Body Weight Makes No Difference in Ovarian Cancer Survival May 25, 2009
Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.Tags: body weight, chemotherapy, Epithelial ovarian cancer, obesity, ovarian cancer, survivor rates
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Body Weight Makes No Difference in Ovarian Cancer Survival
By Todd Neale, Staff Writer, MedPage Today
Published: December 30, 2008
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
BIRMINGHAM, Ala., Dec. 30 — Obese patients with epithelial ovarian cancer do not appear to have worse survival than their slimmer counterparts, a retrospective chart review showed.
Obese and non-obese patients had similar progression-free survival (17 versus 11 months, P=0.14) and overall survival (48 versus 40 months, P=0.37) following primary cytoreductive surgery that resulted in similar rates of optimal debulking, Kellie Matthews, M.D., of the University Alabama at Birmingham, and colleagues reported online in Gynecologic Oncology.
All patients received chemotherapy administered according to their actual body weight. Often, chemotherapy is administered based on ideal weight, which may lead to insufficient doses for obese patients, according to the researchers.
Some past studies have suggested that obesity is an independent predictor of lower survival in patients with epithelial ovarian cancer, but others have not. Few have included information on differences in rates of optimal debulking between obese and non-obese patients, the researchers said.
To explore the issue, they reviewed charts for 304 patients with FIGO stages II to IV epithelial ovarian cancer from a gynecologic oncology database from 1996 to 2005.
All patients underwent primary cytoreductive surgery followed by IV taxane and platinum-based chemotherapy dosed according to actual body weight.
Nearly a quarter (23.4%) were obese and the rest had a body mass index of less than 30 kg/m2.
Obese and non-obese patients had similar disease stage, grade, and histology, rates of platinum sensitivity, and administration of chemotherapy.
Obese patients were significantly more likely to be younger than 65 (P=0.02) and to be black (P=0.01).
There were no significant differences between the groups in estimated blood loss, time spent in the operating room, or operative complications. Only wound complications were more common in the obese group (11% versus 2%, P<0.001).
Rates of optimal debulking — defined as a lack of residual tumors greater than 1 cm in diameter — were similar in obese and non-obese patients (52% versus 51%, P=0.88), in spite of potential challenges to the surgical treatment of obese patients.
Such potential difficulties include comorbid chronic illnesses, administration of anesthesia, operative complications, and technical challenges, the researchers said.
“This demonstrates that any disadvantage obesity affords in the treatment of ovarian cancer is likely not related to the surgeon’s ability to achieve optimal cytoreduction,” the researchers said.
Although obese patients had a lower recurrence rate (68% versus 79%, P=0.04), there were no significant differences in progression-free and overall survival between the two groups.
The authors acknowledged that the study had several limitations, including the retrospective design, a trend toward poorer outcomes in underweight women that could not be compared with outcomes in obese women because of small patient numbers, potential selection bias, and optimal debulking rates that were lower than those found in other studies.
Incorporating Laparoscopy in the Practice of a Gynecologic Oncology Service: Actual Impact Beyond Clinical Trials Data. May 25, 2009
Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.Tags: Laparoscopy; Gynecologic Oncology; long-term survival; endometrial cancer; early-stage; cancer outcome;blood transfusions
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Incorporating Laparoscopy in the Practice of a Gynecologic Oncology Service: Actual Impact Beyond Clinical Trials Data.
Ann Surg Oncol. 2009 May 21
Ghezzi F, Cromi A, Uccella S, Siesto G, Zefiro F, Bolis P.
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy, fabio.ghezzi@uninsubria.it.
BACKGROUND: Feasibility and safety of laparoscopic management of gynecologic cancers have been established by numerous clinical trials. However, the degree to which such results are achievable outside the context of formal research programs and the actual extent of laparoscopy uptake since its introduction are unclear. Purpose of this study was to examine the impact upon operative and cancer outcomes of the incorporation of laparoscopy into the surgical practice of our gynecologic oncology service.
METHODS: Data from 383 consecutive women undergoing surgery for the treatment of an apparently early-stage gynecologic cancer between 2000 and 2008 were analyzed. Integration of minimally access surgery for the treatment of invasive malignancies began with borderline ovarian tumors in 2001 and proceeded sequentially to include endometrial, ovarian, and cervical cancer patients.
RESULTS: The annual proportion of laparoscopic cases has increased significantly over the study period from 7.7% in 2001 to 90.9% in 2008 (P < 0.0001 for trend). A temporal trend toward reduction in estimated blood loss was observed in both endometrial cancer and cervical cancer patients (P < 0.0001). There was a significant decrease in the percentage of patients requiring blood transfusions [18 (17.1%) during the period 2000-2002, 19 (13.6%) during 2003-2005, and 8 (5.8%) during 2006-2008; P = 0.005 for trend]. Length of hospital stay has decreased significantly over time for all disease sites (P < 0.0001 for endometrial and cervical cancer; P = 0.02 for ovarian cancer). No difference was found in median operative time, number of lymph nodes harvested, complication rates, 1- and 2-year disease-free survival, and overall survival when data of subsequent time periods were compared.
CONCLUSIONS: Substantial utilization of laparoscopy in the existing practice of a gynecologic oncology service provided benefits to patients without detrimental effects on clinical outcomes. The relatively short follow-up time of laparoscopic cases disallows firm conclusions on long-term survival.
The biology of ovarian cancer: new opportunities for translation. May 25, 2009
Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.Tags: cytotoxic drugs, individual strategy; cancer cell, outcome, surgery, survival rates, treatmebt
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The biology of ovarian cancer: new opportunities for translation.
Bast RC Jr, Hennessy B, Mills GB.
Departments of Experimental Therapeutics and Systems Biology, University of Texas M. D. Anderson Cancer Center, 1515 Holcolmbe Boulevard, Houston, Texas 77030, USA.
Over the past two decades, the 5-year survival for ovarian cancer patients has substantially improved owing to more effective surgery and treatment with empirically optimized combinations of cytotoxic drugs, but the overall cure rate remains approximately 30%. Many investigators think that further empirical trials using combinations of conventional agents are likely to produce only modest incremental improvements in outcome. Given the heterogeneity of this disease, increases in long-term survival might be achieved by translating recent insights at the molecular and cellular levels to personalize individual strategies for treatment and to optimize early detection.
Annette Mattern: What Every Woman Should Know About Ovarian Cancer January 4, 2009
Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.Tags: BRCA1, BRCA2 gene, CA-125 blood test, ovarian cancer, pelvic exam, symptoms, trans-vaginal ultrasound
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Annette Mattern: What Every Woman Should Know About Ovarian Cancer
“How do I know if I have ovarian cancer?” the question most asked by women about the disease that, for years, was called the silent killer. Ovarian cancer is the fifth leading cause of cancer-related death among U.S. women and yet, most women know very little about it.
What you should know:
1. Every woman is at risk.
2. One is 72 women will develop ovarian cancer; one in 95 women will die from it.
3. Increased risk factors:
• Personal history of breast cancer
• Family history of breast or ovarian cancer.
• BRCA1 or BRCA2 genes, responsible for 5-10% of ovarian cancers. Women of Ashkenazi Jewish descent are at higher risk of carrying these mutations.
4. There is no screening tool, not even the PAP, so it is critical that women recognize the symptoms as early as possible.
• Stage I recurrence rate is only 10%.
• Stage III or IV (about 75% of cases) recur 85-95% of the time. Their 5-year survival rate is only 46%.
5. 95% of women with ovarian cancer experience symptoms, 90% at early stage. Symptoms:
• Bloating
• Pelvic or abdominal pain
• Difficulty eating or feeling full too quickly
• Urinary urgency or frequency
Other symptoms: fatigue, indigestion, back pain, pain with intercourse, constipation and menstrual irregularities.
What you should do:
If you exhibit persistent symptoms for more than a few weeks and this is not normal for your body, see a gynecologist. Your exam may include a CA-125 blood test, pelvic exam, and a trans-vaginal ultrasound. The only conclusive way to determine if it is cancer is by performing a biopsy.
Help spread the word.
Most women with ovarian cancer were misdiagnosed for years while their cancer spread. An earlier diagnosis is a woman’s best hope for a good prognosis.
Bio notes:
Annette Mattern is a 21-year survivor of ovarian cancer and recently survived breast cancer. She is the founder and president of the Ovarian Cancer Alliance of Arizona and serves on the board of directors of the Ovarian Cancer National Alliance. Her book on survival, Outside The Lines of Love, Life, and Cancer, is available on www.amazon.com.
Links: www.ocaz.org
www.ovariancancer.org
Tumour suppressing gene key to ovarian cancer regeneration January 4, 2009
Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.Tags: aplasia Ras homolog member I, ARHI, cancer cell death, dormant cancer cell, tumor supressing gene
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Tumor suppressing gene key to ovarian cancer regeneration Washington (IANS):
A single tumour-suppressing gene is a key to unravel how dormant ovarian cancer cells that persist after initial treatment, to reawaken years later, according to a new study.
The study found that expression of a gene called ARHI (aplasia Ras homolog member I) acts as a switch for autophagy, or self-cannibalisation, in ovarian cancer cells. Often a mechanism for cancer cell death, in this case “self-eating” acts as a survival mechanism for dormant cancer cells.
“Prolonged autophagy is lethal to cancer cells, but a little autophagy can help dormant cancer cells survive, possibly by avoiding starvation,” said the study’s co-author Robert Bast, vice-president for translational research at Texas University MD Anderson Cancer Centre.
“Dormant cells are a major problem in ovarian cancer, breast cancer and other malignancies,” Bast said. “We often see ovarian cancer removed, leaving no remaining sign of disease. After two or three years, the cancer grows back. If any remaining cancer cells had continued to grow normally, the disease should have returned in weeks or months.
“So the assumption is that some cells remain dormant without dividing and without developing a blood supply, but the mechanism for this has not been well understood,” Bast said.
Bast and colleagues focused on ARHI, a gene found in normal cells, but that is underexpressed in 60-70 per cent of ovarian cancers.
When normal levels of ARHI were restored to ovarian cancer cells in the laboratory, autophagy was induced and cancer cells died within a few days.
These findings were published in the Journal of Clinical Investigation.
Tragic results of suboptimal gynecologic cancer operations. January 4, 2009
Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.Tags: cancer operation, cervical cancer, endometrium cancer, gynecologic cancer, leg lymphedema, leg swelling, ovarian cancer, uterine cancer, vulvar cancer
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Tragic results of suboptimal gynecologic cancer operations.
Eur J Gynaecol Oncol. 2008
Kuyumcuoğlu U, Kale A.
Department of Obstetrics and Gynecology, Dicle University School of Medicine Diyarbakir, Turkey.
OBJECTIVE: The goal of this study was to analyze gynecological cancer patients who underwent suboptimal or failed surgeries with unsatisfactory and undesired results.
STUDY DESIGN: During 1997-2007, 74 women were referred to our gynecological oncology service after suboptimal or failed surgeries for ovarian, cervix, endometrium and vulvar cancers. Medical records were evaluated retrospectively to determine the reasons of suboptimal surgery.
RESULTS: Optimal cytoreduction was achieved in ten women (21.7%), 32 women (69.5%) had suboptimal surgical cytoreduction and four women (8.6%) had failed surgery, Seven patients were recurrences (3 had liver metastasis, 2 had pelvic metastasis, 2 had bladder metastasis); two patients died due to bladder metastasis, one patient died six days after surgery due to a pulmonary embolism in the suboptimal cytoreduction group, and one patient died due to ascites in the failed surgery group. Optimal surgery was achieved in three women (27.2%) and eight women (72.7%) had suboptimal surgery in the cervical cancer population. One patient had a recurrence with pelvic metastasis in the suboptimal group. Suboptimal surgery was achieved in one woman with vulvar cancer. Optimal surgery was achieved in seven women (43.7%) and nine women (56.2%) had suboptimal surgery in the endometrial cancer population. One patient died 11 days after surgery due to sepsis in the optimal surgery group. One patient died 21 months after primary surgery and the other patient had a recurrence with paraaortic lymph nodes, ascites and omental thickening in the suboptimal surgery group. The prognosis of 30 (65.2%) women in the ovarian cancer population, eight (72.7%) women in the cervical cancer group, 11 (68.7%) women in the endometrial cancer group, and one woman (100%) in the vulvar cancer population was unknown. The unknown cases of all genital cancers were missed during followup and we could not reach them using their phone or address information.
CONCLUSION: If a gynecologist does not have enough experience or expertise about gynecological cancer operations, he or she must consider the possible harm that any surgical intervention might do, as the latin phrase “primum non nocere” means and should refer patients to a gynecological oncology center without performing any surgery. Optimal gynecologic surgery can only be carried out correctly when education becomes available throughout the world. Thus postgraduate fellowship programs should be considered urgently to extend the general gynecologists’ surgical experience and expertise in developing and undeveloped countries.
Editor’s Note:
This is critical, especially now that we are seeing such a significant rise in leg swelling (leg lymphedema) amongst gynecologic cancer survivors. One of the earliest documented papers I ran accross was Leg Lymphedema from a Botched Abdominal Surgery – and this was published back in 1963 – Pat O’Connor
PMID: 19115691 [PubMed – in process
Prospective study of physical activity and the risk of ovarian cancer. January 4, 2009
Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.Tags: exercise, ovarian cancer, physical activity, rish factors
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Prospective study of physical activity and the risk of ovarian cancer.
Dec 2008
Leitzmann MF, Koebnick C, Moore SC, Danforth KN, Brinton LA, Hollenbeck AR, Schatzkin A, Lacey JV.
Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 6120 Executive Blvd, Rockville, MD, 20892, USA, michael.leitzmann@klinik.uni-regensburg.de.
BACKGROUND:
Available studies on physical activity and ovarian cancer have produced inconsistent findings, with some previous studies reporting a positive association between vigorous physical activity and ovarian cancer risk.
METHODS:
We prospectively investigated the relations of self-reported moderate and vigorous physical activity to ovarian cancer in a cohort of 96,216 US women aged 51-72 years at baseline, followed from 1996-1997 to 31 December 2003.
RESULTS:
During seven years of follow-up, we documented 309 cases of epithelial ovarian carcinoma. In analyses adjusted for age, the relative risks (RRs) of ovarian cancer for individual and joint combinations of moderate and vigorous physical activity such as entirely inactive, neither moderate nor vigorous physical activity, moderate physical activity only, vigorous physical activity only, and both moderate and vigorous physical activity were 0.88, 1.0 (reference), 0.89, 1.05, and 1.08 (95% confidence interval (CI) = 0.81-1.43, respectively. After multivariate adjustment, the relation was essentially unchanged (RR comparing women with both moderate and vigorous physical activity to those with neither moderate nor vigorous physical activity = 1.10; 95% CI = 0.82-1.48). The null association between physical activity and ovarian cancer persisted in subgroups of women as defined by body mass index, parity, oral contraceptive use, menopausal hormone therapy, family history of ovarian cancer, and other variables (all p values for interaction >0.05).
CONCLUSIONS: Neither moderate nor vigorous physical activity showed a statistically significant association with ovarian cancer in this large cohort of women..
PMID: 19116765 [PubMed - as supplied by publisher]
Lymphedema For the Newly Diagnosed November 25, 2008
Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, uterine cancer, vaginal cancer.Tags: acceptance, cancer, coping, emotions, leg swelling, lymphedema, new diagnosis, patient education, treatment compliance
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Lymphedema For the Newly Diagnosed
The immediate time period after being diagnosed with lymphedema can be a confusing and frightening time. In one sense, there may be relief…finally there is a name to this awful “thing” that has attacked your body. But there is also a bewildering amount of emotions, fear…questions of what do I do now and where do I turn to begin dealing with this condition.
I wanted to share a few ideas that hopefully can make this period a little smoother and help give a bit of direction.
Acceptance and Denial
You may go through a time when you try to say to yourself that this swelling will just go away by itself or that you don’t really have to do anything about it and that it may not matter much anyway.
But as hard as this is to say, the reality is that if you have lymphedema, it just isn’t going to go away by itself. It isn’t a medical condition that you can just ignore and hope for the best. While there is no present cure, there is treatment available that can help manage it and help you get back on track with your life.
It is so very important to understand this and to get into a treatment program as soon as you can.
Point to Ponder: Acceptance doesn’t mean surrender or giving up to lymphedema.
Education – Being Proactive
As you may have already experienced, there is a great deal of ignorance in the medical profession about lymphedema. Sometimes, it takes years for a diagnosis and after even that is achieved, most doctors really don’t know what to do next.
That is why it is critical that we as lymphedema patients take the initiative and proactively educate ourselves on every aspect on the condition. You will want to find out what lymphedema is, what it does, what to expect from it, how to have the correct treatment and perhaps most important, how to have a full and meaningful life even with it.
You will also want to educate yourself so you will not fooled by or damaged by all the very bad misinformation out there regarding lymphedema and the lymph system. I’ve noticed that in the last couple years, the lymph system bas become a buzzword in the cyberworld and there a all too many uneducated and badly informed people trying to sell pills, potions and promises of quick cures. Unfortunately, often these supposed cures cause more damage and can even dangerous to your life.
The good thing is that there are many excellent websites that you can go to and find solid, credible, life giving information. In addition to Lymphedema People, there is The Lymphatic Research Foundation, theNational Lymphedema Network, Circle of Hope Lymphedema Foundation, Lymphovenous Canada, Lymphoedema Association of Australia and UKLymph to mention only a few.
Point to ponder: Knowledge is Empowerment. Remember the life you save, may be your own.
Compliance with Your Treatment Program
Once you have finally gotten that diagnosis, it is equally important that you get referral to a trained and certified (Lymphedema Association of North America standards) lymphedema therapist.
Lymphedema therapist are among our best friends and they actually do more on a day to day basis to help us then doctors actually do.
But, sadly as so many therapist will tell you, the number one reason their patients don’t get better or even experience a worsening of their lymphedema is the failure of the patient to be compliant with the proscribed treatment program.
We all understand the fatigue, the pain and the depression that can come with lymphedema. But, my friend, the truth is, is that it is up to you to work with your therapist – as a team to insured you get the most out of your treatment.
Point to ponder: It is your life and your responsibility to do all that you can to help yourself.
Anger, Bitterness and Self pity
After that diagnosis you will go through a period of intense emotional conflict. You may swing from anger, feel bitter that this has happened to you and start feeling sorry for yourself.
Please understand, this is totally normal and yes, you do have a right to experience those feelings. Actually, if you didn’t, I would really be concerned for you.
But the key is not to stop with either of those emotions. They are to me, the triple malignancies of the spirit. They have destroyed more lives throughout history then all the medical conditions combined.
Work your way through them…keep pressing forward knowing that this terrible time of emotional struggle ends.
The following is something I do each morning and it really has made a difference in my life.
Point to Ponder: Every morning, before you start your day, ask God to help you be a source of joy, hope and encouragement to another person
Don’t Stop Living Life
When you are first diagnosed, it is easy to be overwhelmed. You feel like your whole life is over with and you will never be able to do anything you love doing again.
Please, believe me when I say, that is simply not true. Lymphedema isn’t about giving up and quitting life, it is about adaptation. You may need to change how you do things, figure out new and less strenuous ways of working and in recreation. But it doesn’t eman to have to stop everything you are used to enjoying.
Besides, if that were true, why even be alive??
If you do find there may be one particular activity you can not do anymore, find another to replace it with.
It is impossible for me to spend all day (lol..even a couple hours) working in my garden. But, I am able to sit at a computer and reach out to help others with lymphedema.
There just are too many wonderful activities, hobbies and interests to pursue to crawl into a cave and hide.
Point to Ponder: If one dream is taken away, God will send another, even more special to replace it.
In conclusion, yes, it can be devestating to be diagnosed with and stricken by lymphedema. But, I honestly do believe, it ultimately comes down to how we choose to handle it. Do we choose to surrender or do we choose to have a meaningful and joyous life despite lymphedema.
LIFE IS A CELEBRATION OF THAT WHICH WE CAN DO, NOT A REQUIEM FOR THAT WE CAN NOT DO.
Pat
Zeltia: files for approval of Yondelis for ovarian cancer in the US November 25, 2008
Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.Tags: yonddelis, zeltia, second line ovarian cancer therapy, Doxil, response rates, Caelyx, pegylated liposomal doxorubicin
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Zeltia: files for approval of Yondelis for ovarian cancer in the US
24th November 2008
By Sarah Oduekun
Zeltia seeks to add second indication for Yondelis in recurrent ovarian cancer.
Zeltia/Johnson & Johnson are seeking US approval for Yondelis, following a pivotal Phase III trial in second-line ovarian cancer therapy. However, approval in this indication may only marginally increase the commercial potential of Yondelis, as competition from established platinum-based chemotherapy agents will restrict the drug’s market potential.
Zeltia has announced positive results from the pivotal Phase III trial (OVA-301) for its ovarian cancer treatment, Yondelis (trabectedin). The trial involved 672 patients with recurrent ovarian cancer who had received treatment with one platinum-based agent six months prior to trial entry. Patients were randomized to receive Doxil/Caelyx (pegylated liposomal doxorubicin; Johnson & Johnson/Schering-Plough) with or without Yondelis. The primary endpoint of the trial was progression-free survival, which was recorded at a median of 7.3 months for patients who received Yondelis and Doxil, compared to 5.8 months for those who received Doxil alone. Zeltia also reported increased response rates with the use of the Yondelis and Doxil combination (28%) versus Doxil alone (19%), as well as an improved toxicity profile.
Yondelis is a synthetic tetrahydroisoquinoline alkaloid, derived from the Caribbean sea squirt (Ecteinascidia turbinata). It binds to the minor groove of DNA, thereby interfering with cell division, gene transcription and DNA repair mechanisms. The drug received orphan drug designation from both the EMEA and the FDA for the second-line treatment of ovarian cancer in October 2003 and April 2005, respectively.
Ovarian cancer is the most frequent cause of gynecological cancer-related mortality. Incidence in the seven major markets is estimated to be just under 60,000 in 2008, 40% of which are US patients. Surgery is the primary treatment for ovarian cancer, and platinum-based chemotherapy is the standard of care for advanced patients. However, ovarian cancer patients often experience multiple tumor recurrence.
Yondelis’s chosen indication of platinum-sensitive patients who have received prior platinum-based treatment, however, exposes the drug to fierce competition. Because ovarian cancer is chemo-sensitive, patients are usually re-treated with the same platinum-based agents they initially received if they are still platinum-sensitive and more than six months have passed since the first treatment. Significantly, the use of generic drugs such as cisplatin and carboplatin will restrict clinicians from prescribing the more expensive Yondelis.
In addition, established drugs for this indication such as Doxil and Gemzar (gemcitabine; Eli Lilly) are more likely to be prescribed in this setting as clinicians are more familiar with them. Further competition to Yondelis’s market penetration may arise from late-stage pipeline drugs in this setting such as Avastin (bevacizumab; Genentech/Roche), which has shown promising results in Phase II trials.
