National Comprehensive Cancer Network® Posts New Guidelines for Treatment of Ovarian Cancer Patients

National Comprehensive Cancer Network® Posts New “Patient Friendly” Guidelines for Treatment of Ovarian Cancer.

Women with ovarian cancer now have a new resource that provides them with the same credible information their physicians use when determining treatment options. The National Comprehensive Cancer Network® (NCCN®) announces three new additions to the library of NCCN Guidelines for Patients™, patient-friendly translations of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™). NCCN Guidelines for Patients™: Melanoma, Ovarian Cancer, and Prostate Cancer are now available free of charge at NCCN.com.

The NCCN Guidelines for Patients™ are designed to provide people with cancer and their caregivers with state-of-the-art treatment information in easy-to-understand language. Given the prevalence of melanoma and prostate cancer – both among the most frequently diagnosed cancers in men – and the challenges in detecting ovarian cancer in women, it is critical that patients have resources to empower them to take a more active role in their treatment.

The NCCN Guidelines™ are developed by multidisciplinary panels of experts from NCCN Member Institutions and feature algorithms or “decision trees” that address every appropriate treatment option from initial work up throughout the course of the disease. The NCCN Guidelines for Patients™ translate these professional guidelines in a clear, step-by-step manner that patients can use as the basis for making decisions and discussing options with their physicians.

The NCCN Guidelines for Patients™ are available free of charge at NCCN.com, which also features additional informative articles for patients and caregivers.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 21 of the world’s leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives.

The NCCN Member Institutions are:

City of Hope Comprehensive Cancer Center, Los Angeles, CA;

Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA;

Duke Comprehensive Cancer Center, Durham, NC;

Fox Chase Cancer Center, Philadelphia, PA;

Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT;

Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA;

The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD;

Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL;

Memorial Sloan-Kettering Cancer Center, New York, NY;

H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL;

The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, Columbus, OH;

Roswell Park Cancer Institute, Buffalo, NY;

Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO;

St. Jude Children’s Research Hospital/University of Tennessee Cancer Institute, Memphis, TN;

Stanford Comprehensive Cancer Center, Stanford, CA;

University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL;

UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA;

University of Michigan Comprehensive Cancer Center, Ann Arbor, MI;

UNMC Eppley Cancer Center at The Nebraska Medical Center, Omaha, NE;

The University of Texas MD Anderson Cancer Center, Houston, TX; and

Vanderbilt-Ingram Cancer Center, Nashville, TN.

Sources:

PBS Documentary, “The Whisper: The Silent Crisis of Ovarian Cancer.”

To raise ovarian cancer awareness, Long Island’s Public Broadcasting Service (PBS) affiliate WLIW-Channel 21 will present the exclusive New York metro area premiere of a half-hour television documentary entitled, “The Whisper: the silent crisis of ovarian cancer.” The program will debut at 7 P.M. (EDT) on Friday, September 24 in the New York metro area, and will be rolled out to other PBS affiliates across the country over the next 12 months.

More than 13,000 women this year will be struck down by ovarian cancer, which is the most lethal gynecologic cancer. Ovarian cancer statistics are staggering; nearly three out of every four women with this disease will die because of it. Chances of survival can improve if it is detected early and confined to the ovaries. Unfortunately, only about 25 percent of women are diagnosed with early stage disease because there is no reliable early stage screening test available. Victims of ovarian cancer include President Obama’s mother Ann Soetoro, Coretta Scott King and comedienne Gilda Radner.

To raise awareness of this devastating disease, Long Island’s Public Broadcasting Service (PBS) affiliate WLIW-Channel 21 will present the exclusive New York metro area premiere of a half-hour television documentary entitled, The Whisper: The Silent Crisis of Ovarian Cancer.  A preview trailer of the documentary is provided below.

The Whisper:  the silent crisis of ovarian cancer — PBS Documentary

The program will debut at 7 P.M. (EDT) on Friday, September 24, with encore presentations scheduled for 10:30 P.M. on Monday, September 27, and 11:30 P.M. on Friday, October 1. The program will be rolled out to other PBS affiliates across the country over the next 12 months.

The documentary was made possible by a generous grant from the Sonia L. Totino Foundation and the Rocco Totino family. Mr. Totino, a New York resident, lost his wife Sonia to ovarian cancer several years ago, and wished to honor her with an initiative that seeks to raise awareness among women of the warning signs of ovarian cancer, and by doing so, reduce the number of women lost to this devastating disease.

Sharon Blynn is the founder of Bald is Beautiful & the host of “The Whisper: the silent crisis of ovarian cancer” (a PBS documentary)

The host featured in the documentary is Sharon Blynn, who is an ovarian cancer survivor and the founder of the Bald Is Beautiful campaign. Through this campaign, Sharon wants to send a message to women that they can “flip the script” on the many traumatic aspects of the cancer experience, and embrace every part of their journey with self-love, empowerment, and a deep knowing that their beauty and femininity radiate from within and are not diminished in any way by the effects of having cancer.  As an “actorvist,” Sharon communicates the Bald Is Beautiful message through acting, writing, modeling and spokesperson appearances, and she continues to do patient outreach through one-on-one correspondence via her website, hospital visitations, being a chemo buddy and other such activities.

Other Bald Is Beautiful highlights include an international print campaign for the Kenneth Cole “We All Walk in Different Shoes” campaign, an international print and TV campaign for Bristol-Myers Squibb, appearances in “Sex and the City” and a principal role in Seal’s music video “Love’s Divine.” She has been featured in magazine and newspaper articles in Glamour, Vogue, Marie Claire (US & Italia), Organic Style, BUST, the Miami Herald and other publications. Sharon has also performed onstage as part of the “Off the Muff” collective, and she was commissioned to write and perform her one-woman theatrical piece “How Are We Feeling Today?” which saw its world premiere in Los Angeles and was presented in New York City. A QuickTime video compilation of Sharon’s past projects can be viewed here.

Blynn was awarded the prestigious 2010 Lilly Tartikoff/Entertainment Industry Foundation Hope Award at the 2010 National Coalition for Cancer SurvivorshipRays of Hope Gala” held in Washington, D.C. Sharon has also been selected to be part of Lifetime Television Network’s Every Woman Counts “Remarkable Women” campaign, and will appear in a 30-second spot that will run the week of Sept 17–23, 2010.

The nationally-renowned ovarian cancer experts featured in the documentary include:

Barbara A. Goff, M.D., Professor, Gynecologic Oncology, University of Washington School of Medicine. Dr. Goff is the principal investigator responsible for critical ovarian cancer research which revealed that ovarian cancer is generally accompanied by four primary warning signs or symptoms — bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary symptoms (urgency or frequency).  Goff’s research became the foundation for the Ovarian Cancer Symptoms Consensus Statement, which was sponsored and co-authored by the American Cancer Society, Gynecologic Cancer Foundation, and Society of Gynecologic Oncologists in July 2007.

Beth Y. Karlan, M.D., Board of Governors Endowed Chair, Director, Women’s Cancer Research Institute and Division of Gynecologic Oncology, Cedars-Sinai Medical Center; Professor, Obstetrics and Gynecology, David Geffen School of Medicine ,University of California, Los Angeles (UCLA). Dr. Karlan is a world-renowned expert in the field of gynecologic oncology, specifically ovarian cancer surgery, early detection, targeted therapies and inherited cancer susceptibility. She is a past-president of the Society of Gynecologic Oncologists, the Editor-in-Chief of Gynecologic Oncology, and has held many international leadership positions.  She is committed to both scientific advancement and enhancing public awareness about gynecologic cancers.

John Lovecchio, M.D., Chief of Gynecologic Oncology, North Shore-Long Island Jewish Health System; Leader of the North Shore-LIJ Cancer Institute; Professor of Obstetrics and Gynecology, the New York University School of Medicine.  Dr. Lovecchio’s major areas of research are in uterine and ovarian cancers, and he holds administrative and leadership positions in regional and national professional organizations and has published extensively in peer-reviewed journals. Lovecchio is widely regarded as a leading physician-surgeon and has received numerous awards in recognition of his academic and professional achievements.  In the documentary, Dr. Lovecchio offers his insight on ways to combat this deadly form of cancer. He is also credited as the technical advisor for the documentary.

Maurie Markman, M.D., Vice President of Patient Oncology Services & National Director of Medical Oncology, Cancer Treatment Centers of America.  For more than 20 years, Dr. Markman has been engaged in clinical research in the area of gynecologic malignancies, with a particular focus on new drug development and exploring novel management strategies in female pelvic cancers.  Dr. Markman’s many accomplishments include serving as Editor-In-Chief for the Current Oncology Reports journal and Oncology (Karger Publishers) journal, and serves as Chairman of the Medical Oncology Committee of the national Gynecologic Oncology Group.  In addition, Dr. Markman has served on numerous editorial boards, including the Journal of Clinical Oncology and Gynecologic Oncology.  Dr. Markman has been the primary author, or co-author, on more than 1,000 published peer-reviewed manuscripts, reviews, book chapters, editorials or abstracts, and he has edited or co-edited 14 books on various topics in the management of malignant disease, including Atlas of Oncology and the most recent edition of Principles and Practice of Gynecologic Oncology.

“Taking part in this program was a labor of love and concern for my patients,” said Dr. Lovecchio, who is based at North Shore University Hospital in Manhasset. “I wanted to make sure that women are getting the right information, and are aware of the signs and symptoms of ovarian cancer. They must be alert to their own bodies and recognize that abdominal bloating, abdominal pain, pelvic pain, urinary symptoms, difficulty in eating, and feeling full quickly may not be the norm.”

“I wanted to make sure that women are getting the right information, and are aware of the signs and symptoms of ovarian cancer. They must be alert to their own bodies and recognize that abdominal bloating, abdominal pain, pelvic pain, urinary symptoms, difficulty in eating, and feeling full quickly may not be the norm.”

– John Lovecchio, M.D., Chief of Gynecologic Oncology, North Shore-Long Island Jewish Health System

“Women should seek the advice of experts trained in this field and not think that they are being alarmists. Other medical experts and patients interviewed in this documentary are all seeking the same outcome — to make every woman aware of her own body and to encourage every woman to seek help if she feels that something is not quite right,” said Dr. Lovecchio, who was interviewed for the documentary along with Drs. Goff, Karlan, and Markman.

Source:  PBS Documentary on Ovarian Cancer, News Release, North Shore-Long Island Jewish Health System, September 9, 2010.

2010-2011 U.S. News & World Report “Best Hospitals” List

This week, U.S. News & World Report issued its 2010-2011 rankings of the best U.S. hospitals for adults. The University of Texas, M.D. Anderson Cancer Center is rated #1 in cancer treatment, and Johns Hopkins is rated #1 in gynecology and #1 overall based upon all medical specialties.

If you would like more information regarding the 2010-2011 U.S. News & World Report best U.S. hospital rankings, click here. To better understand how U.S. News & World Report ranked the hospitals in each specialty, read Best Hospitals 2010-11: The Methodology, written by U.S. News & World Report’s Avery Comarow.  If you would like to review the current U.S. News & World Report America’s Best Children’s Hospitals list, click here.

Top 10 U.S. Hospitals: Cancer

Top 10 U.S. Hospitals: Gynecology

Top 10 U.S. Hospitals (highest scores in at least six medical specialties)
1. Univ. of Texas M.D. Anderson Cancer Center, Houston, Texas Johns Hopkins Hospital, Baltimore, Maryland Johns Hopkins Hospital, Baltimore, Maryland
2. Memorial Sloan-Kettering Cancer Center, New York, New York Mayo Clinic, Rochester, Minnesota Mayo Clinic, Rochester, Minnesota
3. Mayo Clinic, Rochester, Minnesota Brigham and Women’s Hospital,Boston, Massachusetts Massachusetts General Hospital, Boston, Massachusetts
4. Johns Hopkins Hospital, Baltimore, Maryland Cleveland Clinic, Cleveland, OH Cleveland Clinic, Cleveland, Ohio
5. University of Washington Medical Center, Seattle, Washington Massachusetts General Hospital, Boston, Massachusetts Ronald Reagan UCLA Medical Center, Los Angeles
6. Dana-Farber Cancer Institute, Boston, Massachusetts Magee-Womens Hospital of Univ. of Pittsburgh Medical Center, Pittsburgh, Pennsylvania New York-Presbyterian Univ. Hospital of Columbia & Cornell, New York, New York
7. Massachusetts General Hospital, Boston, Massachusetts Duke University Medical Center, Durham, North Carolina Univ. of California, San Francisco (UCSF) Medical Center
8. Univ. of California, San Francisco (UCSF) Medical Center Univ. of California, San Francisco (UCSF) Medical Center Barnes-Jewish Hospital/Washington University, St. Louis
9. Cleveland Clinic, Cleveland, Ohio New York-Presbyterian Univ. Hospital of Columbia & Cornell, New York, New York Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
10. Ronald Reagan UCLA Medical Center, Los Angeles Memorial Sloan-Kettering Cancer Center, New York, New York Duke University Medical Center, Durham, North Carolina

Clinical Conundrums: Choosing the Best Management Approaches in Patients With Ovarian Cancer

On June 16, 2010, Clinical Care Options Oncology released a Microsoft Powerpoint Presentation entitled, “Clinical Conundrums:  Choosing the Best Management Approaches in Patients With Ovarian Cancer.” The presentation provides the most recent data on managing patients with ovarian cancer in the frontline and recurrent setting and in specific clinical scenarios.

Thomas J. Herzog, M.D., Director, Division of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, New York, NY

On June 16, 2010, Clinical Care Options Oncology released a Microsoft Powerpoint Presentation entitled, Clinical Conundrums:  Choosing the Best Management Approaches in Patients With Ovarian Cancer. The presentation provides the most recent data on managing patients with ovarian cancer in the frontline and recurrent setting and in specific clinical scenarios.

The presentation was created by Thomas J. Herzog, MD, Director, Division of Gynecologic Oncology Columbia University College of Physicians and Surgeons. The topics covered in the presentation include the following:

–Controversies in the Treatment of Newly Diagnosed Ovarian Cancer

–What About Alternative Taxane Therapy?

–Will Adding a Third Drug Help?

–What About Intraperitoneal (IP) Therapy?

–Will Adding a Targeted Therapy Help?

–Prognostic Factors in Ovarian Cancer.

–Does Having a BRCA Mutation Affect Ovarian Cancer Prognosis?

–Ongoing and Recently Completed Clinical Trials in Ovarian Cancer.

–Relevance of CA-125 Levels: Placing Novel Data Into Clinical Context.

–Best Management Approaches for Patients With Platinum-Sensitive Recurrent Disease.

–Who Are the Best Candidates?

–Management of Patients in Challenging Clinical Situations: Platinum Resistance and Other Clinical Scenarios.

  • PARPi Trials: Ongoing/Planned
  • Investigational Agents
  • NKTR-102: Peg-Irinotecan
  • EC145: Novel Folate Receptor Targeted Therapeutic
  • Developmental Strategies

Source: Clinical Conundrums: Choosing the Best Management Approaches in Patients With Ovarian Cancer, by Thomas J. Herzog, MD, Director, Division of Gynecologic Oncology Columbia University College of Physicians and Surgeons, Treatment Updates, Ovarian 2010, Clinical Options Oncology, June 16, 2010.

Libby’s H*O*P*E*™ National Ovarian Cancer Coalition 6th Annual Women’s Health Expo Presentation

On March 20, 2010, Libby’s H*O*P*E*™ made a presentation at the National Ovarian Cancer Coalition’s 6th Annual Women’s Health Expo.  The presentation was entitled, A Patient Advocate’s Perspective on the Importance of Ovarian Cancer Awareness and Helpful Online Resources.

On March 20, 2010, Libby’s H*O*P*E*™ made a presentation at the National Ovarian Cancer Coalition’s 6th Annual Women’s Health Expo.  The presentation was entitled, A Patient Advocate’s Perspective on the Importance of Ovarian Cancer Awareness and Helpful Online Resources.  The topics covered in the presentation include:

  • Genesis of Libby’s H*O*P*E*™,
  • Ovarian Cancer Overview,
  • Helpful Online Resources,
  • Stories of Hope, and
  • Making a Difference

The full presentation is provided below in Adobe Reader PDF document format. To view the full presentation, simply click on the image below.  If you require free Adobe Reader software, click here.

I want to extend special thanks to Nancy Long and Paula Kozik, co-presidents of the National Ovarian Cancer Coalition’s Central Maryland Chapter, for the invitation to speak at this worthwhile event.  Nancy and Paula are two very special ovarian cancer survivors, who put together an informative conference that was well attended and enjoyed by all.  It was both an honor and a privilege to meet Nancy, Paula, and many other ovarian cancer survivors during the conference.  Many women shared with me their personal stories of struggle, inspiration and hope.  These women are my “everyday heroes.”  If you have any questions regarding the presentation, please feel free to contact me by clicking on the homepage “Contact” tab.

Libby’s H*O*P*E* to Present At NOCC 6th Annual Women’s Health Expo (REJUVENATE Finding Balance)

On March 20, 2010, the National Ovarian Cancer Coalition (Maryland Chapter) will hold its 6th Annual Women’s Health Expo entitled, REJUVENATE Finding Balance (NOCC Rejuvenate), at the Sheraton Annapolis Hotel. … On behalf of Libby’s H*O*P*E*™, I will conduct a seminar as part of Session II entitled, A Patient Advocate’s Perspective on the Importance of Ovarian Cancer Awareness and Related On-line Resources.

On March 20, 2010, the National Ovarian Cancer Coalition (Maryland Chapter) will hold its 6th Annual Women’s Health Expo entitled, REJUVENATE Finding Balance (NOCC Rejuvenate), at the Sheraton Annapolis Hotel. NOCC Rejuvenate is sponsored by the National Breast & Ovarian Cancer Connection and Cancer Treatment Centers of America.  Additional funding was also provided through a grant from the Maryland Attorney General Settlement.

NOCC Rejuvenate is designed to appeal to all women who want to rejuvenate their mind, body and spirit. The event is divided into three sessions. Each session offers seven to eight different seminars for attendees. The seminars address a variety of topics including make-up and skin care, going green, photography, plastic surgery, decorating, fashion, finance, retirement solutions, nutrition, fitness, and holistic approaches to wellness. A list of all event seminars is provided below.

Informative seminars about ovarian and breast cancer are offered as part of each session. Knowing the signs and symptoms of ovarian cancer, the screening guidelines for breast cancer, and the basics about hereditary breast and ovarian cancer, could save your life or the life of someone you love.  On behalf of Libby’s H*O*P*E*™, I will conduct a seminar as part of Session II entitled, A Patient Advocate’s Perspective on the Importance of Ovarian Cancer Awareness and Related On-line Resources.  My presentation will address the genesis of the Libby’s H*O*P*E*™ website; highlight critical ovarian cancer awareness information; summarize available online ovarian cancer and cancer-related resources; describe stories of hope involving ovarian cancer survivors and their families; and explain how each individual can make a difference in the fight against ovarian cancer.

NOCC Rejuvenate also targets cancer survivors. The devastating effects of these diseases can rob women of hope and peace. This event will offer an opportunity for survivors to reinvent their self-image and gain more knowledge, offering a sense of hope and a chance to connect with other survivors.

An exhibitor’s area will be offered at the event. This area will include informational tables as well as vendor tables that have been specifically chosen to meet the overarching vision of the event. At the completion of the three event sessions, a nutritious lunch will be served while information is provided on the signs and symptoms of ovarian and breast cancer.

NOCC 6th Annual Women's Health Expo

What:  National Ovarian Cancer Coalition 6th Annual Women’s Health Expo entitled, REJUVENTE Finding Balance (click here to view event brochure, including mail-in registration)

When: Saturday, March 20, 2010 (8:00 A.M. – 3:00 P.M.)

Where: Sheraton Annapolis Hotel, 173 Jennifer Road, Annapolis, Maryland 21401 (driving instructions).

Register: To register online click here.

Contact: Nancy Long (NOCC Maryland Chapter Co-President) at 443-433-2597, or email (click here).

Keynote Speaker:  Yarrow, The Energy Whisperer

Session I Presentations (9:30 A.M. – 10:30 A.M.)

  • Treating Cancer By Alternative Medicine
  • The Survivors’ Connection
  • The Skinny on Fat – Cancer Prevention Naturally
  • Interior Design in Difficult Times – Cost Saving Design Solutions
  • Relaxation & Healing
  • Identifying & Solving the Challenges of Baby Boomer Women
  • Cancer and The Healing Power of Forgiveness
  • Belly Dancing

Session II Presentations (10:45-11:45)

  • Dr. Zandra Cheng, Breast Surgeon at Anne Arundel Medical Center
  • Hereditary Syndromes That Include Ovarian and Breast Cancers
  • Facial & Body Rejuvenation
  • A Patient Advocate’s Perspective On the Importance of Ovarian Cancer Awareness & Related On-line Resources (Paul Cacciatore, Founder, Libby’s H*O*P*E*™)
  • Designing Green Interiors
  • Creating Better Images with the Camera You Own
  • Some Expert Fashion Tips
  • Yoga:  A Balanced Life
  • Relaxation & Healing

Session III Presentations (12:00 P.M. – 1:00 P.M.)

  • New Advances in Ovarian Cancer (William McGuire, M.D., Medical Director of The Harry & Jeanette Weinberg Cancer Institute at Franklin Square Hospital)
  • What is My Daughter’s Chance of Getting My Cancer?
  • Planning for your Retirement Lifestyle:  The New Retirement
  • Super Health Begins with Super-food Nutrition
  • Around the World to Your Backyard
  • Balancing Your Life Wheel
  • Get Fit & Healthy with the Simple Rules of the Big 3
  • Relaxation & Healing

About the National Ovarian Cancer Coalition

The mission of the NOCC is to raise awareness and increase education about ovarian cancer. NOCC is committed to improving the survival rate and quality of life for women with ovarian cancer. Through national programs and local Chapter initiatives, the NOCC’s goal is to make more people aware of the early symptoms of ovarian cancer. In addition, the NOCC provides information to assist the newly diagnosed patient, to provide hope to survivors, and to support caregivers. NOCC programs are possible only with the help of its volunteers; committed men and women dedicated to the mission of the NOCC in communities across the country.  For more information go to http://www.ovarian.org/.

About the National Breast & Ovarian Cancer Connection

The mission of the NBOCC is to raise awareness and educate the general public about the link between breast and ovarian cancer. The organization is dedicated to teaching all women about their inherent risks and how to improve their chances of survival through early detection and research developments.  For more information go to http://www.nbocc.org/.

2009-2010 U.S. News & World Report Best U.S. Hospital Rankings

Today, U.S. News & World Report issued its 2009-2010 rankings of the best U.S. hospitals for adults. The University of Texas, M.D. Anderson Cancer Center is rated #1 in cancer treatment; Brigham and Women’s Hospital is rated #1 in gynecology; and Johns Hopkins is rated #1 overall based upon all medical specialties.

If you would like more information regarding the 2009-2010 U.S. News & World Report best U.S. hospital rankings, click here. To better understand how U.S. News & World Report ranked the hospitals in each specialty, read America’s Best Hospitals: Here’s How We Selected Them – Deaths, reputation, and patient safety were among the factors the rankings took into account, written by U.S. News & World Report’s Avery Comarow.  If you would like to review the current U.S. News & World Report America’s Best Children’s Hospitals list, click here.

Top 10 U.S. Hospitals: Cancer

Top 10 U.S. Hospitals: Gynecology

Top 10 U.S. Hospitals (highest scores in at least six medical specialties)

1. Univ. of Texas M.D. Anderson Cancer Center, Houston, Texas Brigham and Women’s Hospital, Boston, Massachusetts Johns Hopkins Hospital, Baltimore, Maryland
2. Memorial Sloan-Kettering Cancer Center, New York, New York Johns Hopkins Hospital, Baltimore, Maryland Mayo Clinic, Rochester, Minnesota
3. Johns Hopkins Hospital, Baltimore, Maryland Mayo Clinic, Rochester, Minnesota Ronald Reagan UCLA Medical Center, Los Angeles
4. Mayo Clinic, Rochester, Minnesota Duke University Medical Center, Durham, North Carolina Cleveland Clinic, Cleveland, Ohio
5. Dana-Farber Cancer Institute, Boston, Massachusetts Univ. of California, San Francisco (UCSF) Medical Center Massachusetts General Hospital, Boston, Massachusetts
6. University of Washington Medical Center, Seattle, Washington Cleveland Clinic, Cleveland, Ohio New York-Presbyterian Univ. Hospital of Columbia & Cornell, New York, New York
7. Massachusetts General Hospital, Boston, Massachusetts Magee-Womens Hospital of Univ. of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Univ. of California, San Francisco (UCSF) Medical Center
8. Univ. of California, San Francisco (UCSF) Medical Center New York-Presbyterian Univ. Hospital of Columbia & Cornell, New York, New York Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
9. Duke University Medical Center, Durham, North Carolina Massachusetts General Hospital, Boston, Massachusetts Barnes-Jewish Hospital/Washington University, St. Louis
10. Stanford Hospital and Clinics, Stanford, California Ronald Reagan UCLA Medical Center, Los Angeles Brigham and Women’s Hospital, Boston, Massachusetts

Synergistic Anti-Tumor Effect of CRM197 & Paclitaxel in Ovarian Cancer

CRM197, an inhibitor of heparin-binding EGF-like growth factor (HB-EGF), produces a synergistic ovarian cancer anti-tumor effect when combined with paclitaxel, according to study results published in the March 15th issue of the International Journal of Cancer.  The investigators, Dr. Shingo Miyamoto and his colleagues, are affiliated with the Fukuoka University in Japan.  “The treatment of CRM197 in conjunction with paclitaxel results in a marked synergistic anti-tumor effect in ovarian cancer cells in vivo, suggesting a novel combination therapy for ovarian cancer patients including those showing chemo-resistance.”  Accordingly, the investigators generally concluded that inhibitory agents against HB-EGF, such as CRM197, represent possible chemotherapeutic and chemosensitizing agents for ovarian cancer. …

CRM197, an inhibitor of heparin-binding EGF-like growth factor (HB-EGF), produces a synergistic ovarian cancer anti-tumor effect when combined with paclitaxel, according to study results published in the March 15th issue of the International Journal of Cancer.  The investigators, Dr. Shingo Miyamoto and his colleagues, are affilitated with the Fukuoka University in Japan.

According to the researchers, HB-EGF plays a pivotal role in tumor growth and clinical outcomes in patients with ovarian cancer, thereby making it a target for future ovarian cancer therapy. CRM197 is a non-toxic variant of the diphtheria toxin.  The investigators conducted studies in which CRM197 and paclitaxel (Taxol®) were tested against ovarian cancer cell cultures (in vitro) and overexpressing HB-EGF ovarian cancer cells which were injected into mice.

The investigators discovered that paclitaxel induced transient ERK activation and sustained activation of JNK and p38 MAPK, effects that were reduced by overexpression of HB-EGF. CRM197 effectively suppressed the paclitaxel-induced anti-apoptotic signals mediated by ERK and Akt and enhanced the pro-apoptotic signals JNK and p38 MAPK.

The investigators also noted that in the mice with ovarian cancer xenografts, paclitaxel and CRM197 completely blocked tumor formation at doses of 10 mg/kg paclitaxel and 5 mg/kg CRM197.

Based on the foregoing, Miyamoto et. al. concluded that “the enhancement of HB-EGF expression abrogates the antitumor effect of paclitaxel by altering the balance of anti-apoptotic and pro-apoptotic signals induced by paclitaxel. The treatment of CRM197 in conjunction with paclitaxel results in a marked synergistic anti-tumor effect in ovarian cancer cells in vivo, suggesting a novel combination therapy for ovarian cancer patients including those showing chemo-resistance.”  Accordingly, the investigators generally concluded that inhibitory agents against HB-EGF, such as CRM197, represent possible chemotherapeutic and chemosensitizing agents for ovarian cancer.

Phase 1 [clinical] study of the use of CRM197 has already started at Fukuoka University for patients with advanced ovarian cancer under the approval of the ethical committee,” the investigators added.

Primary Sources:

Early Detection Remains Key in Updated National Comprehensive Cancer Network (NCCN) Guidelines for Ovarian Cancer

New updates to the NCCN Clinical Practice Guidelines in Oncology™ for Ovarian Cancer were presented at the NCCN 14th Annual Conference on March 14. Notable additions to the NCCN Guidelines are a section on managing allergic reactions to chemotherapy agents and new agents for recurrence therapy. Robert J. Morgan Jr., M.D., F.A.C.P. of  the City of Hope Comprehensive Cancer Center presented the updated NCCN Guidelines that continue to stress early detection of ovarian cancer and the enrollment of patients in clinical trials.

“Early Detection Remains Key in Updated NCCN Guidelines for Ovarian Cancer


New updates to the NCCN Clinical Practice Guidelines in Oncology™ for Ovarian Cancer were presented at the NCCN 14th Annual Conference on March 14. Notable additions to the NCCN Guidelines are a section on managing allergic reactions to chemotherapy agents and new agents for recurrence therapy. Robert J. Morgan, MD, of City of Hope Comprehensive Cancer Center presented the updated NCCN Guidelines that continue to stress early detection of ovarian cancer and the enrollment of patients in clinical trials.


March 16, 2009

morganrobert

Robert J. Morgan Jr., M.D., F.A.C.P., Professor of Medical Oncology, Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA & Chair of the NCCN Guidelines Panel for Ovarian Cancer

HOLLYWOOD, FL — Improvements in screening and early detection remains the key for women with ovarian cancer according to Robert J. Morgan, MD, of City of Hope Comprehensive Cancer Center and chair of the NCCN Guidelines Panel for Ovarian Cancer. Dr. Morgan discussed the future of ovarian cancer and notable changes to the recently updated NCCN Ovarian Cancer Guidelines at the NCCN Annual Conference on Saturday, March 14.

Dr. Morgan began by explaining that the major challenge in treating ovarian cancer is that by the time the majority of patients (70 percent) are diagnosed with the disease, it has already progressed to stage III or IV. ‘We have not yet found a good way to screen the general population or even the high-risk population of women for ovarian cancer,’ he said.

New to the NCCN Guidelines is a section on the management of allergic reactions in patients receiving chemotherapy for ovarian cancer. Dr. Morgan explained the need for this section as ovarian cancer tends to respond to the same treatment repeatedly. Combined with the fact that recurrence rates of ovarian cancer are high, this can result in patients often being retreated with the same chemotherapeutic agent. Given that virtually all chemotherapy drugs have the potential to cause infusion reactions, including agents commonly used in ovarian cancer, the NCCN Guidelines Panel felt it was important to provide information on allergic reactions and recommendations on desensitization regimens.

‘Most patients experiencing allergic reactions are able to be desensitized allowing for continued chemotherapeutic treatment, which is vital to the management of ovarian cancer,’ said Dr. Morgan.

Also new to the updated NCCN Guidelines is the addition of new agents for recurrence therapy, most notably pemetrexed (Alimta®, Eli Lilly and Company) as well as recommendations for therapies based on the timing of recurrence.

‘Seventy-five to 80 percent of patients with stage III or IV ovarian cancer will experience recurrence and this recurrence can occur at any time – during treatment, within 6 months of completing treatment, or more than a year after completing treatment,’ Dr. Morgan noted. ‘In the updated NCCN Guidelines, we differentiated appropriate therapy for recurrence based upon the time frame on which it occurs.’

Additionally, Dr. Morgan referred to a clinical trial suggesting that pemetrexed is active in recurrent ovarian cancer, to support the new recommendation in the updated NCCN Guidelines.

Dr. Morgan described new updates to the Principles of Primary Surgery section in the updated NCCN Guidelines that included the recommendation to consider completion surgery for patients responsive to chemotherapy with initially unresectable residual disease, as well as recommendations relating to special circumstances including minimally-invasive procedures, and fertility sparing procedures.

Dr. Morgan also discussed recent clinical studies conducted abroad that studied the effect of chemotherapy as an up-front therapy in patients with ovarian cancer, and concluded that ‘in the United States, up-front debulking surgery remains the recommendation for the best overall survival.’

Another addition to the updated NCCN Guidelines is a section on the Principles of Chemotherapy. This section emphasizes the encouragement of patients participating in clinical trials during all aspects of their treatment course as well as noting that patients with newly diagnosed tumors should be informed about the different options available, particularly IV [intravenous] vs. IV/IP chemotherapy and the risks and benefits of each regimen.

‘The future of ovarian cancer lies in early detection and improvements in screening,’ Dr. Morgan noted as he discussed potential biomarkers for the detection, prediction and prognostication of ovarian cancer.

He concluded that steady progress is being made in the treatment of ovarian cancer, but further trials are necessary to investigate the role of targeted agents alone and in combination in newly diagnosed and recurrent ovarian cancer. Finally, he again stressed the need for physicians to encourage their patients to participate in clinical trials.

For questions about NCCN or for interview information, please contact Megan Martin 215.690.0576.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 21 of the world’s leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. For more information, visit www.nccn.org.

The NCCN Member Institutions are

Cited SourceEarly Detection Remains Key in Updated NCCN Guidelines for Ovarian Cancer, News, National Comprehensive Cancer Network (NCCN), March 16, 2009.

Libby’s H*O*P*E*(tm) Adds New Cancer Video Archive Courtesy of Vodpod.com

Yesterday, Libby’s H*O*P*E* added a new cancer video archive to the weblog courtesy of Vodpod.com.  Currently, the archive contains approximately 90 videos that address many general cancer and ovarian cancer issues, as well as the personal voices of those affected by cancer. The new video archive is located on the homepage right sidebar.  All you have to do is “click and play.”

vodpod-logoYesterday, Libby’s H*O*P*E* added a new cancer video archive to the weblog courtesy of Vodpod.com.  Currently, the archive contains approximately 90 videos that address many general cancer and ovarian cancer issues, as well as the personal voices of those affected by cancer. The new video archive is located on the homepage right sidebar.  All you have to do is “click and play.”  The video arrangement is set to “random order” so that new videos appear on the homepage sidebar each time you visit Libby’s H*O*P*E*.

If you are aware of a general cancer/ovarian cancer video that is educational, heartfelt, inspirational, humorous, poignant, or is simply dedicated to the one you love, please provide us with the URL address of the video.  The URL video address can be sent to us by email (click on the “contact” button located at the top of the homepage), or by comment (post a comment under this post).  Upon receipt of the video URL address, we will add the referenced video to the new archive.  We appreciate your participation in adding to our video archive and hope you find the archive helpful.

Working Smarter, Not Harder: Use of Anti-Estrogen Therapy to Battle Recurrent Ovarian Cancer

The Gynecologic Oncology department of the University of Texas, M.D. Anderson Cancer Center took a page out of the breast cancer treatment “playbook,” and conducted a single institution Phase II clinical trial using letrozole (Femara®) to treat recurrent, platinum and taxane resistant, high-grade cancer of the ovary and peritoneum. …The trial investigators concluded that 26% (8/31 pts.) of patients with ER+ … ovarian and primary peritoneal cancer derived a clinical benefit (stable disease (SD) + partial response (PR)) after treatment with letrozole (Femara®).

Pursuant to the breast cancer standard of care, breast tissue tumor is routinely analyzed to determine if it is “estrogen receptor positive” (ER positive or ER+), meaning that tumor growth is fueled by the hormone estrogen. It is well-known in the breast cancer area that hormonal therapy is a very effective treatment against breast cancer that is ER+. Sometimes referred to as “anti-estrogen therapy,” hormonal therapy blocks the ability of the hormone estrogen to turn on and stimulate the growth of breast cancer cells.

For decades, the anti-estrogen therapy of choice for treatment of ER+ breast cancer was tamoxifen. In 2005, several world-wide clinical trials reported that aromatase inhibitors (specifically, anastrozole (Arimidex®), exemestane (Aromasin®), and letrozole (Femara®) were more effective than tamoxifen in post-menopausal women with ER+ breast cancer. Aromatase inhibitor drug use is currently the standard of care for treatment of post-menopausal women with ER+ breast cancer, while tamoxifen remains the hormonal treatment of choice for pre-menopausal women.

The Gynecologic Oncology department of the University of Texas, M.D. Anderson Cancer Center took a page out of the breast cancer treatment “playbook,” and conducted a single institution Phase II clinical trial using letrozole (Femara®) to treat recurrent, platinum and taxane resistant, high-grade cancer of the ovary and peritoneum.

Thirty-three patients enrolled in the Phase II clinical trial, and each had measurable disease that tested ER+ pursuant to trial eligibility criteria. Twenty-three patients (74%) had received three or more prior chemotherapy regimens. Letrozole (Femara®) was administered at a dose of 2.5 mg orally once daily until disease progression or toxicity occurred. The median patient age was 63 years (ranging from 38 to 83 years).

The 31 patients evaluable for response received a total of 81 cycles (4 weeks per cycle) of therapy (ranging from 1 to 14 cycles per patient). The median treatment duration was 8 weeks (ranging from 4 to 52 weeks). The trial investigators reported that (i) none of the patients had a complete response (CR), (ii) 1 (3%) had a partial response (PR), and (iii) 7 (23%) had stable disease (SD). The median duration of clinical benefit (SD and PR) was 9 weeks (ranging from 7 to 46 weeks). The median follow-up for all patients was 25 weeks. All evaluable patients were monitored for toxicity. The most common adverse effects were fatigue (36%) and diaphoresis (21%). No grade 3 or 4 toxicities were reported, and no patients discontinued treatment owing to adverse effects. Eighteen patients (58%) went on to receive additional therapy with other agents.

Based upon the results above, the trial investigators concluded that 26% (8/31 pts.) of patients with ER+, platinum- and taxane-resistant, high-grade ovarian and primary peritoneal cancer derived a clinical benefit (stable disease (SD) + partial response (PR)) after treatment with letrozole (Femara®).

Sources:

Comment: Based upon the references listed above and below, it appears that the opening of clinical trials that utilize anti-estrogen therapy to treat ER+ ovarian cancer is long overdue. The “take away” from the M.D. Anderson clinical trial study results is that an ovarian cancer survivor should request her doctor to test the ovarian cancer tumor tissue obtained from surgery or biopsy for estrogen receptor positivity, so as to determine if she is eligible to use anti-estrogen therapy (within the context of a clinical trial) as part of an overall cancer treatment plan.

It is important to note that letrozole is a low side effect, oral drug. Moreover, M.D. Anderson’s letrozole monotherapy produced a 26% clinical benefit rate among ER+, platinum- and taxane-resistant, ovarian and peritoneal cancer patients, despite the fact that approximately three-quarters of the clinical trial patients were heavily pretreated with multiple lines of chemotherapy prior to their trial enrollment. It is promising to consider the potential clinical benefit that could be generated by anti-estrogen therapy in a neoadjuvant or adjuvant ovarian cancer treatment setting.

Additional Anti-Estrogen Therapy/Ovarian Cancer References:

  • Estrogen-regulated gene expression predicts response to endocrine therapy in patients with ovarian cancer, Walker G et. al.; Gynecol Oncol. 2007 Sep;106(3):461-8. Epub 2007 Jul 10. (“OBJECTIVE: To explore the predictive value of estrogen-regulated gene changes as indicators of sensitivity in ovarian cancer patients treated with the aromatase inhibitor Letrozole. … CONCLUSION: These results suggest that expression levels of certain proteins in ovarian cancers are estrogen-regulated and could help identify patients who would benefit from endocrine therapy.” [i.e., anti-estrogen therapy])
  • Antiestrogen therapy is active in selected ovarian cancer cases: the use of letrozole in estrogen receptor-positive patients, Smyth JF et. al.; Clin Cancer Res. 2007 Jun 15;13(12):3617-22 (“PURPOSE: To evaluate the efficacy of the aromatase inhibitor letrozole in preselected estrogen receptor (ER)-positive relapsed epithelial ovarian cancer patients and to identify markers that predict endocrine-sensitive disease. EXPERIMENTAL DESIGN: This was a phase II study of letrozole 2.5 mg daily until clinical or marker evidence of disease progression in previously treated ER-positive ovarian cancer patients with a rising CA125 that had progressed according to Rustin’s criteria. The primary end point was response according to CA125 and response evaluation criteria in solid tumors (RECIST) criteria. Marker expression was measured by semiquantitative immunohistochemistry in sections from the primary tumor. RESULTS: Of 42 patients evaluable for CA125 response, 7 (17%) had a response (decrease of >50%), and 11 (26%) patients had not progressed (doubling of CA125) following 6 months on treatment. The median time taken to achieve the CA125 nadir was 13 weeks (range 10-36). Of 33 patients evaluable for radiological response, 3 (9%) had a partial remission, and 14 (42%) had stable disease at 12 weeks. Eleven patients (26%) had a PFS of >6 months. Subgroup analysis according to ER revealed CA125 response rates of 0% (immunoscore, 150-199), 12% (200-249), and 33% (250-300); P = 0.028, chi(2) for trend. Expression levels of HER2, insulin-like growth factor binding protein 5, trefoil factor 1, and vimentin were associated with CA125 changes on treatment. CONCLUSIONS: This is the first study of a hormonal agent in a preselected group of ER-positive ovarian cancer patients. A signature of predictive markers, including low HER2 expression, predicts response.)
  • The efficacy of tamoxifen in patients with advanced epithelial ovarian cancer, Karagol H et. al.; Med Oncol. 2007;24(1):39-43 (“BACKGROUND: Activity of tamoxifen as a salvage therapy in patients with advanced epithelial ovarian cancer was evaluated by a number of studies. In this study, we evaluated efficacy of tamoxifen in our patients with platinum-resistant epithelial ovarian carcinoma. … RESULTS: Twenty-nine eligible patients were included to the study. There were 1 (3%) complete response, 2 (7%) partial response, 6 (21%) stable disease, and 20 (69%) progressive disease. All patients were progressed after initiation of tamoxifen. Median progression-free survival was 4 mo (95% CI: 2.98-5.02). Disease progression of 19 (65%) patients were shown within the first 6 mo after initiation of tamoxifen. Progression-free survival was between 6 and 12 mo for 7 (24%) patients and > or =12 mo for 3 (10%) patients. The median survival after initiation of tamoxifen was 15 mo (95% CI: 7.2-22.8). No toxicity attributable to tamoxifen was seen in any of the patients. The only independent prognostic factor that had a significant predictive value for progression- free survival was the response to tamoxifen treatment (p = 0.043, hazard ratio: 0.12, 95% CI: 0.01-0.94). CONCLUSION: Considering minimal side effects and ability to cause objective responses, there is a place for tamoxifen in treatment of patients with platinum-resistant ovarian cancer. A phase III trial is required to confirm the value of the drug in patients presenting these clinical settings.”)
  • Anastrozole therapy in recurrent ovarian adult granulosa cell tumors: a report of 2 cases, Freeman SA, Modesitt SC; Gynecol Oncol. 2006 Nov;103(2):755-8. Epub 2006 Jul 25 (“BACKGROUND: Ovarian sex cord stromal tumors are frequently hormonally active, and adult granulosa cell tumors often demonstrate estrogen receptor positivity. Thus, hormonal agents have been evaluated as potential treatments for advanced stage or recurrent adult granulosa cell tumors. CASE: Two cases of patients with recurrent adult granulosa cell tumors are presented. Each patient received multiple treatment modalities including chemotherapy and had previously progressed on leuprolide. Both patients were started on anastrozole with subsequent normalization of inhibin B levels and clinical exams. They have been maintained on treatment for 14 and 18 months, respectively, and have tolerated the drug without difficulty. CONCLUSION: Aromatase inhibitors may be a viable treatment option for women with advanced stage or recurrent ovarian adult granulosa cell tumors.”)
  • Hormonal therapy in epithelial ovarian cancer, Rao GG, Miller DS; Expert Rev Anticancer Ther. 2006 Jan;6(1):43-7. (“The ovary is an endocrine and end organ. Hormones and their receptors have been associated with ovarian cancer and may be related to its causation. Some data suggest that hormonal therapies may have an effect on ovarian cancer in palliative settings. The most well studied anticancer drugs are tamoxifen, megestrol acetate, medroxyprogesterone acetate, leuprolide acetate, anastrozole and letrozole. Presently, no hormonal therapy is approved by the US FDA for the treatment of any type of ovarian malignancy or is listed as an active agent by any of the authoritative compendia. Owing to the endocrine associations with ovarian cancer, the minimal side effects of hormonal therapy and the demonstrated activity of hormonal therapies in other endocrine organ-associated malignancies, further study of hormonal therapies for ovarian cancer is warranted.”)
  • Aromatase expression in ovarian epithelial cancers, Cunat S et. al.; J Steroid Biochem Mol Biol. 2005 Jan;93(1):15-24 (” … Aromatase activity was evaluated in ovarian epithelial cancer (OEC) cell lines by the tritiated water assay and the effects of third-generation aromatase inhibitors (AIs) on aromatase activity and growth were studied. Letrozole and exemestane were able to completely inhibit aromatase activity in BG1 and PEO14 cell lines. Interestingly, both AI showed an antiproliferative effect on the estrogen responsive BG1 cell line co-expressing aromatase and ERalpha. Aromatase expression was found in ovarian epithelial normal tissues and in some ovarian epithelial cancer cells and tissues. This finding raises the possibility that some tumors may respond to estrogen and provides a basis for ascertaining an antimitogenic effect of AI in a subgroup of ovarian epithelial cancers.”)
  • Hormone therapy in epithelial ovarian cancer, Makar AP; Endocr Relat Cancer. 2000 Jun;7(2):85-93 (“Although epidemiologic studies, animal experiments and receptor studies have shown that not only normal ovaries but also many malignant ovarian tumors can be considered as endocrine related and hormone dependent, the place of hormonal therapy in the management of patients with ovarian cancer remains unsettled. Most trials of hormonal treatment in ovarian cancer have been retrospective, involved only limited numbers of patients, and lacked important patient-related data and information pertaining to tumor characteristics. In addition, a variety of hormonal preparations with different degrees of potency and in different dosages were included in these studies. A literature review shows that response to hormonal therapy even in a preterminal setting, is modest, with about 8% objective response but almost no side effects. In a similar patient setting, more toxic therapeutic agents do not yield a better response. The place of hormonal therapy in the management of patients with epithelial ovarian cancer needs more thorough evaluation in well-designed randomized trials.”)

Cancer Survivors With Low Volume Metastases May Benefit From Radiotherapy

“Precisely targeted radiation therapy can eradicate all evidence of disease in selected patients with cancer that has spread to only a few sites, suggests the first published report from an ongoing clinical trial. … Six of the 29 [21%] initial patients had lasting tumor control, with no detectable evidence of disease 15 months after treatment. Many patients had a complete response in at least one tumor. Thirty-one of the 56 treated tumors (55%) completely disappeared. Two tumors (4%) had a partial response, defined as reduction in tumor volume of more than 30 percent. Only three of the 56 tumors progressed (5%), growing in size by 20 percent or more during the treatment phase … Crucial to this approach is careful patient selection, distinguishing between patients who have a treatable number of tumors and those who have widespread metastasis, including multiple tumors too small to detect. Currently, there are no known genetic “signatures” to differentiate between widespread cancer versus oligometastasis, the authors point out.”

Image-Guided Radiation Therapy Used To Treat "Oligometastasis"

Image-Guided Radiation Therapy (IGRT) Used To Treat "Oligometastasis"

“Precisely targeted radiation therapy can eradicate all evidence of disease in selected patients with cancer that has spread to only a few sites, suggests the first published report from an ongoing clinical trial.

In the August 15, 2008, issue of Clinical Cancer Research, (published online August 12) researchers from the University of Chicago Medical Center report that targeted radiation therapy had completely controlled all signs of cancer in 21 percent of patients who had five or fewer sites of metastatic disease.

‘This was proof of principle in patients who had failed the standard therapies and had few, if any, remaining options,’ said the study’s senior author, Ralph Weichselbaum, MD, professor and chairman of radiation and cellular oncology at the University of Chicago Medical Center. “We had encouraging results, including several long-term survivors, in patients with stage-IV cancers that had spread to distant sites.’

In 1994, Weichselbaum and colleague Samuel Hellman proposed that there was an intermediate state between cancer that had not spread at all and cancer that had spread extensively. They named this phenomenon “oligometastases,” meaning cancer that had spread to a few distant sites.

In some cases, surgeons have successfully treated such limited cancer spread, producing long-term survival by removing the primary cancer and one or two distant tumors, off-shoots of the original cancer–usually in the lung or liver. However, some patients are not fit for surgery or have cancer that is inoperable.

Recent improvements in tumor detection and precise image-guided radiation therapy, however, have made simultaneous treatment of multiple tumor sites with radiation feasible. So in 2004, Weichselbaum organized a clinical trial to test the ability of local radiation therapy to control a limited number of related tumors which colleague Joseph Salama, MD, assistant professor of radiation oncology at the University of Chicago has directed since 2005.

Patients with stage-IV cancer with one to five distant metastases and no tumors bigger than 10 centimeters (about four inches) in diameter were eligible to participate in the study either before or after chemotherapy treatment.

Each patient received three doses, separated by at least two days, of precisely targeted radiation therapy focused on each metastatic tumor. Treatment was usually completed within one week. The first patients in the study received lower doses. As few side effects were seen, radiation doses were gradually increased in subsequent groups of patients.

‘Previous studies determined the maximal radiotherapy doses for single organs,’ said Salama, lead author of the study, ‘but this technique has not been tested for simultaneous use on multiple organs. So we designed a dose-escalation trial to determine the optimal dose, starting with fairly low levels and increasing the dose in later groups of patients.’

From November 2004 through February 2008, 29 patients, with a total of 56 cancerous lesions, enrolled in the trial. Of the 29 patients, 24 had progressed after at least one round of systemic chemotherapy. For the other five, there was no promising choice of therapy.

Six of the 29 initial patients had lasting tumor control, with no detectable evidence of disease 15 months after treatment.

Many patients had a complete response in at least one tumor. Thirty-one of the 56 treated tumors (55%) completely disappeared. Two tumors (4%) had a partial response, defined as reduction in tumor volume of more than 30 percent. Only three of the 56 tumors progressed (5%), growing in size by 20 percent or more during the treatment phase.

Tumor control improved as the radiation dose increased. Thirty-nine percent of the 31 tumors treated with 24 gray of radiation met the criteria for tumor control–a complete or partial response. That increased to 79 percent for the 19 tumors treated with 30 gray, and to 83 percent for the six tumors treated with 36 gray.

‘This suggests that the initial doses were too low,’ said Salama. ‘We have seen improved response rates with higher radiation doses without an increase in side effects yet.’

Typical treatment doses for a patient with breast cancer, for example, are in the range of 50 to 60 gray, spread over 20-30 sessions. The trend however, is toward delivering higher doses in fewer sessions.

Patients tolerated the treatment, the authors write, with ‘limited difficulty.’ All had some fatigue but few had serious side effects. The most severe included one patient being treated for abdominal tumors who developed vomiting that required hospitalization. One lung cancer patient developed a severe cough. One patient had gastrointenstinal [sic] bleeding three months after treatment that required blood transfusion and laser treatment.

Crucial to this approach is careful patient selection, distinguishing between patients who have a treatable number of tumors and those who have widespread metastasis, including multiple tumors too small to detect. Currently, there are no known genetic “signatures” to differentiate between widespread cancer versus oligometastasis, the authors point out. This is one area of active research. Only five of the 29 patients treated so far, however, had tumor progression in more than five sites.

The technique could also be applied after chemotherapy, the authors suggest, in cases where the drugs had eliminated most the smaller cancer, leaving only a few larger tumors behind.

The trial is still underway. ‘We now have about 50 patients,’ said Weichselbaum, ‘and several of them remain disease-free, one of them three years after treatment.’

The Ludwig Center for Metastasis Research and the University of Chicago Cancer Research Center funded this study. Additional authors include Steven Chmura, Neil Mehta, Kamil Yenice, Walter Stadler, Everett Vokes, Daniel Haraf and Samuel Hellman, of the University of Chicago Medical Center.”

Quoted Source: Targeted Radiation Therapy Can Control Limited Cancer Spread, Press Release, The University of Chicago Medical Center, August 15, 2008 (summarizing the findings of An initial report of a radiation dose-escalation trial in patients with one to five sites of metastatic disease; Salama JK et. al., Clin Cancer Res. 2008 Aug 15;14(16):5255-9. (” … RESULTS: Twenty-nine patients with 56 metastatic lesions were enrolled from November 2004 to March 2007, with a median follow-up of 14.9 months. Two patients experienced acute (radiation pneumonitis and nausea) and one experienced chronic (gastrointestinal hemorrhage) grade >/=3 toxicity. Fifty-nine percent of patients responded to protocol therapy. Twenty-one percent of patients have not progressed following protocol treatment. Fifty-seven percent of treated lesions have not progressed at last follow-up. Progression was amenable to further local therapy in 48% of patients. CONCLUSIONS: Patients with low-volume metastatic cancer can be identified, safely treated, and may benefit from radiotherapy.”))

Additional Information:

U.S. News & World Report Issues 2008 Best U.S. Hospitals List

On July 10, 2008, U.S. News & World Report issued its 2008 list of the best U.S. hospitals (for adults). The University of Texas, M.D. Anderson Cancer Center was rated #1 in Cancer, Brigham and Women’s Hospital was rated #1 in gynecology, and Johns Hopkins was rated #1 overall. If you would like more information regarding the 2008 U.S. News & World Report best U.S. hospitals ranking, click here. To read “Your ‘Best Hospitals’ Questions Answered,” written by U.S. News & World Report’s Avery Comarow, click here.  U.S. News & World Report issued its 2008 “America’s Best Children’s Hospitals” last month.  If you would like to review the 2008 “America’s Best Children’s Hospitals” List, click here.

Top 10 U.S. Hospitals: Cancer

Top 10 U.S. Hospitals: Gynecology

Top 10 U.S. Hospitals (highest scores in at least six medical specialties)

1. Univ. of Texas M.D. Anderson Cancer Center, Houston, Texas Brigham and Women’s Hospital, Boston, Massachusetts Johns Hopkins Hospital, Baltimore, Maryland
2. Memorial Sloan-Kettering Cancer Center, New York, New York Johns Hopkins Hospital, Baltimore, Maryland Mayo Clinic, Rochester, Minnesota
3. Johns Hopkins Hospital, Baltimore, Maryland Mayo Clinic, Rochester, Minnesota Ronald Reagan UCLA Medical Center, Los Angeles
4. Mayo Clinic, Rochester, Minnesota Duke University Medical Center, Durham, North Carolina Cleveland Clinic, Cleveland, Ohio
5. Dana-Farber Cancer Institute, Boston, Massachusetts Univ. of California, San Francisco (UCSF) Medical Center Massachusetts General Hospital, Boston, Massachusetts
6. University of Washington Medical Center, Seattle, Washington New York-Presbyterian Univ. Hospital of Columbia & Cornell, New York, New York New York-Presbyterian Univ. Hospital of Columbia & Cornell, New York, New York
7. Massachusetts General Hospital, Boston, Massachusetts Magee-Womens Hospital of Univ. of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Univ. of California, San Francisco (UCSF) Medical Center
8. Univ. of California, San Francisco (UCSF) Medical Center Cleveland Clinic, Cleveland, Ohio -Brigham and Women’s Hospital, Boston, Massachusetts/-Duke University Medical Center, Durham, North Carolina
9. Stanford Hospital and Clinics, Stanford, California Vanderbilt Univ. Medical Center, Nashville, Tennessee
10. Ronald Reagan UCLA Medical Center, Los Angeles Ronald Reagan UCLA Medical Center, Los Angeles -Hospital of the Univ. of Pennsylvania, Philadelphia, Pennsylvania/-University of Washington Medical Center, Seattle, Washington

Increased Worldwide Focus on the Safety of Drugs Used To Treat Chemotherapy-Related Anemia

Over the past month, there was considerable press coverage regarding the safety and proper use of epoetin alfa (marketed as Epogen® & Procrit®) and darbepoetin (marketed as Aranesp®). Both drugs are erythropoiesis-stimulating agents (ESAs).

This controvery began between December 2006 and February 2007, when the U.S. Food and Drug Administration (FDA) was made aware of several studies in cancer patients that showed higher mortality or shorter time to tumor progression in patients randomized to receive an ESA as compared to placebo. Some of the trials dosed patients in the ESA treatment group to achieve hemoglobin levels ≥ 12 g/dl (higher than recommended on the ESAs drug box labeling). Other trials included anemic patients who were not on chemotherapy or radiotherapy. These studies were discussed at a May 10, 2007 meeting of the Oncology Drug Advisory Committee of the FDA (ODAC). The ODAC recommended additional restrictions in the labeling for ESAs including: (i) specific tumor types for which adverse safety signals were observed with the use of an ESA, (ii) instructions for hemoglobin trigger level-based dose modification/suspension, and (iii) instruction to discontinue use of ESAs upon completion of chemotherapy.

With respect to cancer the FDA recommendations to healthcare professionals include the following:

  • ESAs shortened the overall survival and/or time-to-tumor progression in patients with various cancers;
  • Risks of shortened survival and tumor progression have not been excluded when ESAs are dosed with the intent to achieve hemoglobin levels <12g/dL;
  • Use the lowest dose of [Aranesp/EPOGEN/PROCRIT] needed to avoid red blood cell transfusions. Do not exceed the upper safety limit for hemoglobin levels of 12 g/dL;
  • Reduce the ESA dose by 25% when hemoglobin reaches a level needed to avoid transfusion;
  • Withhold dosing with an ESA when hemoglobin level exceeds 12 g/dL;
  • Restart dosing at 25% below the previous dose when the hemoglobin approaches a level where transfusions may be required;
  • Discontinue treatment with an ESA following the completion of a course of chemotherapy; and
  • Use of ESAs in cancer patients have not been demonstrated in controlled clinical trials to improve the symptoms of anemia, quality of life, fatigue, or well-being.

The FDA also provided patient counseling guidance to healthcare professionals with respect to the use of ESAs. As part of a risk minimization plan, the FDA announced that it is developing a patient “Medication Guide” to better communicate the risks and benefits of ESA use to patients. Physicians and other healthcare professionals were advised by the FDA to discuss the following talking points with their patients:

  • The primary goal of treatment with erythropoiesis stimulating agents (ESA) is to increase the number of red blood cells in order to avoid receiving blood transfusions.
  • ESAs require at least 2 weeks of treatment before there is an increase in the number of red blood cells and the dose may be adjusted periodically but not more often than every 4 weeks.
  • ESAs increase the patient’s chance of blood clots and the risk of dying may be greater in certain circumstances
  • Patients should keep appointments for blood tests so hemoglobin levels can be monitored.
  • Patients need to monitor their blood pressure and contact their doctor if there are any changes outside of the range that has been established for them.
  • Patients should contact their doctor if they experience any of the following symptoms:

o Pain and/or swelling in the legs;
o Worsening in shortness of breath;
o Increases in blood pressure;
o Dizziness or loss of consciousness;
o Extreme tiredness; and
o Blood clots in hemodialysis vascular access ports

On June 26, 2008 -in a surprising announcement – the European Medicines Agency (EMEA) urged oncologists to favor blood transfusions over ESAs. Although these popular drugs have been used to treat cancer-related anemia for close to 20 years and have become a mainstay of therapy, the new recommendation is encouraging clinicians to reverse this common practice. The EMEA committee for Medicinal Products for Human Use (CHMP) recommendation is based upon its review of new data from studies that showed an increased risk for tumor progression, venous thromboembolism, and shorter overall survival in patients who received ESAs. “In cancer patients with a reasonably long life expectancy, the benefit of using epoetins does not outweigh the risk of tumor progression and shorter overall survival,” the committee noted in a statement. There are many U.S. doctors who believe that there is simply not enough data to conclude that ESAs are unsafe. Despite that fact, the ESA controversy is likely to continue until definitive fact-based evidence is fully developed.

Sources:

Webcast: Recognizing and Overcoming Challenges in the Treatment of Recurrent Ovarian Cancer

Maurie Markman, M.D. is the Vice President for Clinical Research at the University of Texas M.D. Anderson Cancer Center located in Houston, Texas. On June 6, 2008, Dr. Markman moderated an expert panel discussion entitled, “Recognizing and Overcoming Challenges in the Treatment of Recurrent Ovarian Cancer.” The panel discussion was recorded as a Continuing Medical Education (CME) webcast. The two doctors participating in the panel discussion with Dr. Markman are (i) William P. McGuire, MD, the Medical Director of the Harry and Jeanette Weinberg Cancer Institute at the Franklin Square Hospital Center, located in Baltimore, Maryland, and (ii) Robert L. Coleman, MD, professor of gynecological oncology at the University of Texas M. D. Anderson Cancer Center.

The expert panel discussion was divided into the two sessions listed below. Click here if you are interested in watching the webcast version of each session. A transcript of each session is also provided below.