Tuesday, May 11, 2021

At Home Genetic Testing for Breast and Ovarian Cancer Risk

 

How important is it to receive genetic counseling both before and after testing for risk factors? Can women skip these counseling sessions without adding undue stress on themselves?

This question plus determining the feasibility of doing remote testing are being examined in the Magenta (Making GENetic Testing Accessible) study of 4,000 women participating in all 50 states.

Given the lack of good screening tools for OC, some women, especially those in more rural areas, with strong family histories of breast or ovarian cancer may feel more empowered to make pro-active decisions about undergoing prophylactic surgery rather than live with the fear of possibly getting cancer. To find out more about study, follow this link.

Friday, May 7, 2021

Novel Vaccine Harnesses Tumor Cells to Stimulate Immune Response

 

BioVaxys, the company that has developed a vaccine to stimulate the immune system, is seeking permission for compassionate use for women with advanced OC in Europe. Additionally, the company has approached the regulatory health agencies in the US and Europe to begin clinical trials in the upcoming months.

BVX-0918A, the vaccine, uses the patient's own cancer cells to make them more recognizable to the body's defense system. Specifically, the vaccine would make the cancer cell more visible for cancer-killing T-cells. BioVaxys is also planning to combine their vaccine with checkpoint inhibitors, another class of cancer medication, that block certain proteins from shutting down the body's immune response. Cancer cells hijack this natural function in the body and therefore hide from the immune system.

To read more about this fascinating research, follow this link.

Tuesday, May 4, 2021

Immunotherapy GEN-1Given Fast Track Approval

The FDA announced approval to fast track a novel immunotherapy treatment for advanced ovarian cancer.

The drug, GEN-1, is a non-viral particle that stimulates the production of interleukin-12 to the tumor site. This protein stimulates the immune system to target the tumor. 

The trial successfully completed Phase 1 (Ovation-1) which combined standard chemo with GEN-1 in newly diagnosed women prior to surgery. That study showed that women had a partial or complete reduction in tumor burden compared with women who received the lowest doses. In addition, 88% of these women had complete surgical resection - meaning that they had clean margins, free of any microscopic evidence of cancer. Those women who received both GEN-1 and chemo lived twice as long as those who only received chemo. Because the sample size was too small, the results were not clinically significant.

To find out more about this Phase 1/2 study, you can follow this link that will take you to the Clinical Trials page. To read the article about this study, follow this link.


Tuesday, April 27, 2021

OCRA Partners With Microsoft's "AI for Health"

 

The Ovarian Cancer Research Alliance, which awards yearly grants for cancer research, will be partnering with Microsoft's Artificial Intelligence for Health to provide some grantees access to MS AI lab.

Because there are so many factors (genetic, environmental and acquired) that can cause cancerous mutations, trying to find patterns in the myriad interactions between cells is incredibly time consuming and unpredictable process. Some researchers will now have access to the powerful computing ability of AI to analyze large amounts of data. To find out more about this venture between OCRA and MS, follow this link.

Friday, April 23, 2021

New Study Shows that Progesterone May Help Spur Growth of OC in BRCA-1 Women

A new study suggests that blocking progesterone may prevent ovarian cancer. The study, "Targeting Progesterone Signaling Prevents Metastatic Ovarian Cancer" was released in the journal PNAS.

This study is important to women who have the BRCA-1 mutation. Women with this mutation generally produce high levels of progesterone during their menstrual cycles. Targeting these women with an anti-progesterone medication may provide these high risk women with an alternative to prophylactic breast or ovarian surgery.

To find out more about this study, follow this link.
 

Thursday, April 22, 2021

New Hope for Combo Therapy for Platinum Resistant OC

 

This article appeared on the OncLive webpage and was written by Kristi Rosa. The study results from phase 1b, was presented at the annual AACR meeting this year. By the way, both OncLive and AACR are great resources to check out.

The combination of tislelizumab (BGB-A317) and sitravatinib demonstrated early antitumor activity and a manageable safety profile in patients with recurrent platinum-resistant epithelial ovarian cancer and were naïve to PD-1/PD-L1 inhibition, according to data from cohort E of a phase 1b trial (NCT03666143) presented during week 1 of the virtual AACR Annual Meeting 2021.

The doublet resulted in an objective response rate (ORR) of 26% (95% CI, 15.3%-40.3%), which comprised all partial responses (n = 14). Fifty-one percent of patients had stable disease (n = 27), and 17% of patients had progressive disease (n = 9). The median duration of response was 4.7 months (95% CI, 2.83–not evaluable), and the disease control rate was 77% (95% CI, 63.8%-87.7%).

Per investigator assessment, the median progression-free survival (PFS) was 4.1 months (95% CI, 4.0-22.8) at a median follow-up of 6.9 months, and the median overall survival (OS) was 12.9 months (95% CI, 6.2-17.0) at a median follow-up of 7.5 months.

“Tislelizumab in combination with sitravatinib was generally well tolerated and had a manageable safety/tolerability profile in patients with anti–PD-1/PD-L1 antibody–naïve recurrent platinum-resistant ovarian cancer,” lead study author Jeffrey C. Goh, MBBS, FRACP, of Icon Cancer Centre in Brisbane, Australia, said in a presentation on the data. “The results from this phase 1b study support tislelizumab in combination with sitravatinib as a potential treatment option for patients with platinum-resistant ovarian cancer and further investigation is warranted.”

The frontline standard of care of patients with ovarian cancer is platinum-based chemotherapy with or without bevacizumab (Avastin). However, disease recurrence is frequent and almost all patients will become refractory or develop resistance to platinum-based treatment, according to Goh.

Findings from several early phase 1/2 trials have demonstrated the limited effectiveness of PD-1/PD-L1 immune checkpoint inhibitors when used as single agents in heavily pretreated patients with ovarian cancer. The estimated ORRs in these patients ranged from 10% to 15%, Goh said.

Tislelizumab, a humanized, anti–PD-1 monoclonal antibody, is designed to minimize binding to Fcγ receptor on macrophages to abrogate antibody-dependent phagocytosis, which can overcome the attack of normal lymphocytes by immune cells.

Sitravatinib is an oral spectrum-selective TKI designed to target TAM and split family receptor kinases in VEGFR/KIT. Inhibition of these receptors serves to reduce the number of myeloid-derived suppressor cells and regulatory T cells and increase the ratio of M1/M2 polarized macrophages; this could overcome an immunosuppressive tumor microenvironment and enhance antitumor responses.

For the phase 1b trial, investigators hypothesized that the combination of a PD-1 inhibitor and a TKI with immunomodulatory and antitumor components could result in enhanced antitumor activity.

The multicohort trial has been undertaken in several solid tumor indications. Cohorts A and B of the trial are examining the doublet in patients with nonsquamous non–small cell lung cancer (NSCLC) that was relapsed/refractory or naïve to PD-1/PD-L1 inhibition, respectively. Cohort C will include patients with renal cell carcinoma (RCC) that is relapsed/refractory to PD-1/PD-L1 inhibition, while cohort D will comprise Chinese patients with metastatic/advanced RCC without previous systemic treatment.

Additionally, cohort F is examining the combination in patients with metastatic squamous NSCLC treatment with a PD-1/PD-L1 inhibitor. Cohort G will comprise patients with unresectable or metastatic melanoma who are relapsed/refractory to PD-1/PD-L1 agents; cohort H will include patients with nonsquamous NSCLC who have treatment-naïve, metastatic, PD-L1–positive disease; and cohort I will include those with squamous NSCLC who have treatment-naïve, metastatic, PD-L1–positive disease.

At the meeting, Goh shared data from the study regarding the use of the combination in cohort E, which was comprised of patients with recurrent platinum-resistant ovarian cancer who were naïve to PD-1/PD-L1 inhibitors.

To be eligible for enrollment, patients had to be at least 18 years of age, have histologically or cytologically confirmed advanced or metastatic unresectable solid tumors, an ECOG performance status of 0 or 1, and acceptable organ function. For cohort E, specifically, patients could not have platinum-refractory disease, nor could they have previously been exposed to a PD-1/PD-L1 agent.

Participants received intravenous tislelizumab at a dose of 200 mg every 3 weeks plus oral sitravatinib at a once-daily dose of 120 mg. Treatment was given until either disease progression, intolerable toxicity, death, withdrawn consent, or study termination.

The primary end point was safety and tolerability, while antitumor activity served as the secondary end point. Other exploratory objectives included pharmacokinetics and immunogenicity, potential pharmacodynamic biomarkers, and a retrospective analysis of PD-L1 expression.

As of the data cutoff of October 13, 2020, a total of 60 patients were enrolled to cohort E of the trial; of these patients, 13 remained on the doublet. The median duration of follow-up in this population was 6.0 months (range, 0.2-23.4).

The median age was 64 years (range, 26-80), the majority (80%) were White, and 57% had an ECOG performance status of 1. Seventy-three percent of patients had their primary tumor located in the ovary, while 12% had it in the fallopian tube, 8% in the peritoneum, and 7% in another area. The majority (95%) of patients had serous histology, while the rest had either mucinous (2%), endometrioid (2%), or clear cell (2%) disease.

Moreover, the median number of previous regimens was 4 (range, 1-11). The type of previous systemic therapy was metastatic in 83% of patients, adjuvant in 67%, neoadjuvant in 35%, locally advanced in 18%, and metastatic and locally advanced in 10%. Thirty-five percent of patients previously received bevacizumab.

Regarding PD-L1 expression at baseline, 33% of patients had tumor cell expression of 1% or greater, 48% had expression of less than 1%, and 19% did not have that information available. PD-L1 immune cell expression was 10% or greater in 43% of patients and less than 10% in 38%; 19% of patients did not have that information available.

Additional data indicated that responses were comparable across all subgroups analyzed. “However, patients who received more than 4 lines of therapy observed lower response rates compared with those who had received less than 3 prior lines of treatment,” Goh noted. “The same sample size in each group could be a confounding factor.”

In patients with tumor cell PD-L1 expression of 1% or greater (PD-L1 high), the median PFS was 4.1 months vs 4.2 months in those with tumor cell expression of less than 1% (PD-L1 low). The median OS in the PD-L1 high and low groups was 14.6 months and 11.8 months, respectively. “No significant difference was observed between the 2 groups, but the numbers are fairly small, and the follow-up is not mature,” Goh said.

Similar findings were observed in patients with immune cell PD-L1 expression of 1% or greater (PD-L1 high) and those with immune cell expression of less than 1% (PD-L1 low), with a median PFS of 4.1 months and 4.2 months, respectively. The median OS in the PD-L1–high group was 14.6 months vs 6.9 months in the PD-L1–low group.

“The association between PD-L1 expression and clinical efficacy are less clear due to small sample size in each subgroup,” Goh noted. “However, there was a trend toward a longer OS in patients with PD-L1 immune cell expression of more than 10%. Further investigation in future trials would be warranted to tease out this group.”

Additionally, the pharmacodynamic biomarker VEGF chemokine serum IP-10 increased following treatment. After treatment, increase of VEGF at cycle 2 day 1 and cycle 3 day 1 was observed, confirming the antiangiogenic properties of sitravatinib, Goh explained. The IP-10 level, which is involved in trafficking immune cells to inflammatory sites and mediating tumor regression, was also found to increase following treatment with the doublet.

“However, both biomarkers did not show any association with clinical response,” Goh said.

Ninety-seven percent of patients experienced at least 1 treatment-emergent adverse effect (TEAE) with tislelizumab/sitravatinib, and 68% reported an effect that was grade 3 or higher in severity. Seventy percent of patients had a serious TEAE with the doublet.

Additionally, 4 patients experienced a TEAE that resulted in death; these included 2 cases of dyspnea, respiratory failure, and malignant gastrointestinal obstruction, according to Goh. However, none of these effects were determined to be related to study treatment.

Fifteen percent of patients experienced a TEAE that resulted in discontinuation of tislelizumab, 12% of which were related to the drug, while 23% reported a toxicity that led to sitravatinib discontinuation, 20% of which were treatment related.

The median duration of treatment with tislelizumab was 18 weeks (range, 3-103), while it was 15 weeks (range, 3-103) with sitravatinib. The mean dose intensity with tislelizumab and sitravatinib was 94% and 69%, respectively. Forty-three percent of patients had their tislelizumab dose delayed, while 2% required dose interruption. Eighty-three percent of patients required a dose interruption of sitravatinib and 50% needed a dose reduction.

The most frequently reported any-grade AE with the doublet was diarrhea (67%), followed by nausea (57%), fatigue (48%), and hypertension (40%). The most commonly reported grade 3 or higher effects were hypertension and abdominal pain and these toxicities occurred in 18% and 12% of patients, respectively.

Reference

Coward J, Gao B, de Silva IP, et al. Safety/tolerability and preliminary antitumor activity of sitravatinib plus tislelizumab in patients with advanced platinum-resistant ovarian cancer (PROC). Presented at: AACR Annual Meeting 2021; April 10-15, 2021; virtual. Abstract CT013.


Monday, April 19, 2021

Ovations for the Cure of Ovarian Cancer Fundraising Event

 Let's Support Our Sister Organization:

Image


JOIN US AT PUTTS & MORE FOR AN AFTERNOON OF FUN AND FUNDRAISING!

 

MAY 1, 2021 1OAM TO 2PM

RAIN DATE:  MAY 8, 2021

 

750 Concord Street, Holliston, MA

 

 

18 HOLE MINI GOLF

  $15 PER PERSON (AGES 9 and up)

$10 PER PERSON (AGES 3 -8)

 

PLAY GOLF, VISIT WITH FRIENDS, ENJOY A SNACK FROM THE SNACK BAR AND HELP SUPPORT OUR PATIENT PROGRAMS.

 

Picnic table area also available

 

To comply with covid restrictions, masks must be worn at all times while on the course

 

For more info on Putts and More, please visit

https://puttsandmore.com/

CAN'T MAKE THE EVENT, BUT STILL WANT TO SUPPORT OUR MISSION?

 

SPONSORSHIPS OPPORTUNITIES ARE AVAILABLE

 

 

PREMIER SPONSOR

$100

 

Table at event and logo on tee sign

 

 

 

 

HOLE SPONSOR

$30

 

Logo on tee sign at designated holes**

 

**Tee signs with your logo will remain posted for one week after the event**

 

 

Contact:  susan@ovationsforthecure.org to send your logo 

 



Friday, April 16, 2021

Upcoming Webinar on 1 in 40 Risk for Ashkenazi Jews and BRCA Mutation

 


UPCOMING WEBINARS
April 21, 2021, 6:30 PM EST (Register here)

Join us to learn from experts featuring Dr. Judy Garber and Jill Stopfer, MS, CGC, from Dana-Farber Cancer Institute, about Ashkenazi Jews' one-in-forty risk of inheriting a BRCA gene mutation. Having a BRCA gene mutation significantly increases one's risk of developing breast, ovarian, prostate and other cancers.

A special thank you to Temple Emunah and Temple Isaiah of Lexington for hosting this webinar.

Guest Speakers:

Dr. Judy E. Garber
Director, Center for Cancer
Genetics & Prevention
Dana-Farber Cancer Institute
Jill Stopfer, MS, CGC
Associate Director, Genetic Counseling
Dana-Farber Cancer Institute
Register Today

 

June 2021

Featuring Guest Speaker: Dr. Leif Ellisen, MGH


Tuesday, April 6, 2021

Oxford University surgical lectures: Surgery for the management of advan...


A word of warning with this video - it is quite graphic. This is actually a surgical lecture that also explores the history of surgical techniques for OC. Despite its technicalities, it is still interesting.

Friday, April 2, 2021

Differences between primary peritoneal serous carcinoma and advanced serous ovarian carcinoma: a study based on the SEER database

 

This article recently appeared in a new online Journal of Ovarian Research. Primary Peritoneal Serous Carcinoma is much less common than Advanced Serous Ovarian Carcinoma and within these two groups are other subgroups that impact overall survival rates.

The objective of this study compare the clinical features of these two types of cancer and to determine the prognostic indicators.

There were some interesting differences between the two types in terms of age groups affected and race with PPSC have a lower incidence rate among black women. There were also several limitations to the study that the researchers noted. Data was drawn from Surveillance, Epidemiology and End Result (SEER) database, which did not include CA 125, patient weight, treatment details, residual tumor size post surgery, and mutations - variables that may be of significance.

To read the article in full, follow this link.

Tuesday, March 30, 2021

Ovarian cancer: Current treatments and latest advances


Although a lengthy video, it is targeted to a general audience and does a great job explaining the different subtypes.

Friday, March 26, 2021

Triple Combination Therapy Showing Promise for Platinum Resistant OC

 

This article was reprinted on the website, Ovations for the Cure and originally appeared in Cancernetwork.com

A dostarlimab triplet combination showed promise in a phase 2 study for treatment of patients with platinum-resistant ovarian cancer, according to a presentation at the Society of Gynecologic Oncology 2021 Virtual Annual Meeting on Women’s Cancer.

Antitumor activity as well as tolerability were observed in patients with platinum-resistant ovarian cancer (PROC) treated in the phase 2 OPAL study (NCT03574779), which examined the triplet combination of dostarlimab plus niraparib (Zejula) and bevacizumab (Avastin), according to results presented at the Society of Gynecologic Oncology (SGO) 2021 Virtual Annual Meeting on Women’s Cancer.1

A total of 41 patients were enrolled in the trial to receive the regimen that included the investigational PD-1 inhibitor. Two patients did not undergo a baseline scan and were excluded from the response-evaluable population (n = 39). Findings from cohort A (NCT02715284) were presented at the SGO meeting.

Antitumor activity was assessed in the response-evaluable population. Patients were eligible if they had high-grade PROC, recurrent epithelial ovarian, fallopian tube, primary peritoneal cancer, or recurrent carcinosarcoma of the ovary. Patients had received 1 to 2 prior lines of anticancer therapy for ovarian cancer, but no prior therapy with anti–PD-1/PD-L1 or PARP inhibitors.

The primary end point was investigator-assessed objective response rate (ORR) per RECIST v1.1 and secondary end points were progression-free survival (PFS), safety, and disease control rate (DCR). In addition, investigators conducted a post hoc analysis for biomarker genes including BRCA mutation (BRCAm), homologous recombination repair mutation (HRRm), and PD-L1 status using combined positive score (CPS ≥1%).

After undergoing screening for 21 days, patients received 500 mg of intravenous (IV) dostarlimab every 3 weeks for the first 4 doses, then 1000 mg every 6 weeks thereafter, with 15 mg/kg IV bevacizumab every 3 weeks up to 15 months and 300 mg or 200 mg of oral niraparib (determined by baseline weight and platelet count) once daily until discontinuation.

Median patient age was 66 years (range, 37-83) and ECOG performance score was 0 (46.3%) or 1 (53.7%). Eighteen (43.9%) patients had received prior bevacizumab. Biomarker analysis at baseline showed that 9.8% of patients had BRCAm, 82.9% of patients had BRCA wild-type disease (BRCAwt), and 7.3% had unknown BRCA status. HRR analysis revealed that 17.1% of patients had HRRm, 75.6% of patients had HRRwt, and 7.3% had unknown HRR status. The majority of patients (68.3%) had positive PD-L1 status.

“The objective response rate was 17.9% [90% CI, 8.7%-31.1%] with 7 partial responses and zero complete responses,” said lead author Joyce F. Liu, MD, MPH, associate chief and director of clinical research, Division of Gynecologic Oncology at Dana-Farber Cancer Institute in Boston, Massachusetts. Response data required that patients with a best response of complete response or partial response undergo a confirmation scan ≥4 weeks after the first scan in which a response was observed.

“Additionally, 23 patients had stable disease as their best response and the overall disease control rate was 76.9% [90% CI, 63.2%-87.4%],” she said. ORR was consistent across most subgroups, but investigators noted that patients who received prior bevacizumab showed a lower, nonsignificant, response rate (6%).

When reviewing best percentage change from baseline by HRR and PD-L1 status, the investigators noted that no correlation between these biomarkers or activity was observed. Median PFS in the total population (n = 41) was 7.6 months (95% CI, 4.2-10.6).

Comparatively, a prior phase 1/2 trial (NCT02657889) evaluating niraparib and pembrolizumab (Keytruda) showed an ORR of 18% in patients with PROC or who were otherwise ineligible for further platinum-based therapies.2

Overall the safety profile for patients in cohort A was consistent with the prior experience for each individual drug, and 97.6% of patients reported at least 1 any-grade treatment-related adverse effect (TRAE). Specifically, the most common total reported any-grade TRAEs that occurred with an overall incidence of ≥10% were fatigue (61.0%), thrombocytopenia event (48.8%), and hypertension (43.9%). The most common grade 3 TRAEs with an incidence ≥5% were hypertension (22.0%) and thrombocytopenia event (22.0%).

No TRAEs resulted in death and 34.1% of patients discontinued at least 1 of the 3 study drugs because of a TRAE.

“Although multiple patients [14.6%] developed grade 3 or higher small bowel obstructions, all were assessed as not being related to study drug,” said Liu, who is also assistant professor of medicine at Harvard Medical School. “One patient did develop a grade 4 bowel perforation event that was assessed as related to bevacizumab,” she said.

Liu noted that the majority of patients enrolled had BRCAwt or HRRwt tumors, and that 43.9% of patients had platinum-resistant disease, both of which are predictive factors associated with lower responses to therapy. However, “there were no clear response trends based on biomarkers,” she said.

References

1. Liu JF, Gaillard S, Wahner Hendrickson AE, et al. An open-label phase II study of dostarlimab (TSR-042), bevacizumab (bev), and niraparib combination in patients (pts) with platinum-resistant ovarian cancer (PROC): Cohort A of the OPAL trial. Presented at: Society of Gynecologic Oncology 2021 Virtual Annual Meeting on Women's Cancer; March 19-25, 2021; Virtual Abstract 23.

2. Konstantinopoulos PA, Waggoner S, Vidal GA, et al. Single-arm phases 1 and 2 trial of niraparib in combination with pembrolizumab in patients with recurrent platinum-resistant ovarian carcinoma. JAMA Oncol. 2019;5(8):1141-1149. doi:10.1001/jamaoncol.2019.1048


Tuesday, March 23, 2021

One in Forty: The Jewish-Cancer Connection Webinar on March 24th


Upcoming Events – Oneinforty Webinar Series

March 24th, 6:30 pm EST

Knowledge is Empowering: Understanding the Jewish-Cancer Connection

We will be kicking off our monthly webinar series on March 24th. The webinar will feature guest speaker Dr. Elizabeth Etkin-Kramer. Dr. Kramer has been a longtime friend and supporter of Oneinforty, and co-founded the Prevent Hereditary Cancer Coalition.
 
Join us as we share a tribute to Lauren Corduck, share stories, discuss the 1:40 risk, the importance of knowing your family’s health history, and genetic testing and screening.
 
Registration is now open. Register here at this link.

Upcoming Events from Ovations for the Cure of Ovarian Cancer

 

Ovations for the Cure, located in Framingham, MA has organized a great line up of events to help raise money for research, awareness and patient programs. In total, they have raised over a million dollars to fund these efforts.

Team Ovations Fundraising With Jimmy Fund Walk to Fight Cancer which will be held Oct.3, 2021, goes to directly support the research of Dr. Ursula Matulonis, whom many of our readers will know from Dana Farber.

If walking isn't quite your thing but you love golfing, join Ovations for their annual golf tournament scheduled for Sept. 17, 2021 at the Brookmeadow Country Club in Canton, MA.

To find out more about these events and the other great work that Ovations for the Cure is involved in, follow this link.

Friday, March 19, 2021

NOCC Wellness Retreat Registration is Open!

Friday May 7th , 2021 from 1:00 to 7:00 pm ET  &  Saturday May 8th, 2021 from 11:00 am to 6:00 pm ET Registration $50.00 The NOCC has designed a thoughtful and one-of-a-kind online gathering with YOU in mind.  This community understands the unique challenges of ovarian cancer and this groundbreaking Wellness Retreat gives you the opportunity to engage, learn, support, share, and connect.  Features include: Engaging general sessions • Small group discussions • Mindfulness and wellness breaks • Interactive experiences • Virtual dance party • Easy-to-use online platform

Whether you are a survivor, patient, caregiver, or loved one — join our teal community from around the world online for the NOCC Wellness Retreat on May 7th and 8th, 2021! Learn what's new in ovarian cancer, how to manage stress and anxiety, and connect with others in the ovarian cancer community to hear inspiring stories of bravery and courage.

For more information, follow this link.


Tuesday, March 16, 2021

Cancer and the Covid 19 Vaccine

 


Dana Farber hosted this presentation on Jan. 28, 2021. It was an open forum and the Q&A session covers questions related to safety, efficacy and availability.

Friday, March 12, 2021

Stowe Weekend of Hope Goes Virtual Again

 

This year the Stowe Weekend of Hope will again be held virtually but with some additional changes.

More interactive events are promised by the organizers and folks who would like to attend are encouraged to sign up to receive alerts. 

The dates for this year's retreat are April 30-May 2. There will be presentations by medical leaders in the field of cancer, opportunities to network and on-line workshops.

If you've never attended this event, it is wonderful - and yes, it's even better in person but given the caliber of speakers and the care that goes into the planning and activities, there will be something for everybody to enjoy.

You can find out more info by following this link to the Stowe Weekend of Hope webpage or by clicking on the link to their Facebook page.

Tuesday, March 9, 2021

Covid Vaccine Harder to Get in These States Even If You Have Cancer

 

This article appeared today in the online journal SurvivorNet. Each state has been rolling out the Covid vaccine in different ways which has led to frustration among people because of the inconsistencies.

Essentially, if you live in Maine, Colorado, Ohio, West Virginia, or Nebraska, you may have trouble getting the vaccine early.

In Maine, the roll-out of the vaccine has been changed and is now based on age rather than on health status. In other states, interestingly, cancer was not deemed a sufficient reason to move to the head of the line for vaccination.

To read the article in its entirety, follow this link.

Friday, March 5, 2021

Cancer and Covid-19 Vaccine


 I hope that many of you have by now at least received your first dose of the Covid-19 vaccine. For those who are still wondering, this Q&A appeared in The American Society of Clinical Oncologists and was last updated on 2/1/2021.

On December 17, 2020, the American Society of Clinical Oncology and Infectious Diseases Society of America held a “COVID-19 Vaccine & Patients with Cancer” webinar to discuss the importance of COVID-19 vaccination and to provide expert opinion on its use for cancer patients. At the time of the webinar, there was only one vaccine authorized for use against COVID-19, the Pfizer/BioNTech vaccine, although the expert panel discussion focused on mRNA vaccines and addressed vaccines in general.  The panel of oncology and infectious disease experts agreed that the Pfizer, and now Moderna, vaccines have been shown to be safe and effective for the general population and there was no evidence that they would not be safe for most cancer patients, although it should be noted that patients receiving immunosuppressive and cytotoxic treatments were excluded from participation in the vaccine trials to date so there is little to no data on the safety and efficacy of the Pfizer and Moderna vaccines in cancer patients.

Memorial Sloan Kettering Cancer Center has made available an interim guideline on vaccination for cancer patients. The National Comprehensive Cancer Network (NCCN) has made available preliminary recommendations as well. The recommendations in these documents are based on opinion and extrapolation from other vaccine studies and may change rapidly as new information becomes available.

Should people with cancer be vaccinated against COVID-19?

At this time, patients with cancer may be offered vaccination against COVID-19 as long as components of that vaccine are not contraindicated. The current CDC interim clinical guidance discusses immunocompromised individuals. It states: “Immunocompromised individuals may still receive COVID-19 vaccination if they have no contraindications to vaccination. However, they should be counseled about the unknown vaccine safety profile and effectiveness in immunocompromised populations, as well as the potential for reduced immune responses and the need to continue to follow all current guidance to protect themselves against COVID-19.” The expert panel noted that while some immunocompromised patients may experience decreased response to the vaccine, it may still confer some benefit and is important to reduce the risk or severity of COVID-19 to cancer patients, especially given recent evidence of higher rates of severe infection.

Should people undergoing active treatment for cancer be vaccinated against COVID-19?

At this time, patients undergoing treatment may be offered vaccination against COVID-19 as long as any components of the vaccine are not contraindicated.  Oncologists have experience providing other types of vaccines to patients receiving treatment for cancer, including chemotherapy, immunotherapy, radiation therapy or stem cell transplantation. Strategies such as providing the vaccine in between cycles of therapy and after appropriate waiting periods for patients receiving stem cell transplants and immune globulin treatment can be used to reduce the risks while maintaining the efficacy of vaccination.

Should cancer survivors be vaccinated against COVID-19?

Cancer survivors may be offered vaccination against COVID-19 as long as any components of the vaccine are not contraindicated.

Are there people who should not be vaccinated?

At this time, only those with contraindications to a specific vaccine component should not be offered vaccination with that specific product. These contraindications are described in detail in CDC interim clinical guidance.

What other concerns are there for people with cancer who are vaccinated?

As there is still uncertainty around the extent to which immunocompromised patients with cancer will develop immunity in response to vaccination, vaccinated patients should continue to follow current guidance to protect themselves from exposure to COVID-19. The expert panel underscored the message that while providing the vaccine to cancer patients and their caregivers will reduce risk for infection or clinical COVID-19 disease, they emphasized the importance of continuing practices of wearing masks, social distancing, and maintaining good hand hygiene even after vaccination.

CDC Advisory Committee on Immunization Practices

CDC’s Advisory Committee on Immunization Practices (ACIP) has approved several recommendations regarding the prioritization of COVID-19 vaccination. Once approved by the CDC, these recommendations are intended to help state and local jurisdictions maximize the distribution of the vaccines while they are still in scarce supply. These recommendations are not binding mandates, nor do they relate to the allocation of the vaccine itself which is being managed separately within HHS. To date, they have recommended the following priority groupings:

Phase 1a: The Advisory Committee on Immunization Practices (ACIP) recommended, as interim guidance, that both (1) health care personnel and (2) residents of long-term care facilities be offered COVID-19 vaccine in the initial phase of the vaccination program.

Phase 1b: persons aged ≥75 years and frontline essential workers. For purposes of this recommendation, the following essential workers are considered frontline: firefighters, police officers, corrections officers, food and agricultural workers, Postal Service workers, manufacturing workers, grocery store workers, public transit workers, those who work in the education sector (teachers, and support staff), and daycare workers.

Phase 1c: persons aged 65–74 years, persons aged 16–64 years with high-risk medical conditions, and other essential workers. Cancer has been identified as one of the high-risk medical conditions for Phase 1c.

CDC is regularly updating the number of vaccines distributed and administered at this link. ACIP continues to convene emergency meetings as new information, evidence and clinical trial results are available. Materials from previous meetings and suggested dates and agendas for future meetings can be found on their website.

Resources from the American Medical Association

The American Medical Association (AMA) has produced several resources with helpful advice for clinicians regarding the COVID-19 vaccines. Please visit the links below for concise information on the vaccines as well as tips for how to discuss them with patients.

Disclaimer

Answers to questions about COVID-19 published herein are provided by the American Society of Clinical Oncology, Inc. (“ASCO”) for voluntary, informational use by providers in the rapidly evolving novel coronavirus crisis. This information does not constitute medical or legal advice, is not intended for use in the diagnosis or treatment of individual conditions, does not endorse products or therapies, recommend or mandate any particular course of medical care, and is not a statement of the standard of care. New evidence may emerge between the time information is developed and when it is published or read. The information is not comprehensive or continually updated. This information is not intended to substitute for the independent professional judgment of the treating provider in the context of treating the individual patient. ASCO provides this information on an “as is” basis, and makes no warranty, express or implied, regarding the information. ASCO specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions. Use of the information is subject to the complete ASCO website Terms of Use.

Tuesday, March 2, 2021

New Drug Shows Promise for Resistant OC

 

The Clearity Foundation has just released this update on the Wee1 inhibitor, currently in Phase II trials. Combined w/gemcitibine, it is showing promise in platinum-resistant OC and recurrent OC.

This article was written by Ian Ingram. 

Adding the Wee1 inhibitor adavosertib to gemcitabine reduced the risk of disease progression and death in women with recurrent, platinum-resistant or -refractory ovarian cancer, a randomized phase II trial showed.

For the primary endpoint of progression-free survival (PFS) in 99 patients with high-grade serous tumors, those assigned to gemcitabine plus adavosertib had a median PFS of 4.6 months, as compared with 3.0 months with gemcitabine plus placebo (HR 0.55, 95% CI 0.35-0.90, P=0.015), reported Amit Oza, MD, of Princess Margaret Cancer Centre in Toronto, and colleagues.

Median overall survival was 11.4 months versus 7.2 months, respectively (HR 0.56, 95% CI 0.35-0.91, P=0.017).

“In advanced-stage or heavily pretreated high-grade serous ovarian cancer, few options remain after conventional therapy,” the authors wrote in The Lancet. “This is the first trial to show a significant benefit (progression-free survival, overall survival, and response rate according to RECIST) from the addition of adavosertib to gemcitabine in heavily pretreated platinum-resistant or platinum-refractory high-grade serous ovarian cancer, a setting of clinical need that has yet to be met with standard-of-care therapies.”

No patients in either arm achieved a complete response, but 23% in the adavosertib arm had a partial response, as compared with 6% in the placebo arm. In an exploratory cohort of women with non-high-grade serous tumors, four patients (16%) achieved a partial response.

“Adavosertib plus gemcitabine also showed signs of activity in rare histological subtypes of ovarian cancer (serous and endometrioid, low-grade endometrioid, carcinosarcoma, and clear cell),” noted Oza and co-authors. “Interestingly, both of the two patients in the non-high-grade serous ovarian cancer cohort with available genomic profiling were KRAS mutation positive, suggesting involvement of replication stress in directing treatment response.”

In an accompanying editorial, Sarah Blagden, MD, of the University of Oxford, and Shibani Nicum, MD, of Oxford University NHS Foundation Trust in England, called the correlation of treatment response and tumor histology and molecular features “a key strength” of the study.
While sample sizes were small, adding adavosertib appeared to benefit patients with homologous recombination deficiency, BRCA mutations, and those with CCNE1-amplified tumors.

“This study realizes the potential of targeting the cell cycle derangement present in a substantial subpopulation of patients with resistant ovarian cancer,” the editorialists wrote. “The development of rapid immunohistochemical or circulating biomarkers to identify this subpopulation could herald the more widespread use of cell cycle targeting therapies like adavosertib earlier in the disease course.”
From 2014 to 2018, the double-blind phase II study randomized 99 women with high-grade serous ovarian cancer 2:1 to intravenous gemcitabine (1,000 mg/m2 on days 1, 8, and 15 of 28-day cycles) plus either oral adavosertib (175 mg on days 1, 2, 8, 9, 15, and 16) or placebo at 11 centers across the U.S. and Canada. The exploratory cohort included an additional 25 patients with non-high-grade serous disease, who all received the combination treatment.

Patients had a median age of 62 years, and a median of three prior lines of treatment. Most in the study had platinum-resistant disease, while 10% in the study arm and 15% in the control arm had primary platinum-refractory disease. To enroll, women had to have an Eastern Cooperative Oncology Group (ECOG) performance status ≤2, normal organ function, normal marrow function, and a life expectancy of 3 months or longer.

Toxicity was “generally manageable with intermittent dose modification and did not lead to severe complications,” according to the study authors.

Common grade ≥3 adverse events in the adavosertib and placebo arms, respectively, included neutropenia (62% vs 30%), leukopenia (54% vs 18%), lymphopenia (34% vs 18%), anemia (31% vs 21%), and thrombocytopenia (31% vs 6%).

Blagden and Nicum said the adavosertib dose of 175 mg “might be unnecessarily high for the heavily treated patients with high-grade serous ovarian cancer; an absence of pharmacodynamic evidence of target engagement leaves this question unanswered.”

There were no deaths related to treatment. One patient in the study arm died from sepsis, and one patient in the control arm died from disease progression.

This article was originally published by MedPage Today.

Friday, February 26, 2021

Immunotherapy Clinical Trials with Dr. Ezra Cohen at the 2020 CRI Virtual Immunotherapy Patient Summit

 


Although this video is not specific to ovarian cancer, it does address common questions about who should participate in these immunotherapy trials and how to go about doing this. 

Tuesday, February 23, 2021

Astonishing Podcast: 3-D Model To Be Used for Testing of New Treatments for OC

This is quite an astonishing use of 3-D technology that I had to read several times and it still caused me to shake my head in wonder and amazement.

Joanna Burdette, PhD and her team developed Evatar, a model of the female reproductive tract that uses cultured tissue of the ovaries and oviduct that can be used in the Evatar device to study the effects of new drugs on high grade serous ovarian cancer. 

What makes this model unique is that in basic research, cells are often kept in petri dishes, isolated from the tissue from which it came and stew in their own waste. In the body, cells interact and respond to neighboring cells and cellular waste is carried away by the vascular system. Evatar replicates the reproductive environment and is therefore able to recreate a more natural environment in which to study novel drugs.

To listen to a relatively short podcast about this research, follow this link.


Friday, February 19, 2021

How the Immune System Fights Ovarian Cancer


 Dr. Sarah Spear is an immunologist who is doing research in England about the role of this system to OC. The first minute or so of the video is presented by the host and the audio isn't great BUT once Dr. Spear starts, the audio and video quality is great and her explanations are incredibly accessible! She covers everything from checkpoint inhibitors to vaccines. Overall, a worthy video to watch!

Tuesday, February 16, 2021

Are You Interested in Helping to Decide Which OC Research Gets Funded?

 

I've been a consumer advocate for ovarian cancer with CDRMP. This stands for "congressionally directed medical research program". 

As a consumer advocate, my role is to keep the needs of the "consumer" (ie, those of us who have been diagnosed w/ovarian cancer) in the forefront of the scientific discussions about the research that is looking for funding from the government.

The Department of Defense is the second largest funder of ovarian cancer research (the first is the NIH which apparently is too snobbish to have consumer advocates on their panels). Approximately $20 million is allocated by the DoD for OC research. As a consumer, I have full voting privileges on which research projects get funded. 

Are you interested in being a consumer to do this very important work? I am including a link to the most frequently asked questions. The ONLY requirement to participant on this panel, is to be a survivor or a person living with ovarian cancer. The second link I'm including, is specific to the OC research.

For ovarian cancer, the panel generally meets in September, although sometimes it's early October. We gather just outside of DC and spend anywhere from 1-2 days depending upon the panel you are on, reviewing each of the research proposals. I am NOT required to have ANY medical background - that is not my role on the panel so don't let that stop you from participation. Remember you are only representing the needs of OC patients. You are required to read each proposals impact statement which is only about a page, but I find that it's helpful for me to read the body of the proposal to get a better understanding.

If you're interested in looking into this, contact me at mastrangelo.margaret@gmail.com


Friday, February 12, 2021

New Hope for OC


 What I like about this video is that Dr. Wahner Hendrikson out of Mayo, talks about 4 new options in the treatment of OC.

Tuesday, February 9, 2021

Dana Farber Covid-19 Vaccinations are Underway

 

I found this article particularly useful because so many of our members are seen at Dana Farber or else have had consults with them. In addition, they provide links to other states in New England that give information about the Covid-19 vaccine.

February 8 Update: COVID-19 Patient Vaccinations Now Underway

We are now vaccinating and scheduling vaccinations for our patients who are eligible for the COVID-19 vaccine. For Dana-Farber, this includes patients who are age 75 and older. We will move to the next phase of patients when the state of Massachusetts allows, and when we have supply of vaccine.

If you are currently eligible for a COVID-19 vaccine, please watch for messages that may come to you this week via text, email, phone call, or Patient Gateway with details on how to schedule your vaccine appointment.

  • If you are scheduled for a vaccination at Dana-Farber, your care team will not be present at your vaccination appointment. Our vaccine clinic is operated by trained vaccine personnel. 

  • Please do not call your Dana-Farber doctor's office to ask about the COVID-19 vaccine, as they cannot schedule vaccinations at this time.

We will frequently update this page with the latest vaccine news, which is rapidly changing.

Please Sign Up for Patient Gateway

If you are not already signed up, we urge you to take a few minutes to enroll in Patient Gateway (at www.patientgateway.org). Having a free account on Patient Gateway will make it easier for you to schedule a COVID-19 vaccine appointment when you are eligible to get one.

To get started, visit Patient Gateway and click Enroll Now. For step-by-step instructions, download our How to Enroll in Patient Gateway guide.

For more details about the site, check Dana-Farber's Patient Gateway overview.

COVID-19 Vaccine FAQ for Cancer Patients

When will I be able to get the vaccine?

  • We are now scheduling vaccinations for patients who are age 75 and older. We will move to the next phase of patients when the state of Massachusetts allows, and when we have supply of vaccine.

  • Our ability to offer vaccines to patients depends on the amount of vaccine we get from Massachusetts and the state’s direction on who is eligible.

  • If you are able to schedule a COVID-19 vaccination outside of Dana-Farber before you hear from us, we encourage you to get the vaccine at that other site. Learn more at www.mass.gov/COVIDvaccine.

What if I don’t live in Massachusetts?

Check with your state’s COVID-19 vaccine effort. New England state websites include:

How are you prioritizing vaccinations for patients?

Dana-Farber must follow the rules set out by the state of Massachusetts for phases of the vaccine rollout. We will follow state guidelines and prioritize those patients who are most at risk from COVID-19. To learn more about the state's phases, visit www.mass.gov/COVIDvaccine.

Will you be giving the vaccine during infusion when I visit Dana-Farber?

No. Our vaccination clinic will be held separate from your cancer care. This is to ensure that we can safely give the vaccine to a large number of patients without wasting any of the supply.

  • If you are scheduled for a vaccination at Dana-Farber, your care team will not be present at your vaccination appointment. Our vaccine clinic is operated by trained vaccine personnel.
  • Please do not call your Dana-Farber doctor's office to ask about the COVID-19 vaccine, as they cannot schedule vaccinations at this time.

What if I don’t live near Dana-Farber's vaccination location?

If you are unable to travel to Dana-Farber's vaccination clinic when you are eligible for a COVID-19 vaccine, visit your state’s vaccine website to determine where a COVID-19 vaccine may be available near you. If you are in Massachusetts, visit www.mass.gov/COVIDvaccine.

I am no longer in active treatment at Dana-Farber, but I still have active disease and am seen regularly at Dana-Farber. Can I get the vaccine from Dana-Farber?

Not at this time. Based on our allotment of vaccines, we will follow state guidelines and prioritize those cancer patients who are most at risk from COVID-19. For many cancer patients and survivors, vaccines may be available to you in your community before they are available at Dana-Farber. To learn more about when you might be eligible, visit www.mass.gov/COVIDvaccine.

Can I choose which vaccine I get?

No. Dana-Farber and other vaccination sites do not have a choice in which vaccine they receive. The COVID-19 vaccines that have now been authorized for Emergency Use Authorization by the FDA are nearly identical in their efficacy and safety.

Can my cancer caregiver (a person who is helping me and with me often during my treatment) get the vaccine from Dana-Farber?

No, because Dana-Farber must follow the rules set out by the state of Massachusetts for phases of the vaccine rollout. Learn more about the vaccine phases and where to get a vaccine outside of Dana-Farber at www.mass.gov/COVIDvaccine.

Should I get a COVID-19 vaccine if I've recently had cellular therapy (such as CAR T-cell therapy) or a stem cell transplant?

Yes, but only after 100 days has passed since your transplant or cellular therapy. In fact, we recommend that all transplant and cellular therapy patients strongly consider a COVID-19 vaccine when 100 days have elapsed from their transplant or cellular therapy. We anticipate that some transplant and cellular therapy patients may be able to receive the vaccine at Dana-Farber, depending on your time from transplant or cellular therapy. Please continue to check this Dana-Farber COVID-19 vaccine page for updates.

How can I get a list of my comorbidities?

The after-visit summary that you get after each Dana-Farber appointment should list any health issues that you may have. If you don't have this form handy or haven't visited Dana-Farber in a while, you can also get this information by logging into your Patient Gateway account at www.patientgateway.org.

Can I go back to normal after I get the vaccine (no masks, etc.)?

No. Even after you are vaccinated, it will still be important to follow best practices for preventing spread of the virus as we learn more about how the vaccines protect us under real-life conditions. This includes wearing a facemask, washing hands often, physical distancing, and complying with the Massachusetts COVID-19 travel order, as well as its testing and quarantine requirements.

Is the vaccine safe?

As with any medication, we follow guidance from the U.S. Food and Drug Administration, which has a strong vaccine safety system to ensure that all vaccines are as safe as possible. Many clinical trials are currently evaluating the COVID-19 vaccines to best determine their safety and effectiveness.

If I've had an allergic reaction to chemotherapy in the past, should I worry about reactions to the vaccine?

Talk with your care team if you've had an allergic reaction to certain chemotherapy drugs, such as those that contain polyethylene glycol (PEG), which is a compound that is part of the current COVID-19 vaccines. Learn more at www.cdc.gov/vaccines/covid-19.

Who should not get the vaccine?

According to the Centers for Disease Control, you should not get a COVID-19 vaccine if you have had an immediate allergic reaction to any ingredient in either of the two available COVID-19 vaccines. This includes polyethylene glycol (PEG), a compound found in some chemotherapy treatments. Talk with your care team or healthcare provider if you have questions. Learn more at www.cdc.gov/vaccines/covid-19.

Can I get one vaccine dose at Dana-Farber, and the other dose at another location?

No. Both of the currently approved vaccines require two doses and you must receive both doses at the same location. You must receive the same vaccine for doses one and two.

Is it OK to mix the vaccines (i.e., get a different vaccine for each dose)?

No. You must receive the same vaccine for doses one and two.

Is there a cost to receive a COVID-19 vaccine at Dana-Farber?

No. Per federal rules, there is no cost to you to receive a COVID-19 vaccine. Your health insurance plan may be charged a modest administration fee, but there will be no cost to you.

What if I experience side effects after getting a COVID-19 vaccine?

No matter where you are given a COVID-19 vaccine, you will be given clear instructions on what to do if you experience side effects (which are typically mild). For answers to some of the more common questions about getting the COVID-19 vaccine, please visit www.mass.gov/COVIDvaccine and click on "Frequently Asked Questions" or go directly to www.mass.gov/info-details/covid-19-vaccine-frequently-asked-questions.

My child is younger than age 16. When will he or she be able to get the vaccine?

We do not know, but experts are optimistic that a vaccine for children and young adults may be available by late 2021. Keep in mind that kids and young adults are not typically at high risk for severe illness from COVID-19.

As a parent of a cancer patient, will I be eligible to get a vaccine from Dana-Farber?

No, because Dana-Farber must follow the rules set out by the state of Massachusetts for phases of the vaccine rollout. Learn more about the vaccine phases and where to get a vaccine outside of Dana-Farber at www.mass.gov/COVIDvaccine.

Additional Information on Vaccines