Ovarian Cancer

In less than a decade, docetaxel (Taxotere) has progressed from initial studies in anthracycline-refractory metastatic breast cancer to several large, phase III randomized trials evaluating its efficacy as adjuvant, neoadjuvant, and first-line therapy for metastatic breast cancer, non-small-cell lung cancer (NSCLC), and ovarian cancer. In other tumor types, including prostate, head and neck, gastric, and bladder cancer, ongoing phase III trials are comparing docetaxel-containing regimens to previously established regimens. For the seven tumor types reviewed in this supplement, phase III study information for docetaxel or docetaxel-based combinations are presented. Impressive results have been consistently demonstrated in the trials reported to date.

WASHINGTON, DC-"On the day that changed my life, I heard the words, ‘Congratulations! It’s a girl!’ followed by, ‘Oh, no-this is advanced ovarian cancer," Joan Sommer, RN, recalled. "I kept thinking, Baby? Cancer? Baby? Cancer? How can this be?"

The 4th Investigators’ Workshop sponsored by The University of Texas M. D. Anderson Cancer Center was held on July 25-29, 2001, in Colorado Springs, Colorado. The purpose of these annual workshops has been to review the latest data on new agents, with a particular focus on the broadly used agent irinotecan (CPT-11, Camptosar).

Ovarian cancer, the second most common gynecologic malignancy, accounts for approximately 14,000 deaths annually in the United States. Disease relapse after primary treatment, which consists mainly of surgery followed by platinum-based therapy, occurs in more than 60% of ovarian cancer patients overall, and in more than 80% of those diagnosed initially with advanced-stage disease.

Using a day 1 and 8, every-3-week schedule, our purpose was to determine the maximum tolerated dose of irinotecan (CPT-11, Camptosar) that can be administered immediately after gemcitabine (Gemzar) at a dose of 1,000 mg/m² IV. In this phase I trial, the maximum tolerated dose was defined as the dose level immediately below the level in which two of the first three patients in any cohort, or at least two of six patients in any expanded cohort, experienced dose-limiting toxicity. Dose-limiting toxicity pertained only to toxicity during the first cycle of treatment. Escalation of irinotecan was planned in groups of three patients, with three additional patients added at the first indication of dose-limiting toxicity. A total of 19 patients have been enrolled.

LONG BEACH, California-Treating anemia can reverse the declines it causes in physical function and quality of life for cancer patients and may have an impact on outcomes of cancer therapy, reported Simon Tchekmedyian, MD. Statistics suggest that anemia and its effects are under-recognized and undertreated, he noted, but barriers to treatment may fall as new therapeutic agents prove to be more effective and can be administered more easily and less frequently.

BETHESDA, Maryland-As researchers probe the complex nature of individual cancer cells, unique molecular patterns, or signatures, have emerged. Several drugs based on early findings in the field have already earned US Food and Drug Administration approval. A goal set by the National Cancer Institute (NCI) is to "catalog distinguishing molecular signatures of cancer cells to develop new diagnostic and therapeutic approaches and predict response."

MIAMI, Florida-In women with advanced ovarian cancer who achieved a complete response (CR) with a platinum/paclitaxel (Taxol)-based chemotherapy regimen, continuing single-agent paclitaxel for 12 cycles prolonged the duration of progression-free survival, compared with a 3-cycle continuation, Maurie Markman, MD, of the Cleveland Clinic Foundation, said at the 33rd Annual Meeting of the Society of Gynecologic Oncologists (abstract 1).

MIAMI BEACH, Florida-The Breast Cancer Risk Assessment Working Group is completing work on its consensus guidelines for stratifying patients into risk categories for breast cancer and managing their care accordingly. The model was outlined at the 19th Annual Miami Breast Cancer Conference.

The detailed map of the human genome can potentially transform future cancer therapy by merging genomics with pharmacology, thereby identifying which patients will benefit from specific therapeutic agents. Single-nucleotide polymorphisms (SNPs) provide a valuable tool for this pharmacogenetic approach to cancer therapy.

When the BRCA1 and BRCA2 genes for breast and ovarian cancers were first identified and a screening blood test became available, a debate ensued as to whether there was an advantage to learning one’s risk. Recently, the value of such testing was demonstrated in a study in women who were followed after being identified as carriers of a BRCA genetic mutation. Researchers at Memorial Sloan-Kettering Cancer Center have provided strong evidence that breast and ovarian cancers can be detected at an early stage in women at highest hereditary risk. Results of the study were published in a recent issue of the Journal of Clinical Oncology (20:1260-1268, 2002).

BETHESDA, Maryland-A National Cancer Institute (NCI) panel has declared the creation of a Virtual Shared Specimen Resource (VSSR) to be "absolutely necessary for advancing the detection, classification, and treatment of gynecologic cancer."

Among the most exciting new anticancer products presented at the 2001 ASCO meeting were new drugs that block the epidermal growth factor receptor (EGFR). About 30% to 90% of carcinomas express high levels of EGFR. These include, among others, head and neck cancer, lung cancer, pancreatic cancer, colon cancer, breast cancer, ovarian cancer, and bladder cancer.

WASHINGTON-In recent years online chat rooms and list servers devoted to a vast array of special interests have become a staple of American life. Now a pilot project has shown that an internet support group significantly benefits women coping with breast cancer, said Mitch Golant, PhD, vice president of research and development for The Wellness Community (TWC) National, Santa Monica, California.

BETHESDA, Maryland-A new proteomics blood test for ovarian cancer (developed by researchers at the joint Food and Drug Administration/National Institutes of Health Clinical Proteomics Program) detected all 50 ovarian cancers in a proof-of-principal trial and is now being validated in a major study of recurrence in stage III/IV ovarian cancer.

WASHINGTON-Knowledge, research, and education alone will not end the cancer disparities among American populations, said numerous speakers at the opening session of the 8th Biennial Symposium on Minorities, the Medically Underserved, and Cancer, presented by the Intercultural Cancer Council (ICC) and jointly sponsored by Baylor College of Medicine, Houston.

Treating recurrent ovarian cancer requires a new perspective on the disease and the objectives of therapy, according to Deborah K. Armstrong, MD, assistant professor of gynecology and obstetrics at Johns Hopkins University School of Medicine.

NEW YORK-The combination of gemcitabine (Gemzar) and a potent, novel topoisomerase-1 inhibitor similar to irinotecan (Camptosar) is safe, has predictable toxicities, and has demonstrated significant antitumor activity in a variety of solid malignancies, according to results of a 70-patient phase I/pharmacokinetic study.

NEW YORK-Liposomal doxorubicin (Doxil) may be essentially equivalent to topotecan (Hycamtin) as second-line therapy for ovarian cancer, but the combination of the two may have more promise than either agent alone, according to preliminary results of a phase I study.

NEW YORK-Repeated low-dose administration of amifostine (Ethyol) is being studied in a randomized, multi-center, community-based trial in an attempt to prevent neurotoxicity caused by platinum-based chemotherapy.David Alberts, MD, and Martee Hensley, MD, discussed the new study at the Ethyol Emerging Neuropathy Trial Investigator Meeting.

CHICAGO-Preoperative helical computed tomography (CT) can improve the management of women with recurrent ovarian cancer by identifying disease that cannot be resected in secondary cytoreductive surgery, said Stacey A. Funt, MD, assistant attending radiologist, Memorial Sloan-Kettering Cancer Center.

Chemotherapy-induced toxicities often adversely affect patients’ health and treatment plans, and can result in large costs for treatment and care. In addition to the costs associated with direct medical care, a large amount of indirect and out-of-pocket costs can be incurred.

In this day of encyclopedic oncology texts, frequently updated online reference sites, and literature searches at the click of a button, is there a place for a basic medical oncology textbook? The second edition of the Textbook of Medical Oncology, edited by Drs. Cavalli, Hansen, and Kaye, is approximately 50% longer than the first edition, due in large part to the inclusion of newer therapeutic approaches.

NEW YORK-A monoclonal antibody with high affinity for an ovarian tumor-associated antigen has shown promising activity in preliminary results from a large phase III study, said Jonathan S. Berek, MD, chief of the Division of Gynecology

LISBON, Portugal-Adjuvant platinum-based chemotherapy significantly improves the outlook for women with high-risk early-stage epithelial ovarian cancer, according to the findings of two parallel, randomized phase III trials presented at the 11th European Cancer Conference (ECCO abstract 1019).

Solomon et al have written a valuable primer to guide clinicians in identifying, diagnosing, and treating familial colon cancer syndromes. The authors succinctly describe the essential features of each of the well-defined hereditary colon cancer syndromes, including those associated with colonic adenomas (hereditary nonpolyposis colorectal cancer [HNPCC] and familial adenomatous polyposis [FAP]) and colonic hamartomas (Peutz-Jeghers syndrome, juvenile polyposis, and Cowden syndrome). In addition to the specific features that might trigger recognition of one of these syndromes, we advise health-care providers to consider the possibility of hereditary cancer in cases with the following features:

Management of Patients at High Risk for Breast Cancer, edited by Victor G. Vogel, MD, is designed for all physicians involved in breast cancer risk assessment and prevention. It does not assume a baseline familiarity with cancer risk

The effect of a patient’s race or ethnicity on cancer incidence and mortality rates remains a neglected area of cancer research. However, with cancer statistics differing among various populations, research on racial and ethnic groups could provide clues to cancer trends.

The population dynamics of cellular entry, traverse, and exit, through and from each phase of the cell cycle is coordinated throughout the day in the tissue of the human body. This coordination is particularly robust-ie, the daily peaks and valleys are particularly high and low-in tissues with the greatest average daily cellular proliferation. These tissues are also the most severely damaged by cancer treatments, most prominently cytotoxic drugs and ionizing irradiation.

NEW YORK CITY-Weekly irinotecan (Camptosar) and cisplatin (Platinol) can be successfully given as first-line treatment to women with advanced ovarian cancer. The toxicity is manageable, and some patients with suboptimally resected disease achieved an extended disease-free survival, David Spriggs, MD, reported. He is chief of the Developmental Chemotherapy Service at Memorial Sloan-Kettering Cancer Center in New York City.