Ovarian Cancer

Breast and ovarian carcinomas pose major public health problems in most Western countries. Countless attempts have been made to better understand a patient’s lifetime risk of breast cancer. The most significant etiologic risk is increasing age, followed by family history. In addition, hormonal and reproductive factors-ie, early menarche and later age at menopause, nulliparity (and, therefore, a greater number of ovulations over the patient’s lifetime), and late age at first pregnancy (greater than age 30 years)-also increase a patient’s breast cancer risk.

Women at increased risk of breast cancer have important opportunities for early detection and prevention. There are, however, serious drawbacks to the available interventions. The magnitude of breast cancer risk is a crucial factor in the optimization of medical benefit when considering the efficacy of risk-reduction methods, the adverse effects of intervention, and economic and quality-of-life outcomes. Breast cancer risk assessment has become increasingly quantitative and is amenable to computerization. The assembly of risk factor information into practical, quantitative models for clinical and scientific use is relatively advanced for breast cancer, and represents a paradigm for broader risk management in medicine. Using a case-based approach, we will summarize the major breast cancer risk assessment models, compare and contrast their utility, and illustrate the role of genetic testing in risk management. Important considerations relevant to clinical oncology practice include the role of risk assessment in cancer prevention, the logistics of implementing risk assessment, the ramifications of conveying risk information with limited genetic counseling, and the mechanisms for genetics referral. Medical professionals can embrace new preventive medicine techniques more effectively by utilizing quantitative methods to assess their patients’ risks. [ONCOLOGY 16:1082-1099, 2002]

Both irinotecan (CPT-11, Camptosar) and epirubicin (Ellence) are significant chemotherapeutic agents that are used in the management of many different cancers. Each agent works through the inhibition of topoisomerases, and inhibition of topoisomerases I and II may possibly result in significant clinical synergy. This phase I clinical study represents an investigation of the first combination of irinotecan and epirubicin in patients with advanced cancer.

LEICESTER, England-Pegylated liposomal doxorubicin (Doxil/Caelyx) performs as well as paclitaxel (Taxol) in the treatment of relapsed ovarian cancer, according to a clinical trial that was stopped when paclitaxel won approval for first-line treatment in Europe. The trial was nearly forgotten, but then a second look at the results suggested that pegylated liposomal doxorubicin might be preferred for some patients who have musculoskeletal disorders or are troubled by the prospect of developing alopecia as a side effect (ASCO abstract 808).

BALTIMORE-Giving paclitaxel (Taxol) and cisplatin (Platinol) in an intensive intraperitoneal (IP) regimen increased progression-free survival by 5 months over standard intravenous (IV) treatment for stage III epithelial ovarian carcinoma and primary peritoneal carcinoma in a phase III clinical trial (ASCO abstract 803).

CHICAGO-Adding paclitaxel (Taxol) and G-CSF support to the standard regimen of doxorubicin and cisplatin (Platinol) improved response rates and increased survival by about 3 months for patients with advanced or recurrent endometrial cancer in a randomized controlled phase III trial conducted by the Gynecologic Oncology Group (GOG) (ASCO abstract 807).

Aggressive ovarian cancer may be linked to the presence of thrombocytosis, report investigators from Cedars-Sinai Medical Center in Los Angeles.

Most Men Don’t Need Yearly PSA Screening: PLCO Study

NEW YORK-Treatment of ovarian cancer can cause side effects that have a significant impact on patients’ everyday lives, including walking, according to Lois Almadrones, RN, MS, MPA, clinical nurse specialist, Gynecology Service, Memorial Sloan-Kettering Cancer Center in New York. Speaking at an industry-sponsored symposium held in conjunction with the Oncology Nursing Society annual meeting, she outlined approaches to improve the management of palmar-plantar erythrodysesthesia (PPE), peripheral neuropathy, and hypersensitivity to some chemotherapeutic agents.

WASHINGTON-A survey of 110 Hispanic women at elevated risk for breast and/or ovarian cancer revealed a high degree of interest in genetic testing but a low level of knowledge about their own objective risk of getting these cancers, Martha P. Martinez, PsyD, said at the American Psychological Association Conference on Enhancing Outcomes in Women’s Health. Dr. Martinez is a voluntary instructor of medicine at the University of Miami School of Medicine.

DALLAS-With "significant improvement" in both progression-free and 5-year survival of patients with ovarian cancer, "quality of life becomes important," stated Alan N. Gordon, MD, director of research in gynecologic oncology in the Division of Oncology at Texas Oncology in Dallas.

SAN FRANCISCO-Haptoglobin-alpha, a subunit of the hemoglobin-binding protein haptoglobin, may be a useful marker for ovarian cancer, according to results presented at the 93rd Annual Meeting of the American Association for Cancer Research (abstract 3687).

TORONTO-Beyond its physical effects, ovarian cancer presents women with difficult emotional, social, and spiritual challenges every step of the way. Each of the disease’s phases, from the first suspicions of something seriously wrong, through diagnosis, treatment, survival, possible relapse, and terminal disease, has its own particular psychosocial impact and its own set of needs, said Margaret I. Fitch, RN, PhD, at an industry-sponsored symposium held in conjunction with the Oncology Nursing Society annual meeting.

Docetaxel (Taxotere) has extended the armamentarium of agents with significant activity in the treatment of ovarian cancer. As a single agent in advanced ovarian cancer patients previously treated with a platinum agent, docetaxel at 100 mg/m² every 3 weeks yields a 30% overall response rate and a 6-month duration of response.

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).