Title: Phase III Study of Cisplatin With or Without Paclitaxel in Stage IVB, Recurrent, or Persistent Squamous Cell Carcinoma of the Cervix: A Gynecologic Oncology Group Study

Authors: Moore, David H., Blessing, John A., McQuellon, Richard P., Thaler, Howard T., Cella, David, Benda, Jo, Miller, David S., Olt, George, King, Stephanie, Boggess, John F., Rocereto, Thomas F

Source: J Clin Oncol 2004 22: 3113-3119

Summary:  This GOG study (#169) compared cisplatin 50 mg/m² with or without Taxol 135 mg/m² given every 3 weeks for 6 cycles, in patients with advanced or recurrent cervical cancer.  134 patients received cisplatin and 130 received combination therapy. The response rate for the cisplatin alone was 19% and 36% in the combination group. PFS was 2.8 months for the single agent versus 4.8 months for the combination. There was no difference between the groups with respect to the QOL scores or the median survival, 8.8 months for the single agent and 9.7 months for the combination. Not surprisingly there was a difference in toxicity with 65% of the combination group developed grade 3 or 4 neutropenia as opposed to 4 % of the single agent group. The authors conclude that the combination is superior to single agent cisplatin with respect to response rate and PFS with no improvement in overall survival.

Click here for abstract from JCO

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Nothing of interest this month

Title: Does Tamoxifen Use Affect Prognosis in Breast Cancer Patients Who Develop Endometrial Cancer?

Authors: Slomovitz, Brian M., Sun, Charlotte C., Ramirez, Pedro T., Bodurka, Diane C., Diaz, Paul, Lu, Karen H.

Source: Obstet Gynecol 2004 104: 255-260

Summary:  This retrospective review of 89 patients with a history of breast cancer that later developed endometrial cancer found that 52% (46/89) had a history of tamoxifen use (median duration 48 months; range 2-120 months).  There was no significant difference in the clinical or pathologic features between tamoxifen users and nonusers. In addition, there was no significant difference in overall survival between tamoxifen users and nonusers (39.2 months versus 48.3 months, P = .27) There was, however, a shorter interval from breast cancer diagnosis to endometrial cancer diagnosis (77.2 versus 121.3 months for nonusers; P = .01) associated with a history of tamoxifen use . The authors concluded that tamoxifen use was not a prognostic factor for overall survival.

Click here for abstract from OB/GYN

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Title: Surgical Staging of Ovarian Low Malignant Potential Tumors

Authors: Rao, Gautam G., Skinner, Elizabeth, Gehrig, Paola A., Duska, Linda R., Coleman, Robert L., Schorge, John O.

Source: Obstet Gynecol 2004 104: 261-266

Summary:  Between 1984 and 2003, 248 women with low malignant potential tumors of the ovary were identified at 3 institutions.  One hundred eighty-three (74%) of 248 women were surgically staged. Forty of 183 staged patients had obvious extra-ovarian disease at the time of surgery. Forty (28%) of the remaining 143 women with disease confined to the ovary were upstaged. 28 cases had positive cytologic washings, 10 had microscopic implants detected by peritoneal or omental biopsy, and 2 were upstaged to stage IIIC on the basis of nodal disease. One hundred eighteen women underwent pelvic node dissection (median: 5 nodes), and 86 underwent para-aortic node dissection (median: 2 nodes). Seven (6%) patients had positive pelvic lymph nodes. All  para-aortic nodes were negative. Length of hospital stay (P < .001) and intraoperative blood loss (P < .001) were increased in women who were surgically staged. Eight (3%) of 248 patients received adjuvant platinum-based chemotherapy. After a median follow-up of 28 (range, 1–208) months, fifteen (6%) recurrences developed and 1 (0.4%) death occurred. The authors concluded that pelvic and para-aortic lymph node dissection is not necessary in the majority of women with ovarian low malignant potential tumors.

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Title: Completion hysterectomy after radiation therapy for bulky cervical cancer stages IB, IIA, and IIB: Complications and survival rates

Authors: Melissa A. Decker, James J. Burke II, Donald G. Gallup, Robert W. Silverio, David Weems, John Duttenhaver and Dent Purcell

Source: American Journal of Obstetrics and Gynecology, Volume 191, Issue 2, August 2004, Pages 654-658.

Summary:  The authors performed a retrospective review of 55 patients with bulky cervical CA (IB-IIB) who were treated with radiation followed by completion hysterectomy between 1993 and 2002. 54 patients received brachytherapy, 53 patients received external beam radiotherapy and 29 patients received cisplatin-sensitizing chemotherapy.  Early post-operative complications occurred in 21.8% of patients and late complications occurred in 19.6%. Of the 51 patients with follow-up data (median follow-up 39 months), 72.5% are free of disease, 21.6% died of disease, and 5.9% were alive with disease. The authors conclude that complications with combined modalities were comparable to complications from either modality alone and may be a reasonable treatment strategy to treat potential residual carcinoma.

Click here for abstract from Am J OB/GYN

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Nothing of interest this month

Nothing of interest this month

Title: Three Biomarkers Identified from Serum Proteomic Analysis for the Detection of Early Stage Ovarian Cancer

Authors: Zhang, Zhen, Bast, Robert C., Jr., Yu, Yinhua, Li, Jinong, Sokoll, Lori J., Rai, Alex J., Rosenzweig, Jason M., Cameron, Bonnie, Wang, Young Y., Meng, Xiao-Ying, Berchuck, Andrew, van Haaften-Day, Carolien, Hacker, Neville F., de Bruijn, Henk W. A., van der Zee, Ate G. J., Jacobs, Ian J., Fung, Eric T., Chan, Daniel W.

Source: Cancer Res 2004 64: 5882-5890

Summary:  Investigators from 5 different centers performed a case-control analysis of serum proteomic expression for the detection early stage ovarian cancer.  Serum samples were analyzed from 153 patients with invasive epithelial ovarian cancer (65 stage I/II, 88 stage II/IV), 42 with other ovarian cancers (28 borderline, 14 recurrent), 166 with benign pelvic masses and 142 healthy women.  Proteomic expression profiling was performed using SELDI/TOF on the ProteinChip Biomarker System from Ciphergen.  The identified proteins revealed biomarkers which were then tested by immunoassay on samples from 41 healthy women, 41 patients with ovarian cancer and 20 each with breast, colon and prostate cancers. Three biomarkers were identified, two which were downregulated (apolipoprotein A1 and truncated transthyretin) and one which was upregulated (a trypsin inhibitor heavy chain fragment).  In patients with early stage invasive epithelial ovarian cancer, combining these three biomarkers and CA125 in a multivariate model showed improved sensitivity (74%) vs. CA125 alone (65%), with matched specificity of 97%.  This sensitivity could be improved by adding sonography or additional markers as they are revealed.  Though the sensitivity is still to low to consider clinical applications, the authors emphasize the potential to improve serum screening through identification of these biomarkers. 

Click here for abstract from Cancer Res

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American Journal of Surgical Pathology – Sarah E. Ferguson

Nothing of interest this month

This issue of the Virtual Journal Club is sponsored by GlaxoSmithKline.