Efficacy and safety of bevacizumab in recurrent sex cord-stromal ovarian tumors

abstract

BACKGROUND

The Gynecologic Oncology Group conducted this phase 2 trial to estimate the antitumor activity of bevacizumab and to determine the nature and degree of toxicity in patients with recurrent sex cord-stromal tumors of the ovary.

METHODS

A prospective, multi-institutional cooperative group trial was performed in women with recurrent, measurable ovarian stromal tumors. Patients were allowed to have unlimited prior therapy, excluding bevacizumab. Bevacizumab 15 mg/kg was administered intravenously on day 1 of every 21-day cycle until patients developed disease progression or adverse effects that prohibited further treatment. The primary endpoint was the response rate (RR). Inhibin A and B levels were measured before each cycle, and the values were examined in relation to response and progression.

RESULTS

Thirty-six patients were enrolled, and all were eligible and evaluable. Patients received a median of 9 cycles of treatment (range, 2-37 cycles). Six patients (16.7%) had partial responses (90% confidence interval, 7.5%-30.3%), 28 patients (77.8%) had stable disease, and 2 patients (5.6%) had progressive disease. This met the criterion for declaring the regimen active. The median progression-free survival was 9.3 months, and the median overall survival was not reached in during reporting period. Two grade 4 toxicities occurred, including hypertension and proteinuria; and the most common grade 3 toxicities were hypertension (n = 5) and pain (n = 5). Inhibin A and B values were lower in patients who responded to treatment.

CONCLUSIONS

Bevacizumab has activity in the treatment of recurrent sex cord-stromal tumors of the ovary, and its toxicity is acceptable.  

No link between depression and cancer risk: study- Reuters

Reuters


....Still, researchers worry that despite a lack of clear evidence, some cancer patients may blame themselves for somehow causing or worsening their disease by being depressed.
"Many people are convinced when they develop cancer that they know exactly what caused it," said James Coyne, a health psychology professor at University Medical Center in Groningen, the Netherlands.
Coyne was not involved in the French study, but has investigated connections between depression and cancer.
"I get particularly concerned if patients are left with the idea that they can control the course of cancer through psychological training," Coyne told Reuters Health.....
 

The Nauseating Mistake Hospitals Make And The $10 Fix They Scrimp On (surgical site errors)

Forbes

Putting A Price On Human Life - Forbes

 Blogger's Note: not about ovarian/cancer but about healthcare and access

Forbes (worth reading)

 "..Dr. Shetty and accompanying him (Dr. Shetty ) to the Stanford Graduate School of Business where he gave an inspiring talk called “Putting a Price on Human Life.”"

Critical Care: Small bowel feeding versus gastric feeding in critically ill adults: more attention should be paid to specific populations

Full text (2)

Editorial/Reference: Informative Reporting of Systematic Reviews in Radiology

abstract/reference

extract/editorial:

When we read reports of finished studies in the medical literature, we want more than just the bottom line, the take-home message, and the conclusions from the authors. As fellow researchers and as health care professionals, we also want to see the actual study results and learn about the methods used to generate them. Researchers need this information to replicate critical studies. Decision makers need details about the methods and results for critical appraisal and to evaluate the validity and the applicability of the study findings.

As evident as this may seem, complete and transparent reporting to achieve all this is still far from standard practice. Multiple studies have documented shortcomings in disclosing necessary information for appreciating studies and their findings. Authors sometimes fail to report details on how and where study participants were recruited (eg, how eligibility was evaluated). They do not always present the proper analyses and often misinterpret the implications from their findings.

To assist in making the reporting of studies more informative and more complete, several groups have developed simple checklists. The first to do so was the Consolidated Standards of Reporting Trials group, who targeted the reporting of randomized clinical trials (1). Other initiatives have followed that example. The Standards for Reporting of Diagnostic Accuracy statement was prepared for the reporting of test accuracy studies, that is, studies comparing medical tests against a clinical reference standard for classifying patients as having the target condition (2). The Strengthening the Reporting of Observational …

[Full Text of this Article]

Related articles

Abstract

Original Research - Evidence-based Practice:  

Association of Study Quality with Completeness of Reporting: Have Completeness of Reporting and Quality of Systematic Reviews and Meta-Analyses in Major Radiology Journals Changed Since Publication of the PRISMA Statement? Radiology November 2013 

 

• Abstract

Completeness of reporting is associated with quality of systematic reviews and meta-analyses in major radiology journals with a few deficient areas; complete reporting has improved modestly since publication of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and it is strongly correlated with study quality in these journals.......  

Triple simultaneous primary invasive gynecological malignancies: A case report

abstract

Double gynecologic cancer (primary cancers in two organs) is relatively rare. However, triple gynecologic cancer (primary cancers in three organs) is extremely rare. We experienced a case of triple cancer, with primary cervical, endometrial and ovarian cancers, each showing different histopathological features. A 50-year-old woman with a preoperative diagnosis of cervical cancer stage Ib1 with a pathological diagnosis of mucinous adenocarcinoma underwent radical hysterectomy. The pathological diagnoses of the extracted masses were endometrioid adenocarcinoma in the uterine corpus and serous adenocarcinoma in the left ovary. Consequently, triple cancer was diagnosed. After the operation, six cycles of a paclitaxel/carboplatin regimen were administered, and no relapse of the cancers has been observed to date. To our knowledge, this is only the second case report in the international literature of concurrent gynecologic triple cancers of epithelial origin; that is, invasive cervical, endometrial and ovarian cancers, each with different histopathological features. 

Novel para-aortic lymphadenectomy technique for gynecological malignancies prevents postoperative bowel obstruction

open access

Abstract

Aim

The aim of this study was to evaluate the effect of our novel technique on the prevention of postoperative ileus in patients undergoing systematic para-aortic lymphadenectomy (PALN).

Material and Methods

PALN was performed in 135 gynecological cancer patients (67 with ovarian cancer, 58 with endometrial cancer, 8 with serous surface papillary adenocarcinoma (SSPC) and 2 with fallopian tube cancer) between 2006 and 2011. To prevent postoperative ileus, we performed our novel technique wherein the small bowel and colon are released from pressure and soaked in 2 L of physiological saline for 1 min every 20 min during the lymphadenectomy. We indicated our novel PALN technique and retrospectively analyzed the outcomes of the surgical procedure in terms of the surgical data, and postoperative incidence of gastrointestinal dysfunction in patients with gynecological malignancies.

Results

The mean blood loss was 641.2 ± 800.3 mL in the PALN group and 313.9 ± 278.9 mL in the pelvic lymphadenectomy (PLN) without PALN group (P  < 0.0001). There was no difference in the first passage of flatus between the PALN group and the PLN group (1.8 ± 0.7 days vs 1.6 ± 0.7 days). The mean time to tolerance of a regular diet was significantly longer in the PALN group than in the PLN group (P < 0.0001), whereas the incidence of vomiting was similar in both groups. Surprisingly, there were no cases of postoperative ileus in either group.

Conclusion

Our novel technique is a safe and effective way to prevent the incidence and decrease the severity of postoperative ileus after PALN for gynecological malignancies.

Introduction

Systematic para-aortic lymphadenectomy (PALN) is a common procedure used to stage and treat many primary gynecological cancers. Systematic lymphadenectomy, including PALN, has a prognostic role, and is used to decide the stage of disease in early ovarian cancer. Moreover, many studies have reported that a significant survival impact for systematic lymphadenectomy, including PALN, was observed in patients without residual disease.[1-4] The current recommendations for the surgical management of ovarian cancer include complete resection of all visible intraperitoneal tumors and systematic lymphadenectomy, including PALN.....

 

The Facebook News Experience - infograph

Pew Research Center

 

FGFR signalling in women's cancers

abstract

FGFs, in a complex with their receptors (FGFRs) and heparan sulfate (HS), are responsible for a range of cellular functions, from embryogenesis to metabolism. Both germ line and somatic FGFR mutations are known to play a role in a range of diseases, most notably craniosynestosis dysplasias, dwarfism and cancer. Because of the ability of FGFR signalling to induce cell proliferation, migration and survival, FGFRs are readily co-opted by cancer cells. Mutations in, and amplifications of, these receptors are found in a range of cancers with some of the most striking clinical findings relating to their contribution to pathogenesis and progression of female cancers. Here, we outline the molecular mechanisms of FGFR signalling and discuss the role of this pathway in women's cancers, focusing on breast, endometrial, ovarian and cervical carcinomas, and their associated preclinical and clinical data. We also address the rationale for therapeutic intervention and the need for FGFR-targeted therapy to selectively target cancer cells in view of the fundamental roles of FGF signalling in normal physiology. 

Last Days of Life (PDQ®) - National Cancer Institute

National Cancer Institute

Managing Symptoms

Key Points for This Section

Care Strategy for Death Rattle in Terminally Ill Cancer Patients and Their Family Members: Recommendations From a Cross-sectional Nationwide Survey of Bereaved Family Members' Perceptions

abstract

Kentucky first lady, UK Markey Cancer Center doctors promote ovarian cancer screening - media

Kentucky 

....The Ovarian Cancer Screening Program is open to women age 50 or older, or women over the age of 25 who have a family history of ovarian cancer. Screening is free. For more information, call 859-323-4687 or 800-766-8279. 

Barriers to Study Enrollment in Patients With Advanced Cancer Referred to a Phase I Clinical Trials Unit

abstract

Background. We conducted this retrospective study to identify reasons that patients referred to a phase I clinical trial failed to enroll or delayed enrollment onto the trial.

Materials and Methods. Outcome analyses were conducted independently on data collected from electronic medical records of two sets of consecutive patients referred to a phase I clinical trial facility at MD Anderson Cancer Center. Data from the first set of 300 patients were used to determine relevant variables affecting enrollment; data from the second set of 957 patients were then analyzed for these variables.

Results. Results from the two sets of patients were similar. Approximately 55% of patients were enrolled in a phase I trial. Patients referred from within MD Anderson were more likely to be enrolled than patients seen originally outside the institution (p = .006); black patients were more likely than white patients to enroll (69% vs. 43%; p = .04). The median interval from the initial visit to initiation of treatments was 19 days. Major reasons for failure to enroll included failure to return to the clinic (36%), opting for treatment in another clinic (17%), hospice referral (11%), early death (10%), and lack of financial clearance (5%). Treatment was delayed for three weeks or more in 250 patients; in 85 patients (34%), the delay was caused by financial and insurance issues.

Conclusion. Failure to return to the clinic, pursuit of other therapy, and rapid deterioration were the major reasons for failure to enroll; lengthy financial clearance was the most common reason for delayed enrollment onto a phase I trial.

 

Study on muscle stem cells reveals clues on cancer cachexia

 Stem Cells

Editorial: Is the EMR Enhancing or Hindering Patient-Provider Interactions? | Journal of Participatory Medicine

open access

 

Post-operative bathing and showering to prevent wound complications - Cochrane Summaries plain english/abstract

abstract/plain english summary

Many people undergo surgical operations during their life-time. After an operation the surgical wound is closed using stiches, staples, tape (steri-strips) or an adhesive glue. Usually, towards the end of the surgical procedure and before the person leaves the operating theatre, the surgeon covers the closed surgical wound using gauze and adhesive tape, or an adhesive tape containing a pad that covers the surgical wound. This is called a wound dressing. There is currently no guidance about when wounds can be made wet by bathing or showering post-operatively. Early bathing may encourage the person to move about, which is good after most types of surgery. Avoiding post-operative bathing or showering for two to three days may result in the accumulation of sweat and dirt on the body, but early washing of the wound may have a bad effect on healing by irritating the wound and disturbing the healing environment. We reviewed all the available evidence from the medical literature (up to July 2013) on this issue. In particular, we sought information from randomised controlled trials, which, if conducted well, provide the most accurate information.
We identified only one randomised controlled trial. This trial was at high risk of bias, i.e. there were flaws in the way it was conducted that could have given incorrect results.

Patients’ and professionals’ evaluations of quality of care in oncology outpatient clinics

abstract

Purpose

The purpose of this study is to compare patients' and professionals' evaluations of the quality of care in oncology outpatient clinics.

Methods

The data were drawn from a 2011 survey of 1,379 patients and 155 professionals conducted in 15 % of oncology outpatient clinics in Quebec, Canada. Respondents completed self-administered questionnaires that addressed the aspects of timeliness (TIM), patient-centred care (PCC), communication (COM), quality of the physical environment (QPE), and continuity (CONT). Patients’ and professionals’ mean scores (maximum = 4) for each aspect were compared using mixed model analysis.

Results

Patients’ and professionals’ perceptions of quality of care were largely positive, with mean scores for all items of 3.66 and 3.37, respectively. However, for the majority of aspects of quality, the professionals' scores were lower than those of patients. The aspects rated most positively by both groups were PCC, COM and CONT. Timeliness was the least positively evaluated, with mean scores of 3.34 for patients and 3.16 for professionals.

Conclusions

In many respects, cancer patients and professionals share relatively common views about the most and least positive aspects of the quality of care, although professionals tend to be more critical. Aspects evaluated less favourably by both groups and those on which opinions differ are good candidates for improvements. Some ideas for solutions are proposed. Positive patient feedback is especially important in cancer care, where attraction and retention of professionals is a key concern.

 

Neuroendocrine tumors of the gynecologic tract

abstract

"Tumors of the diffuse neuroendocrine cell system (DNES) may arise in any component of the gynecologic tract, including the vulva, vagina, cervix, endometrium, and ovary. Overall such tumors in the gynecologic tract are rare, constituting only 2% of gynecologic cancers, comprising a spectrum of tumors of variable biologic potential. Due to the rarity of such tumors, pathologists experience may be limited and these may present diagnostic challenges. Currently the nomenclature employed is still that of the pulmonary classification systems, carcinoid, atypical carcinoid, small and large cell neuroendocrine carcinoma that broadly correlates to low/grade 1, intermediate/grade 2, and high grade/grade 3 of the WHO gastroenteropancreatic neuroendocrine tumors classification. Furthermore in keeping with the lung, proliferative rate is assessed based on mitotic index rather than Ki-67 staining. In this review we cover select neuroendocrine tumors of the gynecologic tract."

search=ovarian+Neuroendocrine+tumors

2013 Results for Surgical Specialists. - (Canada) National Physician Survey

National Physician Survey

The following questions were presented to and completed by physicians (family physicians and all other specialists) in Canada in 2013. Questions marked “FP”, were asked of family physicians/general practitioners only, while those marked “SP” were only asked of all other specialist physicians.

(Cardio-vascular/Thoracic Surgeons, General Surgeons, Neurosurgeons, Obstetricians/Gynecologists, Ophthalmologists, Orthopedic Surgeons, Otolaryngologists, Plastic Surgeons, Urologists.).....

 

Court ruling carries lesson on need for advance directives: CMA

 CMA

BRCA1/2 and clinical outcome in a monoinstitutional cohort of women with hereditary breast cancer

abstract

The clinical outcome of BRCA mutation carriers and non-carriers still remains a topic of discussion. In order to interpret controversial data, in the present study, we analyzed a large consecutive monoinstitutional series of breast cancer patients and relatives with familial features carrying or not carrying BRCA mutations. The intense research in recent years regarding the clinical genetics of patients with breast or ovarian cancer and their relatives has allowed the organization of a unique database comprising anamnestic, clinical, pathological and molecular data.

Families with two or more cases of breast cancer under the age of 50 years, or with three cases at any age, were identified. From June, 2003 to June, 2010, a total of 202 patients (136 probands + 66 relatives) from 45 families were included in the analysis. A total of 136 (49 carrier and 87 non-carrier) cases had a cancer diagnosis at the time of their genetic testing. Twenty and 24 events were observed in the carrier and control group, respectively.

The 10-year disease-free suvival rate was 57% for patients in the control group compared with 50% for patients carrying a BRCA mutation (P=0.15 by log-rank test). Finally, 66 (32 genetic and 34 control) cases were unaffected at the time of molecular analysis, and 6 new cases of cancer were observed in the carriers, while no new cases were detected in the control cohort. Thus, at age 50, 40% of carriers had a high risk of disease (P=0.0069 by log-rank test). Our data support the hypothesis that the presence of BRCA mutations does not alter the clinical outcome for hereditary breast cancer patients. Conversely, BRCA mutations are proven to be crucial for prediction of risk in healthy relatives from carrier families.  

Paraneoplastic cerebellar degeneration caused by ovarian clear-cell carcinoma - case report

abstract

Keywords:

• ovarian cancer;
• paraneoplastic cerebellar degeneration;
• paraneoplastic neurological syndrome;
• tacrolimus hydrate;
• Yo antibody

Paraneoplastic cerebellar degeneration is a paraneoplastic neurological syndrome caused by the remote effect of certain systemic cancers and is characterized by subacute cerebellar symptoms. A 62-year-old woman suffering from unidentified cerebellar symptoms was admitted to our hospital. Paraneoplastic cerebellar degeneration was suspected and ovarian cancer was detected after the systemic examination for malignancy. The symptoms of vertigo and dysarthria were improved a little after surgical operation and treatments of γ-globulin, steroid pulse and tacrolimus hydrate. The cerebellar symptoms of paraneoplastic cerebellar degeneration are often evident prior to detection of malignancy. It is important to perform systemic examination for malignancy in case of unidentified cerebellar symptoms.

 

American Public Health Association - Women’s Health Initiative View of Estrogen Avoidance and All-Cause Mortality

Abstract (requires $$ to view full article)

"In a recent article, Sarrel et al.¹ assert that estrogen avoidance since 2002 has caused tens of thousands of premature deaths among posthysterectomy women aged 50 to 59 years in the United States. They fault Women’s Health Initiative (WHI) investigators for inadequate efforts to communicate the benefits of unopposed estrogen and to contrast (unopposed) estrogen findings from those for estrogen plus progestin in reporting on the WHI randomized controlled trials.^2–5"

Read More: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301604

 

UMD-MLH1/MSH2/MSH6 databases: description and analysis of genetic variations in French Lynch syndrome families

Blogger's Note: this is information concerning a French database for Lynch Syndrome 

open access

'We examined MLH1/MSH2/MSH6 variations collected by the 16 licensed laboratories located in France and belonging to the French MMR network during the past 18 years. Updates on new variations or new samples found to carry MMR variations are done twice a year. In June 2012, a total of 7047 variations were provided for registration, and 6480 could be integrated by the UMD software for further analyses. They represent 1174 different variations corresponding to 467 truncating mutations (40%) and 707 VUS (60%). Entries correspond to all variations found through a complete exon screening of the three genes not only in index cases but also in those relatives that were genetically screened and found to be mutation carriers. This nation-wide and systematic registration should improve the prevalence estimate of germline MMR mutations in France....  

Tiny, short-term hair growing experiment grows huge news coverage

healthnewsreviews

A paper in the Proceedings of the National Academy of Sciences describes a technique to grow hairs on human skin grafted onto mice.
New hair follicles appeared on 5 of 7 transplants attempted. The longest duration of any graft in the study was 6 weeks; so no long-term followup.
That’s right.  5 successful attempts.  Yet this dominated the news.....
 

Researchers Re-Grow Hair In Mice, Offering Hope For Hair Loss

Forbes

Consumer Updates > Why Are Jerky Treats Making Pets Sick?

Consumer Updates FDA

Immunomedics Reports Multiple Objective Responses in Solid Cancers With IMMU-132 - Drugs.com MedNews

MedNews

Abstract

BACKGROUND:

Patients diagnosed for a serous ovarian borderline tumor (s-BOT) typically present with an excellent clinical outcome. However there have been controversies concerning the prognostic impact of so-called implants, an extra ovarian spread occurring alongside the s-BOT in certain cases. It remains obscure whether these implants actually resemble metastasis owning the same genetic pattern as the ovarian primary or whether they develop independently.

METHODS:

The current study, in the aim of further clarifying the genetic origin of implants, assessed BRAF/KRAS hot spot mutations and the p53/p16INK4a immunophenotype of s-BOTs and corresponding implants (n = 49) of 15 patients by pyro-sequencing and immunostaining, respectively.

RESULTS:

A significant proportion of both s-BOTs and implants showed KRAS or BRAF mutation and though p16INK4a was found to be abundantly expressed, p53 immunoreactivity was rather low. When genotypes of BRAF/KRAS mutated s-BOTs and corresponding implants were compared no patient presented with a fully matching mutation profile of s-BOTs and all corresponding implants.

CONCLUSIONS:

The current study reveals genetic heterogeneity of s-BOTs and implants, as none of the markers examined showed constant reciprocity. Hence, our findings may assist to explain the different clinical presentation of s-BOTs and implants and might encourage to applying more individualized follow up protocols.

 

Histopathology: Adult Granulosa Cell Tumour-Like Areas Occurring in Ovarian Epithelial Neoplasms: Report of a Case Series with Investigation of FOXL2 Mutation Status

Abstract

AIMS:

To look for FOXL2 mutation in rare ovarian epithelial lesions showing stromal components with morphological features of adult granulosa cell tumour (AGCT).

METHODS AND RESULTS:

We report the 402C→G FOXL2 mutation status in 5 epithelial ovarian lesions in women aged 45-77 showing stromal proliferations morphologically indistinguishable from AGCT. The lesions were mucinous cystadenoma, mixed epithelial cystadenoma, endometriotic cyst, mucinous borderline tumour (intestinal type) and mucinous carcinoma. In 1 case, the AGCT component formed a discrete nodule and in the others it was distributed within the septa and cyst walls. FOXL2 mutation was present in 2 cases and absent in 3. One mutation-positive case showed an AGCT nodule abutting a mucinous borderline tumour and interpreted as a collision tumour. The other positive case had an AGCT component within the septa of a mucinous carcinoma and both components are likely to be neoplastic. In the 3 cases without FOXL2 mutation, the stromal component most likely represents a non-neoplastic AGCT-like proliferation.

CONCLUSIONS:

Areas typical of AGCT are rarely associated with epithelial ovarian lesions. These are heterogeneous and likely to be truly neoplastic in only a subset of cases. FOXL2 mutation testing may be useful in confirming a true neoplastic AGCT component. 

The sex hormone system in carriers of BRCA1/2 mutations: a case-control study

abstract


Penetrance for breast cancer, ovarian cancer, or both in carriers of BRCA1/BRCA2 mutations is disproportionately high. Sex hormone dysregulation and altered end-organ hormone sensitivity might explain this organ-specific penetrance. We sought to identify differences in hormone regulation between carriers of BRCA1/2 and women who are negative for BRCA1/2 mutations.

METHODS:

We assessed endometrial thickness for each menstrual cycle day (as an index of hormone regulation) in 393 scans from 228 women in the UK Familial Ovarian Cancer Screening Study (UK FOCSS) known to carry either mutation and 1573 scans from 754 women known to be negative for the mutations. To quantify differences in endometrial thickness we focused on days 10-14 and days 21-26, and calculated the area under the curve. We then compared serum oestradiol and progesterone titres during these days of the menstrual cycle in the same groups. Follicular and luteal oestradiol and progesterone serum titres were grouped into quartiles and odds ratios were calculated with logistic regression.

FINDINGS:

Follicular phase endometrial thickness of carriers of the mutations adjusted for age and day of the menstrual cycle was higher (odds ratio [OR] 1·11, 95% CI 1·03-1·20; p=0·0063) and luteal phase endometrial thickness lower (0·90, 0·83-0·98; p=0·027) than for women negative for the mutations. Median luteal phase titres of progesterone were 121% higher (p=0·00037) in carriers than in women negative for the mutations, and for oestradiol were 33% higher (p=0·007)-ie, 59% of carriers had concentrations of serum progesterone that would have been in the top quartile of concentrations in the control group (OR 8·0, 95% CI 2·1-52·57; p=0·008).

INTERPRETATION:

Carriers of BRCA1/BRCA2 mutations are exposed to higher titres of oestradiol and progesterone-known risk-factors for breast cancer. Higher titres of oestradiol in carriers are compatible with this hormone having a role in ovarian carcinogenesis in such women. Our findings could not be explained by differential contraceptive pill use.

FUNDING:

Eve Appeal, European Union, Cancer Research UK, and US National Institutes of Health.

the Lancet Oncology

 

Pegylated liposomal doxorubicin and cyclophosphamide in early recurrent ovarian carcinoma: phase I dose-finding study

abstract

This single-arm phase I dose-escalation study determines the optimal dose of the non-platinum treatment pegylated liposomal doxorubicin (PLD) plus cyclophosphamide (CPM) every 4 weeks in early recurrent ovarian carcinoma.

METHODS:

Twenty-one women with ovarian carcinoma relapsing within 12 months of first-line surgery and platinum-taxane chemotherapy received escalating doses of PLD (35-45 mg/m²) and CPM (500-600 mg/m²) every 4 weeks for at least two cycles. Primary objective was assessment of maximum-tolerated dose (MTD) over the first two cycles. Secondary objectives were to assess safety over 2 cycles, efficacy evaluated every two cycles (response evaluation criteria in solid tumours criteria) and overall survival (OS).

RESULTS:

The PLD-CPM MTD was 40/600 mg/m² with 2/3 patients treated at 45/500 mg/m², showing DLTs with Grade 3/4 oesophagitis, thrombopenia/neutropenia, leucopoenia, and Grade 3 stomatitis/asthenia during the first cycle of treatment. Four severe toxicities were reported by three patients during the two first cycles, namely Grade 4 anaemia, and Grade 3 stomatitis. The most common treatment-related toxicities were anaemia (71.4 %), nausea (61.9 %), neutropenia (57.1 %), asthenia (52.4 %), leucopoenia (47.6 %), stomatitis (42.9 %), skin (28.6 %) and palmar-plantar-erythrodysesthesia (19 %). No treatment-related deaths were reported. The overall response rate (complete and partial) was 31 %, and median OS was 8.2 months [95 % CI (3.3-13.2)].

CONCLUSIONS:

The combination of PLD and CPM is feasible and may be considered particularly in cases where platinum-based treatment is not suitable. The recommended doses for a phase II trial are PLD 40 mg/m² plus CPM 600 mg/m² every 4 weeks.

 

Pegylated liposomal doxorubicin for first-line treatment of epithelial ovarian cancer - The Cochrane Library updated review Oct 21, 2012 + plain language summary

The Cochrane Library - abstract



Epithelial ovarian cancer (EOC) is often diagnosed at an advanced stage, requiring primary cytoreductive surgery and combination chemotherapy for its first-line management. Currently, the recommended standard first-line chemotherapy is platinum-based, usually consisting of carboplatin and paclitaxel (PAC/carbo). Pegylated liposomal doxorubicin (PLD) is an improved formulation of doxorubicin that is associated with fewer and less severe side effects than are seen with non-modified doxorubicin. In combination with carboplatin, PLD has recently been shown to improve progression-free survival compared with PAC/carbo in women with relapsed, platinum-sensitive EOC. It is therefore important to know whether any survival benefit can be attributed to PLD when it is used in the first-line setting.

Objectives

To evaluate the role of PLD, alone or in combination, in first-line chemotherapy for women with EOC.

Search methods

We searched The Cochrane Gynaecological Cancer Group's Trial Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE from January 1990 to February 2013. In addition, we searched online trial registries for ongoing trials and abstracts of studies presented at relevant scientific meetings from 2000 onwards.

Selection criteria

We included all randomised controlled trials (RCTs) that compared PLD alone or in combination with other agent/s (e.g. carboplatin) versus other agent/s for first-line chemotherapy in women with EOC who may or may not have undergone primary cytoreductive surgery.

Data collection and analysis

Two review authors independently selected trials, extracted data and assessed the risk of bias for each included trial. We obtained updated trial data when possible.

Main results

We included two large trials. One trial compared three-weekly PLD and carboplatin (PLD/carbo) with PAC/carbo. The other trial included four experimental arms, one of which was PLD plus PAC/carbo, that were compared with the standard PAC/carbo regimen. We did not combine results of these two trials in the meta-analysis. We considered the two studies to be at low risk of bias.

For the comparison PLD/carbo versus PAC/carbo (820 women; stages Ic to IV), no statistically significant differences in progression-free survival (PFS) (hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.85 to 1.19) or overall survival (OS) (HR 0.94, 95% CI 0.78 to 1.13) were noted between study arms. Severe anaemia (risk ratio [RR] 2.74, 95% CI 1.54 to 4.88) and thrombocytopenia (RR 8.09, 95% CI 3.93 to 16.67) were significantly more common with PLD/carbo, whereas alopecia (RR 0.09, 95% CI 0.06 to 0.14) and severe neurotoxicity (RR 0.09, 95% CI 0.01 to 0.66) were significantly more common with PAC/carbo. Quality of life scores were not significantly different.

For the comparison PLD/PAC/carbo versus PAC/carbo (1726 women; stage III/IV), it is important to note that PLD was given for alternate cycles only (i.e. every 6 weeks). No statistically significant difference in PFS (HR 0.98, 95% CI 0.88 to 1.09) or OS (HR 0.95, 95% CI 0.84 to 1.08) between these two treatment arms was reported. However, women in the triplet arm experienced significantly more severe haematological adverse events (anaemia, thrombocytopenia, neutropenia and febrile neutropenia) compared with those given standard treatment.
No RCTs evaluated single-agent PLD for first-line treatment of EOC.

Authors' conclusions

PLD/carbo is a reasonable alternative to PAC/carbo for the first-line treatment of EOC. Although three-weekly PLD/carbo may be associated with increased dose delays and discontinuations compared with the standard PAC/carbo regimen, it might be more acceptable to women who wish to avoid alopecia or those at high risk of neurotoxicity. No survival benefits appear to be associated with the alternating triplet regimen, and the additional toxicity associated with adding PLD to PAC/carbo limits further investigation. Further studies are needed to establish the safest, most effective PLD/carbo regimen for newly diagnosed disease.

 

Plain language summary

A modified formulation of doxorubicin for the treatment of newly diagnosed ovarian cancer

Background
PLD is an improved formulation of an anticancer drug that has been around since the 1960s. When used with carboplatin (carbo), it has been shown to improve survival in women with epithelial ovarian cancer (EOC) that has come back (relapsed) six months or longer after the last platinum (carbo)-based treatment.

Methods
We wanted to find out whether PLD was also useful for the treatment of newly diagnosed EOC. We searched the literature from 1990 to January 2013 for relevant studies and included two studies in this review.

Study characteristics
One study compared PLD plus carbo given to women every three weeks versus the standard treatment (paclitaxel (PAC)/carbo every three weeks), and the other added PLD to the standard treatment and compared it with standard treatment only (the latter study also included other treatments not relevant to this review). These studies spanned three years and included 820 and 4100 women, respectively. Most women in these studies had advanced cancer and had undergone surgery to remove as much of the cancer as possible.

Key findings
Women receiving the PLD/carbo treatment and those given the standard treatment survived for a similar period, but PLD/carbo caused more women to experience low blood counts (anaemia and low platelets) that often led to a delay in treatment or the need to stop treatment. However, PLD/carbo caused far fewer women to experience hair loss and neuropathy (nerve damage causing symptoms such as tingling, numbness, pain, loss of sensation and/or coordination), and so it might help women who find these side effects unacceptable or intolerable. We concluded that three-weekly PLD/carbo is a reasonable alternative to standard platinum-based treatment for newly diagnosed EOC, but more research is needed to establish the safest and most effective dosage and dose frequency.

Adding PLD to standard treatment (PAC/carbo) every six weeks did not help women with newly diagnosed ovarian cancer survive longer and was associated with worse effects on blood counts that increased the chance of infection; therefore this triple drug treatment cannot be recommended.

Quality of the evidence
We considered the evidence related to survival of women after they are treated with PLD/carbo or PAC/carbo, and the evidence related to adverse drug effects to be of high quality.

 

Summary of findings    [Explanations] open access

Internet Use and Cancer-Preventive Behaviors in Older Adults: Findings from a Longitudinal Cohort Study

abstract

Background: The Internet is a key provider of health information, but little is known about its associations with cancer-preventive behaviors. This study investigated the associations between Internet use and cancer-preventive behaviors among older adults.

Methods: Data were taken from Waves 1 to 5 (2002–2011) of the English Longitudinal Study of Aging, a cohort study of men and women 50 years or older in England, United Kingdom. Internet use was recorded at each wave. Breast and colorectal screening, fruit and vegetable consumption, physical activity, and smoking were recorded at Wave 5. Social, cognitive, and physical function variables recorded at Wave 1 were analyzed as predictors of Internet use and included as covariates in analyses linking Internet use to behavior.

Results: Of 5,943 respondents, 41.4% did not report any Internet use, 38.3% reported using it in one to three waves (“intermittent users”), and 20.3% used it in all waves (“consistent users”). Internet use was higher in younger, male, White, wealthier, more educated respondents, and those without physical limitations. Multivariable analysis showed that consistent users were more likely than “never users” to report CRC screening, weekly moderate/vigorous physical activity, and five or more daily servings of fruit and vegetables, and less likely to report smoking. There was no significant association between Internet use and breast screening.

Conclusions: Internet use showed a quantitative association with cancer-preventive behaviors even after controlling for various social, cognitive, and physical correlates of Internet use.

Impact: Promoting Internet use among older adults from all backgrounds could contribute to improving cancer outcomes and reducing inequalities.

 

Dietary Intake and Ovarian Cancer Risk: A Systematic Review

 Blogger's Note: not sure how many times this needs to be done with the same results (eg. decades....)

abstract

"Ovarian cancer is a leading cause of gynecological cancer death. There is a need to identify modifiable dietary risk factors for this disease. To evaluate the role of diet in ovarian cancer risk we performed a PRISMA-directed systematic review that included prospective cohort studies with > 200 cases (n=24). Higher risk for ovarian cancer was shown for total, animal, and dairy fat (5 of 9 studies), as well as total nitrate and possibly total vitamin C. No associations were demonstrated for red meat, fiber, vitamin A, vitamin E, β-carotene, or folate. Vegetables were associated with lower risk in one of three studies; fruit showed no association although risk estimates were all greater than 1.0. Isoflavones and flavonoids were associated with modestly lower risk in two studies and tea intake was associated with lower risk in one of two studies. This review suggests that no specific dietary factors are consistently associated with ovarian cancer risk. Data by tumor subtypes are limited, but suggest that differential associations by tumor subtype may exist and should be evaluated. Studies of ample sample size, varied exposure, which can better control for dietary measurement error, are needed to fully define dietary recommendations for ovarian cancer prevention."  

Ovarian Cancer, Version 2.2013: NCCN Guidelines Insights focus on the major updates to the 2013 NCCN clinical practice guidelines

open access Ovarian Cancer, Version 2.2013

Morgan RJ Jr, Alvarez RD, Armstrong DK, Burger RA, Chen LM, Copeland L, Crispens MA, Gershenson DM, Gray HJ, Hakam A, Havrilesky LJ, Johnston C, Lele S, Martin L, Matulonis UA, O'Malley DM, Penson RT, Powell MA, Remmenga SW, Sabbatini P, Santoso JT, Schink JC, Teng N, Werner TL, Dwyer MA, Hughes M.

J Natl Compr Canc Netw. 2013 Oct 1;11(10):1199-209.

Ovarian Cancer

These NCCN Guidelines Insights focus on the major updates to the 2013 NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Ovarian Cancer by describing how and why the new recommendations were made. Four topics were selected based on recent important updates in the NCCN Guidelines and debate among panel members about recent clinical trials. The topics include 1) intraperitoneal (IP) chemotherapy, 2) CA-125 monitoring for ovarian cancer recurrence, 3) surveillance recommendations for less common ovarian histopathologies, and 4) recent changes in therapy for recurrent epithelial ovarian cancer. 

The recently published NCCN Guidelines Insights on Ovarian Cancer discuss other topics, including 1) screening, 2) diagnostic tests for assessing pelvic masses, 3) primary treatment using neoadjuvant chemotherapy, 4) primary adjuvant treatment using bevacizumab in combination with chemotherapy, 5) therapy for recurrent disease (mainly epithelial ovarian cancer), and 6) management of drug/hypersensitivity reactions.^1...........

 

The X chromosome often affected by mutations in cancer

The X chromosome

Every case of cancer originates from changes in a person's genetic material (mutations). These usually occur as "somatic mutations" in individual cells during an individual's lifetime, rather than being inherited from a person's parents. "Over time, the original damaged cell accumulates additional mutations, and it is still largely unknown why," says Prof. Roland Eils, who leads bioinformatics departments both at DKFZ and Heidelberg University.

By studying when and where mutations occur the researchers hope to gain insights into the early mechanisms that send cells along a pathway to cancer. The new international study coordinated by Roland Eils has now for the first time analyzed the exact distribution of somatic mutations in the genomes of tumor cells of various types of cancer. Mutations do not affect all regions of the genome to the same extent. It is known, for example, that the number of somatic mutations depends on the sequence of bases making up a gene and the frequency at which it is transcribed into RNA molecules.
In the current study, the researchers analyzed the genome sequences of more than 400 tumors from patients suffering from twelve different types of cancer, including brain cancer in children and adults, leukemias and breast cancer.

The scientists were surprised to find that mutations were extremely frequent in the X chromosome of females, which is responsible for determining sex. In many cancers, this chromosome displayed from two to four times as many mutations as were observed in the other chromosomes. Every cell in a female has two copies of the X chromosome and interestingly the rate was not the same in the two copies. From embryonic development onwards, one of the copies is inactivated in each cell. The higher mutation rate exclusively affects the inactive copy.....
 

Seth's Blog: The complaining customer doesn't want a refund

Seth's Blog

The complaining customer doesn't want a refund

He wants a connection, an apology and some understanding. He wants to know why you made him feel stupid or ripped off or disrespected, and why it's not going to happen again.
If you have a department that sends out form letters and refund coupons, what you've done is built the ability, at scale, to get rid of people who are giving you a second chance.
When the refund for the broken M&M's or the artificially flavored nuts that should have been delicious, or the $20 inconvenience fee in exchange for the torture you put a frequent flyer through arrives, you've basically sent a form letter that says, "goodbye."
Which is your choice, of course, but if you think that this expression of goodwill is going to be seen as goodwill, you're wrong.
Try candor or inviting them to an online focus group. Perhaps try being human. Try giving them a chance to be a voice of the concerned, energetic customer, a voice that needs to be heard by people who actually make decisions.

 

Successful Treatment by Adding Duloxetine to Pregabalin for Peripheral Neuropathy Induced by Paclitaxel

abstract

Although paclitaxel is a commonly used anticancer drug, peripheral neuropathy may develop as a side effect. Worsening of the symptoms with time may cause patients who receive paclitaxel to give up their chemotherapy. Duloxetine, a serotonin- and norepinephrine-reuptake inhibitor, has been used to treat peripheral neuropathic pain. We report the case of a 68-year-old man with gastric cancer, who underwent gastrectomy and then received 8 cycles of chemotherapy involving weekly administrations of paclitaxel. Under this paclitaxel treatment, he complained of severe peripheral neuropathy, leading to a diminished quality of life. Following treatment with a combination of duloxetine and pregabalin, a remission of his symptoms was achieved. Duloxetine plus pregabalin therapy may be useful for the peripheral neuropathy induced by paclitaxel.  

Correlation Between the Administration of Morphine or Oxycodone and the Development of Infections in Patients With Cancer Pain

abstract

Morphine and oxycodone are widely used in the therapy for cancer pain. Although some previous studies have reported that morphine induces immunosuppression and oxycodone does not, whether this is true for human infections is unclear. We performed a retrospective study on the correlation between the administration of morphine or oxycodone and the development of infections in patients with cancer pain. This study was undertaken in 841 inpatients receiving only 1 opioid continuously for more than 10 days. Development of infections was based on (1) antibiotic administration and (2) diagnosis of infections, positive microbial culture test, or increase in white blood cells or C-reactive protein. Liver, kidney, and hematological cancer, antineoplastic drugs, radiotherapy, steroid, immunosuppressive agents, granulocyte colony-stimulating factor, and thyroid inhibitors were defined as the exclusion criteria in consideration of influence on immune system or metabolism and excretion of morphine and oxycodone. A total of 60 morphine and 74 oxycodone cases were included, which resulted in 18 and 10 infection cases. Significantly more patients treated with morphine developed infections than those patients treated with oxycodone (odds ratio = 3.60, 95% confidence interval = 1.40-9.26). No significant differences were seen in the other variables analyzed. Although perhaps some confounding variables were included because this was an observational rather than randomized study, these results suggested that morphine’s immunosuppressive effect may contribute to the development of infections in patients with cancer pain.

Oral Contraceptives and Risk of Ovarian Cancer and Breast Cancer Among High-Risk Women: A Systematic Review and Meta-Analysis

abstract

Purpose To estimate the risks of ovarian cancer and breast cancer associated with oral contraceptive (OC) use among women at elevated risk owing to mutations in BRCA1/2 or a strong family history. 

Methods We searched PubMed, Embase, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov for studies published 2000 to 2012 that evaluated associations between OC use and breast or ovarian cancer among women who are carriers of a BRCA1/2 mutation or have a family history of breast or ovarian cancer. 

Results From 6,476 unique citations, we identified six studies examining ovarian cancer risk in BRCA1/2 mutation carriers and eight studies examining breast cancer risk in BRCA1/2 mutation carriers. For BRCA1/2 mutation carriers combined, meta-analysis showed an inverse association between OC use and ovarian cancer (odds ratio [OR], 0.58; 95% CI, 0.46 to 0.73) and a non statistically significant association with breast cancer (OR, 1.21; 95% CI, 0.93 to 1.58). Findings were similar when examining BRCA1 and BRCA2 mutation carriers separately. Data were inadequate to perform meta-analyses examining duration or timing of use. For women with a family history of ovarian or breast cancer, we identified four studies examining risk for ovarian cancer and three for breast cancer, but differences between studies precluded combining the data for meta-analyses, and no overall pattern could be discerned. 

Conclusion Our analyses suggest that associations between ever use of OCs and ovarian and breast cancer among women who are BRCA1 or BRCA2 mutation carriers are similar to those reported for the general population.

 

Clinical and economic outcomes of patients with brain metastases based on symptoms

abstract

BACKGROUND

Insurers have started to deny reimbursement for routine brain surveillance with magnetic resonance imaging (MRI) after stereotactic radiosurgery (SRS) for brain metastases in favor of symptom-prompted imaging. The authors investigated the clinical and economic impact of symptomatic versus asymptomatic metastases and related these findings to the use of routine brain surveillance.

METHODS

Between January 2000 and December 2010, 442 patients underwent upfront SRS for brain metastases. In total, 127 asymptomatic patients and 315 symptomatic patients were included. Medical records were used to determine the presenting symptoms, distant and local brain failure, retreatment, and need for hospital and rehabilitative care. Cost-of-care estimates were based on Medicare payment rates as of January 2013.

RESULTS

Symptomatic patients had an increased hazard for all-cause mortality (hazard ratio, 1.448) and were more likely to experience neurologic death (42% vs 20%; P < .0001). Relative to asymptomatic patients, symptomatic patients required more craniotomies (43% vs 5%; P < .0001), had more prolonged hospitalization (2 vs 0 days; P < .0001), were more likely to have Radiation Therapy Oncology Group grade 3 and 4 post-treatment symptoms (24% vs 5%; P  < .0001), and required $11,957 more on average to manage per patient. Accounting for all-cause mortality rates and the probability of diagnosis at each follow-up period, the authors estimated that insurers would save an average $1326 per patient by covering routine surveillance MRI after SRS to detect asymptomatic metastases.

CONCLUSIONS

Patients who presented with symptomatic brain metastases had worse clinical outcomes and cost more to manage than asymptomatic patients. The current findings argue that routine brain surveillance after radiosurgery has clinical benefits and reduces the cost of care.  

A phase I/II seamless dose escalation/expansion with adaptive randomization scheme (SEARS)

Abstract

Background Standard drug development conducts phase I dose finding and phase II dose expansion sequentially and separately. Information between the two phases is rarely shared. Administratively, such a sequential process is time-consuming and burdensome.

Purpose We propose seamless dose escalation/expansion with adaptive randomization scheme (SEARS), a seamless design that combines phase I dose escalation based on toxicity with phase II dose expansion and dose comparison based on efficacy. SEARS allows extension from phase I to phase II under one design with no gap in between and employs a dynamic and parallel procedure involving simultaneous dose escalation, dose graduation, and adaptive randomization.

Methods SEARS integrates three components into a seamless scheme. Specifically, in phase I, SEARS applies the modified toxicity probability interval (mTPI) method to monitor dose escalation based on toxicity outcome. Doses that show promising efficacy and safety are immediately graduated from phase I and placed to a phase II stage in which patients are adaptively randomized based on efficacy outcome. Phase I dose escalation, dose graduation, and phase II adaptive randomization proceed simultaneously throughout the entire trial.

Results Examples are given comparing SEARS with two other designs, in which superior performance of SEARS is demonstrated. An important and promising finding is that SEARS reduces sample sizes without losing power. R program and demo slides of SEARS can be obtained at http://health.bsd.uchicago.edu/yji/soft.html

Limitation We assume that the binary efficacy and toxicity response can be measured in the same time frame. This is often achievable with surrogate efficacy markers in practice.

 

Checklists are not only for the operating room

no abstract

Can CRNAs ( certified registered nurse anesthetists) Work Alone? Sometimes

Sometimes

Revised ethical principles have profound implications for psychological research | Mind the Brain

blog


The World Medical Association has just released the latest revision of Declaration of the Helsinki Ethical Principles for Medical Research Involving Human Subjects. You can find the full document open access here.
Released on the fiftieth anniversary of the original declaration, the seventh revision will serve as the basis for regulating research involving human subjects. It will also provide the principles for evaluating research protocols submitted to what are called Institutional Review Boards (IRBs) in the United States and to similar bodies elsewhere and as the basis for judging the ethics of investigator behavior.
Manuscripts submitted for publication will have to declare that any research being reported has been reviewed by such bodies and is consistent with the revised Declaration of Helsinki.
The second paragraph of the document notes that it is addressed primarily to physicians, but that others who are involved in medical research are encouraged to adopt the same principles. Based on the reception of past versions of the Declaration of Helsinki, it can be expected that the review of psychological research, whether or not is conducted in medical settings or with medical patients, will be held to the same standards.
The revised standards thus have profound implications for the conduct of psychological research......
 

Declaration of Helsinki Turns 50, Gets Revised — Physician’s First Watch

Declaration of Helsinki

The World Medical Association has issued its seventh revision of the Declaration of Helsinki, a document that outlines the ethical principles regarding research on humans.

The update, released on the 50th anniversary of the original declaration, requires that research-related injuries require compensation and treatment. It also emphasizes disseminating the results of research, including negative and inconclusive findings, and includes guidance for conducting research in resource-poor settings.

A commentary in JAMA calls the update, "a significant improvement," but cautions that its "treatment of informed consent remains inadequate."

Link(s):

JAMA article (Free)

JAMA viewpoint by Ezekiel Emanuel (Free)

JAMA viewpoint by Paul Ndebele (Free)

 

International comparisons of waiting times in health care – Limitations and prospects

open access

Conclusions and recommendations 

A majority of the studied countries measure waiting times and they have some type of national care guarantee. The establishment of such a guarantee suggests that healthcare availability is or has been an issue of concern. Current national waiting time statistics are of limited use for comparing health care availability among the various countries due to the differences in measurements and data collection. Different methodological issues must be taken into account when making such cross-country comparisons.
Within the given context of national sovereignty of health systems it would be desirable if countries could collaborate in order to facilitate international comparisons. Such comparisons would be of benefit to all involved in the process of continuous improvement of health services. They would also benefit patients who seek cross-border alternatives for their care.

 

Evidence-based health information from the users perspectives- a qualitative analysis

open access

Women's Health Initiative reaffirms use of short-term hormone replacement therapy for younger women

NIH

Confirmation Bias Varies According to How Much We Think We Know › Communication Breakdown

blog

 

Refusing treatment - Focus (open access)

Refusing treatment

People take treatment decisions on the basis of their personal perspectives as much as the medical pros and cons. Doctors need to be able to deal with this.

This article was first published in The Oncologist vol. 18 no.5, and is republished with permission. © 2013 AlphaMed Press. doi:10.1634/theoncologist.2012-0436  

Are patients marginalized at health conferences?

blog

Toward an understanding of the pathophysiology of clear cell carcinoma of the ovary (Review) (MLH1,,,,)

open access

also:

"Microsatellite instability
MLH1. Microsatellite instability is proposed to be limited to CCC and endometrioid cancer. The epigenetic inactivation of hMLH1 is also an early event in the malignant transformation of endometriosis (74). Abnormal methylation has been detected in ~10% of endometriosis cases."

Post-operative urothelial recurrence in patients with upper urinary tract urothelial carcinoma managed by radical nephroureterectomy with an ipsilateral bladder cuff: Minimal prognostic impact in comparison with non-urothelial recurrence and other clinical indicators

abstract

Upper urinary tract urothelial carcinoma (UTUC) is a rare disease, and novel prognostic factors for patients who have undergone a radical nephroureterectomy (RNU) for UTUC have been studied intensely. To the best of our knowledge, the prognostic value of urothelial recurrence in patients with UTUC has not been previously described in studies. The present study compared the prognostic value of urothelial and non-urothelial recurrence in patients with UTUC of the kidney and ureter managed by surgery. The inclusion criteria consisted of a diagnosis of non-metastatic UTUC (any T stage, N0-1 and M0) and receipt of an RNU with an ipsilateral bladder cuff as the primary treatment. Of the 153 patients that were screened for the study, comprehensive clinical and pathological data was available for 103 patients, who were consequently included in the analysis. Overall survival (OS) and cancer-specific survival (CSS) times were estimated. A multivariate analysis was performed using the Cox regression model. The median follow-up period was 29 months (interquartile range, 14-63 months). The patient population was comprised of 71 males (68.9%) and 32 females (31.1%). A total of 32 patients (31.1%) showed non-urothelial recurrence, while 38 patients (36.9%) exhibited urothelial recurrence and 33 patients (32.0%) exhibited no recurrence. When comparing the risk parameters between the non-urothelial recurrence categories, the factors of pathological grade, microvascular invasion, lymphatic invasion and pT classification showed significant differences. However, there were no significant differences between the urothelial recurrence categories. No significant difference was observed between the OS and CSS times within the urothelial recurrence categories (P=0.3955 and P=0.05891, respectively), but significant differences were identified in the non-urothelial recurrence categories (P<0.0001 and P<0.0001, respectively). Among the other relevant descriptive pre-operative characteristics in the multivariate analysis, only non-urothelial recurrence remained associated with a worse CSS [P=0.002; hazard ratio (HR) 9.512]. The results show that urothelial recurrence has a minimal prognostic value in patients with UTUC managed by RNU with an ipsilateral bladder cuff.

 

Chemotherapy-induced hyaluronan production: a novel chemoresistance mechanism in ovarian cancer

Full text 

Paclitaxel and Ganetespib in Treating Patients With Recurrent Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

 Full Text View

Purpose

This phase I/II trial studies the side effects and best dose of ganetespib when given together with paclitaxel and to see how well they work in treating patients with recurrent ovarian, fallopian tube, or primary peritoneal cancer. Drugs used in chemotherapy, such as paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Ganetespib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving paclitaxel and ganetespib may be an effective treatment for ovarian, fallopian tube, or primary peritoneal cancer.

Condition	Intervention	Phase
Recurrent Fallopian Tube Cancer Recurrent Ovarian Epithelial Cancer Recurrent Primary Peritoneal Cavity Cancer	Drug: paclitaxel Drug: ganetespib Other: laboratory biomarker analysis	Phase 1 Phase 2

 

Scientists identify genetic errors in 12 major cancer types

Scientists identify genetic errors in 12 major cancer types

"...  The research, published Oct. 17 in Nature, shows that some of the same genes commonly mutated in certain cancers also occur in seemingly unrelated tumors. For example, a gene mutated in 25 percent of leukemia cases in the study also was found in tumors of the breast, rectum, head and neck, kidney, lung, ovary and uterus. ....

Journal of Compassionate Health Care is now open for submissions - BioMed Central blog

Journal of Compassionate Health Care

Compassionate health care is a rapidly growing field. It has come to the forefront following concerns that health care often fails at a fundamental level, and has become particularly pertinent in the UK since the publication of the Francis Inquiry report in February 2013. There is now general agreement that incorporating compassion at the core of basic care helps aid recovery, improves disease management, and reduces anxiety.
As yet, there are limited available resources for addressing the growing need and interest in this area. Therefore, BioMed Central is pleased to announce the launch of Journal of Compassionate Health Care, a new open access journal providing a vehicle for bringing together multidisciplinary perspectives, research and initiatives concerning this topical concept. The journal is led by Sue Shea (UK Research Consultant/University of Crete, Greece), and Christos Lionis (University of Crete, Greece) and is supported by an cross-disciplinary, international Editorial Board.  Journal of Compassionate Health Care invites contributions across a wide variety of topics, with the ultimate goal to improve clinical effectiveness and the quality of health care. Manuscripts can be submitted via our online submission system.

For more information about the journal, please contact jcompassionatehc@biomedcentral.com or visit the journal website. You can also sign up here to be alerted when the journal publishes its first articles.
 

Call for papers: Genome Medicine announces a special issue on Cancer Epigenomics - BioMed Central blog

special issue on Cancer Epigenomics 

In Spring/Summer 2014, Genome Medicine will publish a special issue focusing on Cancer Epigenomics, guest edited by Stephan Beck (University College London).   
Large-scale sequencing and high-throughput ‘omic  studies of a wide variety of cancers have revealed epigenomic variations, including DNA methylation, histone modification and mutations in genes involved in epigenetic regulation. These have provided mechanistic insights into cancer initiation and progression, and are revealing novel approaches and targets for therapeutic intervention.
This special issue aims to bring together translational findings in cancer epigenomics that have the potential to inform new approaches for screening, diagnosis, prevention and treatment of cancer.
The editors are now accepting submissions of Research, Method, Database, Software and Open Debate manuscripts. The deadline for submissions is January 15^th 2014. The publication of these articles will be coordinated with specially commissioned articles by leaders in the field......