Title: Phase III Trial of Doxorubicin Plus Cisplatin With or Without Paclitaxel Plus Filgrastim in Advanced Endometrial Carcinoma: A Gynecologic Oncology Group Study

Authors: Fleming, Gini F., Brunetto, Virginia L., Cella, David, Look, Katherine Y., Reid, Gary C., Munkarah, Adnan R., Kline, Richard, Burger, Robert A., Goodman, Annekathryn, Burks, R. Tucker

Source: J Clin Oncol 2004 22: 2159-2166

Summary:  This article reports the results of GOG #177 which compared the three drug regimen of cisplatin, Adriamycin and Taxol with the standard two drug regimen of Adriamycin and cisplatin using GCSF support for both arms. 273 patients with advanced or recurrent endometrial carcinoma were enrolled onto the study and received 7 cycles of the standard treatment of Doxorubicin 60 mg/m2, Cisplatin 50 mg/m2 with GCSF support every 21 days or Doxorubicin 45 mg/m2, Cisplatin 50 mg/m2, Paclitaxel 160 mg/m2 with GCSF support. The three drug combination was superior in terms of overall response (57% versus 34%, p<0.01), PFS (8.3 versus 5.3 mos., p<0.01) and OS (15.3 versus 12.3 mos., p<0.04). The use of GCSF support was important for the study as there was little difference between the groups with respect to the rate of hematologic toxicity which was quite low (AP 2% versus TAP 3%). 39% of TAP patients developed either a grade 2 or 3 neuropathy versus 5% in the AP arm. Overall this is an important study as it demonstrates the effectiveness and side effects of using Taxol in combination with platinum and Adriamycin in treating patients with advanced cases of endometrial cancer.

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Nothing of interest this month

Title: Ovarian Cancer Risk After the Use of Ovulation-Stimulating Drugs

Authors: Brinton, Louise A., Lamb, Emmet J., Moghissi, Kamran S., Scoccia, Bert, Althuis, Michelle D., Mabie, Jerome E., Westhoff, Carolyn L.

Source: Obstet Gynecol 2004 103: 1194-1203

Summary:  This retrospective cohort study of 12,193 women treated for infertility assessed the long-term effects of ovulation-stimulating drugs on the risk of ovarian cancer. The authors found that ovarian cancer risks were similar for patients unexposed and those exposed to clomiphene. The standardized incidence ratio for subjects unexposed to clomiphene was 2.09 (95% CI 1.4, 3.0), as compared with 1.79 (1.0, 3.0) for those exposed. However, infertility patients had a significantly elevated ovarian cancer risk compared with the general population (standardized incidence ratio 1.98, 95% confidence intervals [CI] 1.4, 2.6). The authors concluded that there is not a strong link between ovulation-stimulating drugs and ovarian cancer.

Click here for abstract from OB/GYN

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Nothing of interest this month

Nothing of interest this month

Title: Frequency of Symptoms of Ovarian Cancer in Women Presenting to Primary Care Clinics

Authors: Goff, Barbara A., Mandel, Lynn S., Melancon, Cindy H., Muntz, Howard G.

Source: JAMA 2004 291: 2705-2712

Summary:  The authors administered an anonymous questionnaire regarding frequency, severity, and duration of symptoms to women who visited 2 primary care clinics (N = 1709) and preoperatively to 128 women with a pelvic mass (84 benign and 44 malignant).  The combination of bloating, increased abdominal size, and urinary symptoms was found in 43% of those with cancer but in only 8% of those presenting to primary care clinics.  In addition, women with malignant masses typically experienced symptoms 20 to 30 times per month and had significantly more symptoms of higher severity and more recent onset than women with benign masses or controls.  The authors concluded that further diagnostic investigation is warranted for women that experience symptoms that are more severe or frequent than expected and of recent onset.

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Nothing of interest this month

Nothing of interest this month

American Journal of Surgical Pathology – Sarah E. Ferguson

Title: More Differences Between HNPCC-related and Sporadic Carcinomas From the Endometrium as Compared to the Colon

Authors: van den Bos, Maartje; van den Hoven, Mabel; Jongejan, Esther; van der Leij, Femke; Michels, Meta; Schakenraad, Sandra; Aben, Katja PHD; Hoogerbrugge, Nicoline MD, PHD; Ligtenberg, Marjolijn PHD; Han van Krieken, J MD, PHD

Source: American Journal of Surgical Pathology. 28(6):706-711, June 2004

Summary:  To recognize hereditary nonpolyposis colorectal cancer (HNPCC)-related endometrial carcinoma from sporadic carcinoma by histologic features as compared with colonic cases, the authors performed a case-control study. Six HNPCC-related endometrial and 18 colorectal carcinomas were selected. For every HNPCC-related tumor, 2 sporadic control cases were included. HNPCC-related endometrial carcinomas were significantly more often poorly differentiated (83% versus 27%), showed the presence of a Crohn-like lymphoid reaction (100% versus 13%) and lymphangioinvasive growth (67% versus 0%), and high number of tumor-infiltrating lymphocytes were more often present (100% versus 36%) compared with sporadic endometrial carcinomas. The differences between HNPCC and sporadic colorectal cancer specimens were less discriminating.

Click here for abstract from AM J Surg Path

Title: Malignant Melanoma Involving the Ovary: A Clinicopathologic and Immunohistochemical Study of 23 Cases

Authors: Gupta, Deepali MD; Deavers, Michael T MD; Silva, Elvio G MD; Malpica, Anais MD

Source: American Journal of Surgical Pathology. 28(6):771-780, June 2004

Summary:  Ovarian malignant melanoma (MM), primary or metastatic, is an extremely rare tumor and can represent a diagnostic challenge. The clinicopathologic and immunohistochemical features of 23 cases over a period of 40 years (1962-2001) were reviewed. The patients' age ranged from 14 to 53 years (mean 35.7 years). A previous history of MM was definitively obtained in 14 patients.  The tumor was grossly pigmented in 8 cases (35%). S-100 was positive in 18 of 19 cases, HMB-45 in 17 of 20 cases, MART-1 in 13 of 15 cases, tyrosinase in 10 of 15 cases, and Mitf in 8 of 14 cases. Inhibin was positive in 3 of 14 cases. Calretinin was focally positive in 1 of 12 cases. All but one patient had metastases in other organs, most often in the lungs. Thirteen patients died of disease (range 2-76 months), 3 are alive with disease (6-18 months), and 2 have no evidence of disease at 24 and 96 months; one was the patient with melanoma arising within a teratoma. In conclusion, MM involving the ovary is a rare disease, predominantly seen in women of reproductive age, and is associated with a poor prognosis. The tumor is most often metastatic from another site.  S-100 is the most sensitive marker. MART-1 was positive in the few cases that were negative with HMB-45. Inhibin can be focally positive in some cases.

Click here for abstract from AM J Surg Path

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