Thursday, January 3, 2019

Opioid Use Disorder in Cancer Survivors - Harder to Treat than Leukemia

This interview appeared in the NEJM. Dr. Alison Loren is interviewed about the risk of opioid use disorder in people who have cancer. The big question is how to adequately treat pain in cancer patients given that many folks have some form of chronic cancer disease.

This interview is approximately 7 minutes.

Follow this link to the interview.

Wednesday, December 26, 2018

NEJM: Maintenance Olaparib in Pts Newly Diagnosed Advanced OC

This article was just released in the latest journal of NEJM. BRCA +Women who have finished standard platinum treatment and surgery and who have had a recurrence are then put on olaparib. In this trial, newly diagnosed BRCA + women discusses the use of olaparib in women who are newly diagnosed.

Here is the abstract from the article. I will also try to include the full link here.

Abstract

BACKGROUND

Most women with newly diagnosed advanced ovarian cancer have a relapse within 3 years after standard treatment with surgery and platinum-based chemotherapy. The benefit of the oral poly(adenosine diphosphate–ribose) polymerase inhibitor olaparib in relapsed disease has been well established, but the benefit of olaparib as maintenance therapy in newly diagnosed disease is uncertain.

METHODS

We conducted an international, randomized, double-blind, phase 3 trial to evaluate the efficacy of olaparib as maintenance therapy in patients with newly diagnosed advanced (International Federation of Gynecology and Obstetrics stage III or IV) high-grade serous or endometrioid ovarian cancer, primary peritoneal cancer, or fallopian-tube cancer (or a combination thereof) with a mutation in BRCA1BRCA2, or both (BRCA1/2) who had a complete or partial clinical response after platinum-based chemotherapy. The patients were randomly assigned, in a 2:1 ratio, to receive olaparib tablets (300 mg twice daily) or placebo. The primary end point was progression-free survival.

RESULTS

Of the 391 patients who underwent randomization, 260 were assigned to receive olaparib and 131 to receive placebo. A total of 388 patients had a centrally confirmed germline BRCA1/2 mutation, and 2 patients had a centrally confirmed somatic BRCA1/2 mutation. After a median follow-up of 41 months, the risk of disease progression or death was 70% lower with olaparib than with placebo (Kaplan–Meier estimate of the rate of freedom from disease progression and from death at 3 years, 60% vs. 27%; hazard ratio for disease progression or death, 0.30; 95% confidence interval, 0.23 to 0.41; P<0.001). Adverse events were consistent with the known toxic effects of olaparib.

CONCLUSIONS

The use of maintenance therapy with olaparib provided a substantial benefit with regard to progression-free survival among women with newly diagnosed advanced ovarian cancer and a BRCA1/2 mutation, with a 70% lower risk of disease progression or death with olaparib than with placebo. (Funded by AstraZeneca and Merck; SOLO1 ClinicalTrials.gov number, NCT01844986.)

Wednesday, December 19, 2018

Cancer Survivorship

This quote from the New England Journal of Medicine, says it best:
"At present, the care of cancer survivors is often an afterthought, tends to be fragmentary, and is not well integrated into the mainstream of cancer care. Also, the best models for providing survivor care remain undefined."

To read the article in its entirety, follow this link

Thursday, November 29, 2018

Sound and Light Could Detect OC Earlier

Researchers have found an innovative way to use sound and light, or photoacoustic, imaging to diagnose ovarian tumors. The method may lead to a promising new diagnostic imaging technique to improve current standard of care for patients with ovarian cancer.
Ovarian cancer claims the lives of more than 14,000 women in the US each year, ranking fifth among cancer deaths in women.
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Researchers recently conducted a pilot study using co-registered photoacoustic tomography with ultrasound to evaluate ovarian tumors in 16 patients. The findings appear in Radiology.
“When ovarian cancer is detected at an early, localized stage—stage 1 or 2—the five-year survival rate after surgery and chemotherapy is 70 to 90 percent, compared with 20 percent or less when it is diagnosed at later stages, 3 or 4,” says Quing Zhu, professor of biomedical engineering in the School of Engineering & Applied Science at Washington University in St. Louis and of radiology.
“Clearly, early detection is critical, yet due the lack of effective screening tools only 20-25 percent of ovarian cancers are diagnosed early. If detected in later stages, the survival rate is very low,” Zhu says.

Detailed Look

In their approach, researchers use a transvaginal ultrasound to obtain information about ovarian tumors, but ultrasound lacks accuracy in diagnosis of ovarian masses, Zhu says.
Photoacoustic tomography, however, gives researchers a very detailed look at the tumor’s vasculature, or tumor angiogenesis, and blood oxygen saturation (sO2) by lighting up the tumor’s vasculature bed and allowing for more accurate diagnoses of ovarian masses seen by ultrasound.
Both tumor angiogenesis and tumor sO2 are related to tumor growth, metabolism, and therapeutic response.
For the study, Zhu and her team created a sheath with optical fibers that wrap around a standard transvaginal ultrasound probe. The optical fibers are connected to a laser. Once the probe is inside the patient, Zhu turns the laser on, which shines through the vaginal muscle wall.
With photoacoustic tomography, the light from the laser propagates, the tumor absorbs it, and it generates sound waves, revealing information about the tumor angiogenesis and sO2 inside the ultrasound-visible ovaries. A normal ovary contains a lot of collagen, Zhu says, but an ovary with invasive cancers has extensive blood vessels and lower sO2.

Information and Assurance

The team used two biomarkers to characterize the ovaries: relative total hemoglobin concentration (rHbT), which is directly related to tumor angiogenesis, and mean oxygen saturation (sO2).
They found that the rHbT was 1.9 times higher for invasive epithelial cancerous ovaries, which make up 90 percent of ovarian cancers, than for normal ovaries. The mean oxygen saturation of invasive epithelial cancers was 9.1 percent lower than normal and benign ovaries. All five invasive epithelial cancerous ovaries, including two stage 1 and 2 cancers, showed extensive rHbT distribution and lower sO2.
“Physicians are very excited about this because it might bring significant change into current clinical practice,” Zhu says. “It is very valuable to detect and diagnose ovarian cancers at early stages. It is also important to provide information and assurance to patients that there is no worry about their ovaries, instead of removing a patient’s ovaries.
“This technology can also be valuable to monitor high-risk patients who have increased risk of ovarian and breast cancers due to their genetic mutations. The current standard of care for these women is performing risk reduction surgeries to remove their ovaries at some point, which affects their quality of life and causes other health problems,” Zhu says.
“We are very fortunate to participate in this research endeavor headed by Dr. Zhu,” says Cary Siegel, professor of radiology and chief of gastrointestinal/genitourinary radiology. “This photoacoustic imaging study has great potential to better identify ovarian cancers and may play a valuable role in screening high-risk patients and triaging patients for follow-up imaging or surgical excision.”
These initial results will need to be validated with more patients, Zhu says. The team is applying for funding to conduct a large clinical trial.
The National Institutes of Health and the Center for Strategic Scientific Initiatives at the National Cancer Institute funded the work.
This article was published by Futurity.