Ovarian Cancer

In this issue of ONCOLOGY, Golan and Javle present a timely review of the current status of the insulin growth factor-1 receptor (IGF-1R) signaling pathway as a therapeutic target, with a specific focus on gastrointestinal (GI) cancers.

From the current literature

A 40-year-old premenopausal woman with a new diagnosis of invasive lobular carcinoma occurring in a background of lobular carcinoma in situ presents to a multidisciplinary second opinion clinic.

Preface

The understanding that epigenetic changes are prevalent in cancer and play a causative role in its biology has led to the development of new therapeutic approaches that target the epigenetic machinery.

Today, March 8, is the 100th anniversary of International Women’s Day, Here is a small sampling of initiatives by health organizations and healthcare leaders dedicated to treating, preventing, and increasing awareness of women’s cancers, and improving women’s health.

The early promise of treating triple-negative and basal-cell breast cancers with poly (ADP-ribose) polymerase (PARP) inhibitors is yet to be realized, according to Lisa A. Carey, MD, who will be delivering a presentation on treatment options for these patients at the Miami Breast Cancer Conference this week.

The Swiss pharmaceutical company Roche and Roche Group member Genentech have announced that addition of bevacizumab (Avastin) to chemotherapy improved progression-free survival over chemotherapy alone in the phase III OCEANS ovarian cancer study, meeting the study’s primary endpoint.

The article by Dr. Echarri Gonzalez and her colleagues regarding intraperitoneal (IP) chemotherapy for women with epithelial ovarian cancer provides a comprehensive yet practical review of the critical questions surrounding the use of IP chemotherapy.

In 2006, after a third consecutive large-scale US phase III trial conducted by the Gynecologic Oncology Group (GOG) confirmed that use of intraperitoneal (IP) chemotherapy in optimally resected stage III epithelial ovarian cancer results in superior overall survival (OS) and/or progression-free survival (PFS),[

While 90% of cancers occur as a result of factors related to lifestyle, the environment, or aging, 5% to 10% of cancers are passed down from generation to generation. Breast cancer is the most common cancer diagnosis in American women.

Epithelial ovarian cancer (EOC) spreads prominently within the peritoneal cavity. In fact, we now know that high-grade serous cancers are often of tubal origin, and their presentation as tubo-ovarian masses renders it likely that intraperitoneal spread occurs as an early event in their clinical evolution.

"Kinome" is the word to know this year in oncology, because it has begun to reveal molecules that some tumors are relying on to survive, which until now we had no idea were involved in cancer or which we hardly knew at all.

Early results from the ICON7 trial suggest that adding bevacizumab (Avastin) to standard chemotherapy in women with newly diagnosed ovarian cancer reduces the risk of disease progression during the first year of treatment.

For women with triple-negative breast cancer, BRCA mutations can be a boon: These patients have a significantly lower risk of relapse than their counterparts who do not carry BRCA mutations, according to a study out of Houston’s M.D. Anderson Cancer Center. SABCS 2010 will feature an education session on the clinical utility of genetic testing for inherited predisposition to breast cancer.

The search for a magic bullet against cancer historically has glowed bright then dimmed, depending on the stage of discovery. Developments surrounding monoclonal antibodies and angiogenesis inhibitors have followed this cycle, as exuberance for their potential has bowed to the nuances that underlie the complex mechanisms on which they depend.

Aetna is examining data from 13,000 of its members to determine if patients who should be getting breast-and-ovarian cancer screening tests are in fact being offered them.

An advisory panel recommended revoking bevacizumab’s approval in breast cancer. Oncologists and patients express concern about what the future holds for those who do benefit from bevacizumab.

Patient preference needs to be weighed against overall societal benefits.

As outlined in the excellent, comprehensive review by Drs. Liu and Matulonis, ovarian cancer is the most lethal gynecologic malignancy in the United States, with approximately 16,000 deaths and 22,000 new cases yearly.[1] The vast majority of patients present with intra-abdominal spread of disease at the time of diagnosis, resulting in low overall cure rates. As outlined, patients are primarily managed with primary surgical resection and subsequent platinum-based chemotherapy.

Epithelial ovarian cancer is the leading cause of death from gynecologic malignancy in the United States, with approximately 15,000 deaths per year. Platinum/taxane doublets have long been considered the standard treatment regimen for advanced-stage disease; however, recent studies have sought to improve on the outcome from this therapy. Intraperitoneal (IP) chemotherapy has been shown to yield superior progression-free survival (PFS) and overall survival (OS); however, logistical problems and toxicities have limited more widespread adoption. Recent studies have also suggested that a “dose-dense” schedule of paclitaxel in combination with carboplatin may result in improved outcomes, and the impact of biological therapies in the first-line setting is under active investigation. In the setting of recurrent disease, preliminary results suggest that novel doublet regimens such as carboplatin and pegylated liposomal doxorubicin may have similar activity to standard platinum/taxane doublets while carrying a reduced risk of allergic reactions. Additionally, targeted therapy remains an active area of investigation, with evidence of activity from agents such as PARP inhibitors, anti-angiogenics, and PI3 kinase inhibitors. Here, we review recent advances in our understanding of ovarian cancer and its treatment in both the newly diagnosed and recurrent settings.

After years of maintaining the status quo in ovarian cancer treatment, a number of recent advances have challenged the paradigm based on intravenous (IV) taxane and platinum as the therapy of choice for advanced ovarian cancer. These new data are summarized concisely by Liu and Matulonis in this issue.

Once thought a risk for malignancy, septated ovarian cystic tumors are actually mostly benign. A study at the University of Kentucky changes the standard of care for those patients.

Citing different studies, two physicians reach different conclusions as to whether ovarian cancer screening is worthwhile.

Mrs. S. is a 37-year-old Caucasian female who sought care at her home institution overseas during a period of several months for complaints of esophageal reflux, constipation, early satiety, increasing abdominal girth, and fatigue.