Ovarian Cancer

WASHINGTON--Interim results from an on-going Italian chemopreven-tion trial of a synthetic retinoid show a "borderline significant" protective effect against contralateral breast cancer and, to a lesser degree, against ovarian cancer, but only in premenopausal women.

Almost exactly one decade ago, in an editorial published in the New England Journal of Medicine [1], I noted that "progress is slow but sure" in the development of monoclonal antibodies for clinical use. At that time, only muromonab-CD3 (Orthoclone OKT3) was approved for human use to prevent rejection of kidney transplants. In the ensuing 10 years, only one oncologic monoclonal antibody product, satumomoab pendetide (OncoScint CR/OV, Cytogen, Princeton, New Jersey) [2] has been approved by the FDA. Progress surely has been slow.

Monoclonal antibodies (MoAbs) of murine origin, when labeled with radionuclides that emit gamma rays, target tumors, permitting detection of disease. SatumoMoAb pendetide (Oncoscint CR/OV), a murine MoAb, was

Over the past 5 years, many new cytotoxic agents with activity against metastatic cancer have been discovered, and several are currently undergoing clinical trials. Whether their marked degree of activity represents a real

This review focuses on the clinical utility and potential value of cell cycle analysis and DNA ploidy interpretation in the diagnosis of human tumors, the application of these techniques to cytologic diagnosis, and their capability

Molecular oncology, as it relates to cancer formation, growth, metastasis, and treatment, is a rapidly progressing and exciting field. Its forward movement is so fast that even scientific journals, because of publication delays, are unable to keep readers informed in a timely manner. What, therefore, is the role of a textbook on molecular oncology?

BETHESDA, Md--The FDA's Oncologic Drugs Advisory Committee (ODAC) has unanimously recommended approval of SmithKline Beecham's Hycamtin (topotecan HCl) for the treatment of patients with metastatic ovarian cancer after failure of initial or subsequent chemotherapy.

PALO ALTO, Calif--ALZA Corporation and U.S. Bioscience, Inc. have announced the availability of Ethyol (amifostine), which was FDA approved in December, 1995.

CHICAGO--The Society of Gynecologic Oncologists (SGO) and the Gynecologic Cancer Foundation (GCF) presented awards in four categories at the SGO's 27th annual meeting in New Orleans. The awards are funded by the GCF and were chosen from the more than 115 abstracts presented at the meeting.

LONDON--Women who have persistent elevations in the serum marker CA 125 may be at substantially increased risk for ovarian cancer, a large study of women in the United Kingdom has shown.

NEW ORLEANS--Intraperitoneal (IP) administration of cisplatin (Platinol) plus IV cyclophosphamide produced an improved outcome over IV cisplatin plus IV cyclophosphamide in a pivotal phase III ovarian cancer trial, intergroup study 0051 (SWOG-GOG-ECOG), researchers reported at the Society of Gynecologic Oncologists meeting.

In the past, the mere mention that a patient with persistent or recurrent pelvic cancer might benefit from a palliative pelvic exenteration was met with vigorous opposition. This was due, in part, to the fact that the term "palliative pelvic exenteration" was new and not clearly defined. There was also concern that the mortality, morbidity, and overall cost previously associated with pelvic exenterative procedures were out of keeping with the concept of palliation for cancer. However, much experience with pelvic exenterative surgery has been gained during the past 40 years, and the mortality, morbidity, length of stay, and overall cost of the procedure have decreased significantly. This has made the concept of pelvic exenteration for palliation reconcilable in carefully selected patients in the 1990s.

It is widely accepted that the causation of cancer is the result of environmental exposures (including endogenous hormone exposure) and genetic susceptibility. Ultimately, to prevent breast cancer, we must understand both the environmental and genetic components.

Early trials of an antibody engineered to target two different antigens suggest that the approach may improve the effectiveness of immunotherapy in selected malignancies.

SEATTLE--Genetically modified hematopoietic cells are being used to protect healthy stem cells from toxic drugs in early clinical trials and, in cell lines, to sensitize cancer cells to toxic drugs and to induce leukemia cells to revert to a normal phenotype, Albert Deisseroth, MD, PhD, said at a symposium held in conjunction with the American Society of Hematology meeting. Dr. Deisseroth is associate director for clinical research, Yale University Cancer Center.

Topotecan HCl, an investigational anticancer drug, has demonstrated significant antitumor activity in previously treated small-cell lung cancer (SCLC) patients, according to European Organization for Research and Treatment of Cancer (EORTC) researchers, who presented phase II trial data at the Eighth European Conference on Clinical Oncology, Cancer Research and Cancer Nursing (ECCO-8) in Paris.

SmithKline Beecham plans to launch a study of topotecan HCl, an investigational anticancer drug, in combination with cisplatin (Platinol) for the first-line treatment of ovarian cancer. The development of this protocol was announced at the Eighth European Conference on Clinical Oncology, Cancer Research and Cancer Nursing (ECCO-8) in Paris.

PHILADELPHIA--Women with advanced ovarian cancer had 50% longer survival when they received a first-line regimen combining paclitaxel (Taxol) and cisplatin (Platinol), says William P. McGuire, MD, and his colleagues in the Gynecology Oncology Group (GOG).

The authors offer a comprehensive overview of familial cancer risk counseling, providing both a general definition of this new genetic counseling specialty and specific components of the counseling process. Genetic counseling is, by and large, a referral service, and this is also true of cancer risk counseling. This places great importance on the health-care provider's ability to recognize families who may be at increased risk for an inherited form of cancer and should be referred for cancer risk counseling. It seems reasonable, therefore, to consider the issues relevant to making such a referral, including information on collecting an initial cancer history, strategies for handling a positive history, and the realities of DNA-based testing.

The authors have compiled an excellent summary of the basic components of cancer risk counseling and the role of the genetic counselor in this process. They note that such counseling may have a different scope, depending on the individual's level of risk. They also point out that the approach to each case tends to be unique, due to individual psychological concerns, interpretation of family history and available risk data, and options for genetic testing and prevention or early detection. I would like to expand on the topics discussed in four major areas: counseling cancer survivors, the role of oncologists and primary-care physicians in cancer risk counseling, informed consent issues, and directions of current and future research.

Drs. Lerman and Croyle provide a quite thorough review of an area in need of continuing research-ie, patients' behavioral and emotional responses to genetic testing for cancer susceptibility. The authors present current information on what we do and don't know about the psychological characteristics of individuals likely to undergo testing, possible adverse reactions, issues specific to the genetic counseling process, family coping and adaptation, and possible ways of managing psychological sequelae of genetic testing. Admirably, the authors note that much of their discussion should be considered speculative until more empirical data specific to genetic testing is available. Given this "state of the science," I will raise some additional questions based on some of the statements made by Drs. Lerman and Croyle.

During the past few decades, cancer patients have sued their physicians for negligence in diagnosing or managing their disease, based on the charge that the clinician failed to consider the patient's genealogy when trying to arrive at a diagnosis. Other suits have charged that the clinician is liable for failing to investigate other members of the cancer patient's family, regardless of whether they were his or her patients.

As genetic testing for susceptibility to cancer becomes more widely available, cancer-care providers will become more involved in counseling patients about cancer risks and the meaning of genetic test results. As a result, oncologists and oncology nurses need to be aware of the unique psychological issues and challenges posed by genetic testing for cancer susceptibility. This paper first describes a psychological profile of individuals who are likely to opt for such testing, based on extrapolation from studies of people at high risk of cancer.

Increased knowledge about inherited susceptibility for cancer and the identification of genes associated with cancer risk has increased the need for individuals with training in genetics to work closely with oncology professionals in the familial cancer arena. Genetic counselors can provide a variety of useful services: They may function as clinical coordinators of a family cancer risk counseling (FCRC) program and serve as study coordinators on research teams.

Multiple endocrine neoplasia type 2 (MEN-2) is characterized by medullary thyroid carcinoma in combination with pheochromocytomas and, sometimes, parathyroid adenomas. Since 1993, the psychosocial implications of DNA analysis for MEN-2 have been studied in the Netherlands. This article summarizes the first results of that study. Individuals who applied for DNA analysis cited the need to reduce uncertainty as the major reason for wanting the test. An unfavorable test outcome resulted in anxiety and depression but also relief.

Topotecan HCl, an investigational anticancer drug, has demonstrated significant antitumor activity in previously treated small-cell lung cancer (SCLC) patients, according to European Organization for Research and Treatment of Cancer (EORTC) researchers, who presented phase II trial data at the Eighth European Conference on Clinical Oncology, Cancer Research and Cancer Nursing (ECCO-8) in Paris.

Recent dramatic advances in the understanding of inherited susceptibility to several common adult-onset cancers have made possible the identification of individuals who may be at significantly increased risk of developing malignant disease. These advances may translate into some of the first opportunities for cancer prevention.

This special reference on genetic counseling in cancer is timely, given the explosive progress that has been made in cancer

Recent identification of gene mutations responsible for hereditary nonpolyposis colorectal cancer (HNPCC) has made possible the presymptomatic diagnosis of at-risk family members. If DNA testing shows that a family member is a gene carrier, that individual's lifetime cancer risk is approximately 90%. If the test is negative, the family member's cancer risk drops to that of the general population.

The discovery of inherited gene mutations that increase the risk of certain cancers could greatly expand the use of predictive genetic testing in healthy individuals. In families with hereditary forms of cancer, the use of genetic tests to determine whether family members have inherited suseptibility mutations (ISMs} may improve out come.