Ovarian Cancer

In their excellent summary of randomized trials examining the management of cancers of the uterus and ovary, Kim and coauthors highlight a significant and worrisome difference that has developed between the two gynecologic malignancies over the past decade, with regard to the direction of clinical research involving chemotherapy. Although it is recognized that cytotoxic chemotherapy is employed in the majority of women with ovarian cancer at initial diagnosis, whereas such treatment is fortunately only required in a minority of individuals with endometrial cancer, it is unclear why there has been such a major divergence in the drugs and combination regimens currently being evaluated in clinical trials.

Historically, two-thirds of patients with endometrial carcinoma had disease confined to the uterus, and the cornerstone of treatment was total abdominal hysterectomy and bilateral salpingo-oophorectomy. Since the introduction of surgical staging in 1988, however, more patients are found to have disease outside the uterine cavity. Unfortunately, the current rules for staging are not followed by every practitioner, and the required specimens for pathologic examination are not always obtained. Therefore, recommendations for postoperative adjuvant therapy are usually based on the surgico-pathologic information available for each patient.

Over the past few decades, we have gained a better understanding of the risk factors associated with the recurrence of endometrial cancer. Adjuvant postoperative radiotherapy in an intermediate-risk group of

The American Cancer Society has estimated that 23,300 women will develop ovarian cancer in 2002, and 13,900 women will die from the disease.[1] The 5-year survival rate is about 80% for women with stage I disease, 50% for women with stage II disease, 25% for women with stage III disease, and 15% for women with stage IV disease. Among women with advanced-stage disease, optimal debulking surgery, as well as platinum/taxane-based adjuvant therapy prolongs disease-free and median survival.[2,3] Population-based data suggest that guidelines for therapy are not uniformly followed in community practice.[4] In addition, older patients appear to receive less aggressive treatment than younger patients.

Pancreatic cancer is a leading cause of cancer-related mortality. Treatment has limited efficacy, and 5-year survival rates remain less than 5%. Insights from epidemiology and discoveries in molecular genetics have laid

ORLANDO-Interim results from a phase I/II clinical trial of patients with recurrent ovarian, fallopian tube, or peritoneal cancer show that polygutamate (PG)-paclitaxel (CT-2103, Xyotax) controlled disease in about half of the evaluable patients.

Although antitumor activity and a low toxicity profile have been demonstrated for several oncolytic viruses, the development of viral therapy in cancer treatment has been limited by a lack of definitive phase III trials. The use

The American Cancer Society has estimated that in 2002 ovarian cancer will strike 23,300 women, and 13,900 women will die from the disease.[1] Five-year survival is about 80% for women with stage I disease, 50% for women with stage II disease, 25% for women with stage III disease, and 15% for women with stage IV disease. Among women with advanced-stage disease, optimal debulking surgery, as well as platinum/taxane-based adjuvant therapy prolongs disease-free and median survival.[2,3] Population-based data suggests that guidelines for therapy are not uniformly followed in community practice.[4] In addition, older patients appear to receive less aggressive treatment than younger patients.

The management of women at high risk for breast cancer presents a clinical dilemma to the health-care provider as well as to the woman herself. Current options include surveillance, prophylactic surgery (mastectomy and/or

The term "blood substitute" is commonly misused when "red cell substitute" is meant. The ideal red cell substitute should deliver oxygen (O2), require no compatibility testing, cause few side effects, have prolonged storage qualities, persist in the circulation, and be available at reasonable cost. While no drug with all of these qualities is on the near horizon, several early generation red cell substitutes are approaching submission for licensure, at least for limited indications.

For more than 2 decades, combination chemotherapy has been the standard treatment for patients with small-cell lung cancer. Despite high initial response rates in both extensive- and limited-stage disease, long-term survival

Despite the impact of prostate-specific antigen (PSA) testing on the detection and management of prostate cancer, controversy about its usefulness as a marker of disease activity continues. This review, based on a

Handbook of Gynecologic Oncology, edited by Drs. Barakat, Bevers, Gershenson, and Hoskins, is a first-edition clinical handbook formulated primarily for fellows in gynecologic oncology as well as for interested fellows in medical oncology and radiation oncology. The textbook presents concise summaries of the critical issues in the care of gynecologic cancer patients and would also be of interest to residents preparing for their gynecologic oncology rotations, obstetrician/gynecologists, other physicians who care for gynecologic cancer patients, and practicing gynecologic oncologists.

ATLANTA-Ovarian cancer that has metastasized to the abdomen and pelvis can be effectively identified by thin-slice dual-phase imaging and 3D reconstruction with multidetector CT (MDCT) scanning, a technique that appears to be more sensitive and faster than spiral and conventional CT scanners, a new study suggests.

Rubinstein and colleagues provide an excellent review of mathematical models for estimating breast cancer risk, including the risk of carrying inherited mutations of BRCA1 and BRCA2. Since we and others reviewed early models to predict the likelihood of inherited susceptibility to breast cancer,[1] newer quantitative tools, most notably by Parmigiani and colleagues,[2] have been developed. These models have been made available on CD-ROM, over the Internet, and in other electronic versions that are accessible to most clinicians and researchers. These quantitative resources constitute useful and important aids in genetic counseling.

The Cancer Trials Support Unit (CTSU) is a pilot program sponsored by the National Cancer Institute (NCI). The CTSU has two primary functions. It centralizes regulatory support for all adult Cooperative Group trials (phases I- III), thereby reducing duplication among Group members regarding credentialing, compliance with federal regulations, and institutional review board (IRB) activities. It also provides all Group members and select non-Group members with access to phase III treatment trials.

Breast and ovarian carcinomas pose major public health problems in most Western countries. Countless attempts have been made to better understand a patient’s lifetime risk of breast cancer. The most significant etiologic risk is increasing age, followed by family history. In addition, hormonal and reproductive factors-ie, early menarche and later age at menopause, nulliparity (and, therefore, a greater number of ovulations over the patient’s lifetime), and late age at first pregnancy (greater than age 30 years)-also increase a patient’s breast cancer risk.

Women at increased risk of breast cancer have important opportunities for early detection and prevention. There are, however, serious drawbacks to the available interventions. The magnitude of breast cancer risk is a crucial factor in the optimization of medical benefit when considering the efficacy of risk-reduction methods, the adverse effects of intervention, and economic and quality-of-life outcomes. Breast cancer risk assessment has become increasingly quantitative and is amenable to computerization. The assembly of risk factor information into practical, quantitative models for clinical and scientific use is relatively advanced for breast cancer, and represents a paradigm for broader risk management in medicine. Using a case-based approach, we will summarize the major breast cancer risk assessment models, compare and contrast their utility, and illustrate the role of genetic testing in risk management. Important considerations relevant to clinical oncology practice include the role of risk assessment in cancer prevention, the logistics of implementing risk assessment, the ramifications of conveying risk information with limited genetic counseling, and the mechanisms for genetics referral. Medical professionals can embrace new preventive medicine techniques more effectively by utilizing quantitative methods to assess their patients’ risks. [ONCOLOGY 16:1082-1099, 2002]

Both irinotecan (CPT-11, Camptosar) and epirubicin (Ellence) are significant chemotherapeutic agents that are used in the management of many different cancers. Each agent works through the inhibition of topoisomerases, and inhibition of topoisomerases I and II may possibly result in significant clinical synergy. This phase I clinical study represents an investigation of the first combination of irinotecan and epirubicin in patients with advanced cancer.

LEICESTER, England-Pegylated liposomal doxorubicin (Doxil/Caelyx) performs as well as paclitaxel (Taxol) in the treatment of relapsed ovarian cancer, according to a clinical trial that was stopped when paclitaxel won approval for first-line treatment in Europe. The trial was nearly forgotten, but then a second look at the results suggested that pegylated liposomal doxorubicin might be preferred for some patients who have musculoskeletal disorders or are troubled by the prospect of developing alopecia as a side effect (ASCO abstract 808).

BALTIMORE-Giving paclitaxel (Taxol) and cisplatin (Platinol) in an intensive intraperitoneal (IP) regimen increased progression-free survival by 5 months over standard intravenous (IV) treatment for stage III epithelial ovarian carcinoma and primary peritoneal carcinoma in a phase III clinical trial (ASCO abstract 803).

CHICAGO-Adding paclitaxel (Taxol) and G-CSF support to the standard regimen of doxorubicin and cisplatin (Platinol) improved response rates and increased survival by about 3 months for patients with advanced or recurrent endometrial cancer in a randomized controlled phase III trial conducted by the Gynecologic Oncology Group (GOG) (ASCO abstract 807).

Aggressive ovarian cancer may be linked to the presence of thrombocytosis, report investigators from Cedars-Sinai Medical Center in Los Angeles.

Most Men Don’t Need Yearly PSA Screening: PLCO Study

NEW YORK-Treatment of ovarian cancer can cause side effects that have a significant impact on patients’ everyday lives, including walking, according to Lois Almadrones, RN, MS, MPA, clinical nurse specialist, Gynecology Service, Memorial Sloan-Kettering Cancer Center in New York. Speaking at an industry-sponsored symposium held in conjunction with the Oncology Nursing Society annual meeting, she outlined approaches to improve the management of palmar-plantar erythrodysesthesia (PPE), peripheral neuropathy, and hypersensitivity to some chemotherapeutic agents.

WASHINGTON-A survey of 110 Hispanic women at elevated risk for breast and/or ovarian cancer revealed a high degree of interest in genetic testing but a low level of knowledge about their own objective risk of getting these cancers, Martha P. Martinez, PsyD, said at the American Psychological Association Conference on Enhancing Outcomes in Women’s Health. Dr. Martinez is a voluntary instructor of medicine at the University of Miami School of Medicine.

DALLAS-With "significant improvement" in both progression-free and 5-year survival of patients with ovarian cancer, "quality of life becomes important," stated Alan N. Gordon, MD, director of research in gynecologic oncology in the Division of Oncology at Texas Oncology in Dallas.

SAN FRANCISCO-Haptoglobin-alpha, a subunit of the hemoglobin-binding protein haptoglobin, may be a useful marker for ovarian cancer, according to results presented at the 93rd Annual Meeting of the American Association for Cancer Research (abstract 3687).

TORONTO-Beyond its physical effects, ovarian cancer presents women with difficult emotional, social, and spiritual challenges every step of the way. Each of the disease’s phases, from the first suspicions of something seriously wrong, through diagnosis, treatment, survival, possible relapse, and terminal disease, has its own particular psychosocial impact and its own set of needs, said Margaret I. Fitch, RN, PhD, at an industry-sponsored symposium held in conjunction with the Oncology Nursing Society annual meeting.

Docetaxel (Taxotere) has extended the armamentarium of agents with significant activity in the treatment of ovarian cancer. As a single agent in advanced ovarian cancer patients previously treated with a platinum agent, docetaxel at 100 mg/m² every 3 weeks yields a 30% overall response rate and a 6-month duration of response.