Thursday, January 19, 2012
Luzia Travado: improving outcomes for patients by attending to their distress - Cover Story - Issues 45 - Articles - Cancer World
“Psychosocial burdens can be more threatening in many cases than the disease itself,” says Travado. “Even when a cancer is treatable someone may feel in despair and not cope. What we need to impress on policy makers and the medical community is that we are part of the frontline team and not a separate department dealing with a different part of a patient.”
2012 conference - WORLD ONCOLOGY FORUM- ESO: 26-27 October 2012, Lugano, Switzerland "Are We Winning the War on Cancer?"
WORLD ONCOLOGY FORUM®
Are We Winning the War on Cancer?
1 Question • 100 Experts • 1 Answer
26-27 October 2012, Lugano, Switzerland
Hosted by ESO Founders: Laudomia Del Drago and Umberto Veronesi
Chaired by: Franco Cavalli
ESO WOF Scientific Coordinator: Kathy Redmond
In partnership with The Lancet and Cancer World
• To update recent advances in familial cancer
• To better define the genetic profile of these cancers and the clinical management of families and patients.
• To analyze the impact of the new technologies and their contribution to familial cancer risk.MAIN TOPICS
• General concepts in familial cancer: genetic variants, variants of unknown significance; modifier factors; genetic counseling
• Common cancers: breast cancer and the family of breast cancer genes; selection criteria and clinical management; new treatments; colorectal cancer and prostate cancer; genetic and clinical management.
• Other hereditary syndromes: Familial pheocromocitoma; pancreatic cancer; Birt-Hogg-Dube syndrome; familial melanoma.
• Rare tumors: Fanconi anemia; Dysqueratosis congenital; genetic syndromes of the RAS/MAP pathway; li Fraumeni syndrome.
• New technologies applied to familial cancer studies: Integrative genomic analysis; cancer genome and personalized medicine; whole exome sequencing in the search of high susceptibility genes.
CONFIRMATION OF REGISTRATION
Registration may be carried out online (www.cnio.es/meetings).
Registration fee is € 200. Registration and payment must be processed by 15 May 2012. After this date registration will only be available on site at the rate of € 300. The registration fee covers admission to the conference, a copy of the programme book, coffee and lunch throughout the conference as indicated in the programme.
PLoS ONE: Lack of Effect of Lowering LDL Cholesterol on Cancer: Meta-Analysis of Individual Data from 175,000 People in 27 Randomised Trials of Statin Therapy
Blogger's Note: Table S1 does not specifically show gyn/ovarian cancers unless they have been reported in 'other' or 'unspecified'; a search of the document for 'gyn'/'ovarian'/'ovary' did not provide a result
BackgroundStatin therapy reduces the risk of occlusive vascular events, but uncertainty remains about potential effects on cancer. We sought to provide a detailed assessment of any effects on cancer of lowering LDL cholesterol (LDL-C) with a statin using individual patient records from 175,000 patients in 27 large-scale statin trials.
Number of patients with a report of cancer (number of cancer deaths), by site and trial.
Conclusion"........ The present report now demonstrates clearly that such reductions in LDL cholesterol do not increase the rate of cancer or cancer death, overall or at any particular site, during a treatment period of about 5 years (and more prolonged follow-up in some of the trials does not indicate any later excess) even among older individuals or those who have their cholesterol levels reduced to very low levels. These findings provide considerable reassurance about the safety of using more intensive statin regimens to lower LDL cholesterol levels substantially in patients who remain at high risk of major vascular events."
".......Despite all those hurdles, a new campaign called Choosing Wisely
aims to answer just that question. Run by the American Board of Internal Medicine, Choosing Wisely has brought nine major medical societies on board to identify five common procedures that are often wasteful and unnecessary. The groups will provide their answers at the end of January and make them public in April......
abstract: Characteristics and management of adnexal masses in a canadian pediatric and adolescent population.
"(Results)....Surgical approaches included cystectomy, oophorectomy, or detorsion. Twelve percent of surgeries were for malignancies, representing 7.0% of all adnexal masses, and malignant masses were larger than benign masses (16.1 cm vs. 10.5 cm, P < 0.05)."
OBJECTIVE:To determine whether there were differences in presentation, imaging, and tumour markers between pediatric and adolescent gynaecology patients with adnexal masses managed expectantly and those managed surgically.
METHODS:We conducted a retrospective review of patients who presented to the pediatric and adolescent gynaecology service with adnexal masses between January 2003 and January 2006 at Toronto's Hospital for Sick Children.
CONCLUSION:Larger masses and masses associated with increased abdominal girth or abnormal tumour markers were more likely to be managed by surgical intervention. Surgically managed patients had more investigations. Forty-one percent of masses in patients referred to pediatric and adolescent gynaecology specialists resolved with expectant management.
"......"This treatment is strictly to alleviate symptoms attributed to disease progression in a cost-effective manner," Dr. Bang explained. "Survival benefit is merely a direct effect in the efficacy of cryoablation, which was able to successfully ablate tumors in 98% of cases."..........
phase 11 - (Mayo) Ovarian Cancer Clinical Trial: Intra-op Detection of Occult Ovarian Carcinoma Using a Folate-Alpha Receptor Specific Fluorescent Ligand
Blogger's Note: as per criteria, recurrent ovarian cancer patients do not qualify for this study
Verified by: Mayo Clinic, January 2012
First Received: January 12, 2012 | Last Updated: January 17, 2012 | Phase: Phase 2 | Start Date: January 2012
Overall Status: Not yet recruiting | Estimated Enrollment: 50
Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction
Use of self-expanding metallic stents (SEMS) as a bridge to surgery has been suggested as an alternative management for acute malignant left-sided colonic obstruction, as emergency surgery has a high risk of morbidity and mortality. This meta-analysis evaluated high-quality evidence comparing preoperative SEMS with emergency surgery.
Four RCTs with 234 patients were included..........Three trials were stopped prematurely, one because the emergency surgery group had a significantly increased anastomotic leak rate, and two others because of stent-related complications and increased 30-day morbidity following SEMS management.......
abstract: Radioembolization for the Treatment of Liver Tumors: General Principles (primary & metastatic)
Radioembolization aims to selectively target radiation to all liver tumors while limiting the dose to normal liver parenchyma. The deposition of yttrium-90 (90Y) microspheres delivered through the hepatic artery are preferentially implanted within liver tumors in a 3:1 to 20:1 ratio compared with a normal liver. The principles and mode of action of radioembolization are fundamentally different from the conventional embolization of liver tumors through transarterial embolization or chemoembolization.............The expanding literature on radioembolization shows that this is an effective treatment for the management of both primary and metastatic tumors.
open access: Integrin Inhibitors as a Therapeutic Agent for Ovarian Cancer (note also reference to Avastin)
Ovarian cancer is a highly metastatic disease characterized by widespread peritoneal dissemination and ascites and is the leading cause of death from gynecologic malignancies. It is often diagnosed at a late stage after tumor cells are disseminated within the peritoneal cavity. Despite aggressive treatments which consist of surgical cytoreduction and chemotherapy, more than two-thirds of all patients succumb to the disease within 5 years . The initial step of ovarian cancer metastasis is that cancer cells, detached from the ovarian surface epithelium, attach to the layer of mesothelial cells that line the inner surface of the peritoneum. Several integrins have been identified as important mediators of ovarian carcinoma metastasis to the mesothelium, suggesting that integrin inhibitors could be a new therapeutic strategy to prevent cancer cells from attaching onto the peritoneal cavity. During the last 10 years, novel insights into the mechanisms that regulate cell survival as well as cell migration and invasion have led to the development of novel integrin inhibitors for cancer treatments . In this short review, we describe the critical roles of integrins during the metastatic process of ovarian carcinoma and discuss the potential of integrin inhibitors as a new therapeutic agent for the treatment of ovarian cancer.
2. Biology of IntegrinThe role of integrins in cell migration and invasion is one of their most studied functions in tumor biology [3, 4].....
Table 1: Candidate integrin inhibitors for ovarian cancer treatment.
Recognition of the need for cytoreduction along with the evolution of surgical techniques and the establishment of chemotherapy regimens through multiple clinical trials allows a majority of ovarian cancer patients to achieve “disease-free” status after the initial treatment. One of the major disappointments with the current ovarian cancer treatments is failure to achieve a complete cure, even in optimally debulked or chemosensitive patients. The establishment of efficacious consolidation or maintenance therapies would be a powerful tool for improving the miserable outcomes of patients with advanced-stage disease.The biological behavior of ovarian carcinoma is unique, differing from the classic and well-studied pattern of hematogenous metastasis found in most other cancers. Once ovarian cancer cells have detached as single cells or clusters from the primary ovarian tumor, they are carried by the physiological movement of peritoneal fluid and finally metastasize to the peritoneum and omentum, suggesting that the attachment of cancer cells onto the mesothelial cells covering the basement membrane is the initial key step in metastasis. Bevacizumab has already shown significant utility in ovarian cancer treatment not only in combination with current chemotherapy but also as a single agent, indicating that antiangiogenic therapy has considerable promise. Given that targeting integrins can affect not only the diverse functions of tumor cells, including adhesion, migration, invasion, proliferation, and survival, but also tumor microenvironments, especially the angiogenic endothelial cells, integrin inhibitors obviously have the potential for clinical use in the near future. Unfortunately, although several clinical trials have been attempted against ovarian cancer, no integrin inhibitor has shown sufficiently promising efficacy to progress to further clinical investigation; the agents targeting only a single integrin, such as αvβ3 and α5β1, failed to show evident clinical benefits in metastatic cancer treatment. In cancer progression, more than one integrin pathway is involved. For example, even if inhibition of the function of α5β1-integrin as a fibronectin receptor could be adequately achieved, the other integrins, such as αvβ3 or α3β1, would eventually compensate for its function. Therefore, a combination of different integrin receptor pathways is likely to be more effective in the clinical setting and should be explored for the future clinical application.
Collectively, although there remain many questions and challenges, integrin-targeted therapies continue to be a promising approach to improve the outcomes of women with ovarian cancer.