PLD in ovarian cancer are focusing on adding novel targeted drugs to this cytotoxic agent. The utility of such approaches in the platinum-resistant population, compared with the sequential administration of single agents active in this setting, remains to be determined.

abstract - Ovarian cancer risk assessment (OCRA): a tool for preoperative assessment

Objectives

The objective of this pilot study was to determine if the combination of CA 125, menopausal status and prealbumin can be used to accurately predict ovarian cancer in women with pelvic masses.

 Highlights

► Correct pre-operative diagnosis of ovarian cancer is key to referral.
► Surgery by gynecologic oncologist helps survival.
► Combination of age, prealbumin, CA 125 helps proper referral.

abstract: Secondary Somatic Mutations Restoring BRCA1/2 Predict Chemotherapy Resistance in Hereditary Ovarian Carcinomas

Conclusion: Secondary somatic mutations that restore BRCA1/2 in carcinomas from women with germline BRCA1/2 mutations predict resistance to platinum chemotherapy and may also predict resistance to PARP inhibitors. These mutations were detectable only in ovarian carcinomas of women whom have had previous chemotherapy, either for ovarian or breast carcinoma.

Daughter's death a chance to inspire -died of OC age 26

http://www.contracostatimes.com/california/ci_18540742

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NCCN and Experts from China Collaborate to Develop Colon, Kidney, Non-Small Cell Lung, and Ovarian Cancer Guidelines, China Editions - Business report

http://www.bradenton.com/2011/07/27/3377182/nccn-and-experts-from-china-collaborate.html

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Biotech Stock Leader: The News behind the Marshall Edwards Craze - NV-128 vaccine

http://www.beaconequity.com/biotech-stock-leader-the-news-behind-the-marshall-edwards-craze-2011-07-27/

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Pink makes women donate less to breast-cancer causes: study (ovarian) - media

From The Globe and Mail:
Pink makes women donate less to breast-cancer causes: study

Via The Globe and Mail's iPhone app

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McGuinty says loss of Ontario health records very serious issue - The Globe and Mail

From The Globe and Mail:
McGuinty says loss of Ontario health records very serious issue

Via The Globe and Mail's iPhone app

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press release: U of M researchers discover gene required to maintain male sex throughout life (Foxl2 gene/DMRT1)

"Previous research has shown that removing a gene, called Foxl2, in ovaries caused female cells to become male cells and the ovaries to become more like testes.....

Contemporary Approaches in Targeting Angiogenesis | prIME Oncology

Topics

• Module One: Concepts in Angiogenesis Inhibition
• Module Two: Biomarkers in Angiogenesis
• Module Three: Optimizing Outcomes with Antiangiogenic Therapy in Non-Small Cell Lung Cancer
• Module Four: Optimizing Outcomes with Antiangiogenic Therapy in Colorectal Cancer
• Module Five: Optimizing Outcomes with Antiangiogenic Therapy in Glioblastoma
• Module Six: Practical Considerations in Patient Management Involving Antiangiogenic Therapy

PipelineReview.com - Biotech News & Online Store - VaxOnco to Sponsor Phase I Trial of a Folate Receptor Alpha-targeted Breast/Ovarian Cancer Therapeutic Vaccine That Recently Received Investigational New Drug Approval From FDA ovarian cancer

http://www.pipelinereview.com/index.php/2011072643918/Vaccines/VaxOnco-to-Sponsor-Phase-I-Trial-of-a-Folate-Receptor-Alpha-targeted-Breast/Ovarian-Cancer-Therapeutic-Vaccine-That-Recently-Received-Investigational-New-Drug-Approval-From-FDA.html

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Breast cancer more lethal in blacks, reason unknown

http://mobile.reuters.com/article/idUSTRE76O5YV20110725?irpc=932

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Frank words about breast screening - Open Medicine - Analysis and Comment

"......As recently observed in the New England Journal of Medicine, we should “work to prevent vested interests from being granted the loudest voices in health care.”² The vested interests in what has been termed “the mammography wars”² are clearly those in the imaging industry, those involved directly in screening programs, and even those in the not-for-profit sector, whose fundraising capacity is enhanced by a public committed to fighting breast cancer.
It is reasonable for women to choose to be screened, but only if they are completely informed about the probability of benefit versus the probability of harm. For 2000 women aged 40–49 who undergo screening for 10 years, the benefit is much smaller in terms of avoiding death from breast cancer than is the harm arising from over-diagnosis and unnecessary treatment for breast cancer, to say nothing of the increased rates of mastectomy associated with screening.^22,23 These issues are not widely known to the general public. After over 20 years of involvement in the screening controversy I can only conclude that this is information few want to hear and many want to suppress."

CDC Home Healthcare-associated Infections (HAIs) checklist

Infection Prevention Guide

Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care
This summary guide of infection prevention recommendations for outpatient (ambulatory care) settings.

Infection Prevention Checklist

The Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care is a companion to the Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care.

Upcoming Advocates Partnership Program Opportunities | Genetic Alliance

Australian author: increasing public awareness about ovarian CA can have downside - Gary Schwitzer's HealthNewsReview Blog

Reported referral for genetic counseling or BRCA 1/2 testing among United States physicians - journal Cancer 2011 - abstract

CONCLUSION:

Physicians reported that they would refer many average-risk women and would not refer many high-risk women for genetic counseling/testing. Intervention efforts, including promotion of accurate risk assessment, are needed.

Many Doctors Ignore Cancer Genetic Testing Guidelines - US News and World Report

Epithelial ovarian cancer and the occurrence of skin cancer in the Netherlands: histological type connotations

Improving early detection of ovarian cancer

http://www.ncbi.nlm.nih.gov/m/pubmed/21776915/?i=15&from=ovarian%20cancer

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CT-Guided High-Dose-Rate Brachytherapy - Abstract

http://www.ncbi.nlm.nih.gov/m/pubmed/21778310/?i=9&from=ovarian%20cancer

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The mutational profile of sporadic epithelial ovarian cancer

http://www.ncbi.nlm.nih.gov/m/pubmed/21778320/?i=6&from=ovarian%20cancer

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Bevacizumab in Heavily Pre-treated ovarian cancer Pts small study

http://www.ncbi.nlm.nih.gov/m/pubmed/21778323/?i=4&from=ovarian%20cancer

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Fwd: My doctor threatened to fire me for going to a walk-in clinic. Why? - The Globe and Mail

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Begin forwarded message:

From: Sandi Pniauskas <sandipn@sympatico.ca>
Date: 23 July, 2011 7:06:58 AM EDT
To: Sandi Pniauskas <sandipn@sympatico.ca>
Subject: My doctor threatened to fire me for going to a walk-in clinic. Why? - The Globe and Mail

From The Globe and Mail:
My doctor threatened to fire me for going to a walk-in clinic. Why?

Via The Globe and Mail's iPhone app

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Mechanical bowel preparation for elective colorectal surgery - Cochrane

http://www2.cochrane.org/reviews/en/ab001544.html

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Aggressive Bowel Preps Don’t Improve Long-Term Outcomes after Colon Surgery

http://fightcolorectalcancer.org/research_news/2011/07/aggressive_bowel_preps_dont_improve_long-term_outcomes_after_colon_surgery?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+c3news+%28FightCRC+Research+%26+Treatment+News%29

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Glossary | The Cochrane Collaboration (worth bookmarking)

examples:

Adverse effect search for term

An adverse event for which the causal relation between the drug/intervention and the event is at least a reasonable possibility. The term ‘adverse effect’ applies to all interventions, while ‘adverse drug reaction’ (ADR) is used only with drugs. In the case of drugs an adverse effect tends to be seen from the point of view of the drug and an adverse reaction is seen from the point of view of the patient.See also: Adverse event, Side effect Also called: Adverse reaction

Baseline characteristics search for term

Values of demographic, clinical and other variables collected for each participant at the beginning of a trial, before the intervention is administered.

Causal effect search for term

An association between two characteristics that can be demonstrated to be due to cause and effect, i.e. a change in one causes the change in the other. Causality can be demonstrated by experimental studies such as controlled trials (for example, that an experimental intervention causes a reduction in mortality). However, causality can often not be determined from an observational study.

Molecular Test Aids in Identifying Cancers of Unknown Origin - Medscape (pathology/molecular diagnostic test - 15 different cancer types...)

".....The identity of most tumors can be determined "with confidence" by clinicians with histologic, clinical, and radiographic findings, say the study authors, led by James P. Grenert, MD, from the Department of Pathology at UCSF. "However, when tumors are poorly differentiated or metastatic with no clear primary, identifying the tissue of origin is difficult," they write.
Immunohistochemical stains may or may not be helpful in identifying the tumor origin. Molecular testing of tumors is an additional means of characterizing these tumors, the authors say.
TOO is the only molecular diagnostic test for cancer tissue of origin cleared by the US Food and Drug Association, the manufacturer notes. It is limited to identifying 15 types of tumor tissues: bladder, breast, colorectal, gastric, testicular germ cell, kidney, hepatocellular, nonsmall-cell lung, non-Hodgkin's lymphoma, melanoma, ovarian, pancreas, prostate, thyroid, and sarcoma. These 15 tumor types represent 90% of all cancers, the company points out....."cont'd

The study was funded in part by a grant from Pathwork Diagnostics.
Clin Chim Acta. 2011;412:1462–1464. Abstract

RID: Preventing "C.diff" - Clostridium difficile

AHRQ: Health Care: 20 Tips to Help Prevent Medical Errors: Patient Fact Sheet

conference notice: (Human Genome Meeting - Sydney) HGM 2012 • Scientific Program

draft agenda

(adverse event) abstract: Inadvertent cystotomy at laparoscopic hysterectomy – Sydney West Advanced Pelvic Surgery (SWAPS)

Conclusion: 
Inadvertent cystotomy is a recognised complication at hysterectomy. The rate in the SWAPS unit is comparable to that of other published series. Overall, there has been a decline in the rate of bladder injury, which appears attributable to more experience gained with an acquisition of increased skill levels and improved techniques.

Predictive Factors in Relapsed Ovarian Cancer for Complete Tumor Resection

"Results:

Overall, 177 consecutive patients (pts) were analyzed. The median age at first diagnosis was 55 years (range, 23-83 years). The complete tumor resection rate was 44.6%. Predictive factors that correlated with an adverse surgical outcome in terms of residual tumor were ascites <500 ml (Odds ratio, OR=0.3; 95% Confidence interval, CI=0.1-0.8 p<0.05), tumor involvement of the small bowel (OR=0.22; 95% CI=0.07-0.71 p<0.05), tumor spread in the upper abdomen (OR=0.33; 95% CI=0.1-0.9 p<0.05) and platinum resistance (OR=0.1, 95% CI=0.06-0.5 p<0.01).

Serous tumor histology (OR=5.8) appeared to have a protective effect. Age and initial FIGO stage were of no predictive significance.

Conclusion:

Platinum-sensitive patients without ascites, no intestinal tumor involvement, tumor restricted to middle and lower abdomen, and of serous papillary histology have significantly higher complete tumor resection rates. Prospective studies are warranted to evaluate the predictive value of these factors."

The Numbers Game: The Risky Business of Projecting Risk (response/reference breast cancer paper)

Note: worth paying attention to the stats

full free access: Individualized Cost-Effectiveness Analysis

Summary Points

Cost-effectiveness analyses typically express their principal results as incremental cost-effectiveness ratios (ICERs).
ICERs are useful in making decisions for allocation of resources at a population level, but typical ICER measures have shortcomings when used for individual decisions.
For the same ICER, the cost-effectiveness may vary among individuals because not everyone assigns the same priorities to specific outcomes, shares the same attitudes toward risk, or faces the same distribution of expected outcomes.
ICER information can be enhanced by providing additional metrics that individualize cost-effectiveness analyses.
These metrics include the per person net benefit and cost, subgroup ICER estimates for observed measured sources of heterogeneity, and distributions of outcomes and costs for unknown or unmeasured sources of heterogeneity.

Full free access-traffic pollution and cancer risk

http://www.ehjournal.net/content/pdf/1476-069X-10-67.pdf

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J&J Is Short of Cancer Drug Doxil - WSJ.com

http://online.wsj.com/article/SB10001424053111903554904576460290484704816.html

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recruiting: Ovarian Cancer Research Program, Congressionally Directed Medical Research Programs

free full access - online presentations - e Health 2011

Note: numerous presentations eg. patient consent, e-records....

Editorial re: ovarian cancer lottery woman's death

http://thechronicleherald.ca/Editorials/1254000.html

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Generous lottery winner loses fight with cancer - NovaScotia - TheChronicleHerald.ca

http://thechronicleherald.ca/NovaScotia/1254067.html

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News - Women’s Height Is Linked to Cancer Risk, Say Researchers

Normal stem cell encourages growth of cancer stem cells and fuels ovarian cancer

http://www.news-medical.net/news/20110720/Normal-stem-cell-encourages-growth-of-cancer-stem-cells-and-fuels-ovarian-cancer.aspx

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Study: Gene therapy could target ovarian cancer | Reesenews

http://reesenews.org/2011/07/21/study-gene-therapy-could-target-ovarian-cancer/17303/

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Normal stem cell encourages growth of cancer stem cells and fuels ovarian cancer

http://www.news-medical.net/news/20110720/Normal-stem-cell-encourages-growth-of-cancer-stem-cells-and-fuels-ovarian-cancer.aspx

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Be Selective When Using Surgical Mesh Transvaginally for Pelvic Organ Prolapse, FDA Warns

Wellesley groups deliver food to ovarian cancer patients - Wellesley - Your Town - Boston.com

http://www.boston.com/yourtown/news/wellesley/2011/07/wellesley_non-_profit_to_deliv.html

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Cancer stem cells recruit normal stem cells to fuel ovarian cancer, U-M study finds | University of Michigan Health System

http://www.uofmhealth.org/news/cancer-ovarian-0718

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Risk for CRC in Lynch Syndrome May Be Lower Than We Thought: Prevalence of Alterations in DNA Mismatch Repair Genes in Patients With Young-Onset Colorectal Cancer - Medscape Oncology

"Clearly, as we develop more accurate estimates of risks associated with specific mutations, personalized screening methods and intervals will need to be further clarified among those with LS. Although it appears that the overall risk for CRC among those with LS may be lower than previously thought, there are likely to be specific mutations that confer a higher risk and require more intensive screening protocols."

Epidural Analgesia or Patient-Controlled Analgesia in Treating Patients Who Have Undergone Surgery for Gynecologic Cancer - Full Text View - ClinicalTrials.gov

2011 Annual Conference Highlights | Ovarian Cancer National Alliance

European Journal of Cancer : Primary versus secondary cytoreduction for epithelial ovarian cancer: A paired analysis of tumour pattern and surgical outcome

Conclusions Secondary cytoreduction due to EOC appears to be associated with significantly lower optimal tumour debulking rates compared to primary setting, since the disease tends to recur in patterns less accessible to complete resection such as gastrointestinal serosa, mesentery and upper abdomen. By maximal surgical effort, tumour residuals significantly correlate between primary and secondary cytoreduction. No other predictors of surgical outcome or tumour-pattern could be identified.

Future Medicine - Immunotherapy (IL-17)- Combinatorial strategies for alleviation of tumor-associated immune suppression and therapeutic vaccination against ovarian cancer Full Text

Poly(ADP-Ribose) Polymerase Inhibition Synergizes with 5-Fluorodeoxyuridine but not 5-Fluorouracil in Ovarian Cancer Cells-abstract

"5-Fluorouracil (5-FU) and 5-fluorodeoxyuridine (FdUrd, floxuridine) have activity in multiple tumors, and both agents undergo intracellular processing to active metabolites that disrupt RNA and DNA metabolism." "These findings underscore differences in the cytotoxic mechanisms of 5-FU and FdUrd and suggest that combining FdUrd and PARP inhibitors may be an innovative therapeutic strategy for ovarian tumors."

abstract - Journal of the Neurological Sciences : Deterioration of anti-Yo-associated paraneoplastic cerebellar degeneration

second link (further information): "Paraneoplastic neurologic syndromes are a heterogeneous group of neurologic disorders associated with systemic cancer and caused by mechanisms other than metastases, metabolic and nutritional deficits, infections, coagulopathy, or side effects of cancer treatment. Paraneoplastic cerebellar degeneration is an uncommon disorder that can be associated with any cancer; the most commonly associated are lung cancer (particularly small cell lung cancer (SCLC)), gynecologic and breast cancer, and lymphoma (particularly Hodgkin disease) [1]. The neurologic symptoms frequently precede the diagnosis of cancer, sometimes by an interval of years....."cont'd

Factors Associated with Altered Long-Term Well-Being After Prophylactic Salpingo-Oophorectomy Among Women at Increased Hereditary Risk for Breast and Ovarian Cancer-abstract

Proteomic biomarkers in combination with CA 125 for detection of epithelial ovarian cancer using prediagnostic serum samples from the prostate, lung, colorectal, and ovarian (PLCO) cancer screening trial

RESULTS:

CA 125 levels were elevated (≥35 U/mL) in 61.5% of 65 patients who had CA 125 data available from samples that were collected <12 months before cancer diagnosis; however, levels of the additional 7 biomarkers were not different between cases and the 3 control groups individually or combined. Two panels that combined CA 125 and the 7 biomarkers failed to improve the sensitivity of CA 125 alone.

CONCLUSIONS:

In contrast to earlier findings from analyzes of postdiagnostically collected sera, the addition of 7 biomarkers to CA 125 did not improve sensitivity for preclinical diagnosis beyond CA 125 alone.

blog: Does Cochrane have a plan for consumer participation? | Cochrane Consumer Network

CDC Releases Infection Prevention Guide to Promote Safe Outpatient Care

ASCO 2011 - Cure Magazine

ASCO EDITION 2011

BROUGHT TO YOU BY CURE MAGAZINE

Public, patients have right to know hospitals' infection rates | Op-Ed | Kentucky.com (C. difficile/MRSA)

abstract: Laparoscopic-assisted cytoreduction for primary advanced ovarian cancer: Success, morbidity and survival

abstract: Feasibility of intravenous gemcitabine and an intraperitoneal platinum agent in the treatment of ovarian cancer

abstract: Antibiotic use and risk of gynecological cancers (Saskatchewan database)

OBJECTIVES: Several studies addressed the association between antibiotic use and breast cancer risk. The objective of this study was to assess the association between antibiotic use and risk of cervical, ovarian, and uterine cancer.

Video Guide: How to Use the NCI Clinical Trials Search Form - National Cancer Institute

Video Guide: How to Use the NCI Clinical Trials Search Form
The NCI Clinical Trials Search Form allows you to search a list of more than 8,000 clinical trials now accepting participants. The list includes trials supported by NCI, pharmaceutical companies, academic institutions, and other research organizations. The following two videos show users how to use the form and review the results. For additional guidance, see
Help Using the NCI Clinical Trials Search Form.

Author Insights: Family Histories Should Be Updated to Better Identify Those Needing Intense Cancer Screening « news@JAMA

(Opinion) Letter of Response: Cancer Test Failure - NYTimes.com (“How Bright Promise in Cancer Testing Fell Apart” )

Letter
Cancer Test Failure
Published: July 12, 2011

To the Editor:

Re “How Bright Promise in Cancer Testing Fell Apart” (front page, July 8):

full free access: Nonpulmonary Outcomes of Asbestos Exposure

" The strongest evidence for reproductive disease due to asbestos is in regard to ovarian cancer. Unfortunately, effects on fertility and the developing fetus are under-studied. The possibility of other asbestos-induced health effects does exist. These include brain-related tumors, blood disorders due to the mutagenic and hemolytic properties of asbestos, and peritoneal fibrosis. It is clear from the literature that the adverse properties of asbestos are not confined to the pulmonary system."

Cochrane review: Short versus long duration infusions of paclitaxel for any advanced adenocarcinoma.

OBJECTIVES:

To assess the effectiveness and toxicity of short versus long infusions of paclitaxel for any advanced adenocarcinoma.

"Adverse events were not comprehensively reported for any of the other comparisons. Outcomes were incompletely documented and QoL outcomes were not reported in any of the trials. The strength of the evidence is weak in this review as it is based on meta analyses of very few trials or single trial analyses and all trials were at moderate risk of bias and two were published in abstract form only."

abstract: A comparison of international breast cancer guidelines - Do the national guidelines differ in treatment recommendations? USA, Canada, Australia, the UK, and Germany

(USA, Canada, Australia, the UK, and Germany)
 CONCLUDING STATEMENT: Considering that the development of guidelines is a very expensive and resource-intensive task the question arises whether the development of national guidelines in numerous countries is worth the effort since the recommendations differ only marginally.

abstract: The association between endometriosis and gynecological cancers and breast cancer: A review of epidemiological data

CONCLUSIONS:

Endometriosis seems to be a precursor of epithelial ovarian cancer, especially clear cell and endometrioid adenocarcinomas. However, current evidence is insufficient to draw any definitive conclusions whether this association represents causality or the sharing of similar risk factors and/or antecedent mechanisms

full free access: Targeted treatment of recurrent platinum-resistant ovarian cancer: current and emerging therapies

Clostridium Difficile Infection Research - Mayo Clinic

Clostridium Difficile Infection

• Overview
• Diagnosis
• Treatment
• Appointments
• Clinical Trials
• Research

Research

Mayo researchers have studied the effect of a medicine that binds to the C. difficile toxin so that the toxin does not harm the colon. Another study compared a new antibiotic to vancomycin.

Mayo Publications

See a list of publications by Mayo Clinic authors about C. difficile on PubMed, a service of the National Library of Medicine.

Fighting a hospital superbug - C. difficile

ongoing media stories - Three more die in C. difficile outbreak - The Globe and Mail

Note:

irrespective of location, C. difficile is an ongoing and unresolved issue (both hospital/non-hospital acquired) and in particular for cancer patients;

it seems the SARS cases of the past have not impacted the 'lessons-not-learned' category and yet people continue to die due to lapses in policy amongst other issues/concerns, patient safety efforts (eg. handwashing...) still need to be addressed (obviously)

abstract - Cancer Letters : Ovarian Clear Cell Carcinoma as a Stress-Responsive Cancer: Influence of the Microenvironment on the Carcinogenesis and Cancer Phenotype

 Highlights

► Ovarian endometriosis is known to transform into ovarian cancer, but its etiology is not clarified.
► A stressful microenvironment within the endometriotic cyst may lead to cancer development.
► Ovarian clear cell carcinoma has unique gene expressions, which may serve as a molecular marker.
► Carcinogenic microenvironment affects the phenotype, character and gene expression of a cancer.
► We might be able to develop new treatment based on the analysis of the influence of microenvironment.

Targeting Src in Mucinous Ovarian Carcinoma (dasatinib/oxaliplatin)

"Targeting src kinase with combination of dasatinib and oxaliplatin may be an attractive approach in this disease."

Abstract/full free access: Sustained platelet-sparing effect of weekly low dose paclitaxel allows effective, tolerable delivery of extended dose dense weekly carboplatin in platinum resistant/ refractory epithelial ovarian cancer