The following articles appeared in this month's issues of the surveyed journals. Articles that seem to be of most interest to the practicing gynecologic oncologist are included. The journals that are surveyed are New England Journal of Medicine, Journal of Clinical Oncology, Gynecologic Oncology, Cancer, American Journal of Obstetrics and Gynecology, Lancet, Cancer Research, Obstetrics and Gynecology, Journal of the National Cancer Institute, Journal of the American Medical Association and American Journal of Surgical Pathology. The participants in this program are the active clinical fellows at Memorial Hospital: Mario Leitao, Christopher Awtrey, Sarah Ferguson, Alan Schlaerth, Destin Black and Margrit Juretzka. The managing editor is Douglas Levine. Comments, questions, complaints and suggestions are always welcome, please E-mail us at: VJC@smgo.org or click here.  To subscribe or unsubscribe to the VJC, click here.

Gynecologic Oncology – Christopher Awtrey

Title: Phase II trial of alternating courses of megestrol acetate and tamoxifen in advanced endometrial carcinoma: a Gynecologic Oncology Group study

Authors: James V. Fiorica, Virginia L. Brunetto, Parviz Hanjani, Samuel S. Lentz, Robert Mannel and Willie Andersen

Source: Gynecologic Oncology, Volume 92, Issue 1, January 2004, Pages 10-14

Summary:  This is one of two articles in this month’s Gynecologic Oncology that looks at the clinical value of adding tamoxifen to progestins in the treatment of advanced or recurrent endometrial cancer. This article describes GOG # 153 in which megestrol acetate (MA) 80 mg given BID for 3 weeks was alternated with tamoxifen (T) citrate 20 mg PO BID for 3 weeks. This sequence was given until disease progression or until adverse effects prohibited further therapy. Of 56 evaluable patients who had not received prior cytotoxic or hormonal therapy, there were 15 responses for a response rate of 27%. There were 12 CR’s and 3 PR’s. Responses were seen in 31% of patients with extra-pelvic disease as opposed to 14% for those with vaginal or pelvic disease only. The median PFS was 2.7 months for the group and the most serious adverse effect noted were thromboembolic events. There were 2 DVT’s and 3 PE's. The authors conclude that this regimen of alternating MA and T is active in treating endometrial cancer and may result in a prolonged CR in some patients.

Click here for abstract from Gynecologic Oncology

Title: Phase II study of medroxyprogesterone acetate plus tamoxifen in advanced endometrial carcinoma: a Gynecologic Oncology Group study

Authors: Charles W. Whitney, Virginia L. Brunetto, Richard J. Zaino, Samuel S. Lentz, Joel Sorosky, Deborah K. Armstrong and Roger B. Lee

Source: Gynecologic Oncology, Volume 92, Issue 1, January 2004, Pages 4-9

Summary:  This paper examines the use of the combination of progestin and tamoxifen in the treatment of patients with advanced or recurrent endometrial cancer. This study is GOG # 119 and patients received a 20 mg BID of tamoxifen given continuously. On alternating even numbered weeks they also received 100 mg PO BID of MPA.  In this study of 58 evaluable patients medication was administered until disease progression or an adverse event. There were 6 complete and 13 partial responses for a total response rate of 33%. The median PFS was 3 months and the median overall survival was 13 months. This response rate is similar to that seen for active single agent cytotoxic chemotherapy suggesting that this treatment should be studied further as these initial results are promising.

Click here for abstract from Gynecologic Oncology

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Journal of Clinical Oncology - Mario Leitao

Nothing of interest this month

Journal of the National Cancer Institute – Alan Schlaerth

[Ed note:  There were two articles in the January 7, 2004 issue of JNCI that investigated the risk of colorectal cancer in Jewish BRCA mutations carriers. Both studies were unable to demonstrate any increased risk of colorectal cancer associated with BRCA founder mutations.  This is noteworthy information when counseling BRCA heterozygotes for prophylactic oophorectomy and other related issues.  Links to these abstracts can be found here: article 1 and article 2.]

Obstetrics and Gynecology – Margrit Juretzka

Nothing of interest this month

American Journal of Obstetrics and Gynecology – Sarah Ferguson

New England Journal of Medicine – Mario Leitao

Journal of the American Medical Association – Margrit Juretzka

Nothing of interest this month

Cancer – Destin Black

Title:  Surgical treatment of recurrent endometrial carcinoma

Summary:  This retrospective analysis included 75 patients who underwent secondary cytoreductive surgery for pelvic or abdominal endometrial cancer recurrence.  Inclusion criteria were as follows: 1) pelvic or abdominal recurrence with or without liver, abdominal wall, inguinal, or vulvar involvement; 2) central pelvic-vaginal recurrence measuring > 4 cm or with lateral pelvic side-wall extension; 3) Gynecologic Oncology Group performance status < 4; and 4) absence of lung, bone, or brain metastases.  Patients with < 1cm residual tumor were classified as optimally debulked.  Postoperative salvage therapy after secondary surgery was undertaken at the discretion of the medical oncologist.  Fifty-six patients (74.7%) were optimally debulked and the mortality rate for surgical complications after the postoperative period was 8%.   Patients who were secondarily optimally debulked had a significantly better cumulative survival than patients who had residual disease (36% vs. 0% at 60 months P<0.05).  In addition to residual disease, the authors found that chemotherapy use after secondary surgery and central pelvis-vagina as the only site of recurrence were also associated with better survival. The authors conclude that this approach has a high mortality rate, yet can useful in improving overall survival.  Careful selection of patients is key.

Lancet – Sarah Ferguson

Cancer Research – Destin Black