Current topics in ovarian cancer:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2003
|
| Schriftenreihe: | Hematology, oncology clinics of North America
17,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVI S., S. 909 - 1093 Ill., graph. Darst. |
Internformat
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| 245 | 1 | 0 | |a Current topics in ovarian cancer |c Mary L. Disis guest ed. |
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| 300 | |a XVI S., S. 909 - 1093 |b Ill., graph. Darst. | ||
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| 490 | 1 | |a Hematology, oncology clinics of North America |v 17,4 | |
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| 650 | 4 | |a Ovarian Neoplasms | |
| 650 | 4 | |a Ovaries |x Cancer | |
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Datensatz im Suchindex
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CONTENTS
Dedication xiii
Preface xv
Mary L. Disis
Pathology of Ovarian Carcinoma 909
Jeffrey D. Seidman and Robert J. Kurman
Serous carcinoma is the most common type of ovarian cancer and
usually is associated with peritoneal metastases and poor survival
except for meticulously staged patients with tumors confined to
the ovaries. Endometrioid and clear cell carcinomas account for
most nonserous carcinomas and more often present with low stage
disease; survival for the various cell types is similar when stratified
by stage. Borderline ovarian tumors can be subdivided into benign
and malignant neoplasms, and in the view of some experts, this
renders the borderline category obsolete. Women with typical
serous borderline tumors (atypical proliferative serous tumors)
constitute most of these patients and have virtually 100% survival,
unless invasive peritoneal implants are present. Micropapillary
serous carcinomas (a less common variant, also called serous
borderline tumor with a micropapillary pattern) and tumors with inva¬
sive implants behave similar to low grade invasive carcinomas.
Oncogenic Pathways Implicated in Ovarian Epithelial Cancer 927
Santo V. Nicosia, Wenlong Bai, Jin Q. Cheng, Domenico Coppola,
and Patricia A. Kruk
Ovarian epithelial cancer is a complex group of neoplasms with an
overall poor prognosis. Comprehension of this cancer pathobiology
suffers because of an incomplete understanding of precursor
lesions and the absence of an orthotopic animal model. There have
been a growing number of studies aimed at identifying controls,
VOLUME 17 • NUMBER 4 • AUGUST 2003 vii
mechanisms, and signal transduction pathways that permit or
inhibit cell growth and apoptosis in malignant ovarian epithelial
cells. These studies are summarized in this article with emphasis
on data obtained within the authors Ovarian Epithelial Cancer
Pathobiology Program, where the roles of the Akt oncogene, telom
erase, estrogens, and insulin like growth factor receptor 1 in ovar¬
ian epithelial cancer are under investigation.
Surgical Advances in the Treatment of Ovarian Cancer 945
Andrew J. Li and Beth Y. Karlan
Although epithelial ovarian carcinoma is among the most chemosen
sitive of all adult solid cancers, surgery remains the cornerstone of
management. Initial surgical exploration is crucial for comprehen¬
sive staging and tumor cytoreducrion and affords prognostic deter¬
mination and adjuvant therapy planning. Definitions of optimal
surgical cytoreducrion are evolving, as are new roles for laparoscopy
and fertility sparing procedures. The identification of increased ovar¬
ian cancer risk associated with generic mutations in ovarian cancer
susceptibility genes has broadened the role of prophylactic surgery in
the prevention of this disease.
Optimizing Primary Chemotherapy in Ovarian Cancer 957
Maurie Markman
Primary chemotherapy for advanced ovarian cancer includes the
administration of a platinum agent (carboplatin or cisplatin) and a
taxane (paclitaxel or docetaxel). Most patients (60% to 80%) expe¬
rience subjective and objective evidence of a favorable response,
with prolonged disease free and overall survival being noted in a
substantial subset of this population. Future investigative efforts
will focus on the incorporation of new and novel antineoplastic
agents into standard treatment, with the important goals of
improving biologic activity, enhancing overall quality of life, and
extending survival.
Intraperitoneal Therapy as Consolidation for Patients with
Ovarian Cancer and Negative Reassessment after Platinum
Based Chemotherapy 969
M. Janice Lu, Joan Sorich, Maitreyee Hazarika, Mimi Kim,
Giuseppe Del Priore, Allan J. Jacobs, Chang Chiang,
Paul C. Liu, Eileen Fusco, John P. Curtin, and Franco M. Muggia
Intraperitoneal chemotherapy (IP) for the treatment of ovarian
cancer has been studied in clinical trials and has shown clinical
benefit when used as primary adjuvant therapy. IP chemotherapy
also may play a role as consolidation after intravenous treatment.
In 1998, a pilot study was initiated using IP cisplatin (or carbo¬
platin) combined with floxuridine (FUDR). Patients received a
viii CONTENTS
mean of 3.2 cycles of FUDR, which was accompanied by cisplatin
or carboplatin in 88% of cycles. The median follow up time was
20 months (range 6.0 to 57.6 months). Eight patients have had dis¬
ease recurrence, with median time to recurrence 19.4 months from
onset of protocol treatment. Only one patient has died of disease at
38.8 months from onset of protocol. Extra abdominal recurrences
(lung, brain, inguinal nodes) tended to occur earlier than peri¬
toneal recurrences. Demonstration of an impact on progression
free survival and overall survival requires confirmation in a phase
III trial.
Salvage Therapy for Recurrent Epithelial Ovarian Cancer 977
Vicki V. Baker
Epithelial ovarian cancer is diagnosed in approximately 23,300
women annually and results in 13,900 cancer related deaths annu¬
ally. Most women show an excellent response to initial treatment
with chemotherapy, but most also develop recurrent disease and
require additional therapy. Although therapy for recurrent ovarian
cancer is rarely curative, women now live much longer with their
disease. This situation has led to a shift in the perception of ovar¬
ian cancer from a quickly fatal disease to one that is more chronic
in nature, requiring repeated rounds of chemotherapy. Chemo¬
therapy studies conducted in the salvage setting typically involve
relatively small numbers of younger patients whose disease shows
good performance. The extrapolation of these observations to the
practice setting, compounded by the clinical and molecular het¬
erogeneity of epithelial ovarian cancer, further exacerbates the dif¬
ficulties encountered in individual treatment recommendations.
Ovarian Cancer Screening 989
Nicole Urban, Martin W. Mclntosh, Marin (Robyn) Andersen,
and Beth Y. Karlan
In an ongoing effort to design an efficacious, cost effective ovarian
cancer screening method, the existing tests, CA 125 and transvagi
nal sonography, are being optimized and combined in a multimodal
strategy, and new promising serum markers, such as mesothelin
and HE4, are being developed and evaluated. Detection has been
found to improve when multiple serum markers are used in a
longitudinal logarithm. The parametric empirical Bayes approach
improves screening algorithms by capturing the stability of mark¬
ers over time in a heterogeneous population. It also has relatively
simple extensions to multiple markers. The evaluation of markers
increasingly accounts for characteristics of a woman that may affect
her marker levels and accounts for the cancer s characteristics, his¬
tology, and grade. Receiver operating characteristic curves are
helpful for evaluation because they relate a marker s sensitivity to
the specificity at which it operates. Large, well designed random¬
ized controlled trials are under way to gauge the performance of
existing screening methods.
CONTENTS ix
New Insights Regarding Pharmacologic Approaches for
Ovarian Cancer Prevention 1007
Gustavo Rodriguez
The pathogenesis of epithelial ovarian cancer is not completely
understood, but it commonly is believed that the process of recur¬
rent ovulation (incessant ovulation) causes genetic damage in
ovarian epithelial cells and that sufficient genetic damage can lead
to ovarian cancer in susceptible individuals. Under this model, it
has been suggested that reproductive and hormonal factors, such
as pregnancy and oral contraceptive use, decrease ovarian cancer
risk mainly via their inhibitory effects on ovulation. There is
mounting evidence that the ovarian epithelium is a hormonally
responsive target organ whose biology can be impacted strongly
by the local hormonal environment. Progestin mediated apoptotic
effects may be a major mechanism underlying the ovarian cancer
protective effects of pregnancy (a high progestin state) and oral
contraceptive pill use. Similarly, retinoids, vitamin D, and non
steroidal anti inflammatory drugs may have biologic effects on the
ovarian epithelium that are cancer preventive, whereas androgens
may have stimulatory effects on the ovarian epithelium, leading to
an increased ovarian cancer risk.
Gene Therapy for Ovarian Cancer: Progress and Potential 1021
Tyler O. Kirby, David T. Curiel, and Ronald D. Alvarez
Technologic advances have provided new insight into the molecu¬
lar basis of carcinogenesis and have provided for the development
of gene therapies as an anticancer strategy in human ovarian can¬
cer. Vectors including adenovirus, adeno associated virus, retrovirus,
and nonviral carionic liposomes are being used to transduce desired
genes into tumor cells in vitro and in vivo. Current strategies focus
on molecular chemotherapy, mutation compensation, immunopo
tentiation, altered drug sensitivity, and oncolytic virotherapy.
Promising preclinical trials have led to the development of clinical
trials for patients with ovarian cancer; however, significant antitu
mor activity has yet to be realized. New efforts are under way to
improve on gene therapy strategies based on lessons learned from
these clinical trials.
Immunologic Principles and Immunotherapeutic Approaches
in Ovarian Cancer 1051
Keith L. Knutson, Tyler J. Curiel, Lupe Salazar, and Mary L. Disis
Ovarian tumors are immunogenic, and several ovarian related
antigens have been identified. The immunologic characteristics of
the tumor microenvironment that may affect ovarian cancer
growth are becoming increasingly understood. The type of
immune based approach selected to treat ovarian cancer depends
on the tumor burden. For minimal disease states, active vaccina¬
tion may be useful for generating adequate protection from
x CONTENTS
relapse. For more advanced stage disease states, more rigorous
strategies may need to be applied, such as adoptive T cell therapy,
cytokine infusions, antibody therapy, or a combination of different
techniques. The immunosuppressive environment observed dur¬
ing advanced malignancy needs to be reversed for improved effi¬
cacy of immune based therapies.
Future Directions in the Management of Ovarian Cancer 1075
Mary L. Disis and Saul Rivkin
Clinicians are making progress in the battle against ovarian cancer.
The advent of molecular techniques and the sequencing of the
human genome heralds an era of cancer therapeutic development
that is unprecedented. Novel treatment strategies aimed at altering
or halting the growth of the cancer cell via specific pathways are
being developed. The future management of ovarian cancer
should include incorporation of these newer therapies into regi¬
mens combined with standard treatment known to improve sur¬
vival in patients. Clinical trials of molecularly targeted treatment
modalities should focus on two major clinical challenges in ovarian
cancer: (1) prevention of relapse after optimal primary therapy and
(2) management of recurrent and chemoresistant disease.
Index 1087
CONTENTS xl
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| title | Current topics in ovarian cancer |
| title_auth | Current topics in ovarian cancer |
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| title_full | Current topics in ovarian cancer Mary L. Disis guest ed. |
| title_fullStr | Current topics in ovarian cancer Mary L. Disis guest ed. |
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| title_short | Current topics in ovarian cancer |
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