Your AI-Trained Oncology Knowledge Connection!
Drs. Levine and Gemignani havecomposed an excellent comprehensivereview of the issuessurrounding prophylactic surgeryin patients at high risk for breast andovarian cancer. Their article focuseson the role of BRCA1/2 mutations inthe risk of developing hereditary breastand ovarian cancer and the data supportingrisk reduction in mutation carriersundergoing prophylactic surgery.
The hereditary breast/ovarian cancer syndrome is responsible forapproximately 5% of all breast cancers and 10% of all ovarian cancers.Although this accounts for a small portion of these diseases, muchattention has been focused on this syndrome because of the abundanceof research in this area. The majority of the hereditary breast/ovariansyndrome can be attributed to germ-line mutations in the BRCA1 andBRCA2 genes. Reliable screening techniques for these mutations havebeen developed and are readily available in clinical practice. Forpatients who are thought to have the hereditary breast/ovarian cancersyndrome based on family history or genetic testing, options exist foreither intensive screening or prophylactic surgery. This review willdiscuss the mechanisms by which mutations in the BRCA genes lead tothe development of cancer, the limitations of currently available screeningtechniques, and the efficacy of prophylactic surgery. In general,prophylactic oophorectomy can be performed laparoscopically as anoutpatient procedure, carrying as its main drawback the associatedconsequence of surgical menopause. Prophylactic mastectomy is quiteeffective in reducing the risk of breast cancer but is a more extensivesurgical procedure and results in disfigurement. For any given patient,the best estimates of individual risk of breast or ovarian cancer shouldbe weighed against the benefits of prophylactic surgery and the patient’spersonal wishes.
BETHESDA, Maryland-New findings by proteomics researchers at the National Cancer Institute (NCI) and the Food and Drug Administration (FDA) have advanced efforts to enable physicians to monitor the response of cancer patients treated with molecularly targeted drugs and to diagnose ovarian cancer in the early stages of the disease.
NEW ORLEANS-With few exceptions, lymphadenectomy should be performed in ovarian cancer patients even if they have stage IA disease. This was the conclusion of French investigators who analyzed 276 women with epithelial ovarian cancer and reported their results at the 34th Annual Meeting of the Society of Gynecologic Oncologists (abstract 94).
NEW ORLEANS-The survival rate for patients with primary invasive epithelial ovarian cancer has steadily increased over the past 3 decades, despite rising diagnoses among African-American women and women over age 60, according to an analysis presented at the Society of Gynecologic Oncologists’ 34th annual meeting (abstract 3).
NEW YORK-Previously treated patients with ovarian cancer who received a novel glutathione (TLK286, Telik, Inc., San Francisco) have thus far survived a median of more than 56 weeks, according to preliminary results from an ongoing multicenter phase II trial. John J. Kavanagh, MD, presented the results at the Mount Sinai School of Medicine Chemotherapy Foundation Symposium XX.
Neurotoxicity is a well-describedside-effect of paclitaxeltherapy, often characterizedas a peripheral sensory neuropathy.Neuropathy is a dose-dependenteffect, occurring with cumulative cyclesand higher doses. Occasionally,this may be dose-limiting for patientswho are benefiting from treatment, aswell as problematic for subsequenttherapies. Another well-recognizedthough less-described neurotoxic effectof paclitaxel is myopathy. Myopathy,consisting of myalgias andarthralgias, can be at least as commonwith standard paclitaxel regimens andequally troubling for patients. In thisissue of ONCOLOGY, Garrison andcolleagues review paclitaxel-associatedmyopathy and offer suggestionsfor patient management.
Paclitaxel-induced myalgias and arthralgias occur in a significantfraction of patients receiving therapy with this taxane, potentiallyimpairing physical function and quality of life. Paclitaxel-inducedmyalgias and arthralgias are related to individual doses; associationswith the cumulative dose and infusion duration are less clear. Identificationof risk factors for myalgias and arthralgias could distinguisha group of patients at greater risk, leading to minimization of myalgiasand arthralgias through the use of preventive therapies. Optimalpharmacologic treatment and possibilities for the prevention of myalgiasand arthralgias associated with paclitaxel are unclear, partially dueto the small number of patients treated with any one medication. Theeffectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs) is themost frequently documented pharmacologic intervention, although noclear choice exists for patients who fail to respond to NSAIDs. However,the increasing use of weekly paclitaxel could necessitate daily administrationof NSAIDs for myalgias and arthralgias and leave patients at riskfor adverse effects. This concern may also limit the use of corticosteroidsfor the prevention and treatment of paclitaxel-induced myalgias andarthralgias. Data from case reports suggest that gabapentin (Neurontin),glutamine, and, potentially, antihistamines (eg, fexofenadine [Allegra])could be used to treat and/or prevent myalgias and arthralgias. Giventhe safety profile of these medications, considerable enthusiasm existsfor evaluating their effectiveness in the prevention and treatment ofpaclitaxel myalgias and arthralgias, particularly in the setting ofweekly paclitaxel administration.
WASHINGTON-Marshall Edwards, Inc. has launched a multi-center phase II clinical trial of its anticancer drug phenoxodiol in women with recurrent ovarian and fallopian tube cancers who have failed other forms of chemotherapy.
NEW YORK-A phase II trial of ecteinascidin-743 (ET-743) is underway in Europe in ovarian cancer patients who have failed platinum/taxane regimens, Nicoletta Colombo, MD, of the European Institute of Oncology, Milan, reported at the Chemotherapy Foundation Symposium XX.
NEW YORK-A trial is being launched to explore whether lengthening the platinum-free interval will affect recurrent ovarian cancer outcomes, William P. McGuire, MD, medical director, oncology, Franklin Square Hospital Center, Baltimore, announced at the Mount Sinai School of Medicine Chemotherapy Foundation Symposium XX.
The Northwestern University Costs of Cancer Program consists ofa series of pilot studies that address the costs of cancer care. Theprogram is designed to serve as a template in preparation for undertakinga large-scale study of a nationally representative sample of cancerpatients-ie, in preparation for a cancer costs and services utilizationstudy in the future. In this article, we outline the theoretical frameworkassociated with a study of cancer costs and summarize findings fromour ongoing pilot studies in this area.
ROCKVILLE, Maryland-An independent advisory board has entered the debate over the safety and efficacy of hormonal replacement therapy (HRT) and recommended against the use of the estrogen/progestin combination in postmenopausal women as a preventive treatment for cardiovascular disease and other chronic conditions. It also concluded that insufficient evidence exists to support a recommendation for or against the use of estrogen alone for preventing chronic conditions in postmenopausal women who have undergone a hysterectomy.
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
