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1.
Gynecol Oncol ; 161(2): 382-388, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33712274

RESUMO

PURPOSE: Increasing measures of adiposity have been correlated with poor oncologic outcomes and a lack of response to anti-angiogenic therapies. Limited data exists on the impact of subcutaneous fat density (SFD) and visceral fat density (VFD) on oncologic outcomes. This ancillary analysis of GOG-218, evaluates whether imaging markers of adiposity were predictive biomarkers for bevacizumab (bev) use in epithelial ovarian cancer (EOC). PATIENTS AND METHODS: There were 1249 patients (67%) from GOG-218 with imaging measurements. SFD and VFD were calculated utilizing Hounsfield units (HU). Proportional hazards models were used to assess the association between SFD and VFD with overall survival (OS). RESULTS: Increased SFD and VFD showed an increased HR for death (HR per 1-SD increase 1.12, 95% CI:1.05-1.19 p = 0.0009 and 1.13, 95% CI: 1.05-1.20 p = 0.0006 respectively). In the predictive analysis for response to bev, high VFD showed an increased hazard for death in the placebo group (HR per 1-SD increase 1.22, 95% CI: 1.09-1.37; p = 0.025). However, in the bev group there was no effect seen (HR per 1-SD increase: 1.01, 95% CI: 0.90-1.14) Median OS was 45 vs 47 months in the VFD low groups and 36 vs 42 months in the VFD high groups on placebo versus bev, respectively. CONCLUSION: High VFD and SFD have a negative prognostic impact on patients with EOC. High VFD appears to be a predictive marker of bev response and patients with high VFD may be more likely to benefit from initial treatment with bev.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Bevacizumab/uso terapêutico , Biomarcadores Tumorais/sangue , Carcinoma Epitelial do Ovário/tratamento farmacológico , Gordura Intra-Abdominal/diagnóstico por imagem , Neoplasias Ovarianas/tratamento farmacológico , Gordura Subcutânea/diagnóstico por imagem , Adiposidade , Adulto , Idoso , Carcinoma Epitelial do Ovário/sangue , Carcinoma Epitelial do Ovário/diagnóstico por imagem , Carcinoma Epitelial do Ovário/mortalidade , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/mortalidade , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
Surg Oncol Clin N Am ; 29(1): 105-113, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757307

RESUMO

Personalized medicine in gynecologic oncology is an evolving field. In recent years, tumor profiling and large databases such as TCGA and NCI-Match have provided us with enormous amounts of molecular data. Several therapies that capitalize on novel genetic and immune discoveries including VEGF inhibitors, PARP inhibitors, and cancer vaccinations are discussed in this article. Additionally, we have seen direct to consumer marketing play an important role in cancer care and prevention as patients have increased ability to access genetic testing. This presents a unique challenge to gynecologic oncology providers as we learn to navigate the world of personalized medicine.


Assuntos
Antineoplásicos/uso terapêutico , Biomarcadores Tumorais/genética , Neoplasias dos Genitais Femininos/tratamento farmacológico , Terapia de Alvo Molecular/métodos , Farmacogenética/métodos , Medicina de Precisão/tendências , Feminino , Neoplasias dos Genitais Femininos/genética , Humanos , Medicina de Precisão/métodos
3.
Ochsner J ; 20(4): 446-451, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33408585

RESUMO

Background: The field of hereditary cancer syndromes and genetic testing for patients and families is a rapidly evolving discipline, with an emphasis on cancer prevention. Methods: We review the literature regarding the most common genetic syndromes associated with gynecologic malignancies and discuss the management of these conditions. We also examine the logistic process surrounding cancer genetic testing and identify some perceived barriers. Results: Five genetic syndromes are known to be associated with gynecologic malignancies: hereditary breast and ovarian cancer, Lynch, Cowden, Peutz-Jeghers, and Li-Fraumeni. Each is associated with varying risks of breast, ovarian, and uterine malignancies. The National Comprehensive Cancer Network guidelines regarding the management of these syndromes are focused primarily on reducing the risk of developing gynecologic malignancies. However, great complexity is involved with genetic testing for patients and their families, and barriers exist for the widespread use and implementation of such testing. Conclusion: Genetic testing is fundamental to primary cancer prevention and to oncologic care. Physicians, payers, and institutions must work collaboratively to maximize genetic testing with the goals of primary cancer prevention and treatment.

4.
Obstet Gynecol Clin North Am ; 46(1): 155-163, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30683261

RESUMO

Personalized medicine in gynecologic oncology is an evolving field. In recent years, tumor profiling and large databases such as TCGA and NCI-Match have provided us with enormous amounts of molecular data. Several therapies that capitalize on novel genetic and immune discoveries including VEGF inhibitors, PARP inhibitors, and cancer vaccinations are discussed in this article. Additionally, we have seen direct to consumer marketing play an important role in cancer care and prevention as patients have increased ability to access genetic testing. This presents a unique challenge to gynecologic oncology providers as we learn to navigate the world of personalized medicine.


Assuntos
Testes Genéticos/tendências , Neoplasias dos Genitais Femininos/genética , Neoplasias dos Genitais Femininos/terapia , Terapia de Alvo Molecular/tendências , Medicina de Precisão , Biomarcadores Tumorais , Atenção à Saúde , Medicina Baseada em Evidências , Feminino , Regulação Neoplásica da Expressão Gênica , Marcadores Genéticos , Neoplasias dos Genitais Femininos/diagnóstico , Humanos , Medicina de Precisão/tendências
5.
Gynecol Oncol ; 149(1): 28-32, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29605046

RESUMO

OBJECTIVES: Age imposes a disparity in the treatment of and outcomes with gynecologic cancer. Older patients are underrepresented in primary treatment trials, but little is known about their ability to withstand trial-based treatment for recurrent or refractory disease. This study sought to examine treatment-related toxicities and outcomes of older versus younger patients participating in phase 1 clinical trials. METHODS: A retrospective analysis of patients enrolled in phase 1 clinical trials for gynecologic malignancies from 2010 to 2016 was performed. Demographic and clinic-pathologic data was abstracted. Toxicities were defined as either grade III or IV by CTCAE criteria. Best response was calculated using RECIST criteria. Associations between categorical variables were determined using Fisher's exact test and continuous variables using Wilcoxon rank sum test. Survival was estimated using the Kaplan-Meier method. RESULTS: 237 patients were included with 22% (n=51) comprising the older cohort (≥70years). The vast majority (98%) were treated for recurrent disease. Older patients incurred similar grade III/IV hematologic (21% vs 16%, p=0.38) and non-hematologic toxicities (26% vs 29%, p=0.64). Older patients discontinued treatment due to toxicity only 8% of the time. Median survival was 13.0 and 10.3months in the <70 and ≥70 groups, respectively (p=0.35). 63% of patients ≥70 achieved clinical benefit. CONCLUSIONS: Although historically older patients have not been routinely considered for enrollment in phase 1 trials, our data demonstrates similar toxicity profiles to that of younger patients and 63% clinical benefit rate. Thus, with careful selection, patients ≥70 should be considered when facing recurrent or refractory gynecologic cancer.


Assuntos
Ensaios Clínicos Fase I como Assunto/métodos , Neoplasias dos Genitais Femininos/tratamento farmacológico , Disparidades em Assistência à Saúde/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Seleção de Pacientes , Estudos Retrospectivos , Adulto Jovem
6.
Intensive Crit Care Nurs ; 18(2): 109-17, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12353649

RESUMO

The issues surrounding paediatric high dependency provision require attention. The field of adult high dependency has revealed some useful studies, which promote the benefits of designated care. These relate to improved quality of care and reduced pressure on the availability of intensive care beds. This review outlines recent initiatives made in the development of paediatric intensive care units in Britain and demonstrates how practical lessons learnt in the adult critical care sector may be used to establish appropriate Level 1 care in paediatrics. Two paediatric clinical issues are reviewed that support the need for high dependency provision, these being: paediatric respiratory management and the management of sedation withdrawal. The options available to district general hospitals, specialist hospitals, as well as lead paediatric hospitals are discussed, and include quality issues, where education, training and clinical audit are integral to structural and staffing HDU considerations.


Assuntos
Cuidados Críticos/organização & administração , Unidades de Terapia Intensiva Pediátrica/normas , Adulto , Criança , Humanos , Unidades de Terapia Intensiva , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Reino Unido
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