The HEROIC Registry, Hereditary Cancer Research Champions | AliveAndKickn

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The HEROIC Registry, Hereditary Cancer Research Champions
 

HEROIC Registry - Hereditary Cancer Research Champions

SHARE... Answer as many questions as you would like, and control how and with whom that information is shared. CONNECT... Find out how you compare to others, and let support and helpful resources come to you. DISCOVER... If you wish, let researchers access your information to help spark innovation for all. Simply click on Start Now! to begin, or Sign In if you are a returning user....

Hereditary cancer foundation launches Lynch Syndrome patient registry

 GI news: Lynch Syndrome patient registry

 AliveAndKickn has announced the launch of the HEROIC Registry, a genetic database for people with Lynch Syndrome to share data and further research, according to a press release.

“If other Lynch patients are like me they will want their data shared with researchers to get a better understanding of how to manage their condition and get involved with research studies and clinical trials,” David Dubin, founder of AliveAndKickn and three-time Lynch cancer survivor, said in the press release. “This registry will enable me as a patient to truly make a difference in the research of this condition.”

The registry will enable researchers to utilize patient data in their efforts to better understand the mutations, perform clinical trials and develop new treatments, according to the press release. Patients will have control over what data are provided.

Patients Teaching Patient Safety

medscape

Postgraduate Medical Journal

The Challenge of Turning Negative Patient Experiences Into Positive Learning Opportunities

print version (text all on one page)

Conclusion

It seems evident that before educators broadly engage patients and families in patient safety training, they will need to: (1) know more about the link between the affective impact of patient narratives and long-term learner outcomes; and (2) develop strategies to mitigate potential negative emotional and cognitive impacts on the learner and the patient or family. One suggestion would be to borrow from more well-established educational approaches, such as the use of high-fidelity simulation and SPs, to inform the patient training and faculty development requirements needed to maximise learning outcomes. Understanding exactly how these elements factor into the planning and delivery of patient safety education that involves patient narratives needs further attention, and will rely on a broad range of study methodologies that extend beyond traditional experimental designs. Future research must also focus on better understanding and mitigating the potential harms that patients experience as trainers. Only then can we be confident that we are optimising the use of patient narratives to deliver the best possible patient safety training to our learners.

Google X SVP Jeff Huber to Be CEO of Cancer Research Startup Grail

Cancer Research Startup Grail 

The Ethical Challenges of Compassionate Use (U.S.) - daratumumab

JAMA Network - open access

 Wiki: daratumumab

Online First

Viewpoint | February 11, 2016

¹Division of Medical Ethics, NYU Langone Medical Center, New York, New York
²Janssen Research & Development LLC, Titusville, New Jersey

  Requests for rapid access to agents still under investigation fall into 2 categories—requests for groups of persons with the same disease and requests by individuals. The former are often described as requests for expanded access, the latter as requests for compassionate use. Regulatory bodies in various countries have created various programs for providing greater access to requests from groups, including the creation of expanded-access programs and emergency use waivers for patients who do not qualify for clinical trials. Compassionate use requests have proven to be more difficult to resolve.

Comparison of cancer survival trends (U.S.) of adolescents & young adults with those in children & older adults

abstract
 

BACKGROUND

With prior reports indicating a lack of progress in survival improvement in older adolescents and young adults (AYAs) aged 15 to 39 years with cancer compared with both younger and older patients with cancer, the current analysis provides an update of survival trends of cancers among AYAs, children, and older adults.

METHODS

Data from the National Cancer Institute Surveillance, Epidemiology, and End Results database for 13 regions were used to ascertain survival trends of the 34 most frequent cancers diagnosed in AYAs compared with children and older adults.

RESULTS

As of 2002 through 2006, the 5-year relative survival rate for all invasive cancers in AYAs was 82.5% (standard error, 0.2%). In AYAs, 14 cancers demonstrated evidence of a statistically significant improvement in their 5-year relative survival since 1992. Survival improved less in AYAs than in children for acute myeloid leukemia and medulloblastoma. Fourteen cancers had survival improvements that were found to be less in AYAs compared with older adults, including hepatic carcinoma, acute myeloid leukemia, high-grade astrocytoma, acute lymphocytic leukemia, pancreatic carcinoma, low-grade astrocytoma, gastric carcinoma, renal carcinoma, cancer of the oral cavity and pharynx, Hodgkin lymphoma, ovarian cancer, fibromatous sarcoma, other soft tissue sarcoma, and thyroid carcinoma.

CONCLUSIONS

Improvements in the survival of several cancer types that occur frequently in AYAs are encouraging. However, survival does not appear to be improving to the same extent in AYAs as in children or older adults for several cancers. Further investment in exploring the distinct biology of tumors in this age group, and of their hosts, must be a priority in AYA oncology.

Ototoxicity and cancer therapy

abstract

 Ototoxicity is a well-established toxicity associated with a subgroup of antineoplastic therapies that includes platinum chemotherapy, radiation or surgery involving the ear and auditory nerve, and supportive care agents such as aminoglycoside antibiotics and loop diuretics. The reported prevalence of ototoxicity in patients who have received potentially ototoxic therapy ranges from 4% to 90% depending on factors such as age of the patient population, agent(s) used, cumulative dose, and administration techniques. The impact of ototoxicity on subsequent health-related and psychosocial outcomes in these patients can be substantial, and the burden of morbidity related to ototoxic agents is particularly high in very young children. Considerable interindividual variability in the prevalence and severity of ototoxicity has been observed among patients receiving similar treatment, suggesting genetic susceptibility as a risk factor. The development and testing of otoprotective agents is ongoing; however, to the author's knowledge, no US Food and Drug Administration-approved otoprotectants are currently available. Prospective monitoring for ototoxicity allows for comparison of auditory outcomes across clinical trials, as well as for early detection, potential alterations in therapy, and auditory intervention and rehabilitation to ameliorate the adverse consequences of hearing loss.

Standards and guidelines for observational studies: quality is in the eye of the beholder

open access

 The use of real-world evidence is critical to transforming health care, and policies need to address this issue. Although the availability of multiple standards/guidelines has the potential to improve the quality and credibility of observational studies, there may be unintended consequences. If those guidelines differ from one another, decisions based on one guideline may subsequently be found deficient if measured against a different one.

 

What is new?

Key findings

•

Nine major standards/guidelines for observational studies have areas of disagreement based on a comparison of 23 common elements.

What this adds to what was known?

•

Comparison of the standards/guidelines is presented, along with an assessment of how actionable each is, and a policy discussion of next steps is provided.

What is the implication and what should change now?

•

Lack of standard/guideline agreement may contribute to variation in study conduct.

•

Common standards/guidelines for conducting observational studies will benefit funders, researchers, journal editors, and decision makers.

•

A consensus process to determine a common set of standards/guidelines needs to be established.

 The nine standards/guidelines are as follows: Agency for Healthcare Research Quality (AHRQ): Developing a Protocol for Observational Comparative Effectiveness Research [10]; Comparative Effectiveness Research Collaborative: Observational Study Assessment Questionnaire [11]; European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) Checklist for Study Protocols [12]; ENCePP Guide on Methodological Standards in Pharmacoepidemiology [13]; The United States Food and Drug Administration (FDA): Guidance for Industry Good Pharmacovigilance Practices and Pharmacoepidemiologic Assessment [14]; Good ReseArch for Comparative Effectiveness (GRACE) Checklist [15]; GRACE Principles [16]; ISPOR Good Research Practices for Retrospective Database Analysis Task Force Report (Parts I, II, and III combined) [7], [8] and [9]; and Patient-Centered Outcomes Research Institute (PCORI) Methodology Standards [17].

Screening for Microsatellite Instability in Colorectal Cancer and Lynch Syndrome - A Mini Review

open access (pdf)

The diagnosis of Lynch syndrome is essential since the patient has a high risk for developing many other cancers and needs appropriate surveillance.

Research uncovers more inherited genetic mutations linked to ovarian cancer

ScienceDaily

  "Descriptions of the identity of these genes and their frequency was lacking in the medical literature," Dr. DiSilvestro explains. "The goal of this research was to better define these issues."

More than 1,900 women with ovarian cancer who were identified through the University of Washington gynecologic tissue bank and from various GOG clinical trials made up the study population.

 What the evaluations revealed was that 18 percent of the women with ovarian cancer carried mutations in genes associated with ovarian cancer risk beyond the BRCA1 and BRCA2 genes.

Journal Reference:

1.  Inherited Mutations in Women With Ovarian Carcinoma. JAMA Oncology, 2015; 1 DOI: 10.1001/jamaoncol.2015.5495

   Conclusions and Relevance  Of 1915 patients with OC, 347 (18%) carried pathogenic germline mutations in genes associated with OC risk. PALB2 and BARD1 are suspected OC genes and together with established OC genes (BRCA1, BRCA2, BRIP1, RAD51C, RAD51D, MSH2, MLH1, PMS2, and MSH6) bring the total number of genes suspected to cause hereditary OC to 11.

video (4.26 min) Health Care and Costs Related to Cancer Deaths in 7 Countries

JAMA

Running Time: (4:26)

Oncology Pathways—Preventing a Good Idea From Going Bad

JAMA Network | Viewpoint (open access)

What Are the Side Effects of Immunotherapy?

Insight

 

Learn more about
Immunotherapy

• What Is Cancer Immunotherapy?
• Hot Topics in Immunotherapy and Targeted Therapy
• The Science of PD-1 and Immunotherapy

Is Cancer Survivorship a 'Complex Chronic Condition'?

media

Does it take too long to publish research? : Nature News

open access

Is “Firing” the Patient an Unintended Consequence of Value-Based Payment?

JAMA Forum

Clinical Pathways Need Oncologists in the Driver's Seat

medscape

Horses May Know What You're Feeling, Study Suggests

Blogger's note: for the many ovarian cancer survivors and their love of horses

MedicineNet

Clear cell carcinoma arising in previous episiotomy scar: a case report and review of the literature

open access
 

Background

Malignant transformation of endometriosis associated with episiotomy scar is a rare event, especially histological type of clear cell adenocarcinoma. There are only three clear cell carcinoma in episiotomy scar reported, no standard treatment established.
 

Conclusions

We report a case of clear cell carcinoma arising from episiotomy scar. There are only three clear cell carcinoma in episiotomy scar reported, no standard treatment established. Accumulation of management data on these rare tumors and long-term follow-up of such patients is therefore important.

Case presentation

A 36-year-old woman presented with a two-month history of painless but puritic perineal lump which she noticed was gradually enlarging. The patient’s past gynecological history included frequent vaginitis owing to bad health habits and the lack of professional treatment. Because of discomfort, the patient often scratched the vulva including the lesion of the episiotomy scar for many years. In addition, her past obstetric history was significant. She had a history of a forceps delivery 20 years ago. The postoperative recovery of perineal wound was slow. Several months after delivery, she experienced cyclic perineal pain and swelling of the episiotomy scar. Mifesterone and Medroxyprogesterone acetate injectable suspension (DMPA) were used and the pain was relieved. She had undergone surgical excision of a mass in the episiotomy scar 9 year ago and resequently histological type of endometriosis. DMPA was administrated for one year and then mifesterone for half a year. Medical treatment with Chinese traditional medicine was prescribed after that.....

Sex-Cord Stromal Tumors in Children and Teenagers: 38 children with ovarian SCT

abstract
 

BACKGROUND:

We present the results of the TGM-95 study for gonadal sex-cord stromal tumors (SCT).

METHODS:

Between 1995 and 2005, children (<18 years) with gonadal SCT were prospectively registered. Primary gonadal resection was recommended whenever feasible. Patients with disseminated disease or an incomplete resection received neoadjuvant or adjuvant VIP chemotherapy (etoposide, ifosfamide, cisplatinum).

RESULTS:

Thirty-eight children with ovarian SCT were registered. Median age was 10.7y. Endocrine symptoms were present in 21 cases. The histological diagnoses were as follows: juvenile (23) and adult (3) granulosa cell tumors, Sertoli-Leydig cell tumors (11), and mixed germ cell SCT (1). An initial oophorectomy ± salpingectomy led to complete resection in 23 patients who did not receive adjuvant treatment; two of them relapsed: one achieved second complete remission whereas the other one died of disease. Fifteen patients had tumor rupture and/or malignant ascites: 11 received chemotherapy and did not relapse, four did not receive chemotherapy and relapsed with a fatal outcome in two cases. With a median follow-up of 5.9y, the 5-y EFS and OS rates were respectively 85% and 94%. Eleven patients had localized testicular tumors (median age 0.83y): juvenile granulosa cell tumors (4), Sertoli or Leydig cell tumors (5) and not otherwise specified SCT (2). Treatment was surgery alone with an inguinal orchiectomy. None have relapsed (median follow-up: 5.4y).

CONCLUSIONS:

Childhood SCT carry favorable prognosis. In ovarian SCT, surgery should be complete and non-mutilating. Adjuvant chemotherapy efficiently prevents recurrences in cases of tumor rupture. In childhood testicular SCT, the prognosis is excellent with an inguinal orchiectomy, prompting the debate on testis-sparing surgery.

Male breast cancer in BRCA1 and BRCA2 mutation carriers: pathology data from the Consortium of Investigators of Modifiers of BRCA1/2

open access:
Male breast cancer in BRCA1 and BRCA2 mutation carriers: pathology data from the Consortium of Investigators of Modifiers of BRCA1/2 | Breast Cancer Research | Full Text
 

The lifetime risk of developing MBC has been estimated to be in the range of 1–5 % for BRCA1 and 5–10 % for BRCA2 mutation carriers, compared with a risk of 0.1 % in the general population [6–9].

Conclusions

On the basis of the largest series analysed to date, our results show that BRCA1/2 MBCs display distinct pathologic characteristics compared with BRCA1/2 FBCs (female), and we identified a specific BRCA2-associated MBC phenotype characterised by a variable suggesting greater biological aggressiveness (i.e., high histologic grade). These findings could lead to the development of gender-specific risk prediction models and guide clinical strategies appropriate for MBC management.

Etiology of Ascites and Pleural Effusion Associated with Ovarian Tumors: Literature Review and Case Reports

open access: Etiology of Ascites and Pleural Effusion Associated with Ovarian Tumors: Literature Review and Case Reports of Three Ovarian Tumors Presenting with Massive Ascites, but without Peritoneal Dissemination

Cancer Care Delivery and Women's Health: The Role of Patient Navigation

abstract
 

BACKGROUND:

Patient navigation (PN) is a patient-centered health-care service delivery model that assists individuals, particularly the medically underserved, in overcoming barriers (e.g., personal, logistical, and system) to care across the cancer care continuum. In 2012, the American College of Surgeons Commission on Cancer (CoC) announced that health-care facilities seeking CoC-accreditation must have PN processes in place starting January 1, 2015. The CoC mandate, in light of the recent findings from centers within the Patient Navigation Research Program and the influx of PN interventions, warrants the present literature review.

METHODS:

PubMed and Medline were searched for studies published from January 2010 to October 2015, particularly those recent articles within the past 2 years, addressing PN for breast and gynecological cancers, and written in English. Search terms included patient navigation, navigation, navigator, cancer screening, clinical trials, cancer patient, cancer survivor, breast cancer, gynecological cancer, ovarian cancer, uterine cancer, vaginal cancer, and vulvar cancer.

RESULTS:

Consistent with prior reviews, PN was shown to be effective in helping women who receive cancer screenings, receive more timely diagnostic resolution after a breast and cervical cancer screening abnormality, initiate treatment sooner, receive proper treatment, and improve quality of life after cancer diagnosis. However, several limitations were observed. The majority of PN interventions focused on cancer screening and diagnostic resolution for breast cancer. As observed in prior reviews, methodological rigor (e.g., randomized controlled trial design) was lacking.

CONCLUSION:

Future research opportunities include testing PN interventions in the post-treatment settings and among gynecological cancer patient populations, age-related barriers to effective PN, and collaborative efforts between community health workers and patient navigators as care goes across segments of the cancer control continuum. As PN programs continue to develop and become a standard of care, further research will be required to determine the effectiveness of cancer PN across the cancer care continuum, and in different patient populations.

Factors predicting low patient accrual in cancer clinical trials

open access

 Related articles

Article:  
Predicting Low Accrual in the National Cancer Institute’s Cooperative Group Clinical Trials
JNCI J Natl Cancer Inst (2016) 108 (2): djv324 doi:10.1093/jnci/djv324 First published online December 29, 2015 (7 pages)
• Abstract
• Full Text (HTML)
• Full Text (PDF)
• Supplementary Data
 
Solicited Editorial:  
Predicting Low Trial Accrual Mathematically: Is That the Right Emphasis? JNCI J Natl Cancer Inst (2016) 108 (2): djv379 doi:10.1093/jnci/djv379 First published online December 29, 2015 (2 pages)
• Extract
• Full Text (HTML)
• Full Text (PDF)

Women’s health mission at the MUHC might close: doctors (Montreal)

Montreal Gazette

 Dr. Lucy Gilbert, chief of the MUHC’s gynecologic-oncology division and one of the signatories of the letter, said that under the proposal, the Women’s Health Mission would likely be split between the departments of pediatrics and surgery in the hope of saving up to $12 million a year.

What is the Most Hyped Drug in Cancer Care? (and by whom)

medscape

So who is actually articulating these superlatives?

Mostly, it is journalists (55% of all the superlatives used, with no other attribution). Then, in order of frequency, it is physicians (27%), industry experts (9%), patients (8%), and a member of the US Congress (1%).

Do Some Physicians Need More Education on Advances in Metastatic Cancer Management? - Opinion

Clinical Oncology News

  Yet, quite remarkably, despite extensively reported and validated data regarding objectively impressive improvements in both the quality and quantity of life for individuals diagnosed with advanced or metastatic cancers, these facts do not appear to have reached the consciousness of the entire medical establishment.

Genetic Testing Underused for GI Cancers (Lynch Syndrome vs. BRCA)

Clinical Oncology News (requires login to view - free)

 Although Lynch syndrome is almost as prevalent as hereditary breast and ovarian cancer (HBOC), twice as many patients are undergoing testing for breast and ovarian cancer as for GI cancer syndromes, according to a recent study presented at the 2015 annual meeting of the American College of Gastroenterology (abstract P159)......

 Observing that there were few referrals for GI cancers during the interim analysis of this study, the researchers set out to quantify the extent of the problem. In an analysis of 500 patients, almost twice as many patients received genetic testing for a primary workup of HBOC as for a workup of GI cancer syndromes (66.4% vs. 28.8%). Although newly diagnosed colorectal and gastric cancer constituted 42% of the approximately 1,798 new diagnoses of all breast, ovarian, colorectal and GI cancers at the three centers, only 29% of the tests were ordered for GI indications.

Can I Eat Yet?

JAMA Network

Cancer Survivorship Care: An Opportunity to Revisit Cancer Genetics

open access

Study examines evolution of cancer

ecancer - News

A novel Yale study answers age-old questions about how cancers spread by applying tools from evolutionary biology.
The new insights will help scientists better understand the genetic origins of tumour metastases, and lead to more effective targets for treatment, said the researchers.
The study, led by associate professor of public health (biostatistics) Jeffrey Townsend, was published by the Proceedings of the National Academy of Sciences.
Scientists have long thought that cancer is an evolutionary process that involves cells acquiring mutations that replicate and persist over time, gaining an advantage over normal cells.
But questions remained about the timing and course of tumour progression.....

Circulating estrogens and postmenopausal ovarian cancer risk in the WHI's Observational Study

abstract

Background: Hormonal and reproductive factors contribute to the development of ovarian cancer, but few studies have examined associations between circulating estrogens and estrogen metabolites and ovarian cancer risk. We evaluated whether serum estrogens and estrogen metabolite levels are associated with ovarian cancer risk among postmenopausal women in a nested case-control study in the Women's Health Initiative (WHI) Observational Study (OS).

Editorial: Making a Difference: Distinguishing 2 Primaries From Metastasis in Synchronous Tumors of the Ovary/Uterus

Editorial: abstract

 For women with early-stage ovarian or endometrial cancers, prognosis is very good, with overall survival for both sites between 80% and 90%. This stands in stark contrast to metastatic disease (advanced stage), where the overall survival is less than 15%. We have long recognized that subtypes of disease also inform these statistics, with high-grade serous carcinomas conferring a far worse prognosis compared with others, including low-grade serous or endometrioid tumors. Yet even with our present understanding, a not uncommon finding is the diagnosis of women with carcinoma at both the ovary and the uterus (a situation that occurs in up to 10% of patients), raising the question of synchronous primaries or of metastatic disease. The implications of these clinical senarios are very relevant: If a conclusion of synchronous primaries is made, then prognosis should be excellent and hence no further treatment beyond surgery is required for cure. However, the finding of metastatic disease (from the ovary to the uterus or vice versa) will substantially change the prognostic implications, with these patients having a higher risk of recurrence and death from metastatic disease. In addition, this differential diagnosis can change therapeutic recommendations, with metastatic disease requiring more aggressive adjuvant therapy. Thus, the issue is both a biologic and clinical one.

Massively Parallel Sequencing-Based Clonality Analysis of Synchronous Endometrioid Endometrial and Ovarian Carcinomas

abstract

Synchronous early-stage endometrioid endometrial carcinomas (EECs) and endometrioid ovarian carcinomas (EOCs) are associated with a favorable prognosis and have been suggested to represent independent primary tumors rather than metastatic disease. We subjected sporadic synchronous EECs/EOCs from five patients to whole-exome massively parallel sequencing, which revealed that the EEC and EOC of each case displayed strikingly similar repertoires of somatic mutations and gene copy number alterations. Despite the presence of mutations restricted to the EEC or EOC in each case, we observed that the mutational processes that shaped their respective genomes were consistent. High-depth targeted massively parallel sequencing of sporadic synchronous EECs/EOCs from 17 additional patients confirmed that these lesions are clonally related. In an additional Lynch Syndrome case, however, the EEC and EOC were found to constitute independent cancers lacking somatic mutations in common. Taken together, sporadic synchronous EECs/EOCs are clonally related and likely constitute dissemination from one site to the other.

Synchronous Endometrial and Ovarian Carcinomas: Evidence of Clonality

abstract

 Many women with ovarian endometrioid carcinoma present with concurrent endometrial carcinoma. Organ-confined and low-grade synchronous endometrial and ovarian tumors (SEOs) clinically behave as independent primary tumors rather than a single advanced-stage carcinoma. We used 18 SEOs to investigate the ancestral relationship between the endometrial and ovarian components. Based on both targeted and exome sequencing, 17 of 18 patient cases of simultaneous cancer of the endometrium and ovary from our series showed evidence of a clonal relationship, ie, primary tumor and metastasis. Eleven patient cases fulfilled clinicopathological criteria that would lead to classification as independent endometrial and ovarian primary carcinomas, including being of FIGO stage T1a/1A, with organ-restricted growth and without surface involvement; 10 of 11 of these cases showed evidence of clonality. Our observations suggest that the disseminating cells amongst SEOs are restricted to physically accessible and microenvironment-compatible sites yet remain indolent, without the capacity for further dissemination.

new release: B.C. is taking the right approach to managing cancer of uterus and ovary (dual early stage primaries)

BC Cancer Agency

....The scientists explain the apparent paradox of the same cancer appearing simultaneously as two independent early-stage tumours on two different organs by invoking a novel process they call “pseudo-metastasis”. They propose that the process is distinct from usual metastasis in that the cancer likely spreads through the fallopian tube, not the blood stream, and that the host organs (ovary and uterus) provide a unique environment where these cancers are initially constrained.     

“Pseudo-metastasis is still something of a mystery,” says Dr. Michael Anglesio, lead author and Research Associate in the department of Molecular Oncology at the BC Cancer Agency. “Whether the initial event takes place in the ovary or the endometrium, and what keeps cells temporarily restricted to these special organs without metastasizing to the rest of the body, are things that we are now researching.”.....

 

.....Meanwhile, a highly complementary study from Memorial Sloan Kettering Cancer Center (MSKCC), published in the same issue of JNCI, is giving both research teams overwhelming confidence in their findings. 

“We are delighted that the findings of our studies are in agreement,” says Dr. Britta Weigelt, Assistant Member of the Department of Pathology at MSKCC. “Together, these studies have resulted in a paradigm shift in the way SEO cancers are perceived. By bringing together pathology and genetics, we have solved a long standing biological question and clinical dilemma.”....

Continuous Low-Dose Oral Cyclophosphamide and Methotrexate as Maintenance Therapy in Patients With Advanced Ovarian Carcinoma After Complete CR to Platinum + Paclitaxel Chemotherapy

open access - Egypt

• Article as PDF (482 KB)

 Continuous Low-Dose Oral Cyclophosphamide and Methotrexate as Maintenance Therapy in Patients With Advanced Ovarian Carcinoma After Complete Clinical Response to Platinum and Paclitaxel Chemotherapy

Abstract

Purpose: The aim of this study was to evaluate efficacy and safety of continuous, low dose of oral, metronomic chemotherapy as maintenance therapy in patients with advanced ovarian carcinoma after complete clinical response to platinum and paclitaxel chemotherapy.

Patients and Methods: In this nonrandomized study, patients older than 18 years, with Eastern Cooperative Oncology Group performance status less than 2, with advanced ovarian carcinoma after complete clinical response to platinum and paclitaxel chemotherapy were enrolled in 2 arms-arm A (maintenance arm), treated with continuous low-dose oral cyclophosphamide 50 mg and methotrexate 2.5 mg, and arm B (observation arm). Both arms were followed up for progression-free survival and toxicity.

Results: Thirty patients were accrued in each arm from January 2009 to December 2010 in Ain Shams University Hospitals, where they received the treatment and followed up for disease progression and toxicity. Patients had a median age of 53 years in maintenance arm and 52.5 years in the observational arm, respectively. Over 80% had papillary serous adenocarcinoma, and over 40% of them had a stage IV disease in both arms. After median follow-up of 27 months, patients achieved median progression-free survival of 18 months in maintenance arm (A) and 15.5 months in observational arm (B), respectively. Toxicity profile was excellent with no grade 3 or 4 toxicity reported.

Conclusions: Current study may provide an evidence of efficacy and tolerability of continuous low-dose oral cyclophosphamide and methotrexate as a maintenance therapy in patients with advanced ovarian carcinoma after complete clinical response to platinum and paclitaxel chemotherapy.

Persistent Neuropathy Increases Fall Risk among (female) Cancer Survivors

1) NCI

2) The study findings were presented on January 11 at the 2016 Cancer Survivorship Symposium in San Francisco

Safety Issues Raised in Key Trial Supporting Rivaroxaban Use

PracticeUpdate

Understanding inherited genetic risk of adult glioma – a review

open access

 ..... In this paper, we review current knowledge about inherited risk for primary adult glioma, specifically, glioblastoma, and grade II/III astrocytoma, oligodendroglioma, and oligoastrocytoma. We also discuss how inherited risk varies by histology and molecular subtypes characterized by acquired mutations. An information sheet is appended to help patients and their families understand these important concepts.....That several rare hereditary cancer syndromes greatly increase risk of glioma has been known for many years. These familial syndromes include neurofibromatosis, tuberous sclerosis, Lynch syndrome, Li-Fraumeni syndrome, melanoma-neural system tumor syndrome, and Ollier disease (Table 1).¹⁴

 It is very important to understand that inherited genetic risk variants, whether common or rare, with low or high penetrance, are neither necessary nor sufficient for glioma formation – rather, they contribute to risk. Even for people with familial syndromes, additional acquired mutations are required for tumorigenesis. Moreover, not everyone who inherits the same mutation necessarily develops cancer or the same type of cancer.

 Understanding inherited genetic risk of adult glioma – a review

Supplementary Data

Supplementary Data

• Supplementary Data - docx file
• Supplementary Table 1 - docx file
• Supplementary Table 2 - docx file

Table 1. Rare hereditary cancer syndromes that increase risk of glioma

Impact of Age at Primary Breast Cancer on Contralateral Breast Cancer Risk in BRCA1/2 Mutation Carriers

open access

Is Cancer Pain Control Improved by a Simple WHO Pain Analgesic Ladder Approach Combined With Tumor-Directed Treatment?

open access
 

The practical use of the WHO analgesic ladder has evolved over time; is there a need for a formal change? Taking into consideration that pain is the symptom most feared by patients and families, and that studies have demonstrated that 90% of patients with cancer experience pain¹ and only 50% receive adequate pain control in unselected cancer cohorts,² there is an urgent need for improvement. The solutions are clearly more complex than simply changing the WHO analgesic ladder. Systematic pain diagnosis during oncology consultations should be incorporated as a minimum requirement into standard inpatient and outpatient consultations. However, it is debatable how to address symptom management in general and pain management specifically in consultations where the primary focus is often how to treat the tumor and prolong life. Cancer pain is affected by many variables, such as tumor type and site, the extent of the disease, cancer therapy, and host factors (sex, genomics, and psychologic and social factors, among others), which challenge a simple solution to pain diagnosis. Is it possible to simplify both pain classification and management, with improved overall pain control as a result?

In the article that accompanies this editorial, Bandieri et al³ challenge the concept of the WHO analgesic ladder.....
 

• See accompanying article on page 436

Gene family turns cancer cells into aggressive stem cells that keep growing

medical news (in research)

Journal Reference:

1. Linlin Luo, Peter Mcgarvey, Subha Madhavan, Rakesh Kumar, Yuriy Gusev, Geeta Upadhyay. Distinct lymphocyte antigens 6 (Ly6) family members Ly6D, Ly6E, Ly6K and Ly6H drive tumorigenesis and clinical outcome. Oncotarget, 2016 DOI: 10.18632/oncotarget.7163

Satisfaction with cancer care among underserved racial-ethnic minorities and lower-income patients receiving patient navigation

abstract

Contemporary Evaluation and Management of Upper Tract Urothelial Cancer

abstract

 Radical nephroureterectomy with en bloc bladder cuff excision and regional lymphadenectomy is the gold standard for the management of high-grade and high-risk upper tract urothelial carcinomas (UTUC). There are few prospective randomized controlled studies in this uncommon and often aggressive disease to support level-1 management guidelines. However, recent developments in imaging, minimally invasive techniques, lymphatic dissemination, and bladder cancer prevention raise the hope for improved risk stratification and treatments without compromising, and hopefully improving, oncological outcomes. Multi-modality approaches in terms of neoadjuvant, adjuvant topical and systemic chemotherapeutic regimens are promising, with 2 prospective trials either open or in development.

Polyphenols (EUFIC)

Polyphenols (EUFIC)
 
What are polyphenols?
The antioxidant hypothesis
Polyphenols and health 
Conclusion

Inhibitory Effects of the Four Main Theaflavin Derivatives Found in Black Tea on Ovarian Cancer Cells

abstract

BACKGROUND:

Some polyphenols induce apoptosis and inhibit angiogenesis. Consumption of black tea, rich in polyphenols, has been found to reduce ovarian cancer risk. Theaflavin (TF1), theaflavin-3-gallate (TF2a), theaflavin-3'-gallate (TF2b) and theaflavin-3, 3'-digallate (TF3) are four main theaflavin derivatives found in black tea.

MATERIALS AND METHODS:

Cell proliferation assay, Hoechst 33342 staining assay, Caspase-Glo Assay, western blot, human umbilical vein endothelial cell tube formation assay and vascular endothelial growth factor (VEGF) enzyme-linked immunosorbent assay were performed.

RESULTS:

All four theaflavin derivatives reduced viability of ovarian cancer cells at lower concentrations than with normal ovarian cells. TF1 mainly mediated apoptosis via the intrinsic pathway, while the others via the intrinsic and extrinsic pathways. TF1 inhibited tube formation via reducing VEGF secretion in a hypoxia-inducible factor 1α-independent manner, while the others in a HIF1α-dependent way.

CONCLUSION:

All four theaflavin derivatives inhibited ovarian cancer cells. Some of the effects and mechanisms of TF1 are different from those of the other three theaflavin derivatives.

Oral mucosal stigmata in hereditary-cancer syndromes: From germline mutations to distinctive clinical phenotypes and tailored therapies

abstract
 

Highlights

•

Several familial-cancer syndromes include distinctive oral mucosal lesions.

•

Their genetic background involve germline mutations in tumor suppressor genes.

•

A multidisciplinary approach is crucial for management of the gene-carriers probands.

•

An early onset of oral disease may lead to genetic testing in suspected probands.

•

The advancements in this field lead to the development of targeted therapies.

Abstract

Numerous familial tumor syndromes are associated with distinctive oral mucosal findings, which may make possible an early diagnosis as an efficacious marker for the risk of developing visceral malignancies. In detail, Familial Adenomatous Polyposis (FAP), Gardner syndrome, Peutz-Jeghers syndrome, Cowden Syndrome, Gorlin Syndrome, Lynch/Muir-Torre Syndrome and Multiple Endocrine Neoplasia show specific lesions of the oral mucosa and other distinct clinical and molecular features. The common genetic background of the above mentioned syndromes involve germline mutations in tumor suppressor genes, such as APC, PTEN, PTCH1, STK11, RET, clearly implied in both ectodermal and mesodermal differentiation, being the oral mucosal and dental stigmata frequently associated in the specific clinical phenotypes. The oral and maxillofacial manifestations of these syndromes may become visible several years before the intestinal lesions,

Sensitivity of ovarian cancer cells to acetaminophen reveals biological pathways that affect patient survival

technical - in research - open access (abstract & pdf)

Received February 11, 2015; Accepted November 16, 2015

Genetic testing for Lynch syndrome: family communication and motivation

open access (pdf)

.....In the Netherlands the communication regarding presence of a LS gene mutation within a family occurs by means of the family-mediated approach. When a pathogenic mutation is detected the counselee is asked to inform all at risk relatives. During the counselling process, communication strategies to inform relatives are discussed with the counselee. Furthermore a letter to inform relatives is supplied. This approach implies that family members are responsible to inform their relatives on the diagnosis of LS and the possibility of genetic testing. Currently, little is known about patients’ experiences with andattitudes towards this family-mediated approach.....